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Financial implications of a model heart failure disease management program for providers, hospital, healthcare systems, and payer perspectives.
Am J Cardiol. 2007 Jan 15; 99(2):256-60.AJ

Abstract

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.

Authors+Show Affiliations

Jefferson Medical College, Philadelphia, Pennsylvania, USA. david.whellan@jefferson.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

17223429

Citation

Whellan, David J., et al. "Financial Implications of a Model Heart Failure Disease Management Program for Providers, Hospital, Healthcare Systems, and Payer Perspectives." The American Journal of Cardiology, vol. 99, no. 2, 2007, pp. 256-60.
Whellan DJ, Reed SD, Liao L, et al. Financial implications of a model heart failure disease management program for providers, hospital, healthcare systems, and payer perspectives. Am J Cardiol. 2007;99(2):256-60.
Whellan, D. J., Reed, S. D., Liao, L., Gould, S. D., O'connor, C. M., & Schulman, K. A. (2007). Financial implications of a model heart failure disease management program for providers, hospital, healthcare systems, and payer perspectives. The American Journal of Cardiology, 99(2), 256-60.
Whellan DJ, et al. Financial Implications of a Model Heart Failure Disease Management Program for Providers, Hospital, Healthcare Systems, and Payer Perspectives. Am J Cardiol. 2007 Jan 15;99(2):256-60. PubMed PMID: 17223429.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Financial implications of a model heart failure disease management program for providers, hospital, healthcare systems, and payer perspectives. AU - Whellan,David J, AU - Reed,Shelby D, AU - Liao,Lawrence, AU - Gould,Stuart D, AU - O'connor,Christopher M, AU - Schulman,Kevin A, Y1 - 2006/11/27/ PY - 2006/04/04/received PY - 2006/08/07/revised PY - 2006/08/07/accepted PY - 2007/1/16/pubmed PY - 2007/2/28/medline PY - 2007/1/16/entrez SP - 256 EP - 60 JF - The American journal of cardiology JO - Am J Cardiol VL - 99 IS - 2 N2 - 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. SN - 0002-9149 UR - https://www.unboundmedicine.com/medline/citation/17223429/Financial_implications_of_a_model_heart_failure_disease_management_program_for_providers_hospital_healthcare_systems_and_payer_perspectives_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0002-9149(06)02011-X DB - PRIME DP - Unbound Medicine ER -