How ChristianaCare, Story Health drove better outcomes for heart failure patients

Through a partnership with Story Health, ChristianaCare has been able to improve care for Black patients living with heart failure and plans to expand the collaboration to other patients.

The health system’s Center for Heart & Vascular Health originally teamed up with Story Health in 2021 to improve outcomes for those with advanced heart failure, expanding to general cardiology in 2022. This year, the health system plans to offer Story Health to its primary care hypertensive patients.

Story Health (which was recently named as a Fierce 15 honoree) serves as an extension of clinical care teams by integrating with EHRs and offering virtual coaching to help patients stay on track with their treatment plans. Its collaborative platform also incorporates remote patient monitoring data and an insight engine that alerts care teams when a patient’s condition is changing or in need of an early intervention.

Though these services could theoretically be offered in-house, it would be difficult to set up and scale, Kirk Garratt, M.D., medical director of the Center for Heart & Vascular Health, said. ChristianaCare decided to team up with Story Health because of the urgent need for its services and benefits.

“Hospital systems … are not prepared to step forward with this kind of care plan,” Garratt told Fierce Healthcare. “It’s a big lift.”

Ultimately, patients in ChristianaCare’s heart failure program saw a significant improvement in the number of Black patients adhering to prescribed doses of guideline-directed medical therapy (GDMT) for heart failure, achieving 2-3x improvement on target doses of various drugs.

GDMT involves the use of medications proven to reduce morbidity and mortality, yet remains underutilized in practice nationwide. To achieve maximum benefit, current guidelines call for therapies to be titrated to the target dose as tolerated. GDMT is under-prescribed for all racial and ethnic groups but is systematically worse for patients of color.

Black patients, which make up a third of ChristianaCare’s heart failure patient population, have historically seen unequal heart failure treatment while also facing a 30% higher risk of death from heart disease than white Americans. 

Getting up to the maximally tolerated dose may take a dozen stages. But patients may not be able to come into a clinic for a dozen visits. That’s where Story Health comes in, enabling the process at home, overseen virtually by its staff of nurses and dietitians. 

“For us, it’s important because these patients are so sick, that they do have licensed professionals working with them at all times,” Story Health Cofounder and CEO Thomas Stanis told Fierce Healthcare. It helps a patient’s primary care team find the right treatment plan and stay on top of it. For some patients who need lab work, Story Health can send a phlebotomist into their home.

A variety of factors can influence patient adherence rates, including poor enrollment, lack of standardized care or social determinants like high prescription costs. For example, SGLT2 inhibitors are critical to treating heart failure, yet are underutilized largely because they are cost-prohibitive at $500 per month or more.

With Story Health’s program, ChristianaCare also saw the baseline of Black patients taking SGLT2 inhibitors rise from 32% to 74%. That’s in part because Story Health’s health coaches can help patients navigate cost barriers by working to qualify those eligible for prescription assistance programs, the company said.

The national rate of 30-day hospital readmissions for patients with heart failure is 23%, according to one estimate. But ChristianaCare was able to lower that to less than 10% for patients in its heart failure program who enrolled in Story Health.

The collaboration with Story Health also recently supported patients with hypertension. Among Black patients, there were significant reductions in average blood pressure levels after 120 days. Because of this success, ChristianaCare’s Center for Virtual Health plans to offer Story Health to its patients, many of whom struggle to manage high blood pressure.

So far, the data shows Story Health’s program helped ChristianaCare patients achieve similar positive outcomes between Black and white patients, Stanis noted. This doesn’t happen often in healthcare, he added, and he attributes this to Story Health’s ability to mitigate complex drivers of health.

“Being able to show that we have equivalent outcomes between groups is something we’re very proud of,” Stanis said.