Improved Clinical and Financial Outcomes Associated with a Comprehensive Congestive Heart Failure Program

Abstract

Congestive heart failure (CHF) has become an increasingly expensive and prevalent condition in the United States. Patients with advanced or unstable CHF often have multiple comorbidities and are expensive and difficult to treat. Humana Inc., one of the largest health plans in the U.S., and Cardiac Solutions, a cardiac disease management company, initiated a heart failure disease management program nationally for Humana's Medicare risk members in 1996. Utilizing the Cardiac Solutions MULTIFIT℠ system, specialized disease managers managed 1,915 patients who had had at least one prior admission for CHF. Medical resource utilization was substantially reduced during the time that patients were on the Cardiac Solutions program. The patients' hospital admissions for all diagnoses dropped 60%, and total hospital days were reduced 58% in the first 13 months. Inpatient costs for CHF admissions dropped 78%, while inpatient costs for all other admissions fell by 50%. Total costs for all conditions dropped 55% (before disease management fees) from prior levels. Patients for whom data are available (431 patients) reduced their sodium intake by 20% from 3,023 mg at program onset to 2,406 mg within the next 3-4 months. Two hundred fifty-nine (259) patients experienced a 15% overall improvement in functional status, from 14.2 to 16.3, utilizing the Duke Activity Status Index. Assessments of 2,442 patients indicated that the weighted average New York Heart Association classification score improved by 3.2%, with more than 90% of all patients maintaining or improving their status. The management of care for heart failure extends to the conditions that predispose to and accompany heart failure. An approach to heart failure that addresses the patient with disease rather than the disease in the patient is not only more likely to achieve overall better clinical results, but greater'financial savings.