Shifting the Paradigm: Cardiology and Population Health
Dec 08, 2016
Rapid advances in science and technology, coupled with a growing demand for care present significant challenges for cardiovascular medicine. Externally there are multiple clinical, societal and economic factors driving global changes in medicine. Clinically, although strides have been made treating cardiovascular disease and reducing mortality over the past several decades, heart disease continues to remain the number one cause of death around the world. An aging population, a worldwide obesity epidemic and the related growth in the prevalence of diabetes and cardiovascular risk factors are amplifying this trend.
Until now, cardiovascular professionals have been predominantly focused on improving survival in patients already diagnosed with cardiovascular disease. Yet, with the burden of disease increasing in the U.S. and globally, there is a need to shift the paradigm from treatment to prevention.
“Cardiologists have long been involved in secondary prevention and have madedramatic improvements in cardiovascular survival in the U.S. over the past several decades,” says Gerard Martin, MD, FACC, who chaired ACC’s Population Health Policy and Promotion Committee. “Unfortunately, survival rates are not uniform across the globe and even in the U.S. rising obesity rates and other risk factors threaten to slow progress.” Key population health experts weigh in on opportunities for cardiovascular professionals and the ACC to play a role in population health promotion.
“We need to look at population health through
a health equity lens, we need to be vigilant in our surveillance, we have to pay critical attention to gaps that exist in health outcomes. We need to build upon existing structures, innovate during this time and transition to support clinical and community integration.”
Sonia Angell, MD, MPH, deputy commissioner for the Division of Prevention and Primary Care, New York City Department of Health and Human Hygiene
“I believe that the strong political commitments for non-communicable diseases, including cardiovascular diseases, present an extraordinary opportunity to improve cardiovascular health
Francisco Becerra, MD, MPH, DPh, assistant director of the Pan American Health Organization
Clinician checklist for changing the culture of medicine:
Practice based on evidence
Reduce unexplained clinical variation
Reduce the slavish adherence to professional autonomy
Continuously measure and close the feedback loop
Engage with the patient across the continuum
David Nash, MD, MBA, dean of the Jefferson College
of Population Health
“The four walls of the physician’s office must expand. Care must take place not only during the patient visit, but between visits and in the communities where patients live.”
Stephen Permut, MD, chair of the Board of Trustees for the American Medical Association
“We need your voice. In everything that we do, we need those that are trusted by the public to speak up more. Policy makers need to hear from medical professionals on what we need to make sure that our policy reflects the latest standards and guidance.”
Debra Eschmeyer, senior policy advisor for nutrition at the White House
“[Progress will be based on] our willingness in medicine to look outside of the clinic and hospital walls and see that there are community partners to help us, and to help our consumers and patients once they leave our facilities…”
Karen DeSalvo, MD, acting assistant secretary for health for the U.S. Department of Health and Human Services
Opportunities for the ACC to lead in population health:
Integrating existing data
Developing evidence to guide legislation and regulation
Communicating best practices to accountable care organizations and industry
Developing clinical guidelines for population health
Getting the denominator right, thinking about the entire population, not just those who have seen a physician
Gregory Roth, MD, MPH, a general cardiologist and assistant professor for the Institute for Heath Metrics and Evaluation
Population Health Management and Reimbursement
Population health is also entering reimbursement schemes. It’s clear that the changing reimbursement system – which is evolving from the traditional fee-for-service to payment based on the effective and efficient delivery of care – will require cardiologists, advanced practice providers and the rest of the cardiovascular care team to collaborate and share accountability for outcomes with their primary care colleagues. According to the Healthcare Payment Learning and Action Network’s Population-Based Payment Model draft white paper on Financial Benchmarks, “all of these population-based models involve provider accountability for a patient population across the full continuum of care, including preventive care to end-of-life care and everything in between – with the goal of achieving better quality and outcomes and lower total cost for the population involved.” Essentially the theme is that providers will be required in the “new world” to provide this great care but at a lower cost.
The ACC and Prevention
Prevention of cardiovascular disease remains important to ACC’s mission. The College’s ability to effect change in prevention through its membership is a key strength. The ACC continues to work through its Board of Governors to impact local prevention issues, such as tobacco policy, congenital heart disease screening and more. The ACC also continues its efforts to combat cardiovascular disease worldwide through its partnerships with the World Heart Federation and other entities.
Additionally, the ACC, working with its Prevention of Cardiovascular Disease Member Section, continues to prioritize its important work in prevention science, education and advocacy to continue to ensure a reduction in the burden of cardiovascular disease. The College’s greatest strength is its members. As the health care environment continues to transition to one that is focused increasingly on improved outcomes and better care, ACC members must come together to implement enhanced prevention strategies in their practices, hospitals and even their communities.
The ACC recognizes Gerard R. Martin, MD, FACC; Erick Alexanderson, MD, FACC; Aaron L. Baggish, MD, FACC; Paul L. Douglass, MD, MACC; Icilma Fergus, MD, FACC; Martha Gulati, MD, MS, FACC; Eileen Handberg, PhD, ARNP, FACC; John Gordon Harold, MD, MACC; Karen Joynt, MD; Dhanunjaya Lakkireddy, MBBS, FACC; Jennifer H. Mieres, MD, FACC; Pamela Morris, MD, FACC; Gregory Roth, MD, MPH; Laurence S. Sperling, MD, FACC; Jonathan Tottleben, MD; Clyde Yancy, MD, MACC; David Aguilar, MD; and Michael Mansour, MD, FACC,
for their roles on the ACC Population Health Policy & Promotion Committee.