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Another Voice: Collaborating with cardiologists to improve care, lower costs

By Thomas J. Foels

In his Buffalo News Sunday Viewpoints column on Oct. 7, Larry Zielinski focused on the benefits of evolving from fee-for-service to value-based care.

Independent Health has long believed partnering with primary care physicians and specialists to establish and implement value-based care models is an effective way to achieve the triple aim of better health, better care and lower costs.

As one example, we have had great success over the past several years bringing high-performing primary care physicians together with select cardiologists, resulting in improved performance, higher quality care and reduced spending by the Western New York cardiology community.

Cardiovascular disease is the leading cause of death in the U.S. The Centers for Disease Control and Prevention estimates cardiovascular disease costs the U.S. nearly $1 billion per day in medical costs and lost productivity. Cardiology services also represent one of the highest shares of specialty physician spending in the U.S., due in large part to overutilization and variation of care.

To examine issues related to cardiology referrals and in collaboration with our referring primary care physicians, we reached out to several forward-thinking cardiology groups to participate in a multiyear effort to decrease variation in cardiology services and move toward consistency in adhering to evidence-based medicine.

The engagement began with the formation of an advisory board of community cardiologists. It included the development of agreed-upon measurement criteria; the sharing of blinded, practice-specific data and quality measures so each practice could better understand their performance against their peers; and constructive discussions between cardiologists and referring physicians on ways to collectively improve care.

Studying the participating cardiologists’ practice patterns uncovered some of the reasons for the variations in care, i.e. the excessive use of diagnostic testing and the use of brand-name drugs instead of generics.

Cardiologists, in turn, engaged with the primary care physicians, creating first-line treatment guidelines to help them more effectively evaluate their patients’ cardiac needs, and to identify a number of other ways to improve their treatment plans and care coordination.

The collaboration and improved working relationship helped increase efficiency and resulted in impressive performance reports from 2013 to 2015, including:

  • A significant reduction in the variation of care and closer adherence to evidence-based medicine
  • A 3.5 percent aggregate cost decrease over the two-year period (compared to previous annual trend increases of 12 to 22 percent prior to the engagement)
  • Improved patient satisfaction

Measurement criteria for 2016-2017 have shown similar results and patients continue to benefit as the primary care physicians and their cardiology partners strive to coordinate care in a manner that is both more patient-centric and evidence-based.

Thomas J. Foels, M.D., is executive vice president and chief medical officer of Independent Health.

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