References
`
`Bigelow, J.H., Cretin, S., Soloman, M., Wu, S.Y., Cherry, J., Cobb, H., and O’Connell, M.
`(2000). Patient Compliance With and Attitudes Towards Health Buddy™, RAND Health,
`Santa Monica, California.
`
`Drummond, M.F., O’Brian, B., Stoddart, G.L., & Torrance, G.W. (1999). Methods for the
`Economic Evaluation of Health Care Programmes. New York: Oxford University Press Inc.
`
`Landi, F., Gambassi, G., Pola, R., Tabaccanti, S., Cavinato, T., Carbonin, P.U., & Bernabeu, R.
`(1999). Impact of integrated home care services on hospital use. Journal of American
`Geriatrics Society, 47 (12), 1430-1434.
`
`O’Connell, M. and Cherry, J. (2000). The Health Hero® Online Service: A new internet-
`based communications platform for disease management, case management and
`performance measurement. Disease Management and Health Outcomes 7 (3), 149-161.
`
`Rich, M.W., Beckham, V., Wittenberg, C., Leven, C.L., Freedland, K.E. and Carney, R.M.
`(1995). A multidisciplinary intervention to prevent the readmission of elderly patients with
`congestive heart failure. New England Journal of Medicine, 333 (18), 1190-1195.
`
`Shah, N.B., Der, E., Ruggerio, C., Heidenreich, P.A., and Massie, B.M. (1998). Prevention
`of hospitalizations for heart failure with an interactive home monitoring program.
`American Heart Journal, 135 373-378.
`
`Warner, P.M., & Hutchinson, C. (1999). Heart Failure Management. Journal of Nursing
`Administration, 29 (7-8), 28-37.
`
`West, J.A., Miller, N.H., Parker, K.M., Senneca, D., Ghandour, G., Clark, M., Greenwald, G.,
`Heller, R.S., Fowler, M.B., and DeBusk, R.F. (1997). A comprehensive management system
`for heart failure improves clinical outcomes and reduces medical resource utilization.
`American Journal of Cardiology, 79 58-63.
`
`Corporate Headquaters:
`2570 W. El Camino Real,
`Sutie 111
`Mountain View, CA 94040
`tel. 650-559-1000
`fax. 650-559-1050
`www.healthhero.com
`
`Case Study
`
`Highlights
`
`Congestive heart failure (CHF)
`affects 4.6 million individuals
`in the US each year. CHF is the
`number one cause for hospital
`admissions in the United States
`with over 1.5 million hospital
`admissions per year. The esti-
`mated total cost of CHF in the
`US for health services and loss
`of productivity is over $22.5
`billion per year.
`
`The PacifiCare CHF program,
`“Taking Charge of Your Heart
`Health”, was implemented in
`California in 1999 to provide
`patients with coaching, educa-
`tion, and reinforcement of
`self-care management skills.
`
`The “Taking Charge of Your
`Heart Health” program,
`powered-by Health Hero’s
`Internet based platform
`and Health Buddy appliance,
`serves as the vehicle for
`delivering structured com-
`munications between
`PacifiCare care managers and
`their in-home CHF patients.
`Through this daily interaction
`care managers receive timely
`information about their
`patients allowing for timely
`intervention and com-
`munication with physicians.
`
`Results from an initial six
`month analysis showed cost
`reductions for hospitalizations
`and ER visits of 50.6% and
`total savings in claims paid
`of $5,271 PMPY.
`
`HMO • Disease Management • CHF
`
`PacifiCare CHF Program - “Taking Charge of Your Heart Health”
`Shows Significant Utilization Reduction and Cost Savings Using
`Health Hero Platform
`
`The PacifiCare CHF program, “Taking Charge of Your Heart Health,”
`was implemented in California in 1999. As an interactive telephonic support
`program, the patient is provided with coaching, education, and reinforcement
`of self-care management skills. The program features in-home daily monitoring
`using the Health Hero® Health Buddy® personal information appliance, and
`timely care manager intervention and physician feedback via the Health Hero®
`iCare Desktop™.
