Partnership For
Health Management

Congestive Heart Failure Program

The Heart Failure Program is the third state-wide disease management program developed by Community Care of North Carolina. In 2004, building on the success of the asthma and diabetes programs, the NC legislature urged the program to develop a new core disease management program. After reviewing prevalence and outcome data for several chronic diseases, the clinical directors chose to design a program to improve the quality of care and health outcomes for North Carolina's Medicaid heart failure population. The program will focus on promoting self management and adherence in high risk heart failure patients and working with clinicians to follow evidence based clinical practice guidelines. Case managers will contact high risk individuals frequently and refer them in to care when the need arises.

Core Elements of the Heart Failure Program

• Identify a PCP physician champion and a cardiology physician champion.
• Adopt the ACC/AHA Guidelines for the Evaluation and Management of Chronic Heart Failure in the Adult.
• Promote best practices in heart failure through the use of the CCNC Heart Failure Guidelines.
• Identify community resources for heart failure patients such as ongoing heart failure programs, case management programs, and cardiology groups.
• Assess each individual in the heart failure program every twelve (12) months.
• Weekly contacts (for a minimum of six months) with individuals that are determined to be high risk.
• Refer individuals that are developing early symptoms of heart failure to their primary provider.
• Provide self management education to patients and their caregivers.
• A patient centered tool kit was developed, "Managing Your Heart Failure", to promote self management.

Heart Failure Program Performance Measures

The Community Care of North Carolina network leadership chose the following outcome measures:

• Heart Failure Hospitalization Rate
• Heart Failre Re-admission Rate
• Heart Failure Emergency Department Utilization Rate
• Mean Heart Failure Enrollee Cost

And the following process measures were chosen:

• Percent Heart Failure Patients with Echocardiogram in past 3 years
• Percent with Ejection Fraction greater than 40%, prescribed ACE Inhibitor or ARB after identification with heart failure
• Percent with Ejection Fraction greater than 40%, prescribed Beta Blocker after identification with heart failure
• Percent of those prescribed ACEI or ARB, filling prescription at least 80% of months in claims database
• Percent of those prescribed Beta Blocker, filling prescription at least 80% of months in claims database