Disease management saves $520,000 a year

CHF program targets Medicare risk patients

Harbor Medical Associates’ (HMA’s) in South Weymouth, MA, disease management program involving everyone in the entire continuum of care has decreased hospitalizations and emergency room visits, increased quality of life for its congestive heart failure (CHF) patients, and saved a projected $520,000 a year.

In 1998, the total cost of providing care for (CHF) patients was about $1,330 per member per month. After just five months into the program, the cost had dropped to $1,140 a month, according to Nick Cleary, MBA, chief operating officer for the 34-provider practice, which has seven locations in southeastern Massachusetts.

The CHF program includes 3,000 patients who are members of HMA’s Secure Horizon Medicare risk population, the physician practice’s fully capitated product. The program is coordinated by the practice’s case managers, who follow patients through the entire continuum of care — hospitalization, home care, and skilled nursing admission, should they have one, says Hilja Bilodeau, RN, CCM, director of case management.

Staff from Secure Horizon’s preferred provider home care program and vendors who provide oxygen therapy and other durable medical equipment helped develop the home care portion of the program and work closely with the case managers to monitor patient conditions, Bilodeau says.

"If homebound individuals can’t come into the clinic to be seen, we educate whoever is going to see them in the home about our program and its parameters. They are our eyes and ears in the field," Bilodeau says.

The case managers work closely with all the providers who see the patients in the home and meet monthly with them to get feedback.

If the vendors notice that any patient is having problems, they call the primary care physician, the nurse practitioner who runs the program, and the case manager.

The disease management program is a joint venture among Harbor Medical Association, CVS Health Connections, and Pfizer Health Solutions. CVS has located a Center for Wellness Education, a disease management center, in the same building as the medical practice’s main location.

CVS Health Connections already has similar operations within its pharmacies. This was the first time it had partnered with a physician group.

"They had studies, a care plan, outcomes measurements, and a software program to bring to our group in a strategic partnership," Cleary says.

The center is staffed by a nurse practitioner, a pharmacist, and a receptionist. 

The case management department developed the program and identified patients at high risk.

After the patients join the program, the case manager meets with the nurse practitioner who runs it. A medical director oversees the program but is not always on site.

"We work closely with her in establishing plans of care and reviewing the protocols in place, as well as enhanced services for patients who need them," she says.

The practice began looking at disease management programs in 1997 as a way to survive in Massachusetts’ mature managed care market.

"We felt like we had exhausted most of the normal strategies, such as stronger case management and better cost reduction. We decided that the next generation of strategies would be disease state management. It’s not only a managed care strategy, but a strategy that involved better managing of care," Cleary says.

The practice considered creating its own disease management program or purchasing an existing program and decided that the practice didn’t have the internal resources to create its own. That’s why Cleary considered the partnership with CVS such a good option.

"For us it was a turnkey operation, but we retained control over the clinical aspects of the program," Cleary says. The practice negotiated an arrangement to share its savings with CVS Health Connections as funding for the project.

The partnership also oversees care for diabetes and asthma patients but not all of them are part of the Medicare risk contract.