`
`There are approximately 400 patients in the “Taking Charge of Your Heart Health”
`program. Patients enrolled in the program receive a Health Buddy appliance
`to receive and respond to daily sessions of questions, and educational information
`sent from their care manager using the Health Hero iCare Desktop. The interactive
`sessions provide coaching and reinforce self-care management with the patients.
`The Health Hero iCare Desktop is a web-based application that enables remote
`monitoring of patients by telephonic support staff and nurses, and regular
`communication with physicians.
`
`Results from an initial six-month data analysis of the “Taking Charge of Your
`Heart Health” program, powered-by Health Hero, showed reductions in costs
`for hospitalizations and ER visits of 50.6% and total savings in claims paid
`of $5,271 Per-Member-Per-Year (PMPY). The program effectively reduced inpa-
`tient hospitalizations by 49.6% (p-value < 0.001) and reduced ER Visits by 73.0%
`(p-value < 0.001). With enrollment similar to current levels, net annualized sav-
`ings are approximately $2.7 million and return on investment is close to 200%.
`
`Congestive Heart Failure
`Congestive heart failure (CHF) is a progressive disease that affects 4.6 million
`individuals in the United States with 400,000 to 700,000 new cases each year
`(American Heart Association 1997). This translates to an overall incidence rate
`of 1.5% to 2.0%, and an incidence rate of 6% to 10% in the 65-year and older age
`group. Heart failure is the only cardiovascular condition that is increasing
`in prevalence and incidence. CHF is the number one cause for hospital admissions
`in the United States with over 1.5 million hospital admissions per year.
`
`In 1998, there were 727,523 discharges for CHF in the Medicare population in the
`U.S. Associated charges to Medicare were $7.2 billion averaging $9,831 per
`discharge. The estimated total cost of CHF in the US for health services and loss
`of productivity is over $22.5 billion per year.
`
`1
`
`Bosch Ex. 2051
`Cardiocom v. Bosch IPR2013-00468
`
`

`
`Summary
`Results from an initial six-month data analysis of the “Taking Charge of Your Heart Health”
`program powered by Health Hero showed reductions in costs for hospitalizations and ER
`visits of 50.6% and total savings in claims paid of $5,271 PMPY. Inpatient hospitalizations
`were reduced by 49.6% and ER Visits were reduced by 73.0%. With enrollment similar
`to current levels, savings are approximately $2.7 million and return on investment
`is approximately 200%.
`
`Additional data collected on the Health Buddy indicates a high degree of patient compliance
`and ease of use. The utilization analysis presented in this case study indicates significant
`reduction in both in-patient and emergency room utilization.
`
`Active patient monitoring and self-management of chronic conditions have been shown
`to dramatically affect chronic disease outcomes. Without remote monitoring, patient care
`is based on episodic encounters between patients and their care providers. This episodic
`approach relies on the patient’s ability or willingness to recollect disease-related events over
`an extended period. Programs such as the "Taking Charge of Your Heart Health" program
`powered-by Health Hero are designed to bridge the gap between office visits by providing
`a platform for daily collection and dissemination of information from and to the patient.
`This practice makes it possible for the care provider to identify problems and
`intervene before a problem escalates. This evaluation suggests impressive reduction in costs
`associated with hospitalization and ER utilization, particularly as scaled to the PacifiCare
`CHF population at large.
`
`CHF has diverse etiologies relating to impaired left ventricular function. This impairment
`results in cardiac output that is insufficient to meet metabolic needs. Fluid retention and
`pulmonary congestion often characterize CHF patients. Treatment consists of diuretics to
`control for fluid retention and vasodilators to improve cardiac output. Self-management
`practice including a low-sodium diet and medication compliance is of crucial importance.
`CHF is a chronic disease and therefore must be treated continuously. The chronic nature of
`the disease increases re-admissions and thereby increases hospital costs.
