At York, Pa.-based WellSpan’s heart failure clinic, about 70% of patients were on three of the four pillar medications over the course of a year. By implementing a virtual clinic model, the system managed to get over 98% of patients on three of the four pillar medications in under six months and 76% on all four.
“The core mission is: you’ve been identified as a patient who would benefit from guideline-directed medical therapy for heart failure and you are not at your medication goal,” James Harvey, MD, vice president and chief medical officer of the heart and vascular service line, told Becker’s. “We know that the four pillars of therapy work: beta blockers, ACE inhibitors or something acting on the angiotensin-endocrine system, mineralocorticoids like spironolactone, and sodium-glucose transporter inhibitors. When you get people on those, they live longer, have less heart failure and come into the hospital less.”
The brainchild of Adnan Malik, MD, system director of the heart failure program, the virtual clinic was created in January 2025 to improve uptake of heart failure medications as safely and rapidly as possible, while also being convenient for the patient. It came about after the system learned that just 19% of patients across all its clinics were on all four pillar medications, and 29% were on three.
Like many systems, WellSpan is “racing to hire more heart failure physicians, more cardiologists, more APPs,” to meet patient needs, Dr. Harvey said. The virtual clinic was built to expand access using staff they already had.
The Heart Failure Virtual Medication Titration Program is run by Sarah Howard, CRNP, an advanced practice provider, who works from home. On average, she sees about 16 patients per day in 30-minute slots, and new patients get a 45-minute visit for their first appointment. Ms. Howard sees the patients at 2-week intervals until they have optimized medications, then the patient returns to their primary heart failure physician for regular follow-ups.
In its first year, the virtual clinic had 354 referrals, 828 visits and saw about 200 new patients. Patients ranged from 32 to 90 years old. The system’s average optimization score was also low, but patients in the virtual clinic went from a score below five to a score of nine in only four months. Dr. Harvey and his team are still working on the financial data, but so far, the program has cut readmission rates, which cost approximately $10,000 per heart failure admission.
With such great success, WellSpan is expanding the program with three additional APPs and creating one clinic per region.
This is just one of the many heart failure programs WellSpan has launched in recent years. In 2024, the system created its own call center protocols for heart failure patients. The protocols cut potentially avoidable admissions by 11.2% and saved more than $3 million in total costs of care. Read more about this initiative here.
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