By Debbie Ritenour and Marycon Young, Vitals contributors

In the fall of 2023, Linda Miller was not feeling well. For months, she had been experiencing shortness of breath, fatigue and bloating, and she was taking a diuretic every day to control her symptoms. When a physician assistant at her cardiologist’s office suggested she speak with a pharmacist, the Grass Valley resident was surprised but quickly agreed.

“The pharmacists at my retail pharmacy don’t know me personally, nor are they aware of my medical conditions, but I was willing to grab for any straws,” said Miller, 73, who was diagnosed with cardiomyopathy in 2007. “I was hoping there was some answer to my not feeling well.”

Linda Miller was very pleased with the VPACC program. “I can’t tell you how heart-warming it was to talk to someone who would spend time with me answering questions when I wasn’t doing well and I wasn’t able to connect with my cardiologist. It felt like a lifeline,” she says.

It turns out the physician assistant wasn’t talking about a retail pharmacy. She referred Miller to Sutter’s Virtual Pharmacy Ambulatory Care Clinic, or VPACC, a program designed to help patients with congestive heart failure better manage their condition and improve their quality of life.

Miller enrolled in the Virtual Pharmacy in 2023, and over the course of 10 visits, she worked closely with ambulatory care advanced practice pharmacist Betsy Cernero to adjust her medications. Not only was Miller able to get on the recommended therapy for her condition, but more importantly, she began to feel much better.

“Betsy was absolutely wonderful,” Miller says. “I can’t tell you how heart-warming it was to talk to someone who would spend time with me answering questions when I wasn’t doing well and I wasn’t able to connect with my cardiologist. It felt like a lifeline.”

Patient Gets Solutions … and Saves Money

When Miller met Cernero, her ejection fraction, or the percentage of blood pumped out of the heart with each beat, was at 35-40% (a normal ejection fraction is 50% or more). The  guidelines-directed medical therapy for heart failure with reduced ejection fraction includes a combination of four recommended medications; Miller was taking three of the four.

“We were able to adjust her medications so that her blood pressure could tolerate all four classes of medications,” Cernero says. “She also began taking furosemide only as needed, and her symptoms were much improved, with only occasional bloating.”

As Miller began the therapy, she needed close follow-up due to her low blood pressure.

“Betsy started with very low dosages and evaluated how I was reacting to those, and then she would increase them,” Miller says. “It gave me hope that I could get on the other side of not feeling well and begin to feel like myself again.”

Cernero also helped enroll Miller in a grant for co-pay assistance that has saved her over $1,000 in the last year.

“I have some medications that are very expensive,” says Miller. “The grant money has been extremely helpful because I don’t have to worry about paying for my medication. We have insurance, but the co-pays add up, and it’s just a lot of money.”

How VPACC Is Transforming Care and Driving Results

Since its launch in April 2023, Sutter Health’s Virtual Pharmacy Ambulatory Care Clinic has achieved remarkable outcomes, including a 45% reduction in one-year mortality rates and a 60% decrease in cardiac-related hospitalizations. Recognized with the 2024 Clinical Excellence Award at the Vizient Connections Summit, the program has also demonstrated significant financial impact.

A recent financial analysis of VPACC’s impact on value-based patients, including those in the Medicare Shared Savings Program, revealed $965 per member per month in savings, primarily through reduced inpatient and post-acute care costs. With plans to expand enrollment to 1,200 patients next year, the program is expected to deliver over $14 million in systemwide savings annually.

 Miller Paying It Forward with Fellow Heart Patients

Miller, who taught children with special needs for 23 years, has been leading a support group for people with heart conditions since 2017. The group meets once a month to share their experiences, discuss a range of health topics and hear from guest speakers such as nutritionists and psychologists.

Miller enrolled in the Virtual Pharmacy in 2023, and over the course of 10 visits, she worked closely with ambulatory care advanced practice pharmacist Betsy Cernero, above, to adjust her medications.

“We’re just trying to help them cope with living with a chronic heart condition,” Miller says. “It’s a win-win — I, too, learn about how I can best enhance my health. The better we practice self-health, the more we can do.”

Miller finds her role extremely rewarding. She understands the need for support from the perspective of both a patient and a family member; her two daughters were also diagnosed with cardiomyopathy, and one of them died of a heart attack at just 47 years old.

“At this stage of my life, I try to take care of myself so I can help others,” Miller says.

Miller encourages her fellow heart patients to work closely with their providers. That of course includes talking to their doctors about their medications thanks to her experience with VPACC.

“I’m feeling extremely well right now,” Miller says. “Betsy started me down that path.”