Heartbeat Health, Regence use telehealth to boost access and outcomes for cardiac care

Heart disease is the number one killer in the U.S., responsible for more deaths each year than all cancers combined; and 80 percent of heart disease is preventable. And yet the U.S. health care system doesn't do a good job of prevention and treatment. Even when heart disease is diagnosed, cardiac care remains expensive and inaccessible for many people.  

For this episode of HealthChangers, host Ashley Bach spoke with Dr. Jeff Wessler, a cardiologist and CEO and co-founder of Heartbeat Health; and William Krenz, senior vice president of government programs for Regence, about how Heartbeat and Regence are working together, using technology and innovation, to improve heart health and cardiac care for Regence members.  

Listen to the full podcast episode on the player above. Below are some highlights, which have been edited for length and clarity. 

AB: Dr. Wessler, before we talk about Heartbeat Health, what’s the current state of cardiac care and heart health in the U.S.? 

JW: Every single year, about 1 in 4 American deaths are due to heart disease, and almost all of us have been touched by heart disease, either ourselves, a family member or a friend. When we think about the cost, this is a $500 billion problem, and less than half a percent of that is spent on prevention. So we're really putting so much of our money and our capital toward advanced care and advanced illness.  

Aside just from the disease burden and the cost burden, it takes 40 to 60 days to get to a cardiologist in the U.S. That not only makes things more expensive, but makes outcomes a lot worse. Most cardiac conditions are not those that you can afford to wait that long. In most of the cases, cardiology patients are referral based. So they come in after somebody has had something happen, and then get referred into a cardiologist. That’s not necessarily the right thing to do, when you want to get ahead of cardiac disease and find managed patients before they get sick.  

In almost half of the counties across the U.S. — about 20-22 million residents — there’s no cardiologist located in that area. These are usually rural, socioeconomically disadvantaged places, and unfortunately, the rates of heart disease are enormous in these areas. This is often due to underlying risk factors. And we see this as a huge opportunity to get in front and improve the care for these underserved populations.  

And then lastly, and perhaps most dramatically, there’s a huge workforce supply-demand issue. There was a shortfall of about 1,700 cardiologists, as of 2008, moving to about 16,000 in 2025. Most cardiologists are at 55-plus and beginning to think through retirement, and this is going to leave us with the need for solutions and answers to the problem of, how do we get patients to cardiology care when they really need it the most? 

AB: How does Heartbeat Health address these issues? 

JW: Heartbeat Health is a virtual medical group with cardiologists, advanced practitioners, nurses, care coordinators, medical assistants, all practicing in a telehealth virtual-first setting. And our mission is to shift cardiac care from reactive to proactive treatment and prevention, using telehealth. 

When you think about our virtual-first approach, Heartbeat can intervene years before that index cardiac event occurs; that saves lives, but it also reduces the enormous burden of cardiovascular disease on our system today. And the way we do this is to partner directly with both health plans and providers to identify members who are at high risk for these cardiac events, or who have recently experienced a cardiac event, and then get in front and care for these patients. We order medicine, see patients, do consults, titrate medications, see them when they leave the hospital, get them diagnostic tests, all of this with a focus on caring for their health while they're at home in their own environment, without needing to come in person to a cardiologist's office. And fundamentally, this makes cardiac care much more accessible, much more affordable, and then drastically improves the health outcomes. 

AB: William, you manage the health plans that Regence offers to our Medicare population. Have you noticed that the health needs of seniors have changed over the years?  

WK: We're seeing a “silver tsunami,” as folks are aging into being eligible for Medicare products at levels in our society we've never seen. Seventy million individuals now are 65 or older, and they're living longer lives with desires to do many active things – take care of grandchildren, or do other kinds of hobbies. And so we need to have an array of benefits for folks that really make it easier for them to take good care of themselves. And telehealth, through the pandemic, has become a common and comfortable way to augment the overall system that we all work in.  

Sometimes people ask me questions about older adults and their digital literacy, and I say, “oh, boy, are they literate.” Anyone who has grandchildren knows how to text and actively does. Working with Jeff's team is a fabulous way to make sure older adults address things like AFib (atrial fibrillation) and other challenges, as opposed to waiting a number of months to get in to see someone. Not jumping on these critical issues is so endemic and shows what we need to do to improve our delivery system.  

AB: Heartbeat Health, beginning this year, is now available for most Regence Medicare and Regence commercial members. What is it about Heartbeat that made you think it could improve care for our Medicare members specifically? 

WK: The idea behind Heartbeat is not to replace some of the wonderful delivery systems that we have in our footprint, in places like Seattle. In fact, the Seattle Times recently reported that the rescue rate locally for those in cardiac arrest are some of the highest in the nation. But that's not true throughout our whole four-state footprint. You might be in a more rural county, or live in an environment where you don't have as easy access to that kind of care.  

