Kenneth Cohen, MD

Within the same physician groups, 2-sided risk in Medicare Advantage (MA) was associated with higher quality and lower utilization for dually eligible beneficiaries compared with fee-for-service MA and traditional Medicare.

Experts agree that developing value-based care models for atrial fibrillation requires collaborative, data-driven strategies—leveraging clinical pharmacists for personalized medication management and prioritizing stroke prevention and rhythm control—while embracing innovation and workforce redesign to balance quality, cost-effectiveness, and avoid overdiagnosis in an evolving health care landscape.

Experts highlight that applying value-based payment models to atrial fibrillation care requires flexible, team-based approaches focused on reducing hospitalizations, repeat procedures, and stroke, with cardiology groups—supported by pharmacists managing complex therapies—best positioned to deliver comprehensive, quality-driven care that addresses both AFib and its cardiometabolic comorbidities.

Experts note that implantable loop recorders are valuable for detecting infrequent arrhythmias and guiding anticoagulation decisions post-cryptogenic stroke or atrial fibrillation ablation, but due to high costs and limited cost-effectiveness, their use should follow initial short-term monitoring and be tailored to individual patient risk, with ongoing research needed to optimize clinical and economic outcomes.

Experts highlight that while universal screening for subclinical atrial fibrillation remains unsupported by current evidence, targeted screening of high-risk populations using data-driven approaches, combined with proactive management of cardiometabolic risk factors, offers a promising path to improve outcomes and optimize resource use.

Experts emphasize that remote patient monitoring (RPM) is most effective when supported by structured care teams and workflows, with artificial intelligence–enabled tools helping to interpret data and guide timely interventions—making RPM a vital component of personalized, proactive arrhythmia management.

Experts highlight that well-integrated electronic health records and wearable devices can enhance diagnostic accuracy and patient engagement in arrhythmia care, while emphasizing the importance of combining technology with comprehensive clinical evaluation to guide efficient, personalized testing.

Experts discuss how choosing the right cardiac rhythm monitor involves balancing symptom frequency, patient risk, and device capabilities to ensure efficient, cost-effective, and patient-centered diagnosis while avoiding unnecessary testing.

Experts discuss how arrhythmia evaluation is tailored based on symptom frequency, severity, and patient risk, using a stepwise approach from short-term to extended monitoring to guide timely and effective diagnosis and management.

Experts discuss how rising arrhythmia burdens and workforce challenges are driving a shift toward team-based care, smarter diagnostics, and artificial intelligence–driven risk stratification to improve outcomes and efficiency.

Experts discuss the persistent clinical and systemic challenges in diagnosing and treating atrial fibrillation, emphasizing the need for earlier identification—especially in high-risk, comorbid populations—while highlighting the limitations of current risk models, the complexity of managing atrial fibrillation burden, and the importance of integrating wearable data into precision-based care without overburdening clinicians or compromising clinical relevance.

Experts discuss the multifaceted management of atrial fibrillation, stressing the importance of addressing comorbid conditions alongside the arrhythmia itself, while highlighting the challenges of underdiagnosis, the rise of subclinical cases detected through wearable technology, and the need to align emerging diagnostic tools with evidence-based care to avoid unnecessary interventions and optimize outcomes.

Experts discuss the complex clinical and economic challenges of atrial fibrillation, emphasizing the need for personalized care that balances symptom management, stroke prevention, and risk factor control—while recent evidence on subclinical atrial fibrillation highlights the limitations of widespread anticoagulation, reinforcing the importance of targeted, value-based strategies for optimal outcomes.

Experts discuss the growing role of early detection and predictive strategies in managing arrhythmias—particularly atrial fibrillation—highlighting the impact of wearable technology, challenges in diagnosis due to intermittent symptoms, and the shift toward more personalized, value-based care driven by timely evaluation and evidence-based interventions.

In 2025, each issue of Population Health, Equity & Outcomes will feature a profile of a health system leader transforming care in their area of expertise. This issue spotlights a conversation with Ken Cohen, MD, executive director of translational research at Optum Health.

Physician groups under 2-sided risk–based Medicare Advantage provide care associated with higher quality and efficiency compared with care by these same groups under fee-for-service Medicare.

Medicare beneficiaries treated by physicians with high levels of Medicare Advantage risk exposure had higher care quality and efficiency outcomes compared with those treated by other physicians.

Analysis of more than 16 million visits for hypertension care suggests that a large fraction of face-to-face care is low value and could be provided differently or potentially eliminated.

One-third of health care in the United States is wasted. Despite this recognition, solutions are sparse. The Optimal Care model combines evidence-based medicine, patient-centered technology, and outcomes reporting to transform health care.