`
`Monitoring CHF patients using case management programs to reduce re-admissions and
`in-patient costs has become popular in recent years. Numerous studies have demonstrated
`that care management can reduce hospital costs by reducing the number of hospitalizations
`and ER visits. For example, Landi et al. (1999), Warner and Hutchinson (1999), West et al.
`(1997), Shah et al. (1996) and Rich et al. (1995) have reported reductions in the number of
`hospitalizations, LOS and costs with care management.
`
`There are two primary mechanisms for achieving reduction in utilization. First, the case
`manager monitors patient symptoms (e.g., changes in weight, edema, shortness of breath,
`and fatigue), and notifies the patient or patient’s physician of any abnormality in a timely
`fashion. Second, the case manager educates and motivates the patient to improve their
`behavior. For example, the case manager may help the patient self-manage their compliance
`with prescribed medications and diet. In short, behavioral change, knowledge building and
`symptom monitoring play a key role in optimizing medical management of CHF.
`
`The PacifiCare “Taking Charge of Your Heart Health” Program
`The PacifiCare “Taking Charge of Your Heart Health” program is designed for patients with
`moderate to severe CHF. As an interactive telephonic support program, the patient
`is provided with 6 to 12 months of coaching, education, and reinforcement of self-care
`management skills. The critical program components are educational support, in-home
`daily monitoring and timely physician feedback. The in-home daily monitoring and much
`of the reinforcement of self-care management is done with the patient using the Health
`Buddy. The Health Hero iCare Desktop enables tracking of patients by the telephonic
`support staff and nurses and regular communication with the physicians.
`
`Specific program objectives include:
`
`* Reduce hospitalizations and emergency room visits for CHF patients
`
`* Improve provider satisfaction with the program
`
`* Improve patient satisfaction with the program
`
`PacifiCare implemented the program on 8/1/99, with three selected Northern California
`Medical Groups. The pilot enrollment period was 8/99 through 10/99, with a total of 52
`patients enrolled in this period. The patient population was of fairly even gender-ratio and
`predominantly over the age of 65 (Figures 1 and 2).
`
`2
`
`

`
`Patient Gender Summary
`
`60
`
`N = 51
`
`56%
`
`44%
`
`60
`
`50
`
`40
`
`30
`
`20
`
`10
`
`0
`
`Female
`
`Male
`
`Figure 1. Gender Distribution
`
`Patient Age Summary
`
`52%
`
`21%
`
`17%
`
`4%
`
`6%
`
`Under 55
`
`55 - 64
`
`65 - 74
`
`75 - 84
`
`85 - older
`
`60
`
`50
`
`40
`
`30
`
`20
`
`10
`
`0
`
`50
`
`40
`
`30
`
`20
`
`10
`
`0
`
`Percent (%)
`
`60
`
`50
`
`40
`
`30
`
`20
`
`10
`
`0
`
`Percent (%)
`
`Hospital+ER Utilization per Member per Year
`
`1.92
`
`57% PMPY Savings
`
`0.82
`
`2.0
`
`1.6
`
`1.2
`
`0.8
`
`0.4
`
`0.0
`
`Control
`
`Health Hero
`
`Figure 3. Hospitalizations + ER Visits — All Causes
`
`Hospital+ER Utilization Cost per Member per Year
`
`$10,427
`
`$5,271 PMPY Savings
`
`$5,156
`
`Control
`
`Health Hero
`
`$10K
`
`$8K
`
`$6K
`
`$4K
`
`$2K
`
`$0K
`
`2.0
`
`1.6
`
`1.2
`
`0.8
`
`0.4
`
`0.0
`
`Number of Encounters PMPY
`
`$10K
`
`$8K
`
`$6K
`
`$4K
`
`$2K
`
`$0K
`
`Total Cost PMPY
`
`Figure 4. Total Costs—All Causes
`
`Figure 2. Age Distribution
`
`3
`
`

`
`Results from an initial six-month data analysis of the “Taking Charge of Your Heart Health”
`program showed reductions in costs for hospitalizations and ER visits of 50.6% and total
`savings in claims paid of $5,271 PMPY. The "Taking Charge of Your Heart Health" Program,
`powered-by Health Hero, effectively reduced inpatient hospitalizations for any cause by 49.6%
`(p-value < .001) and reduced ER Visits for all causes by 73.0% (p-value < .001). These results
`are given in Table 1 and Figures 3-4.
