Health plan takes steps to identify CHF patients
Health plan takes steps to identify CHF patients
Screening admissions for heart failure works best
When HealthPartners, a Minneapolis-based health plan, began offering a capitated Medicare risk product, administrators and disease managers set to work designing a program that would allow them to identify high-risk congestive heart failure (CHF) patients within the context of an integrated delivery system.
Under the Medicare arrangement, HealthPartners would be responsible for managing all care for enrolled patients, in exchange for a set amount of money per patient per month. Because of the risk involved, it was vital that managers identify CHF patients early and take an aggressive role in early intervention, says Barry Baines, MD, associate medical director of HealthPartners.
"We looked at the process of care that was already in place for heart failure patients, and what we found was a process that was so inconsistent that it represented almost no process," he says.
Under the new program, managers chose, as their "trigger point," to use identification of a patient being admitted to the hospital. Specifically, HealthPartners takes the following steps to identify CHF patients:
• Identification at the hospital.
Care coordination specialists hired by the plan make rounds every day with physicians, says Baines. During rounds, they directly identify patients who are admitted to the hospital with CHF. "At that point, because they get very involved with discharge planning, the specialists are able to move patients into the program, which cuts across the continuum of care. It deals with patients who are in the hospital, once they go home, back to the clinic, that whole process as they change venues of care," says Baines.
• Risk screening of Medicare patients.
All Medicare patients who enroll in the plan fill out a screening survey. A geriatric case management unit then goes through the surveys and selects out patients who self-identify as having heart failure. Case managers conduct assessments with those enrollees over the phone.
• Identification from clinical data.
Case managers also conduct identification of CHF patients on the basis of clinical data, by selecting patients whose physicians have coded for CHF.
"But," Baines notes, "the readmission rate for CHF tends to be so high that if you pick up people who are being admitted [to the hospital] with heart failure, you’re going to pick up the bulk of your population."
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