Population Health Implications of Cardiorenal Metabolic Syndrome - Episode 12
Neil Minkoff, MD, and Nihar R. Desai, MD, MPH, provide insight into quality measures to incentivize value-based care in cardiorenal metabolic syndrome.
Neil Minkoff, MD: One of the things that we think about on the payer side are the quality measures. There are the HEDIS [Healthcare Effectiveness Data and Information Set] measures, which were originally designed for employers to measure the quality of health plans. Those started with mammogram rates and colon screening rates and moved to A1C rates and some other things. They are now often applied to commercial populations. The clinics are taking care of those commercial populations as an evaluation of quality. Then there are the Stars measures, which are more for the Medicare or Medicare Advantage population and clinics, or at least those who are taking risks on those. There are also some hospital-based measures, and there are some that seem like they would be relevant: percentage of patients with blood pressure control, percentage of patients with A1C control, and admission and readmission rates, especially as Medicare measures them specifically around cardiac diagnoses. I can see plans looking to try to do value-based care, which is to try to reward those entities that show either the best of those levels or the most improvement in some set of those levels. Medicare is already being rather aggressive with reimbursement, but those are generalized measures. Are there things you would recommend that would help to define the value of the care that’s being provided in your clinics beyond basic things like blood pressure, A1C, and admission or readmission rates? How do you think we should measure quality in a clinic like that?
Nihar R. Desai, MD, MPH: Let’s try and measure things that matter to the patients that we are serving. If we take that as the standard, then that will guide us in a couple of different places. One is around end points that matter to patients, like hospitalizations, rates of cardiovascular events, and other things that affect their quality of life. We should be trying to line up a set of quality metrics around best-in-class evidence-based care, so propitious measures that measure what the guidelines codify as best-in-class medical care for a patient with cardiovascular disease, diabetes, metabolic syndrome, or renal dysfunction. We can put forth guidance that endorses the use of SGLT2 [sodium-glucose cotransporter-2] inhibitors and other similar therapies because of the value that they provide to patients. If we want to talk about reimagining the quality measurement enterprise to best align the interests of the patient and the interests of providers, payers, and systems—those that are bearing risk and providing coverage for those patients—then that’s a good framework for what a quality metric program should look like on the cardiometabolic and cardiorenal side of things. Then you’re going to look at total cost and utilization, but that quickly brings you to just how powerful these therapies can be because the effects are not modest or negligible. The effects are quite profound. It can’t be that we get these therapies to pockets or subsets of our populations. We can’t see the kinds of disparities that have emerged and persisted for too long in cardiovascular medicine and other parts of our health care system. This has to mean best care for all patients. Ultimately, that will drive value to the extent of reducing overall utilization because the benefits of these therapies are that dramatic and that important.
Transcript edited for clarity.