Optimal Medical Therapy Makes a Difference at a State Level

More Solid Proof that OMT Works

Minnesota has the lowest heart disease death rate of any state in the country. 124 individuals per 100,000 die of heart disease in Minnesota. The highest death rate from heart disease occurs in Oklahoma at 264 per 100,000. That is over twice as many people dying of heart disease depending on what state you live in. Mississippi is next at 255 per 100,000. Then Alabama and Louisiana at 247 and 235 per 100,000 follow close behind. If you look at the county level map, the story is even more impressive. Minnesota still stands out as a beacon of heart health. Even in other states with low heart disease mortality there are counties that really stand out. There is huge variation in heart disease mortality depending on where you live. Some counties have death rates that are 4 times higher than the counties with the lowest number of deaths from heart disease. If you run a healthcare system or provide health insurance for your employees, you have to ask yourself, why are these heart attack death rates so different?

Many of you are involved in businesses where quality matters and you must produce products that met the six-sigma standard in quality. If you are involved in quality improvement, you know that you cannot improve what you don’t measure and that is an important clue. Minnesota is the only state that measures OMT performance at the state level. Doctors are very competitive. If you merely report their performance, that leads to some level of improvement. If you pay them based on their performance, it is even better. To achieve the lowest number of heart disease deaths, you need new systems of care using advanced primary care teams, protocols, and population health tools. For diabetes, OMT is defined by concurrent achievement of five goals in diabetes— blood pressure less than 140/90, on a statin for cholesterol, a hemoglobin A1c less than 8, not smoking, and on an aspirin if high risk. The goals for artery disease are very similar and drop off the hemoglobin A1c which is specific for diabetes.

Even within Minnesota, there is lots of variation in OMT performance. I have seen reports by individual practice where some practices in Minnesota achieve OMT performance in 13% of patients with diabetes and some achieve it in 65 or 70% of patients. I have coached practices that have achieved 65% performance. We had several doctors in my last practice that achieved comparable OMT performance. The system produces what it is designed to produce. OMT is a product. If you set up your systems, teams, and protocols to produce that product, you can match what they are doing in Minnesota.

Nationally, diabetes care is terrible. Most practices and health systems don’t measure OMT performance. A national survey showed “the percentage of participants in whom all three targets were simultaneously achieved plateaued after 2010 and was 22.2%.” That is much lower performance on three elements of diabetes care. It doesn’t include smoking cessation and aspirin treatment for appropriate patients.  The latest average performance stats for Minnesota are below. If I am reading the maximums and minimums correctly, some practices in Minnesota are achieving OMT in 7% of patients with diabetes and some are achieving it in 57%. Would you tolerate that level of variation in any other product you buy? Of course not!

You have seen clearly that this is a simple issue. It is a life-or-death issue, and yet Minnesota is the only state that is even measuring achievement of OMT. Most practices and health systems are not measuring it. OMT is available to very few Americans.  Are you a leader in one of those dark purple counties? Are you a leader in a company that provides health insurance for workers? It is not just the county residents and employees that are in the cross hairs. We are all in the same boat. If OMT is not available in your community, you are much more likely to die of a heart attack or a related condition. Your friends and family are at risk too. This is not hard. OMT can be produced in outpatient primary care practices. You can bring OMT to your county at very low cost.

We are a real outlier as a country. Great Britain has been treating patients with OMT for over a decade. They spend half as much and live longer. Singapore has a system based on one stop primary care sites with hypertension, diabetes, and cholesterol teams within them. They live longer for one fourth the money. We work with other stakeholders to make OMT available to your community or employees. That is what I write about on this site. You can have better health at lower cost right now.