COPD Stakeholder Summit: Utilizing Peak Inspiratory Flow Rates to Individualize Treatment and Improve Outcomes - Episode 12
An overview of COPD management programs available and offered by payers to members to help support patient adherence to chronic obstructive pulmonary disease therapies.
Neil Minkoff, MD: What are the management programs you are supporting for COPD [chronic obstructive pulmonary disease]? I would also like Mr Hess to weigh in on how there’s an interaction between long-term follow-up, pulmonary rehab, and coordination of benefits.
Maria Lopes, MD, MS: Absolutely. I think we start with smoking cessation and offer smoking cessation at zero-dollar cost share. I think this is heavily underutilized. Many patients may not even recognize that they have COPD, so focus on early screening. Probably half of patients may be smokers and don’t even realize they have COPD as well, so focus on risk stratification, which starts with identification, smoking cessation, and patient support. Then we get to the appropriate treatments, and I think there is still a big opportunity to educate even clinicians. Many patients don’t have the benefit of seeing respiratory therapists and pulmonologists, so how do we do more in terms of those practices with very busy practitioners? And finally, there’s the care management side, so how do we do more in terms of understanding some of these early signs that patients may not be doing well in terms of technique, adherence, and overcoming some of the clinical inertia around clinical adherence?
We have [emergency department] and hospitalization data, but if we’re successful with what we’re saying, it’s really about preventing those events. So how can we incorporate some of these predictive analytics that help with better care and the delivery of that care? I totally agree with the shared decision support and patient engagement, maybe even having some predictors of nonadherence to the extent we can, as well as patient motivation and dealing with the cognitive dysfunction Dr Mahler highlighted. Some of these patients also have depression, so their ability to engage may be lessened unless we address the mental health component as well—so thinking holistically.
From a payer perspective, we’re also thinking about how we can screen for things like cancer, such as with high resolution CT. How do we ensure patients get the appropriate immunizations, including flu vaccination and pneumococcal vaccines? And how do we do more, particularly around transitions in care, to stop the next admission and hospitalization?
Michael Hess, MPH, RRT, RPFT: It’s hard to build on any of that. Dr Lopes, you hit it right on the head. Care coordination is absolutely essential. In the system we have, we really need a COPD navigator-type of person. We need somebody who can be the lead coordinator for a lot of these things. Our most fortunate patients may have a primary care provider, a pulmonologist, a pulmonary rehab facility, and a mental health specialist, so you’re looking at 4 different specialists there who may be on different EMRs [electronic medical record systems], have different recordkeeping practices, and aren’t always in close communication with each other. If we have somebody who can be outside of that bubble a little bit, steering the ship and making sure everybody is on the same page, that’s where we’re going to see the greatest benefit in trying to keep people healthy.
This activity is supported by an educational grant from Boehringer Ingelheim.