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Comprehensive Heart Failure Case Study

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The solution proposed by this author includes, immediate identification of patients admitted with heart failure and early implementation of interventions to prevent readmissions. Interventions include, care coordination, home health care and remote monitoring as needed. Initially, the recommended process will be presented during a one to one meeting with the Senior Vice President of Health Partner Services with the assistance of a power point presentation, supplemental handouts including the LACE index tool (Appendix A), as well as the proposed policy and procedure (Appendix E). The Senior Vice President of Health Partner Services will serve as the corporate champion and key stakeholder responsible for network provider contracting. Additional …show more content…

(Heart Failure Society of America, 2010). HF is accountable for 25% of all readmission within 30 days in the United States and represents an estimated $17 million dollars in healthcare spending (Desai, 2012). HF is most commonly seen in person’s age 65 or greater with common clinical presentations of dyspnea with exertion, orthopnea, edema in lower extremities and weight gain Patients often experience frequent exacerbations and decompensations (Anderson, 2014). The Heart Failure Society of America (2010) published the Comprehensive Heart Failure Practice Guidelines with the underlying goal to improve symptoms and to optimize the patient’s volume status. These guidelines include evidence based recommendations for “prevention, evaluation, disease management, and pharmacologic and device therapy” (Heart Failure Society of America, 2010, p 476). The Institute for Healthcare Improvement (n.d.) supports the balance of evidence based treatment during acute admission but asserts that it is equally as important to assess and provide patient education for self-management after …show more content…

CS Health Plan will work with hospital case manager to arrange for three skilled nursing visits as well as remote monitoring equipment and follow up through the designated vendor. Depending on patient needs additional home care service may be authorized as needed and according to patient’s benefit package.
All plans of care will be individualized to the needs of the patient. Should the care coordinator identify additional needs for a patient or determine the initial LACE score is lower or higher, this information will be documented in the patient’s record with the appropriate adjustment in the interventions per the risk stratification. This process will be followed over a 6-month pilot time frame at which time an evaluation will be completed assessing the effectiveness of the process change as compared to a defined control group. The author will compile and analyze the outcomes for presentation to the stakeholders with the anticipation that the process will be adopted across all lines of business. As well, consideration will be given in regards to programming of CCA to include the LACE index tool within the system therefore creating process efficiencies related to no further need for paper documentation and uploading of the

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