The prevalence of heart failure (HF) is estimated to be about 2% of the general population of the United States. According to data from the American Heart Association, approximately 5 million people are living with heart failure and over 550,000 new cases are being diagnosed annually. The estimated direct cost for heart failure in 2006 is $29.6 billion in the United States.
Blue Cross’ multidisciplinary team of healthcare professionals collaborate to ensure each enrollee receives a “whole-person” approach to their disease management by addressing clinical functional, financial, psychosocial, environmental and support system needs.
The Heart Failure Disease Management program’s objectives are consistent with those set forth by the American College of Cardiology/American Heart Association (ACC/AHA). The main objective is to reduce the burden of disease due to heart failure by optimizing patient self-care efforts to ultimately, improve the patient’s quality of life and to promote provider satisfaction.
The program is available to Blue Cross and Blue Shield of Louisiana, HMO Louisiana, Inc. and Federal Employee Program (FEP) primary members 18 to 80 years of age.
The selection process for our Heart Failure program is based on hospital claims, encounters, and pharmacy and laboratory data. We analyze claims data to assess relative health risk, identify medical conditions and build a member-centric clinical profile.
The program is not available to members who have other insurance as primary, are being actively treated for cancer, a transplant recipient, have ESRD, HIV/AIDs, are a hospice care recipient or nursing home resident. This is a voluntary program and members may “opt out” of the program at any time.
Our Care Management team includes physician advisors, registered nurses, pharmacists and behavioral health specialists.
Physicians receive the following when their patient enrolls:
ACCA/AHA-2005 Guideline Update for the Diagnosis and Management of Chronic HeartFailure in the Adult, 2009
ICSI Guideline - Heart Failure in Adults, July 2013
American Heart Association
If you wish to contact a nurse to inquire about our programs, please call the Case and Disease Management Unit at 1.800.317.2299.
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