`
`The average cost per IP hospitalization was $7,690 and the average ER costs were $859 per visit.
`With enrollment similar to current levels, savings are approximately $2.7 million and return
`on investment is approximately 200%.
`
`Utilization Measure
`
`Baseline
`N=638
`
`Intervention
`N=43
`
`Utilization
`Reduction
`
`[1]
`Z, p-value
`
`Hospitalizations PMPY
`All Causes
`
`ER Visitations PMPY
`All Causes
`
`Total Costs PMPY
`All Causes
`
`Reporting Period
`(approx.)
`
`Notes
`[1] Z test for Proportions used
`
`1.29
`
`0.65
`
`49.6%
`
`0.63
`
`0.17
`
`73.0%
`
`Z=3.60,
`p<.001
`
`Z=3.65,
`p<.001
`
`$10,427
`
`$5,156
`
`50.6%
`
`11/97-04/99
`
`11/99-04/00
`
`Estimated
`Cost
`Savings
`
`$4,882
`
`$389
`
`$5,271
`
`Table 1. Utilization Reduction
`
`The Health Hero Service
`Health Hero provides a value-added communications platform that enables a cost-effective,
`highly efficient, two-way link between caregivers and patients. The Health Hero platform
`aims to ensure a high rate of patient compliance with health regimens and ultimately, better
`outcomes at far lower costs to the healthcare system.
`
`The Health Hero platform consists of the Health Hero iCare Desktop which hosts a series
`of web-based tools and the Health Buddy Personal Information Appliance - an easy-to-use
`appliance placed in the patient’s home or other point of care. Together the web tools and
`appliance form an infrastructure that links care givers to their at-home patients, while
`providing a flexible, cost effective means for daily support and monitoring.
`
`From a standard personal computer with an Internet connection, care managers use the
`Health Hero iCare Desktop to review risk-stratified patient responses, analyze patient trends,
`present reports to physicians and quickly identify those patients in need of care.
`
`The Health Hero service is based on the following design elements:
`
`* Flexibility is key in targeting and addressing the needs of sub-populations
`
`* Simplicity is essential to user compliance
`
`* Timeliness in data collection is required for managing disease progress
`
`* Cost is a critical issue in the practical application of disease management systems
`
`Outcomes Improved
`In an effort to quantify the impact of the “Taking Charge of Your Heart Health” program,
`the following utilization measures were analyzed:
`
`* Hospitalizations of CHF patients for all causes
`
`* ER visits of CHF patients for all causes
`
`* Cost (claims paid) for Hospitalizations of CHF patients for all causes
`
`* Cost (claims paid) for ER Visits of CHF patients for all causes
`
`The intervention population comprised 52 patients enrolled in “Taking Charge of Your
`Heart Health” sometime after 8/1/99. Patients from this population were included in the
`data analysis if they had been in the “Taking Charge of Your Heart Health” program for
`a minimum of 6 months (n=43), and utilization data for these patients from 11/1/99 to
`4/1/2000 were included in the analysis. Patients were eligible for inclusion in the intervention
`and control groups if they had one inpatient admission or three ER visits in the prior year.
`
`Utilization data for the control group were drawn from the period 11/1/97 to 4/1/99 in six
`month sliding windows with start dates corresponding to dates for which patients would
`have been eligible for the intervention if it had been available. A total of 638 patients were
`included in the control group, matched for sex and age with the intervention group. This
`provided a robust estimate of utilization in the non-intervention population. Inpatient,
`emergency room visits, age, gender, and patient counts were recorded.
