% Optimal Medical Therapy Achievement: The Most Critical Quality Measure in Cardiovascular Disease
Look at this map. It shows the annual number of women killed by heart disease down to the county level. Now really look at the map. The rates are highly variable. Part of the reason for that is healthcare is highly variable. This fact jumped out at me. The entire state of Minnesota is an outlier. Heart disease deaths per year are one third as high in Minnesota as they are in broad areas of the southeastern US. Here is one important reason for the difference. Minnesota is the only state that I know of that publicly reports percent attainment of optimal medical therapy for arterial disease (V4) and diabetes (D5) by medical organizations.
In Minnesota, optimal medical therapy for diabetes (D5) is defined by the concurrent achievement of 5 goals.
1. Blood pressure less than 140/90
2. Statin use as recommended
A1c less than 8%
Tobacco free
On aspirin as recommended.
Optimal medical therapy for vascular disease (V4) drops the third component—the A1c.
Nationally, percent OMT achievement for diabetes is horrible—arount 20%. In Minnesota it is highly variable, but at least they are focused on the measure and reporting it. Some groups are doing very well. Ridgeview Excelsior Clinic is leading the list today at 72%. Click on the link, you can review the list yourself. The worst 4 clinics achieve OMT in 14% of their diabetic patients or less. There are many clinics achieving 60% or higher. The main goal of reporting is to foster improvement but this level of variation would not be acceptable in any other industry. Minnesota and these practices are way ahead because at least they are measuring and reporting. Payers should let patients know how important OMT is and steer them to the high performers.
If I want to know in an instant the quality of cardivascular care in an organization, I look at the percentage OMT achievement. That is the most important quality measure that directly translates into improved health at lower cost. Again, just look at the map. Minnesota is doing something different and it matters.
Many of the quality measures in current use do not make a difference in helping you life a longer, healthier life for less money. Some of them are process measures like “screening for the hemoglobin A1c” Process is much less important than outcome. The real quality question is this: did you control the blood pressure, cholesterol, and sugar to aggessive targets and did you do it with interventions that protect cells and organs. The OMT measure gives you that information at a glance. That is the measure you want to focus on. This entire site provides the evidence that it improves health and lowers cost.
I worked with an insurance company as a senior clinical advisor on the topic of cardiometabolic disease. I focused on increasing the number of patients achieving OMT. I worked with primary care groups, large medical systems, and individual primary care providers. We had regular meetings of primary care leaders in the state. One of the main barriers to improvement was this idea: “ We should not be held accountable for our patient’s failures.” They thought they provide the right medication and the right advice. It is not their fault that the patients don’t follow it. That view is completely counterproductive. Low OMT performance scores are a systems problem. They reflect a failure to implement the systematic approach I described yesterday. If you develop a trusting relationship and help the patient understand why OMT is worth their time—if you support them in self management and help remove barriers—then many more will achieve it and fewer women will die needlessly. Let’s do this! It is time to move!
One thing missing is ALL these discussions is early detection and early warning to enable primary wellness practices and lifestyle optimization for all stages of these diseases. Lifestyle plays a central role in disease prevention and reversal. Multifunction Cardiogram Technology has proven that very principle.