Population Health Management Strategies for Cardiorenal Metabolic Syndrome


Om P. Ganda, MD, discusses population health-management tactics to improve patient outcomes in cardiorenal metabolic syndrome.

Neil Minkoff, MD: Dr Ganda, I have a similar question for you because we’re going to ask Yale and Harvard about it. What’s going on in your institutions? I know you formed an alliance with Beth Israel Deaconess [Medical Center] recently. There are a lot of resources there. When you’re looking at these patients, what are things that your network or hospital system can do to help you manage these patients, reduce their time on the hospital, reduce their admission rates, etc—whether it’s tracking services or getting the recalcitration into the clinic more frequently, or whatever it might be?

Om P. Ganda, MD: We’re very fortunate to have a large cardiology group with our partners at Beth Israel Deaconess, and now the group is going to become even larger with the Lahey Health System hopefully being part of this soon. We started a clinic called the Cardiometabolic Clinic. This is in conjunction with the advanced heart failure clinic at Beth Israel Deaconess. That initially excited us. The cardiologists go on to deal with patients with complicated diabetes, multiple insulin injections, and more, so there’s a strict advantage to both of us. We don’t argue with the cardiac procedure. We don’t know anything about LVAD [left ventricular assist device], for example.

I’ve been seeing those complicated patients in that clinic, along with my colleagues, so we’re in the middle of that collaboration, but we want to expand it. We need to expand this to include people with much more advanced kidney disease so we can all be on the same page and look at the data together. We start with heart failure and then go on to other cardiovascular [diseases]. We talk about how to transition patients and discharge. It’s not a good idea to start them while they’re in the hospital with SGLT2 inhibitors for the reasons we’ve mentioned before, but right after the discharge, we should be seeing them again soon and working with the primary care physician.

Much of the problem is a lack of coherence in the education with the primary care physician because there’s so much to deal with. Look at the most recent data from health care payers—they looked at half a million people in the paper just published in Diabetes Care a few months ago—where they looked at commercially insured patients and Medicare-insured patients. In 1 group, the use of these new agents was less than 1%, but those in the commercial group obviously had a better coverage than those in the Medicare group. Why should that be the case? It’s baffling when you see those data. Hopefully it improves. It included data from 2019 only if I recall correctly, which is decent. They did find that people with cardiovascular disease had a greater uptake of these agents, which was covered in Medicare as well as commercial, but it’s far below what it should be as we discussed.

Neil Minkoff, MD: I haven’t seen those data. My educated guessis that there’s so much emphasis on older adults using generic as a way of trying to curtail health care cost, covering any semblance of their drugs. There’s always been such a proponent to generics in Medicare as a potential opportunity for clinician education and patient education. You might pay more of a co-pay, but if you avoid hospitalization, you’re still ahead of the game, purely on that risk-benefit analysis before we get to value-based care and potentially assigning co-payer cost share levels based on value rather than on direct cost of the drug.

Transcript edited for clarity.

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