Case Study: How Medication Care Management Transforms Heart Failure Care and Cuts Costs in Rural Wisconsin Community

PlanPlus by Curant Health Serves Security Health Plan Heart Failure Members and Significantly Reduces Total Cost of Care in One Year.  

Authors:

Jeremy Combs, MBA¹ (Corresponding author: jcombs@curanthealth.com)  

John Cox, MD²  

Paula Jacobson³  

Executive Summary

In 2023, Security Health Plan (SHP) partnered with PlanPlus by Curant Health to address rising Total Cost of Care (TCOC) among members diagnosed with Congestive Heart Failure (CHF). Heart failure is one of the most resource-intensive chronic conditions in the United States, accounting for an estimated $32 billion in direct medical costs and $14 billion in indirect costs in 2020, with projections exceeding $142 billing by 2050.These costs are amplified in rural geographies where access barriers exacerbate medication non-adherence and avoidable acute events.  

To address these challenges, PlanPlus deployed its validated, proprietary Medication Care Management® (MCM) program to proactively detect, resolve, and prevent medication-related and health-related issues among SHP’s heart failure population. The program was designed to improve medication adherence, reduce avoidable hospital utilization, and lower downstream medical spend through longitudinal, relationship-based clinical engagement.  

Year 1 – Results were significant. 

Across the intervention population, PlanPlus delivered an average PMPM Total Cost of Care reduction of $585.98 per member per month, driven primarily by reductions in medical spend; an expected and desirable shift reflecting improved adherence and preventative therapy. This translated in substantial PMPM savings and a positive financial return, securing an estimated ROI of 5:1 for Security Health Plan.  

This collaboration demonstrates that targeted, clinically driven Medication Care Management® can meaningfully reduce cost of care while improving outcomes for rural heart failure members.   

The Challenge 

• Context: Security Health Plan serves a predominately rural membership with higher-than-average barriers to consistent care delivery. For members living with heart failure, adherence to complex medication regimens is critical to preventing exacerbations, hospitalizations, and emergency department utilization.  

• Problem = Costs: Heart failure represents one of the highest drivers of medical expense nationally. Despite having medical facilities across its service area, SHP recognized that access alone was insufficient to control costs, as many members continued to experience preventable exacerbations and acute events. In terms of total Cost of Care for the Medicare Advantage population by Chronic Condition Hierarchical grouping, heart failure has been in the top 4 chronic conditions by total spend in each of the past 4+ years. 

• Problem = Barriers: Common medication adherence challenges among SHP heart failure members included:  
  • • Transportation limitations 
    • Social stigma and isolation 
    • Cost of medication  
    • Medication side effects 
    • Regimen complexity and confusion  
• Impact: Without proactive intervention, these barriers led to:  
  • • Inconsistent medication adherence 
    • Increased hospitalization and ER utilization 
    • Rising per-member medical costs 

Through the application of PlanPlus’ MCM® methodology, trusted clinical relationships were established,enabling early identification and resolution of both medical and non-medical barriers. As a result:  

• • • Medication adherence improved to 90.6%  
    • Medical spend declined by 25%, contributing directly to PMPM Total Cost of Care reductions 

The Solution 

• Strategy: A cohort of 574 unique members diagnosed with heart failure was selected to receive PlanPlus Medication Care Management® services.  

• Implementation: Security Health Plan and PlanPlus established a daily medical and pharmacy claims data transfer, which was ingested into the MedPlan® platform. Members were continuously analyzed by PlanPlus’ proprietary V.I.T.AL. ™ (Variable Intervention Treatment Algorithm), which integrates predictive analytics to identify emerging risk and intervention needs. 

• The Member Experience and Outcomes Team (MEOT) – a multidisciplinary clinical team – engaged members through a longitudinal, relationship-based care model, emphasizing trust, education, and ongoing support rather than episodic outreach.  

• Overcoming Obstacles:
  • One early challenge identified was that a small percentage of members were initially unaware of their heart failure diagnosis. PlanPlus clinicians navigated these conversations with sensitivity and care, coordinating education efforts alongside member providers to ensure alignment, clarity, and member confidence.  
  • Wisconsin experienced a significant and severe respiratory virus season during the winter of 2024-2025, which experts described as one of the worst in several decades. Influenza activity began in this region in mid-November and reached its peak in early February 2025. There was a 211% rise in flu-associated hospitalizations from late December to late January, immediately following holiday gatherings.  

Figure 1: The PlanPlus Workflow (V.I.T.A.L.™ Process) 

1. Data Ingestion: Daily medical and pharmacy claims from Security Health Plan flow into the MedPlan® platform. 
2. Predictive Analytics:  The V.I.T.A.L.™ algorithm identifies members at elevated risk based on real-time clinical, utilization patterns, and predictive variables. 
3. Clinical Outreach:  The MEOT initiates proactive, relational engagement, and longitudinal support with the members 
4. Barrier Removal: Clinicians resolve medication-related issues, side effects, regimen confusion, and social barriers while providing essential education on heart failure. 
5. Outcome Realization: Improved adherence and early intervention lead to reduced medical utilization and lower Total Cost of Care.  