`
`4
`
`

`
`The Health Hero Service
`Health Hero provides a value-added communications platform that enables a cost-effective,
`highly efficient, two-way link between caregivers and patients. The Health Hero platform
`aims to ensure a high rate of patient compliance with health regimens and ultimately, better
`outcomes at far lower costs to the healthcare system.
`
`The Health Hero platform consists of the Health Hero iCare Desktop which hosts a series
`of web-based tools and the Health Buddy Personal Information Appliance - an easy-to-use
`appliance placed in the patient’s home or other point of care. Together the web tools and
`appliance form an infrastructure that links care givers to their at-home patients, while
`providing a flexible, cost effective means for daily support and monitoring.
`
`From a standard personal computer with an Internet connection, care managers use the
`Health Hero iCare Desktop to review risk-stratified patient responses, analyze patient trends,
`present reports to physicians and quickly identify those patients in need of care.
`
`The Health Hero service is based on the following design elements:
`
`* Flexibility is key in targeting and addressing the needs of sub-populations
`
`* Simplicity is essential to user compliance
`
`* Timeliness in data collection is required for managing disease progress
`
`* Cost is a critical issue in the practical application of disease management systems
`
`Outcomes Improved
`In an effort to quantify the impact of the “Taking Charge of Your Heart Health” program,
`the following utilization measures were analyzed:
`
`* Hospitalizations of CHF patients for all causes
`
`* ER visits of CHF patients for all causes
`
`* Cost (claims paid) for Hospitalizations of CHF patients for all causes
`
`* Cost (claims paid) for ER Visits of CHF patients for all causes
`
`The intervention population comprised 52 patients enrolled in “Taking Charge of Your
`Heart Health” sometime after 8/1/99. Patients from this population were included in the
`data analysis if they had been in the “Taking Charge of Your Heart Health” program for
`a minimum of 6 months (n=43), and utilization data for these patients from 11/1/99 to
`4/1/2000 were included in the analysis. Patients were eligible for inclusion in the intervention
`and control groups if they had one inpatient admission or three ER visits in the prior year.
`
`Utilization data for the control group were drawn from the period 11/1/97 to 4/1/99 in six
`month sliding windows with start dates corresponding to dates for which patients would
`have been eligible for the intervention if it had been available. A total of 638 patients were
`included in the control group, matched for sex and age with the intervention group. This
`provided a robust estimate of utilization in the non-intervention population. Inpatient,
`emergency room visits, age, gender, and patient counts were recorded.
`
`Results from an initial six-month data analysis of the “Taking Charge of Your Heart Health”
`program showed reductions in costs for hospitalizations and ER visits of 50.6% and total
`savings in claims paid of $5,271 PMPY. The "Taking Charge of Your Heart Health" Program,
`powered-by Health Hero, effectively reduced inpatient hospitalizations for any cause by 49.6%
`(p-value < .001) and reduced ER Visits for all causes by 73.0% (p-value < .001). These results
`are given in Table 1 and Figures 3-4.
`
`The average cost per IP hospitalization was $7,690 and the average ER costs were $859 per visit.
`With enrollment similar to current levels, savings are approximately $2.7 million and return
`on investment is approximately 200%.
`
`Utilization Measure
`
`Baseline
`N=638
`
`Intervention
`N=43
`
`Utilization
`Reduction
`
`[1]
`Z, p-value
`
`Hospitalizations PMPY
`All Causes
`
`ER Visitations PMPY
`All Causes
`
`Total Costs PMPY
`All Causes
`
`Reporting Period
`(approx.)
