The Updated Case for Optimal Medical Therapy

The American College of Cardiology supports Optimal Medical Therapy (OMT) first                       as the standard of care for stable heart artery disease.

Optimal medical therapy (OMT) is the name healthcare professionals use to describe a systematic approach to treating chronic diseases like heart artery disease or type 2 diabetes. It always involves a protocol or a specific combination of medications and lifestyle measures. These treatments don’t just lower risk factors like high blood pressure or high blood sugar. They reduce oxidant production to protect every cell and organ in the body. They are antioxidants that work to reduce the risk of death, heart attack, and stroke. They are precision medications.

OMT is a product. Getting that product right makes all the difference. If you want to consistently produce that product, it requires the use of consistent systems and protocols. Quality is a systems property. Reducing production errors requires a systematic approach even if you are making hamburgers. If you want a consistent product in Savannah and Seattle, you must use systems and protocols. That makes it possible to replicate and scale your excellent results. Usual care is the care that everyone else receives. It is based on what a very busy clinician remembers from her medical school and continuing education. Usual care is highly variable even between clinicians within the same small practice. You cannot replicate and scale usual care.

Grasping that concept is critical because there is a huge difference in clinical and financial outcomes between OMT and usual care. Consider this slide on patients who had had a heart attack. All the individuals in the OMT group and the usual care group were treated in the Kaiser Permanente system in Colorado. The only difference was how they were treated.

This difference in results is the most impressive I have ever seen. Over 5 years, nearly 10 times as many people died of heart disease if they were receiving usual care. Even more impressive, 10 times as many people died of all causes. That means that OMT reduces the risk of dying from anything over 5 years compared with usual care. The OMT group cost $21,900 less per person per year. A team of nurses and pharmacists delivered the care.

This team-based care is critical. Other approaches make sense but don’t succeed. The protocols and systems get the doctors, nurses, and pharmacists on the same sheet of music. Nurse coaches, case managers, and navigators are all trained in OMT. They have the time to develop trusting relationships with the people they serve and that makes all the difference. That is why Kaiser has a hypertension control rate of 90% compared to 44% nationally.

OMT produces similar results for people with type 2 diabetes and chronic kidney disease. This combination is especially dangerous. Most of these people die of heart attacks and strokes before they go on dialysis. OMT makes all the difference.

Compared with individuals in usual care, people treated by teams using OMT had one fourth as many heart attacks, one fifth as many strokes, and one sixth needed dialysis. They lived eight years longer free of heart attacks and strokes. OMT drastically reduced the number of diabetic complications compared with usual care.

The best news is that advanced primary care teams providing OMT produce these results at very low cost with high levels of individual engagement. Most of the work can be done remotely by helping individuals understand their disease and manage it. The precision medications involved are proven products that are generic and inexpensive.

Weight reduction, caloric restriction, and exercise work by impacting the same molecular biology as these medications. By blocking oxidant production from genes that are inappropriately switched on, this approach protects every cell and organ in the body while slowing the aging process. Best of all, it has been systematized and it can be scaled to protect you, your family, and your members.

Research studies are fine, but the ultimate question is this. Can you replicate the results of these research studies in real world clinical practice? The answer is a resounding yes. I have been working with an advanced primary care team at a worksite clinic located at the Coushatta Casino Resort in southwest Louisiana. The lead physician for Vestra, Dr. Nick Heinen and his 4 nurse practitioners are all well-versed in optimal medical therapy. If you compare patients who are treated in the clinic with those who are treated in the community, their total medical costs are half, they are hospitalized one fifth as often, and they are seen in the ER one third as much. Better care keeps you healthier longer. It produces better health at lower cost and that is what matters.

These findings are so impressive that the American College of Cardiology supports OMT first as the standard of care for stable heart artery disease. Once the diagnosis of heart artery disease is established, OMT is the appropriate treatment. Catheterizations and stents are only appropriate if OMT fails to provide adequate pain relief. OMT is so effective that seventy percent of individuals on this treatment never need a heart catheterization or stent. Here is the crazy part. Despite this mountain of evidence, OMT is not available to most American patients and it is not being taught in our schools for the health professions. Health Direct Partners can bring this most effective treatment to your members.