Duke Heart Failure Program - Case Study Example

How much money is Duke health System losing? Value of the Health System caring for 33,000 employees and dependents 2 billion Duke’s Loss per year on Medicare- reimbursed inpatient care for CHF = $ 200, 000 to $ 300,000 according to Duke’s data for a national trial. Seed money by Duke to the salary program = $ 125,000 Salary and Benefits of 3 NPs and 10 cardiologists = $ 80, 000 x 13 = $ 1040,000 Number of Patients at DUHS (Duke University health System) by 2003 = 600 Fee for the outpatient’s first visit = $ 150 Fee for the outpatient’s return visit = $ 100 Income of DUHS as per the number of patients in 2003 provided each patient visits twice a week = (150 x 600) + 95(100 x 600) = $ 90,000 + $ 5700,000 = $ 5790000 2.

What are the financial results of the CHF disease management program? Hint: Examine revenue and cost impacts for the Hospital (inpatient and outpatient) and Physicians perspective. According to the American Heart Association, the annual direct cost was estimated to be $ 22.2 billion to treat the CHF patients, in addition to $ 2.1 billion in the loss of productivity. The costs of the hospital were about 60 percent of the direct costs of CHF. Hospital readmission rates were about 2 percent with in 2 days, 20 percent with in 1 month, and 50 percent for 6 month time.

The only one largest expense for Medicare was CHF and it was also the basic cause of admission in emergency room among the Medicare population. Non-compliance of diet and medication resulting in readmission was about 33 percent to 64 percent whereas 35 percent of readmissions were related to inadequate discharge planning or follow- up. 3. What are the pros and cons of the CHF disease management program like the one at Duke from the perspective of payers, providers, employers, patients, and a private carve-out?

Disease management (DM) was basically a proactive form of medical care so as to manage chronic conditions and avoid costly hospitalizations and problems before they occur. It focuses on the communication with patients and physicians, coordination of care and self- management. Various substantial CHF disease management programs based on different systems and processes had been formulated by providers, for- profit companies, and insurers. Each program varied in design in relation to the targeted condition and its severity.

CHF disease management programs with respect to the providers were located commonly within physician organizations and integrated health systems. The basic purpose of the CHF disease management program at Duke is to teach patients self- management tools and problem- solving skills so that they are able to prevent or deal with congestive heart failure. In the late 1990s, the popularity of For- profit Disease Management companies was significantly raised, many of which were publicly traded. The trend passed to the decade of 2000 as well, where the Disease Management industry expectedly grew to $ 1.

2 billion in 2006 from a $ 579.3 million commercial market in 2002. For- profit Disease Management companies provided their services to 3 groups which are private managed care companies constituting 85 percent of market, public managed care contractors constituting 10 percent of the market; and employers constituting 5percent of the market. The CHF disease management program at Duke was effective for the treatment but found to be costly and less penetrating from the perspectives of payers, providers, employers, patients, and a private carve-out.