The Results 

• Quantitative Outcomes:  
  • Average PMPM Pharmacy: $108.81 Increase  
  • Average Intervention PMPM TCOC: $694.79 Decrease 
  • Average PMPM Savings: $585.98 
  • 81 CHF medications were added to cohort  
  • ER Visits were reduced by 15.6% 
  • Hospital Admissions were reduced by 39.5% 
• Primary Driver: 
• Medical PMPM decreased by over $694.79 PMPM, driven by reductions in hospitalizations and ER visits 
• Pharmacy PMPM increased modestly (~$108.81 PMPM), reflecting improved adherence and optimized therapy  

This shift represents true value creation, where preventative investment offsets high-cost medical events.  

• Qualitative Outcomes:
  • “For a rural population with complex needs, the longitudinal engagement Curant provides filled a critical gap. Members weren’t just receiving needed medications, they were supported by clinicians who understood their barriers and helped them stay well between visits.”– John Cox, Medical Director – Security Health Plan 
  • “In an industry where member complaints can be common, Curant Health has distinguished itself as a consistently high-performing solution with an exceptional complaints record—delivering quality, trust, and outstanding service to our members.” – Paula Jacobson, Director, Quality and Population Health, Security Health Plan 
  • “Total Cost of Care reduction at the partner level is accomplished through medication adherence maximization and hospitalization minimization at the member level. On a personal note, my family has been profoundly impacted by CHF and I empathize with what these members go through every day of their lives. On a professional note, I am proud to be a part of this partnership which supports and empowers members with CHF to take their therapies as prescribed and avoid unnecessary Emergency Room visits and Hospitalizations which are so costly to the member physically and emotionally and to the plan financially and administratively.”  – Jake Caines, Chief Revenue Officer, PlanPlus by Curant Health   
  • “For our team, this work has never just been about moving a metric, it’s about the person behind every prescription. I’m deeply passionate about the journey we’ve taken operationally because it’s allowed us to move beyond transaction-based care and into meaningful, personal engagement. When we meet members where they are and truly understand their barriers, adherence stops being something we manage and becomes something we build together. The outcomes matter but what matters more is knowing we’re showing up in a way that genuinely impacts our members’ everyday lives. That’s what continues to drive me, and our team, forward.” – Michell Butler, PharmD, Sr. Director of PlanPlus Operations  

Figure 2: Clinical and Economic Outcomes Post-Intervention 

This table highlights the quantitative success of the PlanPlus Medication Care Management (MCM) approach. 

*Calculated based on a 574-member cohort at Security Health Plan. 

Conclusion & Lessons Learned

PlanPlus’ Medication Care Management program demonstrates that precision clinical engagement combined with predictive analytics can meaningfully reduce Total Cost of Care while improving outcomes for rural heart failure populations.  

• Summary:
  • Proactive MCM® reduced PMPM Total Cost of Care significantly  
  • Medical cost reductions outweighed pharmacy increases 
  • Longitudinal clinical relationships drove sustainable impact 

• Lessons Learned:
  • Predictive analytics enable earlier, more effective intervention  
  • Preventative pharmacy investment reduces acute medical spend 
  • Relationship-based care is essential for rural populations 

• Future Outlook: This partnership is concluding year 2 and is continuing to drive improved TCOC. Security Health Plan is identifying additional heart failure members to add to the cohort for expansion, recognizing PlanPlus as a scalable, value-driven solution for complex chronic populations.  
• Plan Impact: “Curant’s program demonstrated that improving the member experience and lowering total cost of care are not competing goals. By focusing on the members who are actively engaged, we saw meaningful clinical stability alongside a measurable financial return for the health plan.” – John Cox, Medical Director – Security Health Plan 

Special Thanks

Providing best-in-class service and achieving optimal outcomes for our members is made possible through the dedication, expertise, and collaboration of many individuals across our organizations. We would like to extend our sincere appreciation to the following contributors. The names listed below are presented in no particular order:

Tony Esposito, Dave Cunnold, Scott Haygood, Kerry Sparks, Kazia Karpinski, Amanda Griffin, Kevin Do, and Tracey Hills

Citations:

1. Heart Failure Society of America. (2025 September 22) Cardiology Experts Warn of Growing Heart Failure Epidemic and Soaring Costs in New HF Stats 2025 Report [Press Release]  https://hfsa.org/cardiology-experts-warn-growing-heart-failure-epidemic-and-soaring-costs-new-hf-stats-2025-report#:~:text=Heart%20failure%20accounted%20for%20an,to%20$858%20billion%20by%202050.
2. Gleeson, C. (2025, March 10) After a Record Flue Season, Cases Are Beginning to Decline in Wisconsin Milwaukee Journal Sentinel https://www.jsonline.com/story/news/local/wisconsin/2025/03/10/flu-season-2025-activity-is-still-high-but-decreasing-in-wisconsin/81591661007/?gnt-cfr=1&gca-cat=p&gca-uir=false&gca-epti=z1167xxp000150c000150u003852e1167xxv002753&gca-ft=164&gca-ds=sophi

Media Contacts
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tgriffin@curanthealth.com