This data comes directly from CMS. As you can see at a glance, cardiometabolic conditions are the low hanging fruit for your value initiative. There is a lot here. These diseases are much more common in the Medicare age group than they are in the general adult population. Six of the most common conditions are cardiometabolic. Depression increases the risk of cardiometabolic disease and if you have these conditions you are more likely to be depressed. If you manage patients with cardiometabolic disease, treating depression effectively is important. That makes it sever out of ten related conditions.
Ischemic heart disease, diabetes, chronic kidney disease, congestive heart failure, and stroke are very high-risk, high-cost conditions. Managing hypertension, hyperlipidemia, and diabetes much more effectively improves clinical and financial outcomes in these high-risk conditions. These diseases are all related at the level of epigenetics and molecular biology. Their management should be integrated and coordinated for maximum benefit. The advanced medical home for cardiometabolic disease is the perfect instrument to achieve that goal.
The greatest success comes when these medical home teams integrate new science, new systems, and new payment models. New science in genetics, epigenetics, and molecular biology provides much better understanding of cardiometabolic conditions that leads to much more effective and precise treatment. New systems bring together teams, clinical and financial analytics, population health tools, and protocols to apply the science more consistently. New payment models like capitation support the work. We know what to do. Let’s do it!
They have missed the real white elephant in the room: the metabolic dysfunction, the root cause of the 90% of the cardiovascular diseases, including hypertension, diabetes, cardiovascular disease, and 70% of cancer.