The Centers for Disease Control and Prevention states that cardiovascular diseases, including heart disease and stroke, account for more than one-third of all deaths in the United States. The total costs of these diseases in 2010 were estimated to be $444 billion. Implantable cardioverter defibrillator (ICD) pacemakers are implanted as a preventative measure in people at high risk of developing ventricular tachycardia, ventricular fibrillation, or sudden cardiac death. However, up to 40% of ICD pacemakers do not meet evidence based criteria for implantation * which validates the need for specialty medical management and cost containment. We have such a solution to address cardiac devices before, during and after implantation.
Comprehensive Cardiovascular Care Management, an Accountable Care SolutionTM powered by inVentiv Medical Management, provides a clinically accountable solution focused on promoting cost-effective, evidence-based and integrated care management for patients affected by cardiovascular disease.
The Comprehensive Cardiovascular Care Management team is a multi-disciplinary team that includes:
- Board-Certified Medical Director, Consulting Board-Certified Interventional Cardiologists
- Utilization Review Nurses, RN
- Billing, Coding and Negotiation Professionals
Prevention of costly, unsafe and over-utilized cardiovascular interventions and placement of unnecessary medical devices are a particular focus of the clinical review. In conjunction with the prospective clinical review, plan language is consulted, claims are monitored retrospectively to ensure adherence to the stated service billing and coding edits are performed and the opportunity for cost negotiations are assessed. Regular reporting is provided to the client and reflects the coordination of care.
The Comprehensive Cardiovascular Care Management program aligns care with recognized authorities in quality including the American Heart Association and the clinical team relies on the ACC/AHA Guidelines™ to ensure all patients receive the correct cardiovascular intervention resulting in the appropriate quality and cost of care that promotes positive patient outcomes.
*Source: Duke Clinical Research Institute
Some specialty review work is accomplished through business relationships with Health Utilization Management and Independent Review Organizations.