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Program Aims at Better Odds On Heart Attack, Stroke Risk

On Jan. 1, iHeart Champion, a remote medical management program aimed at reducing the risk of heart attacks and stroke became available to all commercial members of a health plan that’s part of an integrated health system in Massachusetts. Executives on the payer and provider sides of the initiative tout the clinical results of pilot programs that saw a 40% reduction in “bad” LDL cholesterol in as little as 12 weeks, and an average decrease in blood pressure values of 20/10.

They also say the two pilots, now expanded and joined as a single program for a larger population, also were shown to be “highly cost effective” as a result of taking an approach that stresses regular telephonic contact with patients and the use of digital tools to avoid multiple physician office visits and labs.

“A lot of visits to the primary care physician are not necessary, so it’s more convenient and cost effective for the member and the health plan to have a program like this,” says Tony Dodek, M.D., chief medical officer of AllWays Health Partners, which is part of Boston-based Partners HealthCare, a not-for-profit integrated health care delivery system that includes Brigham and Women’s Hospital and Massachusetts General Hospital. The plan, formerly known as Neighborhood Health Plan, was rebranded as of Jan. 1.

Under the iHeart Champion program, developed by Brigham Health’s Cardiovascular Medicine Innovation Group, trained lay “navigators” work under the direction of a team of pharmacists, nurse practitioners and cardiologists — the latter having created a clinical algorithm, based on guidelines, to treat patients whose elevated blood pressure or “bad” cholesterol puts them at increased risk of heart attack or stroke.

“This program has allowed us to improve our patients’ health with significant blood pressure and cholesterol reductions with either one or in most cases no in-person visits,” says cardiologist and researcher Thomas Gaziano, M.D., clinical director of the iHeart Champion program who is affiliated with Brigham and Women’s Hospital.

Navigators Help Patients Adjust Doses:
Through proactive communication with navigators, patients who previously might have discontinued potentially life-saving medications due to side effects can get adjustments
in doses and frequencies. Navigators call patients, develop relationships with them and are “aggressive” about calling back, since it may take repeated interactions for anywhere from two to six weeks to titrate medicines, Gaziano explains.

Gaziano, assistant professor of cardiovascular medicine at Harvard Medical School, says it boils down to using each member of the iHeart team effectively. Physicians want their patients’ blood pressure or cholesterol levels lowered, for example, but they “won’t call to remind [patients] to pick up their meds [and] get labs, so we created an algorithm and work flow,” he says.
With many more interactions conducted remotely, some by using a Bluetooth-enabled blood pressure cuff that allows at-home monitoring, he cites potential savings on the costs of prescriptions and routine office visits that might no longer be needed.

Dodek sees inherent value in the iHeart program’s convenience, given its solid clinical results. “Traditionally, I [as a patient] go in, my blood pressure is high, and the doctor has me back for two additional visits to double check,” Dodek explains. “This way, I can go home with a blood pressure cuff… and the doctor may see it’s consistently high, and prescribe a diuretic or beta blocker, and can adjust [medications] multiple times without necessitating a visit.”

Hands-On Approach Can Save Money:
Dodek further notes that the program’s hands-on approach can lead to cost savings as well as better compliance and outcomes. For example, he says, roughly 20% of people are intolerant to statins, according to the medical literature. But within the iHeart program, he says, “We found by varying dosages or using different medications or different dosing schedules, the incidence of statin intolerance goes down to 1% to 2%.” He adds that getting people better controlled with statins mitigates the use of expensive PCSK9 inhibitors, drugs that cost about $14,000 annually.

The pilots, which began two and-a-half years ago with about 1,000 Brigham patients, expanded to AllWays plan members several months ago. “It started with a subset of our commercial members in July, and is now open to all commercial members,” totaling about 240,000 as of Jan. 1, Dodek says. Another 260 patients have enrolled since two of the plan’s larger employer groups began offering the program last summer, he notes, and, while it’s a two-year program, “most patients are controlled before that and referred back” to their primary care physicians.

Potential program participants are found through data analysis of Partners’ electronic health records, then their physicians are contacted to see whether they’re good candidates. If so, the program reaches out to patients. “We’re helping PCPs scan their lists,” Gaziano says, noting that a much smaller number of at-risk patients is referred directly by their primary care physicians.

Dodek cites two major challenges inherent in treatments for high cholesterol and high blood pressure: medication side effects can interfere with compliance, and patients tend to stay uncontrolled because they don’t feel unwell.

He also notes how prevalent these two conditions are — affecting around 40% of 40- to 64-year-olds — which makes them “good candidates for innovative intervention.”

AllWays Is Looking at Other Diseases:
In fact, the integrated health system is formulating a similar approach for other diseases, looking at congestive heart failure and prediabetes, Dodek says. “We feel that our affiliation with the Partners delivery system distinguishes us locally as an integrated payer-provider that can take advantage of these products,” he adds.
Gaziano says the idea is to find chronic conditions, such as heart failure, where there are big gaps in care, and which can be remotely managed in a safe manner. “We’re actually looking at other conditions,” he says, “and within the next six months to a year, we may add programs.”

Contact Dodek via Jennifer Rosenberg at jenn@howellcomm.com and Gaziano at tgaziano@bwh.harvard.edu.

This article was originally published in an issue of Health Plan Weekly by AIS Health.

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