Digital Innovation and New Drugs Converge to Transform CRM Care

Am J Manag Care. 2025;31(Spec. No. 15):SP1159

Recent years have seen a transformation in the way cardio-renal-metabolic (CRM) conditions are managed, with novel drugs and frameworks helping clinicians address these increasingly common diseases, including heart disease, chronic kidney disease, and obesity.

An Institute for Value-Based Medicine^® event held in New Haven, Connecticut, on October 30, 2025, brought together a diverse group of specialists to explore how novel therapeutics and digital tools must align to transform the health care delivery model from a siloed, fee-for-service structure to one that is multidisciplinary and value based.

Proactive Management of CRM Risk Factors

The opening session, “The Cardiologist’s Perspective on CV Prevention and Risk Reduction,” established that organ dysfunction in the heart, kidneys, and brain does not follow a linear path. These conditions often develop concurrently, and cardiologists can play a key role in identifying at-risk patients early and altering their trajectories.

Erica Spatz, MD, MHS, associate professor of cardiovascular medicine at the Yale School of Medicine and director of preventive cardiovascular health at the Yale Heart and Vascular Center, discussed the framework of cardiovascular-kidney-metabolic (CKM) syndrome, which is a relatively new framework developed by the American Heart Association.¹ Spatz focused on stage 1—excess or dysfunctional adipose tissue—which she said is the leader of numerous other conditions in the CRM realm.

“The 2 factors that are increasing the most, including in low- and middle-income countries, are obesity and high blood glucose, or insulin resistance,” Spatz said, citing a recently released report on the global burden of disease.² “The tsunami is here in the US, but it is going throughout the world, and we’re going to just see higher and higher rates of cardiovascular disease, HFpEF [heart failure with preserved ejection fraction], and brain and cognitive dysfunction.”

Spatz argued for shifting the focus away from body mass index toward more meaningful metrics such as visceral fat and abdominal waist circumference, which better predict risk. She also highlighted that adipose tissue is not inert; it is an active endocrine organ that releases adipokines, leading to systemic and vascular inflammation, microvascular dysfunction, and conditions including HFpEF.

“We have traditional risk factors—hypertension, hyperlipidemia, diabetes—that lead to diabetes and CKD [chronic kidney disease], but visceral adiposity, in and of itself, is leading to systemic and vascular inflammation, and that’s really fundamental to the atherosclerotic process,” Spatz explained. “When I’m seeing patients, I’m not just thinking about their lipids. I also am thinking about their inflammatory pathway that’s coming together around vascular endothelial dysfunction, as well as endothelial injury and creating that vulnerable plaque that might be leading to myocardial infarctions.”

In discussing the therapeutic landscape, Spatz noted that many studies of glucagon-like peptide 1 (GLP-1) receptor agonists are primed around cardiovascular outcomes. One example is the SELECT trial of semaglutide, which showed a 20% risk reduction in major adverse cardiovascular events vs placebo in patients with or without diabetes.³ She noted the intriguing finding that the curves in the trial began to divide early, suggesting mechanisms beyond simple weight loss.

For clinicians, the key will be helping patients understand their long-term risk and how overall health, including weight management, impacts long-term risk.

From the nephrologist’s perspective, the CKM framework brings kidney health out of the background and into focus, said Jeffrey Turner, MD, clinical chief in the Section of Nephrology at Yale School of Medicine and codirector of the Yale Medicine Nephrology Hypertension Clinic. He addressed the staggering prevalence of chronic kidney disease (CKD), which places a significant financial burden on the health care system, especially when patients progress to end-stage kidney disease (ESKD).

“Sometimes, what we call success is just delaying dialysis for 5 years, 10 years, what have you,” Turner said. “It’s a huge success, and it can really relay a number of cost savings to the health care system.”

Turner outlined the historical lack of effective therapies beyond angiotensin-converting enzyme inhibitors and angiotensin receptor blockers for more than 20 years, before highlighting the game changers that have emerged recently. He emphasized the transformative role of sodium-glucose cotransporter 2 (SGLT2) inhibitors and nonsteroidal mineralocorticoid receptor antagonists such as finerenone, which have been shown to slow CKD progression and lower cardiovascular risk.^4,5 He also echoed Spatz’s sentiment that GLP-1 agonists are gaining momentum, noting that sequencing in the new therapy landscape will be an ongoing consideration.

