St. Luke’s has designed many programs and services to support our transformation from fee for service to pay for value. Many of these programs, including our heart failure clinic, would not be financially feasible under fee for service, but are critical to our work under pay for value of improving health outcomes and lowering the total cost of care.
Writing about our heart failure clinic is St. Luke’s Communications Coordinator Chereen Langrill.
- David C. Pate, M.D., J.D.
Heart failure can be a devastating disease, financially and physically.
There are 6 million people living with heart failure in the United States. Heart failure happens when the heart doesn’t pump blood through the body efficiently and can’t meet the body’s needs for blood and oxygen. People with heart failure are often tired and weak, and daily activities such as walking and climbing stairs can be a challenge. It is one of the most expensive chronic diseases in the country, costing billions of dollars each year, and complications such as kidney and liver damage can lead to repeated visits to the emergency department or hospital for additional treatment.
A St. Luke’s clinic dedicated to people who have heart failure helps patients avoid costly complications while also improving well-being. St. Luke’s Heart Failure Clinic has been so successful in making a difference for patients that it expanded in October 2017 to serve more people.
“There was always a need. We uncovered that need and it continues to grow,” said Dr. Andrew Chai, the cardiologist who helped form the clinic nearly a decade ago.
The clinic’s expansion was funded entirely through philanthropic support from St. Luke’s physicians and employees and members of the community who believed in the clinic’s ability to keep patients healthier.
Statistics strongly support the need for a heart failure clinic in Idaho. In the past two years, the clinic has seen a 50 percent increase in patient encounters, visits and program referrals. The total number of patients presenting to hospitals with a primary diagnosis of heart failure has doubled in the past five years.
The clinic had a humble start. When it began, it was open on a part-time basis, with Dr. Chai and Anna McCreath, a St. Luke’s nurse practitioner, providing patient care. Justin Baines was the heart failure program coordinator who provided assessment and education for patients in the hospital.
The clinic now employs three cardiologists who are board-certified in advanced heart failure and transplant cardiology: Dr. Chai, Dr. Brian Nolan and Dr. Murali Bathina.
Over the years, the clinic has kept pace with the growing community and increased need. It is now open five days a week and includes social workers, four advanced practice practitioners, a medical director for inpatients, two inpatient care coordinators and an outpatient care coordinator. Care transition nurses also are part of the staff and visit patients’ homes to provide support.
Heart failure patients have complex needs, made more challenging because of barriers that can disrupt the care they need. Because the clinic contains a deep bench of providers and offers an array of services, it helps reduce the need for patients to travel to multiple appointments or locations for care, which can include lab work, IV treatments or services that help patients manage symptoms.
The clinic also maintains a strong relationship with Intermountain Medical Center, a transplant and advanced heart failure center in Salt Lake City. Intermountain specialists come to Boise about every four weeks so transplant patients in the area don’t have to travel to Salt Lake City to be seen for follow-up appointments.
“It’s a benefit to everyone involved,” Dr. Chai said.
In addition to offering multiple resources in a single location, the clinic is designed to see patients more frequently. Some patients come to the clinic on a weekly basis; in a typical cardiologist’s office, those patients would see their provider once or twice a year.
Overall, the clinic helps reduce readmission rates by addressing problems that can lead to hospitalization, which demonstrates the power of value-based care.
“In a fee-for-service world, this clinic wouldn’t exist,” Dr. Chai said.
Heart failure is increasing, and Dr. Chai believes the clinic will continue growing to keep pace with the increased need in the community. Heart failure is diagnosed more often now because of better tools for diagnosis, and it is more common for people to survive a heart attack. But the health of the population isn’t improving, and Idaho’s population is growing. There is an obesity epidemic. People are less active, and many eat a diet loaded with processed food. Those factors all contribute to a need for more resources.
In the beginning, Dr. Chai didn’t anticipate he would need to staff the clinic on a full-time basis. He quickly realized the community’s need would demand more support.
“Dr. Chai did this because he saw it was the best way to intervene in this population’s mortality,” Dr. Nolan said.
Chereen Langrill is a former communications coordinator for St. Luke’s Health System