Centers of Excellence help manage the high cost of congenital heart disease

Most case managers are unfamiliar with congenital heart disease (CHD) or how to identify it. For health plans, that’s a costly problem.

CHD is a broad term, encompassing multiple, often complex diagnoses. It is present at birth and can affect the structure of a baby’s heart and how it functions. More than 35,000 children are born with congenital heart defects in the U.S. every year, many requiring multiple surgeries and a lifetime of medications to keep their hearts working.

CHD is a high-cost condition:

  • $404,000 – average annual billed charges per case[1]
  • $19.5 million – expected annual charges billed per million members1
  • $2 million – the amount billed charges can exceed for a single case1

Two categories within the population of CHD cases in which complex procedures are performed in the first year of life can be identified early.

  • Segment one: complex cases diagnosed in utero
  • Segment two: complex cases diagnosed shortly after birth that do not undergo surgery immediately

Since CHD is an infrequent condition, we estimate that only about 25 medical centers nationally have sufficient volume to develop the expertise and experience necessary to consistently deliver superior clinical outcomes. That’s why offering members a network of CHD centers of excellence is so critical. The Optum CHD Centers of Excellence are rigorously credentialed and monitored on an ongoing basis.

How are CHD cases typically identified today, and how would this present the best opportunity for making a positive impact on patients? Take a look at the 5-minute brief to learn more.


[1] Tao. UnitedHealthcare commercial population 2011–2014. November 2015.

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