- When it comes to improving the scope and effectiveness of chronic disease management, the American College of Cardiology has an enormous opportunity to effect change among primary care providers and specialists across the healthcare continuum. Cardiovascular disease is one of the top killers in the United States, and its impact is growing quickly in any number of developing countries.
As providers seek to implement population health management strategies that focus on prediction and prevention instead of delivering reactionary services, specialist organizations like the ACC are becoming critical focal points for the industry’s efforts to collaborate, communicate, and educate stakeholders on the importance of preventative care.
For Dr. Gerard Martin, Chair of the ACC Population Health Policy and Health Promotion Committee and Senior Vice President of the Center for Heart, Lung, and Kidney Disease at Children’s National Health System, tackling the enormous challenge of cardiovascular disease requires a multi-pronged plan.
Through better big data analytics, improved quality measurement, patient advocacy, and systematic changes, the healthcare industry can make a dent in the costs and impacts of heart disease across the world.
Dr. Martin sat down with HealthITAnalytics.com to discuss how the American College of Cardiology is making population health management a top priority as chronic disease management becomes increasingly important to healthcare organizations looking to provide high quality, effective care.
What is the American College of Cardiology’s position on the importance of population health management, and how is it helping to bring high quality care to patients?
The College has been engaged in population health over the last few years, and several members of our Presidential team have been working either directly with the World Health Organization or with the World Heart Federation on the efforts to address the increasing burden of cardiovascular disease that's occurring globally.
As a result of this increasing trend, the College added population health management to its 5 year Strategic Plan. That became a critical addition to our thinking about what was important at the College. In addition to everything we do in science, in quality, in education and in advocacy, we needed to get engaged with population health and health promotion.
I’m chairing the committee we formed to address population health policy and health promotion. We had our first meeting in March 2015. It was clear to our members of the committee was that we first needed to better define what “population health” meant to the American College of Cardiology. We also needed to decide where our efforts should focus and who our partners should be in this monumental task.
What are some of the specific challenges of managing and preventing cardiovascular disease?
When it comes to cardiac health, there’s some good news and some very sobering news. The good news is that we have been able to improve cardiovascular survival in the United States by over 40 percent since the year 2000. People are living with their heart disease much longer than they ever have in the past, and all of that's been driven by science, clinical guidelines and by delivering better care.
However, at the same time that we’re acknowledging the excellent care being delivered to these patients and its effectiveness, we’re now talking about how we need to prevent disease and deliver less care. Can we keep people well?
The other challenge is the fact that people may be living longer, but the global burden of cardiovascular disease is expected to increase by 57 percent by the year 2020. The number of people impacted by heart disease is increasing.
This is a very important time to talk about the prevention of heart disease and health promotion. Yes, it’s a problem in the United States, and it’s a problem in Europe, but it’s a much bigger problem in low- and middle-income countries that aren’t used to dealing with chronic disease. They have made successes with hunger and communicable disorders, but now, as people are living longer, they're now developing the middle- to high-income problems that cause death. And that's cardiovascular disease.
Cardiovascular disease will cause over 50 percent of deaths in the world. So we need to do something to prevent this growing burden of cardiovascular disease. Can we get away from actually treating more heart disease by getting engaged in prevention? What do we have to do on the population health management front to reduce this huge, global burden?
How can healthcare organizations reduce these alarming disease rates in the United States and elsewhere?
The first thing we can do is educate people. Tobacco accounts for close to 60 percent of the risk for cardiovascular disease. Although tobacco exposure has improved in the United States and Europe, there are parts of the world where smoking continues to increase. And so just simply educating folks about not smoking is not enough.
There are different strategies that have been promoted for getting at this problem of the risk factors. We've got smoking, we have diet, we have exercise, we have alcohol – and so I think it takes a combination of education and a little bit of legislation and rulemaking. In other words, we have to have some more effort put into ways in which government can actually protect their populations. There are so many things that we can do to protect our populations, and one of the best ways to achieve that kind of change is through advocacy.
How can big data analytics and EHR data inform the process of population health management?
In addition to education and advocacy, we need measurement. We are doing a pretty good job in the United States with big data analytics. We’re collecting more data and we are learning so much about who is at risk as we look at the patterns of chronic disease.
That's not the case in much of the rest of the world. As hard as it is for the United States, imagine how much more difficult it can be in a low-income country. How do we start to help them collect their data so that they know their risk and then can track their progress in the area of prevention?
In the United States, we still need to work on interoperability to facilitate this. I participated in a recent NIH group that looked at big data for congenital heart disease. We know that data registries and health information exchange is critical for understanding this issue, but there are still so many data siloes that are preventing meaningful work from getting done. The data sits in different buckets. Either it sits in electronic health record, or it sits over in a registration area, or it sits over in a cardiac practice which has imaging data and EKG data, and none of it is tied together.
We have administrative data sets, and clinical data with imaging, but they can’t get together. And we all know that vendors don't exactly make it easy to get the data from one place to another. So one of the big wins would be getting a little bit more connectivity between data sets in a way that’s cost-effective for care providers.
What’s missing from the toolset for healthcare organizations that want to achieve more meaningful interoperability?
I think unique patient identifiers would be a huge benefit for all of this. We pass patients from one organization to the next, and they start all over each time. We think a unique patient identifier would be a huge benefit so that a patient could be tracked from childhood to adulthood. Cardiovascular disease begins in childhood. It may actually begin during fetal development.
There’s a lot of data in pediatrics that could inform on what's going on in the adult arena. So I think a unique patient identifier and greater connectivity between data sets would all be huge benefits.
How can specialists and the societies that support them work more closely with other members of the care continuum to foster population health management?
One of the biggest problems we face as cardiologists is how to get upstream. We're down at the area where the specific problem is. We need to get upstream where the patients are before they have active disease. So how do we do that? By working with primary care, certainly, but also by working with the community and the Department of Health, and with schools and employers.
We can’t just stay stuck in primary care. We have to be working with the organizations that monitor what happens in the community. We have to work with schools where the children are. We need to work with the employers, because primary care can't carry all the burden of it alone.
A primary care provider may only see their patients once or twice a year, whereas your employer or your school sees you five days a week. With population health management, there are so many interactions that have to be taken into account so that healthcare can be engaged in people's lives more often than the one or two or three encounters per year where the patient comes into the office.
That’s going to be critical, both for the ACC and for the healthcare system as a whole. We need to be finding those key targets upstream in both internal medicine and pediatrics, which is something we’re very focused on doing.