We were recently asked to explain our delivery model for population health management. Most population management efforts fail to reduce cost because they don’t target the appropriate high-risk, high-cost patients. These are people with multiple but relatively manageable chronic diseases who are in the top 5% of costs and those who could end up there in the coming years if their medical problems worsen and their health deteriorates. We support provision of the optimal medical therapy (OMT) product for these patients with cardiometabolic disease.
OMT is proven to reduce mortality and cost after a heart attack compared with usual care. OMT does not just reduce cardiovascular mortality. It reduces all-cause mortality. Because of this evidence, OMT first is the new universal standard of care for stable coronary artery disease in the latest American College of Cardiology guidelines. The benefits are similar in patients with type 2 diabetes. Patients with that condition on OMT have one fourth as many heart attacks, one fifth as many strokes, and one sixth as many progress to dialysis. OMT reduces congestive heart failure hospitalization by 70%. Patients on OMT live eight years longer and diabetic complications are delayed by eight years. We can prolong healthier life now! Twenty-one years of follow-up in this diabetes study provides the proof!
We support practices and payers with data and analytics, new systems, disease management, consulting company, education, and stakeholder aggregation in their efforts to consistently produce OMT.
Our Comprehensive Production Solution
Data and analytics platform
§ Clinical analytics
o Identify high-risk, high-cost candidates for OMT from TPA claims
o Population health tools to identify members who have never been seen, are not at goal, or who have not had a test or visit within a specified window
o Triggers to close gaps in care
Baseline and quarterly
§ Risk factor control rates and average values
§ % OMT achievement for diabetes and artery disease
§ ER and hospital visits with duration of stay
§ Hard outcomes like death, stroke, heart attack, and dialysis
Financial analytics
o Baseline and quarterly total cost of care and cost of care by condition
o Cost of care by type of service
o Healthcare cost trends
OMT support
§ Identify Patients with the high-risk, high cost cardiometabolic conditions
§ Integrated protocols to treat these patients
Systems support
o Assist organizations in advanced medical home team formation
o Cardiometabolic disease updates
o Cardiometabolic education with CME for these team members including case managers and nurse navigators
Stakeholder aggregation and collaboration
§ Telehealth partner
§ OMT coaching partner
§ Worksite clinic partner
§ CCM partner
§ Provider Organizations
§ Self-insured Employers
All these elements are essential. Producing OMT consistently requires integration of new science, new systems, and new payment models. Progress to improve health and reduce cost requires a comprehensive solution that brings these elements together and collaboration with stakeholders to produce OMT consistently. Don’t try to reinvent the wheel. Let us help. Bring OMT to your community. 423-782-0372
Every employer sponsoring and financing a health plan on behalf of their employees must now comply with a new fiduciary standard which requires that they document how and why they contract for services on behalf of plan beneficiaries and that they do so prudently. To comply, employers must know their spend, outcomes and utilization and must bring appropriate supply side resources and best practice strategies to the plan. Simply stated, OMT is best practice for the huge cardio metabolic category and employers must contract supply side solutions that integrate OMT into their care paths potentially guaranteeing predictable outcomes. This has high value to employers now.