Optimizing heart failure care management program delivers additional $42 PMPM savings

​Robust analysis drives successful program optimization

By any measure, congestive heart failure is an expensive and increasingly frequent chronic condition. The annual median cost per patient is $24,383 and it climbs to more than $100,000 when all-cause readmissions are included. The American Heart Association projects a 46 percent increase in prevalence by 2030.

That’s why a regional health plan had a long-standing program to provide enhanced care management for Medicare Advantage members with congestive heart failure (CHF.) Supported by a nurse, members who chose to enroll created personalized care plans to promote self-management and optimal outcomes and spend. Nurses regularly contacted participating members to gauge progress and recommend additional actions. 

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