Clinical Innovators | Increasing Access, Lowering Costs, and Improving Quality: An Interview with Lonny Reisman, MD | CardioSource WorldNews

Interview by Katlyn Nemani

Lonny Reisman, MD, is chief medical officer for Aetna, a Fortune 100 diversified health care benefits company serving an estimated 44 million people. Appointed to this role in 2008, he is responsible for the company's clinical strategy to improve the health of Aetna's members and to help build a better health care system supported by evidence-based accountability. Prior to his CMO position, Dr. Reisman was chief executive officer of ActiveHealth Management, now an Aetna subsidiary. He co-founded ActiveHealth following nearly 20 years of experience as a physician and consultant. Dr. Reisman was an attending physician at New York Hospital and St. Luke's–Roosevelt Hospital Center and was a cardiology fellow at the University of Chicago.

What was your path to your current position, and what are some of the major changes you have advocated for during the past decade?

When I was a practicing cardiologist, I was constantly bombarded with new information—from volumes of patient data to the latest medical innovations, studies, and clinical trials. Doctors spend a great deal of time sorting through this "information overload" to identify important insights that can improve outcomes and impact quality of care. I also was often frustrated that many of my patients did not follow my instruction—whether it was medication adherence or lifestyle modification. This experience led me to create a better way for doctors to work with their patients to help them stay adherent to treatment according to the most current clinical data.

In 1998, I launched ActiveHealth Management. I envisioned a unique service that used advanced technology to apply accepted clinical standards to available patient data, creating information to help support decision-making. With the aid of this service, health care organizations could identify opportunities to improve care, help to optimize utilization, and make an impact on rising health care costs. Providers could also spend less time reviewing volumes of information and more time collaborating with patients and improving their health. I invested in leading-edge technology and brought together a team of clinical and analytics experts. As a result, ActiveHealth's innovative CareEngine® product was born.

When I joined Aetna in 2008, I continued to look for the barriers that prevented doctors and their patients from following the best clinical practices. Working with clinical experts around the country and within Aetna, I engaged in several clinical studies that have promoted the application of clinical evidence to help doctors and patients achieve better health outcomes.

Could you discuss one of the most important clinical studies you have conducted, and describe how Aetna applied the findings?

In 2011, Brigham and Women's Hospital, Harvard Medical School, and Aetna conducted a prospective, randomized study that looked at the impact of reduced cost-sharing on medication adherence on cost and—for the first time—on health outcomes for a targeted condition. The results of the Post-Myocardial Infarction Free Rx Event and Economic Evaluation (Post-MI FREEE) Trial showed that reducing cost sharing for targeted medications among high-risk members who have suffered a heart attack is a simple and scalable action that can substantially improve adherence and health outcomes, with no added costs. Still adherence was less than half among patients in the study—even when the medication was free.

As a result, we launched Aetna Rx Healthy Outcomes to deliver a multifaceted approach focused on high-risk members. In addition to no copay for generic cardiac drugs or reduced copay for preferred-brand cardiac drugs following a heart attack, members receive personal support from Aetna's pharmacists to help them clearly understand what the prescribed drugs do and how and when to take them. These specialists also assist members in managing any side effects. Additionally, members may have support from nurses within Aetna's Disease Management program. The nurses help address any questions or challenges with the treatment plan including helping to align plans with the members' cultural values. Aetna's clinical teams also work closely with members' doctors to help members stay compliant.

This is an example of how we must approach developing a health care system based on outcomes. We must examine and address the interrelated components that impede treatment and add unnecessary costs.

You are a strong proponent of market-based solutions and the use of health information technology. How will this improve health care?

Today's model of health care delivery rewards volume of service, with little to no reward for quality outcomes. We need and must move to a model that requires and rewards managing patient populations and the actual improvement in health outcomes. This fundamental change from volume to quality will require providers, patients, and payers to work together to transition to new models of health care delivery and patient management that are guided by clinical evidence to improve quality and efficiency.

At Aetna, we look at opportunities where we think the system could do a better job. And this is where collaboration is so important. No one party has all the information that they need. For example, a patient may need chemotherapy. But the oncologist may not have all the information on the biopsy or the genetic makeup of the patient that could guide more effective treatment. The doctor also may not have the most current clinical evidence on treatment. This is where health information technology and exchange can help provide clinical decision support and where Aetna is uniquely able to contribute. Aetna is helping connect information beyond claims data to get more clinical data (e.g., radiology, tissue results, and clinical evidence) to doctors in real time to support decisions based on the medical literature.

What is your vision of the future of Aetna and the health care industry? What changes need to happen to increase access, lower costs, and improve care?

We will continue to look to clinical evidence to drive efficiency and quality. We will use technology to connect the system and deliver appropriate payment reform and incentives to patients and doctors that reward quality outcomes, not the volume of tests and procedures.

We understand this change cannot happen overnight, and doctors also have barriers to change including the need to invest in new technology and revising office procedures—all while ensuring continued care to patients. We are committed to working with doctors so the change is collaborative and creates a more affordable health care system with better quality. A sustainable system won't be successful without them. I also must emphasize the role of patients. Doctors are important, but 99% of a patient's life isn't spent with the doctor or in the hospital. Patients have to participate more actively in their health.

Aetna is working to help people understand the health trajectory they are on and how to maintain or get to better health. This isn't a cliché about being healthy. We won't halt the progression to chronic—often costly—health conditions without trying to prevent them in the first place. The system will always take care of the sick, but ideally, we need to be better at preventing or stopping disease earlier. I believe a number of new innovations that Aetna is working on with others in the health care system will help get us closer to that point in the next several years.

Katlyn Nemani, MD, is from Tufts University School of Medicine in Boston.

Keywords: Medication Adherence, Life Style, Health Care Sector, Cost Sharing, Delivery of Health Care, Schools, Medical, Disease Management, Health Care Costs, Medical Informatics, Health Services Needs and Demand, Reward, ACC Publications, CardioSource WorldNews

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