`
`Notes
`[1] Z test for Proportions used
`
`1.29
`
`0.65
`
`49.6%
`
`0.63
`
`0.17
`
`73.0%
`
`Z=3.60,
`p<.001
`
`Z=3.65,
`p<.001
`
`$10,427
`
`$5,156
`
`50.6%
`
`11/97-04/99
`
`11/99-04/00
`
`Estimated
`Cost
`Savings
`
`$4,882
`
`$389
`
`$5,271
`
`Table 1. Utilization Reduction
`
`5
`
`

`
`Patient Gender Summary
`
`60
`
`N = 51
`
`56%
`
`44%
`
`60
`
`50
`
`40
`
`30
`
`20
`
`10
`
`0
`
`Female
`
`Male
`
`Figure 1. Gender Distribution
`
`Patient Age Summary
`
`52%
`
`21%
`
`17%
`
`4%
`
`6%
`
`Under 55
`
`55 - 64
`
`65 - 74
`
`75 - 84
`
`85 - older
`
`60
`
`50
`
`40
`
`30
`
`20
`
`10
`
`0
`
`50
`
`40
`
`30
`
`20
`
`10
`
`0
`
`Percent (%)
`
`60
`
`50
`
`40
`
`30
`
`20
`
`10
`
`0
`
`Percent (%)
`
`Hospital+ER Utilization per Member per Year
`
`1.92
`
`57% PMPY Savings
`
`0.82
`
`2.0
`
`1.6
`
`1.2
`
`0.8
`
`0.4
`
`0.0
`
`Control
`
`Health Hero
`
`Figure 3. Hospitalizations + ER Visits — All Causes
`
`Hospital+ER Utilization Cost per Member per Year
`
`$10,427
`
`$5,271 PMPY Savings
`
`$5,156
`
`Control
`
`Health Hero
`
`$10K
`
`$8K
`
`$6K
`
`$4K
`
`$2K
`
`$0K
`
`2.0
`
`1.6
`
`1.2
`
`0.8
`
`0.4
`
`0.0
`
`Number of Encounters PMPY
`
`$10K
`
`$8K
`
`$6K
`
`$4K
`
`$2K
`
`$0K
`
`Total Cost PMPY
`
`Figure 4. Total Costs—All Causes
`
`Figure 2. Age Distribution
`
`6
`
`

`
`CHF has diverse etiologies relating to impaired left ventricular function. This impairment
`results in cardiac output that is insufficient to meet metabolic needs. Fluid retention and
`pulmonary congestion often characterize CHF patients. Treatment consists of diuretics to
`control for fluid retention and vasodilators to improve cardiac output. Self-management
`practice including a low-sodium diet and medication compliance is of crucial importance.
`CHF is a chronic disease and therefore must be treated continuously. The chronic nature of
`the disease increases re-admissions and thereby increases hospital costs.
`
`Monitoring CHF patients using case management programs to reduce re-admissions and
`in-patient costs has become popular in recent years. Numerous studies have demonstrated
`that care management can reduce hospital costs by reducing the number of hospitalizations
`and ER visits. For example, Landi et al. (1999), Warner and Hutchinson (1999), West et al.
`(1997), Shah et al. (1996) and Rich et al. (1995) have reported reductions in the number of
`hospitalizations, LOS and costs with care management.
`
`There are two primary mechanisms for achieving reduction in utilization. First, the case
`manager monitors patient symptoms (e.g., changes in weight, edema, shortness of breath,
`and fatigue), and notifies the patient or patient’s physician of any abnormality in a timely
`fashion. Second, the case manager educates and motivates the patient to improve their
`behavior. For example, the case manager may help the patient self-manage their compliance
`with prescribed medications and diet. In short, behavioral change, knowledge building and
`symptom monitoring play a key role in optimizing medical management of CHF.
`
`The PacifiCare “Taking Charge of Your Heart Health” Program
`The PacifiCare “Taking Charge of Your Heart Health” program is designed for patients with
`moderate to severe CHF. As an interactive telephonic support program, the patient
`is provided with 6 to 12 months of coaching, education, and reinforcement of self-care
`management skills. The critical program components are educational support, in-home
`daily monitoring and timely physician feedback. The in-home daily monitoring and much
`of the reinforcement of self-care management is done with the patient using the Health
`Buddy. The Health Hero iCare Desktop enables tracking of patients by the telephonic
`support staff and nurses and regular communication with the physicians.
