Ryan Haumschild, PharmD, MS, MBA: Introducing accessibility and affordability. It is great to have wonderful treatments for heart failure, but if patients are unable to meet them or remain non-compliant with these treatments, their positive health benefits may not be seen. No. How can we discuss population health care approaches to heart failure and identify opportunities to improve care? We have previously talked about how many of these patients are treated similarly whether ejection fraction is maintained or decreased. [EF]But how do we identify and treat heart failure patients who are at risk of worsening their health from each other? How can we identify early who needs timely intervention or intensive care?
Rohit Uppal, MD, MBA, SFH: Great question. The advantage of being a hospitalist is that you have a lot of data at your disposal. Many high-risk indicators, especially of morbidity and mortality, are available in the hospital setting.we always have BNP [brain natriuretic peptide]Patient has GFR [glomerular filtration rate]These patients have telemetry, thus identifying ventricular arrhythmias. We know their EF. I know if they needed cardiotonic drugs.We know their NYHA because we have history [New York Heart Association] class. We know if they were intolerant to medical therapy. All of these cues help stratify high-risk patients based on medical characteristics. It needs to be combined with social determinants of health, which also increases risk.
Once identified at-risk patients, addressing all medical and social issues in this population becomes a daunting task for any clinician, and certainly for any hospitalist. We talked about team care. We need villages to treat these very high-risk patients. One way she trains clinicians is to provide them with the knowledge and skills to have effective conversations about advanced care planning with these patients. It is essential to make advanced care planning a standard component of our care for these patients. This improves patient quality of life and impacts healthcare costs.
Emphasizing its team-based approach, you will need an effective multidisciplinary team that includes nurses, case managers, pharmacists, social workers and nutritionists. and hospice practitioners. Another important part of the team for these patients is the advanced heart failure team or cardiologist. We want to involve them early to manage some of these important decisions.
Ryan Haumschild, PharmD, MS, MBA: Dr. Uppal, you talked about team-based care and having so many great team members on board. Another issue I often think about is payers. They are part of the team when it comes to caring for patients. they provide support. Dr. Murillo, from your perspective, what are the payer-level support programs for heart failure patients? Is it for case management or some kind of navigator? Are there better opportunities for us to work more closely together to enroll in these programs and better manage and monitor them?
Jaime Murillo, M.D.: i love that question. Thank you for asking. As mentioned earlier, health plans are playing a more positive role in helping people become healthier and the system working better for everyone. There are pilots across the country from various payers for remote patient monitoring and integration with ACOs. [accountable care organizations]healthcare systems, and employers on how to improve care for these patients, how to prevent complications, and more.
You’d be surprised to hear that health insurance is eager to work together and establish innovative interventions to help people. Heart failure is an important area. If you have the opportunity to work with health insurance and have an innovative way of thinking about it, I want my viewers, especially those who practice medicine, to go to health insurance and say, ‘Let’s work together. I think. It goes beyond just negotiating a contract on payment methods. Ask, “What can we do together to make the patient better?” they are very receptive. Thanks for that question.
Ryan Haumschild, PharmD, MS, MBA: Yes, I love that approach too. It’s a united front. Dr. Uppal, when you think about the health of the population, especially when you think about heart failure patients, you have to have some measure of success. You can monitor and track them over time. As a scientist and a doctor, you are familiar with this. What interventions are you trying to implement? What metrics are you monitoring to see how they are impacting patient outcomes?
Rohit Uppal, MD, MBA, SFH: One of the challenges we have across the continuum is integrating all the data sources we have. Within the hospital space, we also get some data from payers. Some of the metrics we monitor are the length of stay of inpatients. Readmission rates at 3, 7, 30, and 90 days. mortality; referral rates to hospice and palliative care; Cardiology referral rate. We also examine patient experience scores, a strong driver of post-discharge patient adherence.
Ryan Haumschild, PharmD, MS, MBA: Dr. Anderson, I have a question for you. Can you discuss some of your organization’s best practices for guiding appropriate care? Do you have a treatment pathway?Are there any specific guidelines, policies or EMRs? [electronic medical records]How will that guideline-based pathway impact heart failure care from a payer’s perspective as well?
John E. Anderson, MD: that’s a great question. I will answer in two parts. Hospitals follow good guidelines for treatment. Many organizations have expectations about what is expected and what guideline-based care is. When I go out of the country, some people have them and some don’t. For example, my EMR system does not incorporate anything that prompts SGLT2 inhibition or ARNI. [angiotensin receptor-neprilysin inhibitor]You can do a better job by adopting a systematic approach.
Ryan Haumschild, PharmD, MS, MBA: You want to create consistency, so a systematic approach seems like probably the right way to go. Dr. Januzzi, what are some of the best practices you’ve seen so far? Ordered sets for EMR? What are you looking at to create that consistent practice?
Jim Jannuzy, M.D.: Every institution has different opportunities.Uses guidelines for treatment [GDMT] clinic approach. Embedding in electronic medical records is an interesting approach that has not yet been fully explored. His recent PROMPT-HF trial by the Yale University System showed that the EMR prompt approach improved his GDMT. Importantly, he needed 10 prompts before one change was made. So while it seems like a potentially useful way to improve care, more work needs to be done to better understand how to encourage clinicians to follow prompts. It should be emphasized that telling them. You can prompt them all day long, but if they don’t make changes, it won’t necessarily improve care.
Ultimately it comes down to education. The American College of Cardiology Expert Consensus Decision Pathway document, which focuses on this approach, also comes with a smartphone app that clinicians can use at their bedside or in the office. Another way to take advantage of new techniques and technologies for
Ryan Haumschild, PharmD, MS, MBA: I like strategy There are a lot of apps out there, but if it’s easy at your fingertips and gives you better practice, it’s not a bad thing.
Edited transcript for clarity.