Cost Management of Chronic Illness (CHF and DM)

51 year old female employee with multiple complex medical morbidities (coronary artery disease s/p bypass 2011, automatic internal defibrillator 2011, progressive congestive heart failure (50%), type 1 diabetes on an insulin pump, hypertension, dyslipidemia, left hip replacement for avascular necrosis 2014, hypothyroidism) , who became a Clinic patient late in 2016, and has since utilized the Clinic heavily to coordinate and manage her many chronic and ongoing medical issues with her plethora of subspecialists. Her costs were very high in 2016, claims analysis showed this was primarily due to congestive heart failure, with significant contributions from her pump-managed diabetes, and new avascular necrosis of the right hip.

The patient used the Clinic heavily (15 visits from late 2016 thru 2017), specifically coordinating and managing her congestive heart failure care (resulting in sharp reductions in congestive heart failure claims (20 2016 > 7 2017)), and her diabetes care (resulting in sharp reductions in diabetes claims (41 2016 > 25 2017)). The total value of medical claims reduction for 2017 relative to 2016 was $74,260. (Cost in 2017 for this very sick and complicated patient was only $10,686, her lowest cost to the Plan in the last four years.) There were no hospitalizations or surgeries in 2016. ER visits were reduced from 3 in 2016 to 0 in 2017. In 2018, the Clinic continues to manage the patient’s pathway to probable right hip replacement for avascular necrosis as well as the resolution of a diagnostic dilemma related to elevated parathormone levels, which promises to help avoid/minimize further costs.