What Came After the Heart Attack

Glimpse how health plans and pharmacy benefit managers (PBMs) can use real-time insights to deliver data-driven value-based care for members.

Tracking risk and care plan adherence isn’t easy. And yet it’s key to delivering value-based care. How can care managers close care gaps—like a health plan member’s ballooning blood pressure and cholesterol—if they don’t know about the problem as it’s happening?

Real-time insights can make the difference.

These insights made the difference for our fictional patient “Aaron,” whose care manager Carrie not only knew about the problem but worked to get Aaron’s health back on track after a heart attack.

On a Walk

Aaron went out to walk the dog. The day was beautiful, but the sunshine wasn’t enough to ease his mind.

There was stress at work. There were his aging parents, who needed more and more help around the house. And then there were his own health concerns, which came after his first checkup in who knows how long.

His blood pressure and cholesterol were sky high, as it turned out—higher than he would’ve thought—and now he had a new set of prescriptions waiting for him at the pharmacy. When would he find the time to pick them up? Maybe, if he just exercised a bit more, he wouldn’t need to take them ...

But then, just after he got home with the dog, the classic signs appeared: a squeezing in his chest, pain shooting down his left arm, a bloom of sweat on his brow.

Aaron was rushed to the hospital in an ambulance.

On the Hospital Ward

At Aaron’s health plan, his care manager, Carrie, knew that his blood pressure and cholesterol had skyrocketed. Under the value-based care agreement between the health plan and the clinic, the decision had already been made to monitor his care activity more closely.

So, when Aaron was admitted to the hospital with chest pain, Carrie didn’t even need to be told about it: The hospital admission triggered an alert through Care Event Notifications, which tracks care events across settings—like a visit to the ER—for instant visibility.

On the Straight and Narrow

Aaron’s heart attack turned out to be relatively “mild,” as far as that goes, and he was expected to make a full recovery. But his long-term prognosis was less clear.

It largely came down to what Aaron and his care team did next.

Aaron could get regular check-ups and take his medication, for starters, and his care team (including Carrie at the health plan) could keep themselves up to date on Aaron’s adherence to the care plan, all to move his health in the right direction.

If Aaron failed to take his medication, for example, Carrie would know about it.

She already knew about his high blood pressure and cholesterol, but the heart attack had just happened, so she used Clinical Direct Messaging to get in touch with the clinic and coordinate Aaron’s post-discharge care. Carrie would talk with Aaron about the importance of taking his medication, as patients who take their statin medications have roughly twice the odds of controlling their disease state compared to those who don’t. To know whether Aaron was taking his medication or not, the care team would rely on Medication History for Populations, which makes it simpler to identify nonadherent patients for outreach.

Having a heart attack, however “mild” it was, inspired Aaron to take his medication as prescribed. He also began to exercise and eat better, and with the support of the care team and health plan, Aaron’s blood pressure and cholesterol levels plateaued, then dropped to normal levels.

And when Aaron felt ready to take his dog for a walk again, it was one of the best walks he ever had.