`
`Specific program objectives include:
`
`* Reduce hospitalizations and emergency room visits for CHF patients
`
`* Improve provider satisfaction with the program
`
`* Improve patient satisfaction with the program
`
`PacifiCare implemented the program on 8/1/99, with three selected Northern California
`Medical Groups. The pilot enrollment period was 8/99 through 10/99, with a total of 52
`patients enrolled in this period. The patient population was of fairly even gender-ratio and
`predominantly over the age of 65 (Figures 1 and 2).
`
`Summary
`Results from an initial six-month data analysis of the “Taking Charge of Your Heart Health”
`program powered by Health Hero showed reductions in costs for hospitalizations and ER
`visits of 50.6% and total savings in claims paid of $5,271 PMPY. Inpatient hospitalizations
`were reduced by 49.6% and ER Visits were reduced by 73.0%. With enrollment similar
`to current levels, savings are approximately $2.7 million and return on investment
`is approximately 200%.
`
`Additional data collected on the Health Buddy indicates a high degree of patient compliance
`and ease of use. The utilization analysis presented in this case study indicates significant
`reduction in both in-patient and emergency room utilization.
`
`Active patient monitoring and self-management of chronic conditions have been shown
`to dramatically affect chronic disease outcomes. Without remote monitoring, patient care
`is based on episodic encounters between patients and their care providers. This episodic
`approach relies on the patient’s ability or willingness to recollect disease-related events over
`an extended period. Programs such as the "Taking Charge of Your Heart Health" program
`powered-by Health Hero are designed to bridge the gap between office visits by providing
`a platform for daily collection and dissemination of information from and to the patient.
`This practice makes it possible for the care provider to identify problems and
`intervene before a problem escalates. This evaluation suggests impressive reduction in costs
`associated with hospitalization and ER utilization, particularly as scaled to the PacifiCare
`CHF population at large.
`
`7
`
`

`
`Case Study
`
`Highlights
`
`Congestive heart failure (CHF)
`affects 4.6 million individuals
`in the US each year. CHF is the
`number one cause for hospital
`admissions in the United States
`with over 1.5 million hospital
`admissions per year. The esti-
`mated total cost of CHF in the
`US for health services and loss
`of productivity is over $22.5
`billion per year.
`
`The PacifiCare CHF program,
`“Taking Charge of Your Heart
`Health”, was implemented in
`California in 1999 to provide
`patients with coaching, educa-
`tion, and reinforcement of
`self-care management skills.
`
`The “Taking Charge of Your
`Heart Health” program,
`powered-by Health Hero’s
`Internet based platform
`and Health Buddy appliance,
`serves as the vehicle for
`delivering structured com-
`munications between
`PacifiCare care managers and
`their in-home CHF patients.
`Through this daily interaction
`care managers receive timely
`information about their
`patients allowing for timely
`intervention and com-
`munication with physicians.
`
`Results from an initial six
`month analysis showed cost
`reductions for hospitalizations
`and ER visits of 50.6% and
`total savings in claims paid
`of $5,271 PMPY.
`
`HMO • Disease Management • CHF
`
`PacifiCare CHF Program - “Taking Charge of Your Heart Health”
`Shows Significant Utilization Reduction and Cost Savings Using
`Health Hero Platform
`
`The PacifiCare CHF program, “Taking Charge of Your Heart Health,”
`was implemented in California in 1999. As an interactive telephonic support
`program, the patient is provided with coaching, education, and reinforcement
`of self-care management skills. The program features in-home daily monitoring
`using the Health Hero® Health Buddy® personal information appliance, and
`timely care manager intervention and physician feedback via the Health Hero®
`iCare Desktop™.
`
`There are approximately 400 patients in the “Taking Charge of Your Heart Health”
`program. Patients enrolled in the program receive a Health Buddy appliance
`to receive and respond to daily sessions of questions, and educational information
`sent from their care manager using the Health Hero iCare Desktop. The interactive
`sessions provide coaching and reinforce self-care management with the patients.
