Improving Coverage and Multidisciplinary Care Delivery for MASH

The hepatologist examined the challenge of identifying patients most likely to benefit from MASH therapies, noting that the high prevalence of metabolic comorbidities — including type 2 diabetes, chronic kidney disease (CKD), and obstructive sleep apnea — in younger patient populations raises unresolved questions about when to initiate therapy and for how long, and that layering artificial intelligence (AI)-driven data analytics over EHR systems to proactively identify high-risk patients represents a promising but as-yet unrealized opportunity for health systems. Dr. Behari outlined a multi-step framework for system-wide transformation of MASH care, beginning with broader integration of the FIB-4 Index into EHR workflows to prevent unnecessary subspecialty referrals, expanding access to transient elastography and blood-based biomarker panels such as the Enhanced Liver Fibrosis (ELF) panel — for which insurance coverage remains inconsistent — and deploying AI-based clinical decision support tools to help primary care physicians and subspecialists identify, risk-stratify, and triage MASH patients more efficiently. He also emphasized that sustainable multidisciplinary MASH care must be grounded in a metabolic medicine framework that prioritizes lifestyle modification and nutritional support as a first-line intervention before pharmacotherapy, lowers barriers to high-quality lifestyle counseling through greater insurer support, and targets patients with early-stage metabolic organ dysfunction to prevent costly downstream complications across the cardiorenal metabolic (CKM) spectrum.

Throughout the conversation, the expert provided a comprehensive reflection on the field and the factors that may shape how clinicians approach care moving forward.

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