posted by Rashi Venkataraman
on February 15, 2018
Cardiovascular disease, also called heart disease, accounts for one out of every three deaths in the United States. Approximately 2,200 Americans die from heart disease each day, an average of 1 death every 40 seconds. Looking to the future, researchers estimate future costs of heart failure may more than double from 2012 to 2030, from $21 billion to $53 billion.
Health insurance providers are committed to improving heart health and reducing cardiovascular risk in their communities. Often, plans employ personalized engagement strategies to best support patients who might be at a higher risk. Emerging technologies provide health plans with exciting opportunities to continue to engage with and monitor patients beyond the doctor’s office. As a part of American Heart Month, we wanted to highlight one plan’s efforts to keep its members’ hearts healthy.
Geisinger Health Plan, part of Geisinger’s integrated health care system serving more than 2.6 million people in northeastern and central Pennsylvania, and southern New Jersey, has made headlines for innovative treatment strategies. By leveraging remote monitoring technology and redesigning care models, Geisinger offers high-quality heart and vascular care to its members.
Geisinger launched a telemonitoring program in 2008 to reduce hospital readmissions and the cost of care for members diagnosed with heart failure. At-risk members received Bluetooth scales with Integrated Voice Response (IVR) technology pre-programmed with a list of questions designed to detect changes that may require follow-up with a case manager or provider (shortness of breath, swelling, appetite changes).
The real-time data collection allows case managers to coordinate with the primary or specialty care teams to ensure timely follow-up. Further, data collection automation provides case managers with more time for direct patient care. The telemonitoring program led to significant drops in hospital admission and readmission rates, saving Geisinger $3.30 for every $1 spent to implement this program, research shows.
Enhancements to the program reflect emerging technologies, such as a new portable vest using high-tech radar that can be quickly applied to detect fluid build-up inside the lungs. Heart failure patients typically suffer from a dangerous buildup of lung fluid that can lead to hospitalizations. Thanks to this radar technology, providers can monitor the amount of fluid accumulation in a patient’s lungs and make treatment adjustments as needed to prevent admissions and readmissions.
“These kinds of data-driven population health innovations are transforming the way we think about patient care,” said Janet Tomcavage, Chief Population Officer at Geisinger. “Health plans have a huge incentive to get ahead of and prevent acute complications in individuals with chronic conditions. Beyond improving the patient’s well-being, these interventions drive cost savings that can help us further invest in innovative clinical care.”
Geisinger’s ProvenCare model standardizes quality for patients with heart failure and allows physicians to efficiently deliver a bundle of evidence-based care. Geisinger focused its efforts on patients with unplanned acute heart failure who require only diuretic therapy. These patients were referred to multidisciplinary care teams, where nurse navigators, case managers, and pharmacists all work collaboratively to coordinate care transitions, perform medication reconciliation, oversee medication adherence, and provide education to patients.
As a result of the program, patients are less likely to experience complications or be readmitted to the hospital following their admission. The percentage of hospitalized heart failure patients who avoided the emergency department increased from 4%t in 2013, to 28% in 2015, representing approximately $240,000 in savings.
Recognizing the impact of the social determinants of health on cardiovascular health, Geisinger was an early investor in interventions to tackle the sometimes unseen conditions in which patients are born, grow, live, and age. The Community Health Assistant staff work in the community to coordinate care and connect patients to other health care resources they may need.
Geisinger’s Community Health Assistants address underlying problems that impact a patient’s health, but may not present during a typical health care appointment, such as access to healthy food or living conditions. They also can support members with healthy eating, disease management, transportation, as well as other wellness activities, all of which can improve heart health.
“To ultimately tackle issues related to cardiovascular health, all stakeholders of the health care ecosystem have a role to play,” says Tomcavage. “We see the best results when patients and their families, health care providers, and health plans are all working together towards the same treatment goals. Advances in technology and extending interventions outside the typical walls of health care can really enhance how care is coordinated and ultimately improve cardiovascular outcomes across the communities we serve.”