Using evidence-based strategies, including coverage of remote cardiac rehabilitation, to increase cardiac rehabilitation participation -a community health insurance plan's experience

BackgroundBarriers to referral, enrollment, and participation in cardiac rehabilitation (CR) contribute to low rates of completion despite known benefits. Barriers are system, provider and patient related. In this observational cohort quality improvement study, we examined the impact a community-based, not-for-profit health insurance plan had on barriers to CR participation. MethodsThe Capital District Physicians Health Plan (CDPHP) in Albany, New York developed and implemented a cardiac rehabilitation initiative (CRI) to increase CR rates using evidence-based strategies. CDPHP: 1) eliminated patient cost-share, 2) covered remote CR (RCR), 3) implemented physician valued-based incentives, 4) presented metrics to providers, 5) educated providers and patients, and 6) dedicated staff to facilitating enrollment. Chi-square tests were used to identify differences among patients who enrolled in facility-based CR (FBCR), RCR and no CR. CR enrollment rate distributions were evaluated between Q1, 2021 and Q2, 2022. ResultsA total of 1,736 patients with varying cardiac conditions were eligible for CR in the study period. Between Q1, 2021 and Q2, 2022, enrollment went from 11.1% (32/286) to 16.2% (50/308) in FBCR; 0.7% (2/286) to 10.7% (33/308) in RCR; and 11.9% (34/286) to 26.9% (83/308) overall (P<.0001). Time to enrollment went from 40 to 47 days for FBCR (P=0.1792), 53 to 20 days for RCR (P<.0001) and 43 to 36 days overall (P=0.3348). Older patients were more likely to enroll in CR as were patients who underwent cardiac procedures. ConclusionsThe CRI created a call-to-action among providers to address CR referral and enrollment. RCR increased CR rates and were additive to FBCR rates, suggesting that the introduction of RCR will not displace FBCR. Time to enrollment improved overall, driven by improvement in those enrolling in RCR. Increasing CR engagement requires coordinated effort from stakeholders--cardiology providers, hospitals, CR providers and health plans.