Congestive heart failure (CHF) is a major chronic disease for older Americans, which accounts for about 260,000 deaths a year. The majority of the 4.8 million patients with heart failure are older than 65 years and, according to the Centers for Disease Control and Prevention, the number of patients is expected to double over the next forty years. In 1995, Medicare paid $3.4 billion for heart failure claims.
While the management of CHF has traditionally been reactive under managed care, Blue Cross and Blue Shield of Georgia (BCBSGA) has developed a proactive approach to managing these patients. The Proactive Care Management (PCM) program is designed to improve the quality of care provided to CHF patients by reducing, and in some cases preventing, admissions and secondary costs related to the diagnosis. The PCM program is designed to educate all members about their disease, support their physician's treatment plan, promote patient accountability, and assist members in access and coordination of covered benefits.
The CHF PCM program is intended to achieve several objectives: 1) decrease hospitilization rates, 2) decrease hospital readmission rates, 3) reduce ER visits, 4) improve quality of life, 5) increase member satisfaction and, 6) reduce treatment costs.
The success of this program will serve as catalyst for further development of PCM programs for other chronic diseases common in the Southeastern U.S., effectively shifting the emphasis of care from reactive to proactive healthcare management.
This paper will present data from the first year of the program and discuss options for applying it to other populations.
Learning Objectives: 1) Recognize general shift in managed care to proactive preventive care and rationale behind it. 2) Discuss the need for disease management programs and the successes/failures. 3) Identify key interventions in CHF management to produce positive outcomes
Keywords: Heart Disease, Prevention
Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: Blue Cross and Blue Shield of Ga provides the CHF program services
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.