`The Health Hero iCare Desktop is a web-based application that enables remote
`monitoring of patients by telephonic support staff and nurses, and regular
`communication with physicians.
`
`Results from an initial six-month data analysis of the “Taking Charge of Your
`Heart Health” program, powered-by Health Hero, showed reductions in costs
`for hospitalizations and ER visits of 50.6% and total savings in claims paid
`of $5,271 Per-Member-Per-Year (PMPY). The program effectively reduced inpa-
`tient hospitalizations by 49.6% (p-value < 0.001) and reduced ER Visits by 73.0%
`(p-value < 0.001). With enrollment similar to current levels, net annualized sav-
`ings are approximately $2.7 million and return on investment is close to 200%.
`
`Congestive Heart Failure
`Congestive heart failure (CHF) is a progressive disease that affects 4.6 million
`individuals in the United States with 400,000 to 700,000 new cases each year
`(American Heart Association 1997). This translates to an overall incidence rate
`of 1.5% to 2.0%, and an incidence rate of 6% to 10% in the 65-year and older age
`group. Heart failure is the only cardiovascular condition that is increasing
`in prevalence and incidence. CHF is the number one cause for hospital admissions
`in the United States with over 1.5 million hospital admissions per year.
`
`In 1998, there were 727,523 discharges for CHF in the Medicare population in the
`U.S. Associated charges to Medicare were $7.2 billion averaging $9,831 per
`discharge. The estimated total cost of CHF in the US for health services and loss
`of productivity is over $22.5 billion per year.
`
`References
`
`Bigelow, J.H., Cretin, S., Soloman, M., Wu, S.Y., Cherry, J., Cobb, H., and O’Connell, M.
`(2000). Patient Compliance With and Attitudes Towards Health Buddy™, RAND Health,
`Santa Monica, California.
`
`Drummond, M.F., O’Brian, B., Stoddart, G.L., & Torrance, G.W. (1999). Methods for the
`Economic Evaluation of Health Care Programmes. New York: Oxford University Press Inc.
`
`Landi, F., Gambassi, G., Pola, R., Tabaccanti, S., Cavinato, T., Carbonin, P.U., & Bernabeu, R.
`(1999). Impact of integrated home care services on hospital use. Journal of American
`Geriatrics Society, 47 (12), 1430-1434.
`
`O’Connell, M. and Cherry, J. (2000). The Health Hero® Online Service: A new internet-
`based communications platform for disease management, case management and
`performance measurement. Disease Management and Health Outcomes 7 (3), 149-161.
`
`Rich, M.W., Beckham, V., Wittenberg, C., Leven, C.L., Freedland, K.E. and Carney, R.M.
`(1995). A multidisciplinary intervention to prevent the readmission of elderly patients with
`congestive heart failure. New England Journal of Medicine, 333 (18), 1190-1195.
`
`Shah, N.B., Der, E., Ruggerio, C., Heidenreich, P.A., and Massie, B.M. (1998). Prevention
`of hospitalizations for heart failure with an interactive home monitoring program.
`American Heart Journal, 135 373-378.
`
`Warner, P.M., & Hutchinson, C. (1999). Heart Failure Management. Journal of Nursing
`Administration, 29 (7-8), 28-37.
`
`West, J.A., Miller, N.H., Parker, K.M., Senneca, D., Ghandour, G., Clark, M., Greenwald, G.,
`Heller, R.S., Fowler, M.B., and DeBusk, R.F. (1997). A comprehensive management system
`for heart failure improves clinical outcomes and reduces medical resource utilization.
`American Journal of Cardiology, 79 58-63.
`
`Corporate Headquaters:
`2570 W. El Camino Real,
`Sutie 111
`Mountain View, CA 94040
`tel. 650-559-1000
`fax. 650-559-1050
`www.healthhero.com
`
`8