Even with new therapies emerging, Turner emphasized the importance of counseling patients on lifestyle factors that can make a difference in overall health, such as healthy eating, exercise, and abstaining from smoking.

Jorge Moreno, MD, an assistant professor of medicine at Yale School of Medicine and a practicing internist specializing in obesity medicine, provided an overview of the management of obesity and its associated metabolic complications.

Moreno reframed obesity as a matter of biology, not simply willpower, citing the body’s neurological defense mechanisms that fight to return to a set fat mass after weight loss.

“We should recognize it as [the] disease that it is,” Moreno said. “It is chronic, it is relapsing, it is progressive, and at the core is really adiposity.… It’s really contributing to the obesity and the dysregulation of the set point, which is really what this is about.”

Individualized, multicomponent management including lifestyle interventions, pharmacotherapy (specifically GLP-1 receptor agonists), and bariatric surgery—which he noted has the longest track record of success—is key to optimizing outcomes. However, the role of GLP-1 agonists continues to grow and has changed the game for obesity management, he explained.

Moreno also highlighted the crucial role of the internist as a coordinator of care and an advocate for the patient, emphasizing the power of validating a patient’s lived experience. Explaining to patients that obesity is a matter of biology and not necessarily willpower can help get patients more engaged in a multifaceted care plan with set goals.

Barriers to Optimal CKM Management

A panel discussion moderated by Nihar Desai, MD, MPH, shifted the focus from clinical science to the structural impediments within the health care system. Desai is an associate professor of medicine, vice chief of the Section of Cardiovascular Medicine, and executive director for Bundled Payments and Clinical Service Line Operations, Yale New Haven Health System.

Panelists included the following:

• Silvio Inzucchi, MD, professor of medicine (endocrinology), director of the Yale Medicine Diabetes Center, and clinical director of the Section of Endocrinology
• Aldo Peixoto, MD, medical director at Regeneron Pharmaceuticals, Inc, and former professor emeritus of medicine at Yale School of Medicine
• Tariq Ahmad, MD, MPH, chief of heart failure, Yale Section of Cardiovascular Medicine

“The new model—I don’t think it’s that new, actually, but I think it’s super important that it brings the simultaneity of all this that's happening,” Peixoto said. “That is the main contribution of this framework.” He noted that a major issue is the need to address high blood pressure.

Ahmad explained that if risk factors for heart failure and ESKD are addressed early, these largely preventable conditions will become less common.

“I think the issue with American medicine is that…we all should start thinking of ourselves as primary care doctors,” Ahmad said. “Everyone has a responsibility, and if we do our job right, I think we can wipe out all of heart failure in 10 or 20 years. The vast majority of heart failure is preventable, and you all have come up with the therapies that can allow that to happen, along with diet and exercise and things that people have known for thousands of years.”

Inzucchi highlighted the burden of polypharmacy, especially now with GLP-1 agonists growing in popularity. Collaboration among providers is a must to help mitigate this burden, he said. Improving electronic health records (EHRs) is one way to improve coordination.

“An all-hands-on-deck approach is important.… Anybody who touches this patient, whether it’s a cardiologist or a nephrologist or a primary care or an endocrinologist, should have a pact that we will focus on cardiovascular risk reduction. And none of us are perfect; I’ll tweak your statin, you can tweak my GLP-1. It’s OK, and [we’re] not getting insulted by that.”

Desai challenged the audience to consider the incompatibility of advanced CKM science with current payment structures. He wondered, “I can’t help but think about transactional, fee-for-service financing models for health care: Doesn’t that fully conspire against what is needed and what patients want, what they deserve?” Although there are significant challenges to overcome, he championed the use of population health models to better align incentives around the prevention of CKM syndrome.

Digital Health and the Future of Medical Informatics

Allen Hsiao, MD, chief health information officer at the Yale School of Medicine and Yale New Haven Health System, focused on the potential for digital health to solve the systemic and informational challenges of CRM care. He outlined the dual problem facing modern clinicians: the complexity of multidisciplinary care, which can involve a patient seeing more than a dozen providers, and the explosion of medical knowledge.

The health care space nowadays brings information overload, Hsiao said, with each specialty seeing new research and guidelines at an unprecedented rate. Large language models and other artificial intelligence (AI) tools can be part of the solution to this information overload, with 1 example being Yale’s ongoing work to deploy tools that can chat with the EHR and summarize hundreds of notes to pull out relevant CRM information. He also touched on “ambient intelligence,” in which AI quietly listens to a patient-physician conversation, generates the note, and even drafts orders—allowing the doctor to focus on the patient interaction.

