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FAQ Public And Commercial
Why should I consider a focused specialty case management program such as Heart Failure Management?
Heart failure accounts for 11 million physician visits each year, more hospitalizations than all cancers combined, and contributes to approximately 287,000 deaths annually. About 5 million Americans of all ages suffer heart failure, and around 500,000 new cases are diagnosed each year. Nearly 1.4 million heart failure patients are under 60, with the annual incidence approaching 10/1,000 after age 65 (American Heart Association). There is no cure for heart disease, so effective condition management is critical.
KEPRO’s heart failure program is modeled after the infrastructure and principles of our oncology program. It incorporates the nurse counseling process of assessing members and collaborating with each participant’s physician, planning and implementing appropriate interventions to address gaps in care, promoting effective cost management tactics, and evaluating the targeted results and outcomes of the programs, all aligned with heart failure guidelines. Heart failure case management plans are created and adjusted based on the physician’s defined stage of failure and functional classification.
Maximizing participant quality of life and functional status and reducing avoidable healthcare utilization are the primary program goals. They are accomplished by enabling participants to modify their behaviors, and improve self-monitoring and management skills critical to managing a chronic condition. We work as an extension of each participant’s physician to:
- Ensure prescribed treatment plans are consistent with evidenced-based protocols
- Remove barriers preventing participant compliance with prescribed treatment plans
- Educate participants on their conditions, complications and management plans
- Manage all co-morbidities that may harm quality of life and heart failure outcomes
- Educate particpant about managing stress and better coping with their conditions
- Facilitate health care power of attorney, advance directives, and end of life planning
Our case managers build a strong relationship with the participant’s physician to realize program goals. They continuously assess clinical, social, economic, and behavioral health status and use motivational interviewing to facilitate behavioral change and compliance. Our case managers also monitor medication compliance and efficacy, and recommend home monitoring devices to assist higher risk participants in managing their heart failure.