Winning the CV Services Game: Stick to Basics, Know Your Strengths
Plan. Execute. Analyze. Repeat. If you watched the Super Bowl earlier this month, you saw this done in real time over and over again. Coaches call the plays, players execute the plays, then both coaches and players look at the results or decode the other team’s strategy to prepare to repeat it with, hopefully, better outcomes. Often we get so consumed in the planning and execution phases that we spend little time analyzing the results to see how we did and understand how to improve. So, as we gear up for the year ahead, let’s take a brief pause and review what we learned in cardiovascular services over the last 12 months. These learnings will help frame the strategies to move cardiovascular service lines forward in 2015.
“The future ain’t what it used to be.” —Yogi Berra
In 2014 alone, we responded to over 250 questions from our clients on a wide variety of CV topics (depicted in the word cloud above). The most frequent topic was around the Sg2 Impact of Change® forecast, suggesting that the vast majority of organizations are thick into planning, trying to move their cardiovascular service lines forward. To paraphrase hockey great Wayne Gretzky, show me where the puck is going to be, so I can be ready when it comes. This is, from our perspective, the right way to plan and why we spend countless hours building the best forecast in the business. While technology plays a large part in the delivery of high-quality care, you asked us even tougher questions on how to structure your service line for success and taking a more programmatic view of delivering care. As we have said in the past, it is about the program, not the procedure. We will spend more time helping you think through care delivery programmatically in 2015.
Success Is a Marathon, Not a Sprint
The CV community remains on the forefront of data-driven quality initiatives on a large scale, but last year also reminded us to not lose sight of the individual patient. The American College of Cardiology/American Heart Association (ACC/AHA) cholesterol guidelines released at the end of 2013 removed the high-density lipoprotein (HDL) target and recommend focusing on risk factors at the individual patient level to determine the appropriate treatment. In general, risk factor modification, wellness and behavioral changes have been shown to increase the success of many therapies, such as atrial fibrillation (AF) ablations and coronary revascularization procedures, and decrease overall cardiovascular risk as well. This is supported by a Swedish study looking at five modifiable health measures that reduced the risk of a myocardial infarction by 79% if all were followed. Furthermore, the ARREST-AF study showed that AF ablations were more effective in those who participated in an aggressive risk factor modification program—by a lot. Although it was a small study, it highlighted the need for a multipronged approach to treating chronic diseases as well as the idea that supporting the patient through a wellness program may have as much to do with a procedure’s success as the procedure itself.
Similarly, results from the Symplicity HTN-3 Trial, which tested the efficacy of a renal denervation procedure to treat uncontrollable hypertension, reminded us that there is rarely a procedural “cure” that can make up for all of our lifestyle choices. Counter to results from previous, less-rigorous trials, this robust, randomized, sham-controlled trial aimed at obtaining FDA approval showed no difference between the treatment group and the control group. If something looks too good to be true, often times it is.
Build on the Strengths of Your Team
While the tendency is to look at the Results section of the most recent publication of a new therapy, a more critical review of the Methods section may shed light on the potential impact. Yes, a therapy must be safe, efficacious and cost-effective, while improving the quality of care in measurable ways. However, the resources necessary to implement a new therapy or access channel into your service line or organization will determine the value the therapy brings all stakeholders: providers, patients and payers.
As we move into 2015, we see an increased need to carefully consider the “how” in addition to the “why” when assessing new treatments. An example we will explore throughout the year is remote monitoring of patients with chronic diseases such as arrhythmias and heart failure. Managing the data influx with appropriate infrastructure and staffing will be critical to turning this new information stream into treatment changes that have the potential to proactively manage deteriorations in patient status and, ultimately, readmissions. More research will be needed to support what metrics are meaningful, what technologies are cost-effective and what resource intensity is needed.
Don’t Rely on the Hail Mary; Perfect the Short Game
I hope you are as ready as we are to take what we learned over the past year and work on the “how” to create high-quality cardiovascular service offerings. Most often this means continuing what you are doing, but do it better. Dr Clyde Yancy from Northwestern Memorial Hospital in Chicago reminds us to “improve the process of care, don’t get distracted with the many new things.”
Here are four steps you can do today to help focus your 2015 planning:
- Expand your use of advanced growth metrics to guide the execution of your cardiovascular service line strategies. Important metrics for the CV service line to consider are avoidable ED visits, network leakage, evidence-based screening volumes and growth rate.
- Increase your organization’s participation in CV registries, and research projects to generate meaningful data that will inform future improvements.
- Focus on a System of CARE approach to building a successful program, leveraging channels, partners, innovations and techniques that can help improve patients’ quality of life.
- Reduce variability in care delivery, such as cost, quality and procedure choice, to improve quality. Potential areas of focus for the CV service line may include standardizing protocols and implementing guideline-based treatment algorithms for the care of chronic conditions like heart failure, angina and atrial fibrillation.
Edward Winslow, MD, FACP, FACC, FAHA, Sg2 Associate Vice President, contributed to this post.