Yesterday, I wrote about the key role that nurse practitioners should play in such an effort. There are 270,000 nurse practitioners in the United States and 85% are certified in family practice, adult medicine, or geriatrics. These providers deliver the most effective, least expensive treatment for cardiovascular disease and related conditions like diabetes and high blood pressure. We have a triple crisis in chronic disease management in this country. This entire site is devoted to that topic. Our management systems are high cost, low quality, and disconnected from the latest science and systems. We can lower cost, improve quality, adopt the newest science, and improve the primary care shortage quickly in your state or community.
Chronic Cardiovascular Condition teams manned by nurse practitioners (NPs), physician assistants (PAs), pharmacists, and case managers can dramatically and quickly improve care in these focused units. Nurse Practitioners can practice independent of physician supervision in over half the states in the US. Here’s what you need to get started.
None of this can happen without an appropriate payment model. The best payment model is capitation. The average annual cost for a patient with type 2 diabetes and chronic kidney disease in the first year after discovery is $24,000. Those costs will relentlessly increase with inflation and the inevitable worsening of kidney function that occurs in the absence of optimal medical therapy (OMT). Pay the team $22,000 per year for patients in the first year of this condition. You are saving money and they have the resources to spend the time caring for these very high-risk, high-cost patients. The old capitation failed because it incentivized less care.
The best care is less expensive care. The new capitation is different. It incentivizes the best care. Optimal medical therapy saves money because it is the most effective care. The very high costs in these patients come from hospitalizations, ER visits, heart caths, stents, stroke, and progression to dialysis. Optimal medical therapy reduces all that dramatically. Five percent of the patients are generating half the cost. It takes time to establish trusting relationships with patients so that they participate in the treatment planning and execution. Our current fee-for-service system will never make progress with reducing costs in these complicated patients. It incentivizes short, ineffective visits.
Robust analytics make capitation effective. Analytics support the provision of care. They identify patients who are not at goal for their blood pressure, glucose or cholesterol, have not had a visit at all, have not had a visit or test within a six-month window, are not on best-practice OMT medications. Analytics also identify the percentage of patients who are achieving OMT for vascular disease and diabetes at baseline and quarterly. Analytics are also important to document progress from baseline on clinical and financial outcomes. Concurrent control of sugar, pressure, and cholesterol to appropriate goals while stopping smoking in diabetes only happens in about 20% of patients with type 2 diabetes. The benchmark for OMT in these cardiovascular teams is 60% and that is what protects patients from less care. Teams that don’t meet these goals will lose self-insured clients. The entire system must be transparent to work.
Systems to produce OMT. The biggest and most rapid health outcome improveemnts and cost reductions come from the highest-risk, highest cost patients. You will need:
ICD10 codes to identify patients with:
A. Congestive heart failure
B. Heart artery disease
C. Other arterial disease like stroke or leg artery disease.
D. Diabetes complicated by chronic kidney disease
E. Uncomplicated diabetes
Protocols to Produce OMT in each of these conditions A single chronic cardiometabolic team can address all these conditions. The protocols are very similar for each. There are three aggressive risk factor targets and eight interventions. It is like a copilot check list.
Any community large enough to have a critical access hospital could support a team like this and dramatically improve cardiovascular care in your area. Our team has all the elements listed that are needed to support you. Putting this together and keeping it up to date is complicated but implementing it is easlier than what we are doing now. We can have better health at lower cost now! Let us help you get there. wbestermann@congruityhealth.com
We need to see more examples of cardio metabolic care teams with effective compensation models achieving superior clinical, satisfaction, and financial outcomes published in peer reviewed journals and the popular press.
With 21st Century bedside diagnosis tool such as Multifunction Cardiogram Technology, and a distributed individual data network for objective unadulterated data vetting, verification, and validation, to keep everyone honest, we can turn this 270,000 nurses into a force for much better future in a21st Century 💯% evidence based early detection primary and secondary preventive cardiovascular diseases care continuum! Absolutely!