The Payer Cost of Congestive Heart Failure Management: A case study of cost savings with supportive in-home health care

 

The Challenge: Cost Containment for Chronic Conditions 

Management of Congestive Heart Failure is extensive and expensive, placing heavy demands on health care system resources due to long hospital stays, multiple readmissions and other ongoing medical needs. As CHF progresses, acute episodes become more frequent and can lead to higher risks of mortality. [1] 

Because CHF symptoms can be non-specific or attributed to other causes, gradual or abrupt, and vary from person to person, quality care management with clinical oversight is vital to improved outcomes. Factors that contribute to the complex nature of disease management for CHF include: 

  • Congestive Heart Failure is one of the most expensive diagnoses. 

  • Patients can present with varying symptoms and experience a rapid change in their health. 

  • Post-discharge instructions may be hard for patients to follow, either due to a lack of understanding or difficulty making changes due to deeply ingrained habits. 

  • This chronic condition is often exacerbated by lifestyle choices such as lack of exercise, poor nutrition, smoking, etc. 

  • Lack of medication compliance or dosing errors can compromise recovery. 

Proving superior clinical outcomes has been a long-standing challenge for the home care industry due to fragmented care standards across states, the lack of standardized measures in personal care, and the lack of visibility home health care agencies have on claims data for patients. 

The Solution: Nurse-Led In-Home Personal Care 

BrightStar Care’s nurse-led care teams coordinate post-acute transitions and provide oversight on medication compliance, patient education and ongoing monitoring of patient change of condition. This care can help reduce avoidable hospitalizations, medication errors, emergency room usage and improves quality of life, while also delivering a reduction in health care costs and providing value creation for payers. For patients with Congestive Heart Failure and other chronic conditions, this care is essential. 

Many of the services that BrightStar Care has been providing for the last 20 years can help reduce poor patient outcomes and lessen health care costs. Here are some of the key factors that contribute to accomplishing these goals [2]: 

  • Smoother care transitions. 

  • Improved discharge instruction understanding and compliance. 

  • Enhanced patient education and support. 

  • Focus on symptom monitoring and management. 

  • Intervention to reduce acute heart failure incidents. 

  • Improved quality of life, improved self care and end-of-life care. 
     

Registered Nurse (RN) oversight for all BrightStar Care clients includes the following: 

  • Review of discharge instructions and transitional care needs, which gives the client and their loved ones an opportunity to absorb and understand this information in a more relaxed home environment. 

  • Initial assessment and reassessments to identify clinical exacerbations. This provides a clinical set of eyes in the field in between appointments and hospitalizations. 

  • Medication reconciliation to identify gaps in medication lists and/or non-compliance. 

  • Education for clients and families on signs and symptoms of disease exacerbation, recommended lifestyle changes and the importance of adherence to the plan of care. 

  • Recommendation of risk mitigation strategies which may include fall reduction, home safety, emergency planning and other helpful insights. 

  • Monitoring changes in condition and escalating to external care teams when appropriate. 


Certified Nursing Assistants (CNAs) and Caregivers provide support under RN oversight. The following services may be performed by CNAs, Caregivers or both based on their scope of practice: 

  • Report changes to RN by answering client specific, disease specific change in condition questions at the end of each shift. The RN is immediately notified and can intervene and/or investigate as needed. 

  • Serve as the “eyes and ears” of the post-discharge Plan of Care (POC) and provide encouragement to the client to follow the plan. The RN is notified of any changes in condition. 

  • Support self-care and/or end-of-life needs. Older adults living with chronic disease can often experience depression, anxiety or other issues that need support. Our staff provides companionship, creates routines, plans safe daily activities and participates in those activities with their clients, which can improve the client’s overall quality of life. 

  • Aid with personal care tasks such as toileting, bathing and grooming, dressing, feeding and ambulating. In addition to providing the client with physical support to do these activities, it also helps reduce falls, decreases infections due to proper hygiene and ensures that the client is eating a healthy diet – all of which contribute to a lower risk of hospitalization and extend the amount of home time. 

  • Provide medication reminders to ensure compliance and reduce the risk of medication errors. 

  • Encourage lifestyle modifications such as exercising, meeting special dietary needs by grocery shopping and/or doing meal prep, smoking cessation support, watching for signs of alcohol mis-use and other healthy habits. 

Although BrightStar Care has observed and documented patient care that reduces the likelihood of avoidable hospitalizations and other expensive care options, we – like most other in-home personal care providers – wanted to have data to validate that personal care can lead to positive outcomes and cost savings for the healthcare ecosystem. 

The Results 

In order to address the lack of data quantifying the benefits of in-home personal care for clients with chronic conditions, BrightStar Care engaged leading health care analytics firm, Avalere Health, to evaluate client outcomes and cost benefits of in-home personal care. Avalere Health enables data-driven health care by informing actionable insights, delivering meaningful impact, and driving stronger patient outcomes and business economics. 

The analysis from Avalere Health validates BrightStar Care’s delivery of positive outcomes for personal care clients and value for downstream payers. Clients receiving in-home personal care experience lower rates of hospitalization, Emergency Department visits and Skilled Nursing Facility utilization across 30 different health care conditions. 

How the study was conducted: Avalere Health compared BrightStar Care clients to a matched control group of Medicare Beneficiaries and assessed the relative utilization of Medicare services between the two populations for different health care conditions with the average age of the population being 80. 

Avalere’s analysis revealed that the change (baseline vs. follow-up) in the total cost of care was up to $29,902 lower for patients who received BrightStar Care services when compared to patients who did not receive services. 

 

Among patients with Congestive Heart Failure, 

the average savings per client was $6,618. [3] 

 

The analysis provides the latest evidence that personal care services, such as medication management, meal preparation, personal care assistance, and patient education, can have a positive impact on overall health, leading, in turn, to a reduction in healthcare costs and value creation for payers. 

When payers partner with in-home personal care companies like BrightStar Care, it can deliver positive results for all parties involved – most importantly, for the patients we care for.  

Learn more how BrightStar Care can help you keep your costs down while providing high-quality in-home care. Call 833-306-5142, visit brightstarcare.com/business-partnerships or reach out to David Simic at david.simic@brightstarcare.com or 404-805-3229



[1] Source: https://www.medicalnewstoday.com/articles/317848 
[2] Source: https://onlinelibrary.wiley.com/doi/10.1002/ehf2.12021  
[3] Based on 1,058 patients. Source: https://avalere.com/insights/home-care-services-reduce-medicare-spending-for-30-chronic-conditions