Provena Covenant Medical Center
Urbana, Ill.

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In order to significantly impact the patients with HF and reduce their readmission rates at Provena Covenant Medical Center, the Heart Failure Support Program, part of Disease Management Services, was initiated in the spring of 2010 and full implementation occurred in June 2010.

National indicators show that the proliferation of heart failure (HF) disease management programs across the United States has been driven by an enormous HF health care burden. Based on current estimates, more than six million Americans suffer from HF. New HF cases are identified at a rate of 550,000 per year. Health care expenditures (direct costs) for HF in 2007 are estimated by the National Heart, Lung and Blood Institute to exceed $30 billion. Current health care economics dictate that a significant proportion of this burden is borne by hospitals. Nationwide HF disease management programs have proven successful in improving the quality of HF health care while favorably impacting hospital costs.

Of significance to the HF burden, are the disparities that exist among ethnic groups, especially among African-Americans. National statistics indicate that African Americans are disproportionately affected by mortality and hospitalizations resulting from heart failure when compared with other racial/ethnic groups. Studies show they are 1.5 times more likely to develop HF than Caucasians.

Local Experience
Provena Covenant Medical Center is located in Champaign County, Ill. According to the 2010 census, the ethnic breakdown of the county is 78 percent white, 12 percent African-American, 7.7 percent Asian, and 4.3 percent Hispanic. Even though the proportion of the African-American community is 12 percent, the proportion of African-American HF enrollees was 46 percent compared to 50 percent white and 4 percent Asian for 2011.

The following summary illustrates the overall design and impact of the program. The results show that HF readmission rates dropped significantly for all patients including the high proportion of African-American patients.

Disease Management Services Summary, 2010

Purpose:

• To align with Accountable Care Organizations and health care reform initiatives.
• To align with future quality incentives related to Medicare readmissions.
• To reduce negative margins associated with costly patient care, particularly uninsured.
• To enhance the quality of care to all of our patients.
• To support our mission by enhancing the resources for the poor and vulnerable.

Current Design:

• Patients discharged with heart failure are automatically referred to outpatient Disease Management Services. In addition, the case management team and other clinical providers refer patients who they assess as having a high risk for readmission.
• Those referred are assessed (via chart review and personal phone call) for understanding and confidence with disease management skills, follow up appointments/ home care, payer source(s), and access to care issues including financial or support barriers by the Disease Management Coordinator RN.
• Those at high risk for readmission are enrolled in a follow up care coordination program and are regularly counseled by the RN to help navigate through barriers.
• Patients are enrolled into pertinent Center for Healthy Aging health education classes including the chronic disease self management program and cardiovascular wellness program.

2010 Outcomes:

• The trend shows that as the referrals to the CHF disease management program increased, the 30 day readmissions decreased.
• Medicare CHF 30 day readmissions decreased from 33 percent in the first quarter to 13 percent in the fourth quarter as follows:
  • 1st quarter average 33.9 percent.
  • 2nd quarter average 25.6 percent.
  • 3rd quarter average 25.2 percent.
  • 4th quarter average 13.0 percent.
• Medicare annual CHF 30 day readmission rate decreased from 25 percent in 2009 to 24.4 percent in 2010 for all hospital HF patients.

The overall experience of the Heart Failure Support Program at PCMC has been encouraging. The use of a registered nurse that can provide follow up education and care coordination is instrumental in driving positive outcomes. The program improves the quality of life of HF patients and at the same time reduces hospital readmission rates. Furthermore, focusing on the underserved population and especially the African-American community is a key component to a successful program.