Columbia, S.C. – A study designed by BlueCross BlueShield of South Carolina and Roper St. Francis Heart and Vascular Center, Charleston, S.C., showed positive results for heart failure patients — cutting hospital readmissions in half.
The innovative approach illustrates BlueCross’ leadership and collaboration with the medical community to improve health care for South Carolinians.
As a result, BlueCross may roll out the same technology to patient-centered medical homes run by primary care practices in its networks in South Carolina, and Roper St. Francis plans to expand it to its diabetes and hypertension patients. A patient-centered medical home is an individualized approach to patient care. A primary care physician leads a medical team that coordinates all preventive, acute and chronic condition services.
Heart failure is a condition in which the heart doesn’t pump enough blood to meet the body’s needs. Of all diseases, it has the highest rates of hospital readmissions within 30 days. Unplanned readmissions cost the U.S. health care system an estimated $17.4 billion. The study was to determine if an interactive voice response system by telephone could reduce 30-day heart failure readmissions.
Sixty heart failure patients at Roper St. Francis received information via an mp3 player while they were still in the hospital. Following discharge, they received a daily phone message offering self-management tips and asking them to enter data through the phone about specific symptoms. Responses that indicated the need for medical guidance triggered an alert to hospital staff, who would then call the patient. The software platform and content were developed by AudiaHealth, Charleston.
As a result of the study, conducted in Spring 2011, readmissions were reduced by half.
Dr. Linda Austin, chief medical officer of AudiaHealth, and Cathy Landis, RN and service line director at Roper St. Francis, ran the study. Dr. Laura Long, BlueCross’ vice president for clinical quality and health management, coordinated BlueCross’ work. BlueCross helped to plan the study, including its measurement criteria and return on investment evaluation, and developed billing codes for it.
“Poor patient medication and dietary adherence at home combined with lack of knowledge about self-management contribute to rehospitalizations,” Dr. Austin said. “This study showed that an automated program, requiring minimal clinical intervention, can work and is operable at minimal cost. We’re now developing a similar program for diabetes and hypertension.”
“This was a cost-effective technology solution that shows promise to help improve the health of patients,” said Dr. Long of BlueCross. “We plan to consider it for our patient-centered medical home partners in South Carolina. This is just one example of how we’ve taken a leading role to work with hospitals and doctors to improve health care outcomes in our state.”
Other BlueCross efforts have included establishing patient-centered medical homes and accountable care organizations, and launching the South Carolina Partnership for Health. The company supports hospital quality improvements with monetary incentives. It also supplements physician care plans with wellness and disease management programs in which BlueCross health coaches offer patients support and information.
Headquartered in Columbia, S.C., and operating in South Carolina for nearly 65 years, BlueCross BlueShield of South Carolina is an independent licensee of the Blue Cross and Blue Shield Association. The only South Carolina-owned and operated health insurance carrier, BlueCross BlueShield of South Carolina comprises more than 45 companies involved in health insurance services, U.S. DoD health program and Medicare contracts, other insurance and employee benefits services, and a philanthropic foundation that funds programs to improve health care and access to health care for South Carolinians.