title: ICONS: Managing Care and Costs: The Sustained Cost Impact of Reduced Hospitalizations in a Partnership-Measurement Model of Disease Management.
abstract: Improving Cardiovascular Outcomes in Nova Scotia (ICONS) was a multidisciplinary-partnership, measurement-driven disease management project designed to improve the care and outcomes of patients with acute and chronic heart diseases in Nova Scotia. Previous analyses demonstrated beneficial clinical and macroeconomic end points at the population and system levels, including heightened awareness of the value of team care, increased use of proven therapies, decreased re-hospitalizations and a positive dollar return on investment for the economies of Nova Scotia and Canada. This article analyzes the additional cost-reduction benefits resulting from the reduced re-hospitalizations that occurred among patient populations with heart attacks and heart failure. Over the five-year course of ICONS, one-year readmissions and readmission rates fell continuously for both index disease states. Despite a general inflationary rise in real hospital costs, the per-event cost of readmissions expressed in constant 2002 dollars also decreased: from $10,377 in 1997 to $9,022 in 2002 for the heart attack patient population; and from $9,020 to $8,697 for patients with heart failure. Total real yearly costs for heart attack readmissions fell from $7.4 million in 1997 to $6.4 million in 2002, a 14% decrease; for heart failure, yearly costs decreased by 26%, from $9.2 million to $6.8 million. These microeconomic data supplement the previously reported improvements in patient care and the positive macroeconomic impact of ICONS. Overall, ICONS demonstrated that quality and cost of healthcare could be simultaneously and successfully managed over a sustained period of time for whole patient populations in a real-world setting. ICONS offers strong evidence of the value of the partnership-measurement model of disease management and prevention as a reproducible and desirable template for next-generation healthcare in Canada.
authors: MA, DESS, is currently senior economist, Groupe d'analyse, in Montréal, Québec.
authors: Pierre Emmanuel
authors: PE
authors: Paradis
authors: BSc, is currently a principal in STRIVE Health Management Consulting, and a partner in PHM Alliance. She is based in Halifax, Nova Scotia.
authors: Joanna
authors: J
authors: Nemis-White
authors: MA, is currently manager of health economics and outcomes research, Merck Frosst Canada Ltd., in Montréal, Québec.
authors: Marie-Claude
authors: MC
authors: Meilleur
authors: PhD, is currently senior economist, Groupe d'analyse.
authors: Marissa
authors: M
authors: Ginn
authors: MD, is currently director of research in the Division of Cardiology and professor in the Departments of Medicine and Community Health and Epidemiology, at Dalhousie University, in Halifax, Nova Scotia.
authors: Jafna
authors: J
authors: Cox
authors: MD, is currently principal in CareNet Corporation Ltd., a health management consulting company, and a partner in PHM Alliance. He is based in Montréal, Québec. He can be contacted by e-mail at terrymontague@sympatico.ca.
authors: Terrence
authors: T
authors: Montague
mesh_terms: D019033:Delivery of Health Care, Integrated / Q000191:economics* / Q000458:organization & administration; D019468:Disease Management; D006333:Heart Failure / Q000191:economics / Q000628:therapy; D006801:Humans; D009203:Myocardial Infarction / Q000191:economics / Q000628:therapy; D009674:Nova Scotia; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data; D010359:Patient Readmission / Q000191:economics*