I'll personalize this. A number of years ago, I started feeling a bit down in terms of having what I thought was an intense cold, and it went on and on, only to discover with my primary care physician that I was in AFib (atrial fibrillation); and this was in my early 50s, and it surprised me. I had no clue. It went untreated for a while, and I quickly ended up getting support and having a procedure called an ablation, which has really turned my life around, and it just further emphasizes for me the level of active screening that can be done.  

So much of what I did to care for myself was, and still is, a very virtual-style approach, wear a heart monitor every few years and just, you know, check. I've got a device that I can check my arrhythmia if I'm concerned. Knock on wood, it's been in great shape, but it's through that kind of collective support.  

I share the personal story because providing additional ways to make sure high-quality access is provided and a caring person is on the other end of the line is just so critical. The improved access Heartbeat Health brings isn’t just for our older members – our Medicare Advantage and our Medicare Supplement members – it's also for our commercial members, someone like myself, who had high-school-age kids and really didn't appreciate that I needed a cardiologist to help me out. And boy, has that changed my life for the better. 

AB: Dr. Wessler, how can Heartbeat Heart lead to a lower cost of cardiac care? 

JW: First, William, I so appreciate your willingness to share your personal journey with cardiac disease, in part, because I think it resonates with so many people who have their own friends, family or self who are dealing with the same thing.  

One of the things that is just so remarkable about cardiology is the care works really well when we can get it to people in the appropriate setting, at the right time. This is a field that has exceptional care modalities, treatment offerings, medications and diagnostic tests. We just have to bring those earlier in the care journey, so that it gets to people before it's too late. And that fundamentally is a cost-saving proposition. It’s almost always the events that happen when they're advanced in their disease progression that become the high-cost events. Think your first hospitalization for heart failure, your readmission for heart failure, the first time someone has a heart attack; all of those things are preventable conditions that could have been staved off if we got to them sooner, and instead end up being incredibly expensive conditions because they start in the hospital and they start a cascade of downstream events. 

AB: Heartbeat Health just published research earlier this year showing improved health outcomes for Heartbeat patients. What did that data show? 

JW: For background here, heart failure remains a significant and a growing public health challenge for the U.S. Right now, there are more than six million adults that have heart failure and over a million hospitalizations every year. And despite our advancements in treatment, almost a quarter of Medicare beneficiaries with heart failure are still readmitted within 30 days of their discharge. 

So Heartbeat, a few years ago, embarked on our first randomized control trial to say, let's study our care in this highest risk population. We just published this study in the British Medical Journal, and we took Heartbeat patients who were treated with our telehealth and virtual care, combined with our remote monitoring, our diagnostics and medication adjustments, and compared them to the patients who were randomized into standard cardiology care. And what we were able to show is that Heartbeat patients had a 53 percent reduction in cardiac readmissions and a 44 percent reduction in all cause readmissions, and this was across 30, 60, and 90 days after the hospital discharge.  

So the care works. It affected these very hard outcomes of readmissions, but also gave patients an average weight loss of about four and a half pounds. In heart failure that's quite significant. It reduced blood pressure, improved shortness of breath scores and quality of life.  

AB: Dr Wessler, I wanted to make the distinction that Heartbeat Health is not intended to be a one-stop-shop for all cardiology, right? It seems like there really is a place for in-person cardiac care. 

JW: That’s right; we've designed our services to complement, but not to replace in-person care. Heartbeat can offer immediate help with routine evaluation and management visits. This allows patients not to have to wait weeks or even months to be seen by a doctor, and instead, the in-person teams can spend more of their time on the procedural care and the interventions that are critically important and life-saving.  

We like to think at Heartbeat that we support brick-and-mortar cardiology practices directly in most markets. We have very good relationships with them so that it's part of the care team together, and patients are seamlessly being handed off back and forth.  

At Heartbeat, we really believe in the primary-care-first model, that primary care can be that quarterback and help refer in patients who have cardiac issues.  

Finally, I think it's worth mentioning that potential patients can reach out to us directly. We certainly welcome patients who believe that they may have heart disease and need to be assessed for it, as well as patients who have already been diagnosed and want to work on their management strategy together. There are lots of different ways to find your way to Heartbeat services, but we do have a landing page for all Regence members where they can learn more about our services at Heartbeat and what we can offer for your membership. 

AB: William, how can the Heartbeat Health virtual model, working hand and hand with brick-and-mortar cardiac care, help older adults? 

WK: For older adults, there are many different needs; and you build a quilt of services that come to them and it all has to work together. And I think this notion that in-home support or telehealth support is standalone and somehow a replacement is really not the way to think about it.  

Waiting six months to see a specialist in person might sound wonderful because you're going to go see someone who's eminently qualified. But in those six months, your health status could degrade if you're not careful. So through providers like Heartbeat, it’s important to have the right kinds of screenings at home. We offer in-home assessments. We offer nurse advice programs and remote patient monitoring. All the kinds of things that in a modern environment we can bring to people to help them live their fullest and most productive life.