Healthcare 2019, continued from page 17
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organ Chase announce their plans to form an independent healthcare company for their employees, and a number of other large employers have begun exploring population health management projects, as well. In addition, Dashiff continued, “The more sophisticated players in employersponsored healthcare are doing more holistic things like narrow network management in connection with their approach. I believe this is an area where you’re going to see employer-sponsored healthcare evolve rapidly over the next several years and emerge as one of the more disruptive things that has happened to healthcare service delivery in a very long time. Not surprisingly, it will be another area of disruption that has been around a long time but simply had its model of care evolve.” He added, “As this all plays out, it won’t be at all surprising if you see similar models that address the commercial population, address the Medicare population, the Medicaid population. That’s not happening overnight, but the self-insured employer marketplace is happening now, and it’s pretty exciting.”
The Upside of Upheaval
“There continues to be a lot of areas in healthcare that have taken their licks over the years but are ubiquitous,” said Dashiff. Diagnostic imaging is an example where reimbursements took a pretty significant hit for several years. “That being said, imaging as a diagnostic modality is
Resolve to Address Obesity, continued from page 13 Garvey said medications are not as rigorously prescribed for obesity as for other chronic conditions. He said he believes there is both a bias that obesity is a lifestyle choice rather than a disease and lingering negative perceptions surrounding older pharmaceutical treatments. “Some healthcare professionals have this memory from the past that obesity medications are harmful so there is a legacy perception.” However, liraglutide and phentermine/topiramate have been shown to be effective in managing weight loss and preventing progress to diabetes.
Better News: Risk Stratification
Drawing from our past Innovating for the future
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18 • JANUARY 2019
Birmingham Medical News
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not going away. In fact, it’s a critical path area for effective and efficient care,” he pointed out. Dashiff added there isn’t much left to be taken away at this point so those reimbursement headwinds that battered the sector have faded. He continued, “What you have left is a universe where the really good management teams figured out how to survive and come out on the other side. They figured out interesting strategies and are now at a point where they can grow with the market from a trend standpoint … and if they have the right strategy, they can grow market share.” That lean, mean model has become interesting to private equity firms looking for value. Dashiff said transactions are once again happening in areas like diagnostics and infusion that have weathered the storm. While change comes slowly … and sometimes painfully … in healthcare, Dashiff and Walker both pointed to very real signs of transformation and a growing willingness by industry stakeholders to innovate and rethink the business model to create a more efficient, more intuitive delivery system with a greater emphasis on wellness, early intervention and smarter disease management. “I think it’s a very exciting time in the industry both as a professional and as a patient,” said Walker. “The industry has just needed this efficiency for so long, and the innovation that’s taking place using best practices from other industries is creating new success stories across the healthcare continuum.”
“We’re not using our tools. One reason is the at-risk pool is so huge it becomes daunting,” said Garvey of aggressively treating nearly 40 percent of the adult population. However, he continued, “We can risk stratify these patients. We have a rational way to intervene using effective, evidencebased tools targeted to those at highest risk, which effectively prevents diabetes and improves the benefit-risk ratio and improves cost effectiveness.” Garvey, who also serves as director of the UAB Diabetes Research Center, was part of the team who created Cardiometabolic Disease Staging (CMDS), which looks at obesity in much the same way as other diseases are staged. Someone at ‘0’ is con-
sidered ‘healthy obese’ with no metabolic syndrome traits. On the top end of the scale, someone staged at ‘4’ is considered ‘end-stage cardiometabolic disease.’ Garvey noted, “We’ve developed a way to stage these patients using readily available clinical information.” The staging, he continued, corresponds to American Association of Clinical Endocrinologists (AACE)/American College of Endocrinology (ACE) clinical practice guidelines for comprehensive medical care of patients with obesity (see AACE.com under the publications tab). Garvey, who was lead author of the guidelines, noted using the staging model and guidelines in concert gives providers an evidence-based model for patient care with the tools to know when to treat more aggressively and guidance on modality options and intensity. While scoring puts the focus on patients with progressive disease at highest risk of developing diabetes, Garvey was quick to say providers should discuss healthy lifestyle modifications with obese patients at any stage, noting even those deemed ‘healthy obese’ often have biomechanical complications that could be improved by losing weight. In this season of New Year’s resolutions, it’s a great time for providers to resolve to tackle obesity more aggressively to help those at highest risk of developing complications face the new year with new hope.
Birmingham Medical News January 2019