DENVER — A new study from Kaiser Permanente Colorado is one of the first to show that an intensive population management program that matches heart disease patients to personal nurses and clinical pharmacy specialists not only reduces the risk of death but reduces health care costs as well.
The findings are published in the November issue of the journal Pharmacotherapy.
Researchers examined health care expenditures in two populations of patients with heart disease: a group of 628 people enrolled in the Kaiser Permanente Collaborative Cardiac Care Service, a population disease management program, and 628 matched patients receiving standard care. The goal of the study was to determine if an intensive disease management program could provide more value than usual care.
The study found that patients cared for by the CCCS experienced superior health outcomes. As compared to patients receiving usual care, enrollees in the CCCS had better cholesterol control, were more likely to be screened and adhere to important medications like statins, and had far fewer hospitalizations. Overall, CCCS patients had an 89 percent reduction in overall mortality and 88 percent reduction in cardiac mortality compared with patients receiving standard care
When the researchers compared costs, they found that health care expenditures for CCCS enrollees were, on average, $60 less each day for an annual average of $21,900 per patient, per year.
These are exciting findings, said the study’s lead author, Tom Delate, PhD, of Kaiser Permanente Colorado. “The goal of the CCCS is to get patients with heart disease on the right medications and deliver needed screenings and care, so one might expect to see health care costs go up with the increased service,” he said. “However, we found the opposite effect: the CCCS was able to keep patients so healthy that they were more likely to stay out of the hospital. At the end of the day, expenditures from this major cost driver were reduced.”
The researchers calculated total health care expenditures by extensively reviewing health care utilization claims and electronic health record files. They also attributed an overhead cost to the staff and systems used to administer the population management program. Ultimately, the analysis found that enrollees in the CCCS had lower health care expenditures across the board, including the following key areas:
- Medications: $4 per day, compared to $5 per day
- Doctor’s office visits: $7 per day, compared to $8 per day
- Hospitalizations: $19 per day, compared to $69 per day
“This program works because it is a team approach,” added John Merenich, MD, study co-author and medical director of the Clinical Pharmacy Cardiac Risk Service. “Our teams of nurses and clinical pharmacists, as well as our health information technology, require significant investment. We always knew it was the right investment because it saved lives. Now we know it’s also the right investment because it provides the highest quality care at a lower cost. This is the value people have been looking for in health care.”
How the Collaborative Cardiac Care Service Works
The goal of the CCCS is to help patients with heart disease receive the evidence-based treatment that has been shown to reduce their risk of another event. The program is unique because the majority of care is delivered over the phone by nurses and clinical pharmacy specialists who work under the direction of a physician.
After a hospital discharge, patients with coronary artery disease are enrolled into a 3–6 month rehabilitation program. Patients are assigned a personal nurse. The nurse works with the patient to implement recommendations for a healthy lifestyle. When the rehabilitation program is completed, patients are then transferred to a personal clinical pharmacy specialist, who manages medications known to decrease the risk of future heart problems. Electronic medical records and computerized disease registries help the clinicians coordinate the care. For example, the electronic tools notify the clinical pharmacist if a patient forgets to pick up a prescription or a cholesterol test shows a change in medication is needed. Using this electronic data, clinical pharmacists can proactively outreach to the patient to support them in making necessary changes.
Additional study authors include: Kari L. Olson, PharmD, Jon Rasmussen, PharmD, Kara Hutka, PharmD, Brian Sandhoff, PharmD, Roseanne Hornak, PharmD, for the Clinical Pharmacy Cardiac Risk Service Study Group.
About Kaiser Permanente Colorado
About Kaiser Permanente ColoradoThe Colorado Permanente Medical Group has an exclusive contract with Kaiser Foundation Health Plan of Colorado to form Kaiser Permanente Colorado, the state's largest private, non-profit health care provider in the state. CPMG is Colorado's largest medical group practice within a health care organization, and employs 800 regular status physicians representing all medical specialties and major sub-specialties. More than 483,000 members in the Denver/Boulder and Colorado Springs areas have access to Kaiser Permanente care through an expanded suite of health care products. Kaiser Permanente physicians and care teams focus on prevention as well as managing disease, all in an effort to help patients live well and thrive. Visit us online at kp.org or get the latest in health news at our News Center.
About Kaiser Permanente
About Kaiser Permanente Kaiser Permanente is committed to helping shape the future of health care. We are recognized as one of America’s leading health care providers and not-for-profit health plans. Founded in 1945, our mission is to provide high-quality, affordable health care services and to improve the health of our members and the communities we serve. We currently serve 8.6 million members in nine states and the District of Columbia. Care for members and patients is focused on their total health and guided by their personal physicians, specialists and team of caregivers. Our expert and caring medical teams are empowered and supported by industry-leading technology advances and tools for health promotion, disease prevention, state-of-the art care delivery and world-class chronic disease management. Kaiser Permanente is dedicated to care innovations, clinical research, health education and the support of community health. For more information, go to: www.kp.org/newscenter.