The bottom line
- New research published in Value in Health found that participation in Hello Heart among adults with heart failure was associated with $7,001 lower total medical spend per participant.
- Participants had 47 fewer inpatient admissions and 297 fewer inpatient days per 100 participants.
- Primary care use moved in the opposite direction, with 139 additional primary care visits per 100 participants.
- The study compared 292 Hello Heart participants with 292 propensity-matched controls over the year before and after enrollment.
- For health plans, the findings point to an important opportunity: helping high-risk members stay engaged with their cardiovascular health while reducing expensive inpatient utilization.
Why heart failure is a major cost challenge for health plans
Health plans are under growing pressure to control medical spending without making it harder for members to get the care they need.
PwC projects commercial medical cost trend will reach 9% in 2027, the highest level in nearly two decades. That puts greater scrutiny on chronic condition programs and whether they can demonstrate measurable impact on utilization and total cost of care.
Heart failure is an especially important population. Approximately 6.7 million U.S. adults over age 20 are living with heart failure, according to the American Heart Association.
Managing heart failure can require ongoing medication management, attention to cardiovascular risk factors, regular interactions with care teams, and quick action when health changes. When problems escalate, they can lead to emergency care and costly hospital stays.
The focus on earlier intervention is also showing up in federal payment policy. The Centers for Medicare & Medicaid Services' Ambulatory Specialty Model, which begins in 2027, specifically includes heart failure and aims to improve upstream chronic disease management while reducing avoidable hospitalizations in Original Medicare.
For health plans, the challenge is not simply reducing healthcare use. It is helping members get the right support earlier, before a manageable cardiovascular issue becomes an expensive acute event.
What did the new Value in Health heart failure study find?
New research published in Value in Health evaluated medical spending and healthcare utilization among adults with heart failure who enrolled in Hello Heart.
Researchers used a propensity score-matched difference-in-differences design, comparing medical claims during the one year before and one year after enrollment.
The matched study population included:
- 292 Hello Heart participants
- 292 matched controls
- Mean age of 56 years
- 45% women
Researchers evaluated total medical spending, cardiovascular spending, primary care visits, emergency room visits, inpatient admissions, and inpatient days.
After adjusting for baseline differences, participation in Hello Heart was associated with:
- $7,001 lower total medical spend per participant
- 47 fewer inpatient admissions per 100 participants
- 297 fewer inpatient days per 100 participants
- 139 additional primary care visits per 100 participants
The differences in total medical spending, inpatient admissions, inpatient days, and primary care utilization were statistically significant. Emergency room encounters also declined by 8.4 visits per 100 participants, but that finding was not statistically significant.
Why fewer hospital days matter for health plans
The $7,001 difference in total medical spending is an important finding for health plan finance leaders.
The inpatient results help explain why.
Hello Heart participation was associated with 47 fewer inpatient admissions and 297 fewer inpatient days per 100 participants.
For plans managing high-risk cardiovascular populations, inpatient care represents more than a line item. A hospitalization can signal that a member's condition has progressed to the point where more intensive and expensive care is required.
Reducing avoidable hospital utilization can therefore matter on both sides of the equation: fewer disruptive hospital stays for members and lower acute care costs for plans.
More primary care, less acute care
One of the most interesting findings is what happened to primary care utilization.
Hello Heart participants had 139 additional primary care visits per 100 participants in the adjusted analysis.
That makes the overall utilization pattern more meaningful.
Participants were not simply using less healthcare. Primary care utilization increased while inpatient admissions, inpatient days, and total medical spending decreased.
Study co-author Edo Paz, MD, cardiologist and Executive Medical Advisor at Hello Heart, said the increase in primary care visits suggests participants may have been more engaged in proactive care.
"Heart failure is one of the most complex and expensive conditions to manage. By combining AI-driven personalized coaching, consistent monitoring, and advanced medication management tools, we can help people stay healthier while reducing the need for costly hospital care."
For a health plan evaluating cardiovascular programs, this distinction matters. Lower utilization by itself is not necessarily a better outcome. Greater engagement with routine care alongside lower acute utilization is a much more useful pattern to examine.
How did Hello Heart support people with heart failure?
Study participants used the Hello Heart platform, including its connected heart monitor, app, and AI-driven heart health coaching to support management of their cardiovascular risk factors.
The Hello Heart platform helps members track blood pressure and other heart health information, receive personalized guidance, manage medications, and share relevant health information with their clinicians.
This kind of support matters because heart health does not stand still between medical appointments.
Blood pressure changes. Medication routines change. Symptoms and behaviors change. Connected heart health data can help people see patterns over time, while AI can help make that information more understandable and actionable.
The result is a different role for healthcare AI than the administrative applications receiving much of the industry's attention.
For cardiovascular health, AI can help support people between clinical encounters, when many of the daily decisions that affect long-term heart health actually happen.
What does this research mean for health plans?
The findings point to several questions medical directors, population health leaders, quality teams, and health plan CFOs should ask when evaluating digital heart health programs.
Are high-risk members actually engaging?
A cardiovascular program cannot affect utilization or outcomes if members stop using it.
Plans should examine whether a solution can maintain meaningful engagement among people with more complex cardiovascular needs, not only among generally healthy populations.
Does engagement connect members with appropriate care?
Lower healthcare utilization should not be the only objective.
In this study, primary care utilization increased at the same time inpatient utilization decreased. For plans, that makes it important to understand not just how much healthcare members use, but where and when they receive it.
Is there evidence of an impact on expensive acute care?
Hospitalization is a particularly important outcome in a high-risk heart failure population.
Hello Heart participation was associated with significantly fewer inpatient admissions and hospital days in the adjusted analysis.
Are the financial outcomes measurable?
Health plans should expect vendors to connect engagement and clinical outcomes to healthcare utilization and spending.
In this analysis, Hello Heart participation was associated with $7,001 lower total medical spending per participant.
That gives health plan finance and clinical teams a concrete outcome to evaluate alongside engagement and utilization.
The opportunity for AI in heart failure management
Heart failure gives health plans a difficult combination of clinical complexity, member burden, and high medical costs.
It also presents an opportunity for technology to make cardiovascular management more useful between visits.
Connected heart health tools can give members a better view of how their health changes over time. AI-driven guidance can help make that information easier to understand and act on. Medication support can help people manage another important part of their cardiovascular health.
The new Value in Health findings add financial and utilization evidence to that model: lower total medical spending and fewer hospitalizations alongside greater primary care utilization among Hello Heart participants with heart failure.
For health plans trying to manage cardiovascular risk earlier, that combination deserves attention.
Read the full research findings from Hello Heart
Explore the study published in Value in Health
Learn more about the Hello Heart platform