“If you told me 3 years ago that AI could do this today, I’d be like, ‘That’s science fiction,’” Hsiao said. “But it’s actually here and being used by 1200 doctors daily. I think we’re almost at a million notes at Yale—and that’s just what we’re doing today.” In the future, AI may even be able to help with pending prescription orders based on patient-doctor conversations, he explained.

The final panel built upon Hsiao’s vision, focusing on clinical decision support (CDS). Ralph J. Riello III, PharmD, BCPS, assistant professor adjunct (nephrology) at Yale School of Medicine, clinical pharmacy specialist, and member of the Clinical & Translational Research Accelerator (CTRA), moderated the panel, which included the following:

• Bashar Kadhim, MD, MHS, MPH, director of clinical informatics and clinical informatics specialist, Yale University School of Medicine, and attending physician, internal medicine, Yale New Haven Health System
• Rohan Khera, MD, MS, cardiologist and data scientist and clinical director of the Center for Health Informatics and Analytics at the Yale Center for Outcomes Research and Evaluation
• F. Perry Wilson, MD, MSCE, associate professor of medicine (nephrology) and public health (chronic disease epidemiology), and director, CTRA

“For us, some of the crux of what has been discussed tonight is that there’s this incoming tidal wave of cardio-renal-metabolic patients hitting our health system, and the only way we can meet the demands of their care to provide guideline-concordant, evidence-based medicine for these patients with a human touch is finding a way for AI health informatics to close those gaps for us and improve our efficiency,” Riello said.

Kadhim encouraged careful consideration when it comes to AI, noting that it is important to utilize the appropriate tool for the task at hand and allocate resources appropriately. Therefore, understanding the problem at hand is the crucial first step.

“I believe the future will hold more of what we call agentic AI,” Kadhim said. “There is an AI with multiple agents, and each agent is designed to do a specific task, and then that different task will be provided to the main agent that will summarize individual information. There will be a lot of optimization around that in the foreseeable future.”

With the advent of digital tools for notetaking and information sharing, the patient interaction was minimized, Khera said. In the days of writing notes on paper, the information was not as shareable, but doctors were able to talk to patients more. AI can alleviate some of the burdens on doctors, beyond consulting with patients, allowing them to do more for their patients, Khera explained.

The panelists closed in agreement that optimizing and scaling technology solutions is key in the evolving world of medicine, but it will require overcoming systemic barriers.

“Giving some more autonomy to patients about their data and the use thereof, more universal forms of consent, and embracing alternative study designs that can scale relatively quickly and answer questions relatively fast” would be Wilson’s choices if he could snap his fingers and spark immediate change, he said, “even if they require some reframing of the standard methods that we provide; and completely revamping the payment system for medicine in the United States.”

Author Information: Ms McNulty is an employee of MJH Life Sciences^®, the parent company of the publisher of Population Health, Equity & Outcomes.

REFERENCES

1. Ndumele CE, Rangaswami J, Chow SL, et al. Cardiovascular-kidney-metabolic health: a presidential advisory from the American Heart Association. Circulation. 2023;148(20):1606-1635. doi:10.1161/CIR.0000000000001184

2. GBD 2023 Cardiovascular Disease Collaborators. Global, regional, and national burden of cardiovascular diseases and risk factors in 204 countries and territories, 1990-2023. J Am Coll Cardiol. Published online September 24, 2025. doi:10.1016/j.jacc.2025.08.015

3. Lincoff AM, Brown-Frandsen K, Colhoun HM, et al. Semaglutide and cardiovascular outcomes in obesity without diabetes. N Engl J Med. 2023;389(24):2221-2232. doi:10.1056/NEJMoa2307563

4. Perkovic V, Jardine MJ, Neal B, et al. Canagliflozin and renal outcomes in type 2 diabetes and nephropathy. N Engl J Med. 2019;380(24):2295-2306. doi:10.1056/NEJMoa1811744

5. Bakris GL, Agarwal R, Anker SD, et al. Effect of finerenone on chronic kidney disease outcomes in type 2 diabetes. N Engl J Med. 2020;383(23):2219-2229. doi:10.1056/NEJMoa2025845