Congenital Heart Disease (CHD), which includes numerous conditions that vary widely in complexity, is the leading cause of birth defect-related deaths in the United States.1 Complex CHD cases drive more than $17 million in annual charges per million members and average $286,000 per case.2 Case charges can exceed $2M depending on the complexity of the condition.3
Our market-leading Congenital Heart Disease Resource Services (CHDRS) product helps our clients manage costs associated with CHD through a combination of our CHD Centers of Excellence (COE) network and clinical management. This addresses the needs of our clients, their membership and the industry as a whole.
Our value is delivered through:
- Reduced Discharge Mortality Rates — Qualified COEs average a 31 percent lower discharge mortality rate for all CHD cases and an average 59 percent lower discharge mortality rate for the most complex CHD cases in comparison to surveyed facilities that did not qualify for COE status.4
- Reduced Likelihood of Catastrophic Spend — CHD patients at facilities that are not qualified are 50 percent more likely to incur billed charges that exceed $500,000 and more than twice as likely to incur billed charges that exceed $1 million.4
- Reduced Inpatient Days — The average length of stay at a COE is 25 percent lower than that at facilities that are not qualified.5 Shorter lengths of stay reduce annual charges an average 8 percent per case. This translates into an average savings of $22,000 to $70,000 per case depending on the complexity of the condition6.
- Contractual Discounts — Contractual discounts average more than 42 percent, or $90,000, per case. On average this is 23 percent higher than the discounts clients receive before accessing OptumHealth contracts.7
2 Complex is defined as those cases that undergo a procedure that falls within the RACHS risk scoring system, RACHS 1-6.
3 Clinical Science Institute 2007-2008 survey data; COE n=15 facilities, non-COE n=7 facilities.
4 OptumHealth commercial population 2007 – Apr 2008 unique members with CHD RACHS 1-6, ages < 18, Non-COE n=615, COE n=180.
5 OptumHealth commercial population, 2007 – Apr 2008 unique members with CHD RACHS 1-6, ages < 18; COE n=180, Non-COE n=615.
6 OptumHealth commercial population, 2007 – Apr 2008 unique members with CHD RACHS 1-6, ages < 18; COE n=180, Non-COE n=615., “the most complex” defined as RACHS 6.
7 OptumHealth 2005-2008 commercial population, compares OptumHealth clients’ contractual discounts before and after using OptumHealth contracts. Discounts with OptumHealth contracts n=200, discount without OptumHealth contract n=458. Same COE facilities.