Hardly a day passes without hearing some drug company or medical system tell you how their product is the answer to your problems. “We have the best cardiology care. We are here for you. We provide the best quality healthcare for you.” Most of it is just talk!
We all know what the walk is. The National Academy of Medicine (NAM) spelled it out over two decades ago. The NAM was founded by congress to advise government and major institutions on healthcare matters. NAM members are the best and brightest in medicine and they did not sugarcoat it when they wrote about our healthcare system in 2001. Here is their stinging indictment: “Americans should be able to count on receiving care that meets their needs and is based on the best scientific knowledge. Yet there is strong evidence that this frequently is not the case. Crucial reports from disciplined review bodies document the scale and gravity of the problems. Quality problems are everywhere, affecting many patients. Between the health care we have and the care we could have lies not just a gap, but a chasm.” I have read that book cover to cover. My copy is extensively dog eared and highlighted. It is a comprehensive roadmap to improvement, and it makes complete sense. Despite this excellent guidance, nothing has changed, and the very same comments could be made today.
The NAM described a system that is focused on acute episodes of care rather than managing chronic diseases to keep us healthy and avoid acute episodes. If you have a heart attack or stroke, we are the greatest in the world at rescuing you. Think about it. We have the ability to open arteries with stents and bypasses, implant automatic defibrillators, put in pacemakers, and the like. Rescuing people late in the disease process is not the path to better health at lower cost. Late intervention is not the walk.
Chronic diseases cause most premature death, disability, and they generate 86% of healthcare costs. Since the NAM report, we have learned a great deal about keeping you healthier longer by more effectively addressing chronic conditions. Now we know that excess oxidant production and the resultant inflammation kill the functional cells in our organs, stimulate replacement of those cells with scar tissue, gradually reduce organ function and eventually kill us. We know precisely how to interfere with those processes to protect cells and organs. Since the report, we have much more evidence that optimal medical therapy (OMT) does just that. Patients with diabetes on OMT have one fourth as many heart attacks and one fifth as many strokes compared with usual care. Patients who have had a heart attack on OMT are ten times as likely to be alive and we have been working with a worksite clinic for five years to replicate those results. Patients seen in the clinic cost half as much and they are hospitalized one fifth as often as patients seen in the broader community. Those outcomes suggest the research results can be replicated in the community.
The NAM report states that stakeholders must work together to improve chronic disease management. I have been working with Justin Davis, the CEO at Congruity health for three years. He has deep experience and expertise in health care finance and information technology. There are many organizations that can analyze your employer’s healthcare costs to tell them where the problems are. We take the next step and solve those problems. Together we have worked for three years to develop the systems to support your organization in consistently providing OMT for patients with chronic diseases like diabetes, chronic kidney disease, and heart artery disease. We have worked together to collaborate with other stakeholders including Convergence Health, TruLife Care, Patient Pal, Health Direct Partners, and others. These point solutions can all come to your employer under a single contract. Taking these collaborators all together, they can provide all of the services that a large health insurance can more effectively and less expensively. They are all mission driven with a common goal of better chronic disease management at lower cost.
The NAM also identified 15 priority conditions to focus on. We are aiming our efforts at the priority conditions high blood pressure, high cholesterol, diabetes, heart artery disease, and stroke. They recommended adoption of “evidence-based care processes consistent with best practices”. That is the basis of our optimal medical therapy. We identify the high-risk high-cost patients, we have nurse coaches to develop long-term trusting relationships, we identify gaps in care for the coaches to close, we train clinicians in OMT delivery, we measure clinical and financial performance at baseline and quarterly and we provide coaching to achieve further improvements. It is systematized and automated to the extent possible and all of it is supported by AI.
The NAM has published a comprehensive plan to give us better health at lower cost. Research and our experience show what their recommendations can do, and we are already working with other stakeholders to get it done. Of course, there is more than I can relate to you in two pages. There are recommendations for patient education, clinician education, and IT support. We have addressed it all and we have already begun to deliver the massive benefits to real communities. Everything we do is totally transparent, and clients have a dashboard where they can see their data as soon as claims are adjudicated. Here is the website for Congruity Health where I am working with Justin Davis. Based on real data on real patients in the community, we are saving $5000 per patient per year and delivering a 5x ROI. We have developed an ROI calculator and you can easily determine your potential savings by entering your data.
The NAM wrote Crossing the Quality Chasm 23 years ago. OMT was just beginning. Combining these ideas leads to much better clinical and financial outcomes. Join us in walking the walk! It is time to do a better job of managing chronic disease.
This is awesome news!!!!
So why didn’t we listen??? “We all know what the walk is. The National Academy of Medicine (NAM) spelled it out over two decades ago. The NAM was founded by congress to advise government and major institutions on healthcare matters. NAM members are the best and brightest in medicine and they did not sugarcoat it when they wrote about our healthcare system in 2001. “ we failed to listen to our own advice