Improving health outcomes for heart patients
In North Carolina, heart failure is the second leading cause of preventable hospitalization and expenditures per individual far exceed those for individuals with diabetes or asthma. Furthermore, more than half of the hospitalizations are thought to be avoidable -- lack of adherence to medications and diet accounts for 41 percent of hospitalizations due to heart failure. About 3,000 individuals in CCNC are identified with heart failure. While asthma and diabetes are more common, and the annual mean Medicaid expenditure for individuals with heart failure is $27,000, versus $7,900 and $12,000 for people with asthma and diabetes, respectively.
Fortunately, heart failure is a treatable condition and there are proven strategies that can improve health outcomes: promotion of evidence-based therapies, self management and access to a medical home. These strategies there are very familiar to CCNC as key components of all our disease management initiatives. In addition, networks work with providers through care management to reduce four key, modifiable factors leading to hospital readmissions such as:
- Inadequate patient and caregiver education and counseling – especially around medications
- Poor communication among health care providers
- Failure to organize follow-up care
- Clinician failure to emphasize non-pharmacologic aspects of heart failure care (e.g., diet, activity and symptom monitoring)