US Cardiologists Embrace Population Health
Having achieved steadily declining rates of coronary heart disease in the United States during the past 4 decades,1 US cardiologists like former American Heart Association (AHA) president Clyde W. Yancy, MD, are turning their sights on a new goal, preventing cardiovascular disease through population health initiatives.
Yancy, who continues to volunteer for AHA, said that the substantial evidence supporting the effectiveness of population health initiatives has driven the development of AHA’s population health programs like Life Simple 7, which outlines 7 steps individuals can take to improve their heart health.
“[Physicians] are not passive participants in the life cycle of heart disease,” Yancy said. “We can be much more active in the process and can, in fact, prevent disease.”
Although preventing a second or third heart attack has long been the core of many cardiology practices, many cardiologists have not had as much experience with primary prevention and managing population health. But that is changing as value-based health payment reform and evidence-based population health initiatives broaden the role of cardiologists beyond one-on-one patient care into population health. Groups like the AHA, the American College of Cardiology, and the US Department of Health and Human Services, as well, have all developed initiatives to help cardiologists as they take on this new role.
“It is an evolution in medical care where the responsibility of the physician extends beyond the individual patient he or she is seeing at that moment to groups of patients,” said Richard Chazal, MD, president of American College of Cardiology. “It’s a different perspective from how most of us were trained.”
Healthcare reform, including the newly released Centers for Medicare & Medicaid Services rules for value-based payments for physicians, is one of the factors accelerating population health initiatives.
“Instead of just taking care of patients when they are sick, we will be paid to some extent on whether we are able to keep a population well,” Chazal explained. “It’s really the right thing to do anyway to take care of these patients in our communities.”
To help cardiologists with this transition, the American College of Cardiology is working to develop training and education programs, Chazal said. For example, the recent American College of Cardiology meeting had numerous sessions focusing on population health and primary prevention interventions.
Already, many cardiologists are participating in the Million Hearts initiative, a joint effort launched by the US Centers for Disease Control and Prevention and the Centers for Medicare & Medicaid Services in 2011 to prevent 1 million heart attacks and strokes by 2017.2 As part of the program, cardiologists are being called on to focus on the “ABCS”: aspirin for people at risk, blood pressure control, cholesterol management, and smoking cessation.
The Million Hearts program has yielded valuable insights for cardiology groups embarking on their own local and practice-level health initiatives. The first is to focus on a narrow set of goals and not “try to accomplish too many things at once,” said Janet S. Wright, MD, executive director of the Million Hearts initiative.
“In clinical environments these days, the earth is shifting under the very feet of people who have been doing this for a while,” Wright said. “It’s almost a relief to focus on a specific outcome and a small set of interventions.”
A Leg Up
As cardiologists begin to delve into their practice- and community-level data to find ways to improve population health, they may find their experience using registries very helpful, noted Wright.
“Cardiologists almost have a leg up on many other specialties because they have this experience in rich data,” said Wright.
For example, clinicians who have improved blood pressure control in their practices as part of a Million Hearts program frequently comb their electronic health records for patients with uncontrolled hypertension and work with those patients to improve their control, explained Wright. Both Wright and Chazal emphasized the importance of building the right team, including individuals with expertise in mining data from electronic health records, advanced practice nurses, and behavioral counselors who can work with individual patients on improving their health.
“In a Million Hearts, [we have learned] that getting great at the ABCS is a team sport,” she said.
The biggest challenge for physicians and their teams, however, may just be shifting their focus from strictly caring for 1 patient at a time to thinking about how to improve population health, Wright said.
“It’s the tension between making sure that an individual gets what he or she needs and keeping your perspective broad so a whole population moves toward a healthier status,” Wright said.
To do this, healthcare teams will have to carve out time to develop processes and programs that prevent the need for care, Chazal said.
“I’ve been telling patients for 30 years don’t smoke, exercise, and try to eat right,” explained Chazal. “But I have not been faced with a spreadsheet with a list of my patients and individuals in my community I share responsibility for and their collective list of health problems. It’s a different way of looking at some of the same problems.”
Initiatives like the Life Simple 7 program, which provides patients with an online assessment tool and tips to adopt a more heart-healthy lifestyle, as well, can help physicians better engage patients in the process, noted Yancy. Patients and the public are very interested in learning how to prevent heart disease, noted Yancy, and feel “empowered” that there are things they can do to stay healthy that do not require medication or a visit to the doctor.
Cardiologists also can lend their expertise and voice to efforts to boost community health and tackle social factors that may contribute to cardiovascular disease. For example, the AHA’s Voices for Healthy Kids program provides communities with the evidence and technical assistance they need to create heart-healthy environments starting in early childhood, said Jennifer Weber, director of AHA’s child care initiatives. For example, she noted that many preschools across the country have no outdoor play area or lack the kitchen equipment needed to prepare healthy meals. Cardiologists, she noted, can play an important part in helping to ensure that such programs are evidence based and to boost community support.
“That voice of the cardiologist carries a lot of weight in the community with people trying to make the changes,” Weber said.
Whether cardiologists choose to participate in practice, local, or national population health efforts, Yancy noted that these efforts could have a powerful impact.
“We are physicians because we want people to live and feel better,” Yancy said. “The ultimate way to make that happen is to prevent disease.” n
- © 2016 American Heart Association, Inc.
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- 2.↵Million Hearts. http://millionhearts.hhs.gov. Accessed July 20, 2016.