Financial implications of a model heart failure disease management program for providers, hospital, healthcare systems, and payer perspectives.
Although heart failure disease management (HFDM) programs improve patient outcomes, the implementation of these programs has been limited because of financial barriers. We undertook the present study to understand the economic incentives and disincentives for adoption of disease management strategies from the perspectives of a physician (group), a hospital, an integrated health system, and a third-party payer. Using the combined results of a group of randomized controlled trials and a set of financial assumptions from a single academic medical center, a financial model was developed to compute the expected costs before and after the implementation of a HFDM program by 3 provider types (physicians, hospitals, and health systems), as well as the costs incurred from a payer perspective. The base-case model showed that implementation of HFDM results in a net financial loss to all potential providers of HFDM. Implementation of HFDM as described in our base-case analysis would create a net loss of US dollars 179,549 in the first year for a physician practice, US dollars 464,132 for an integrated health system, and US dollars 652,643 in the first year for a hospital. Third-party payers would be able to save US dollars 713,661 annually for the care of 350 patients with heart failure in a HFDM program. In conclusion, although HFDM programs may provide patients with improved clinical outcomes and decreased hospitalizations that save third-party payers money, limited financial incentives are currently in place for healthcare providers and hospitals to initiate these programs.
Whellan
David J
DJ
Jefferson Medical College, Philadelphia, Pennsylvania, USA. david.whellan@jefferson.edu
Reed
Shelby D
SD
Liao
Lawrence
L
Gould
Stuart D
SD
O'connor
Christopher M
CM
Schulman
Kevin A
KA
D017046:Cost Savings; D017598:Efficiency, Organizational; D005376:Financial Management; D006333:Heart Failure / Q000191:economics / Q000628:therapy*; D017721:Hospital Costs; D006801:Humans; D007349:Insurance, Health, Reimbursement / Q000191:economics; D018803:Models, Economic; D017063:Outcome Assessment, Health Care / Q000191:economics*; D010816:Physician Incentive Plans; D011216:Practice Management, Medical / Q000191:economics*; D011320:Primary Health Care / Q000191:economics*; D011445:Prospective Payment System / Q000191:economics; D014481:United States