BIG news this morning from the ACC. After learning some lessons from our pilot program IC³, the ACC is launching the first-ever registry-based network for cardiology practices, called the PINNACLE Network. Its goal is to give practices the tools they need to be both innovative and high quality.  Learn more from the press release below or watch the CVN video.

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AMERICAN COLLEGE OF CARDIOLOGY LAUNCHES THE NATION’S FIRST
REGISTRY-BASED CARDIOVASCULAR PRACTICE NETWORK

Washington, DC – The American College of Cardiology today announced the launch of the PINNACLE Network, the first-ever registry-based cardiovascular network to link thousands of cardiology practices to each other and to the ACC’s National Cardiovascular Data Registry (NCDR), the preeminent cardiovascular data repository in the United States.

The PINNACLE Network™ immediately addresses the rapidly shifting business environment that private cardiovascular practices face with a wealth of practice management and financial management tools. The PINNACLE Network™ also builds a foundation for innovative, registry-based systems to reward practices for the high quality care that they provide.

“With the legislative and regulatory threats to traditional payment systems and the emergence of value-based payment programs, the ACC is in a unique position to develop and offer the PINNACLE Network™ with its suite of practice management tools to help practices not only survive but thrive,” said Alfred A. Bove, M.D., Ph.D., president of the ACC.

A comprehensive practice management system, the PINNACLE Network™ provides financial management tools to help practices thrive; workforce strategies to enable physicians to meet the increasing demand for cardiovascular care; guidance for the adoption of health information technology; and risk management education and strategies to lower the cost of liability premiums.

The PINNACLE Network™ will provide access to data management systems that translate data into clinical insights and leverages the power of the ACC’s national data registries to give practices negotiating power with payers for value-based payment systems.

“Embedding quality improvement and value-based payment in the natural flow of practice operations will be the foundation for a practice’s success clinically, financially and professionally,” said Janet Wright, M.D., the ACC’s senior vice president for Science and Quality. “By creating health information technology solutions for using ACC Guidelines and Appropriate Use Criteria at the point of care, the PINNACLE Network™ will show patients, colleagues and the health care community that we are delivering the right care for the right patient at the right time.”

The PINNACLE Network™ is powered by the PINNACLE Registry™, the nation’s first operational office-based data registry and will provide a centralized system for clinical practices to promote practice innovations and achieve clinical excellence.

The PINNACLE Registry™, designed by cardiologists, benefits from its two-year pilot phase as the IC3 Program and now will be integrated into the NCDR® to provide participants with access to both hospital and ambulatory patient-focused data. As one of the largest practice-level scientific efforts undertaken in the United States, the IC³ Program®, now the PINNACLE Registry™, contains hundreds of thousands of clinical patient records focusing on four common cardiac conditions -- coronary artery disease, hypertension, heart failure and atrial fibrillation.

For more information on the ACC’s PINNACLE Network™ visit www.pinnaclenetwork.org.

Kaiser Permanente’s CEO George Halvorson called for a celebration this month for the successes of a program launched decades ago they call Archimedes. It is a computerized artificial intelligence system that creates models of the human body and then projects the probable impact of care and treatment approaches. Archimedes has been used to do a couple of clinical trials and ended up with results that matched the actual clinical trials done on live patients. They routinely use it to improve care. And it works.

One of their primo researchers, David Eddy, M.D., just did a large scale test of Archimedes relative to the prevention of heart attacks and strokes. One of the scenarios that the researchers ran through Archimedes looked at what might happen when a mixture of prescriptions that science has suggested are helpful in CAD was combined to prevent heart attacks and strokes. (The drugs considered were aspirin, Lisinopril, and a statin). There was no tool to do that study. So they used Archimedes and ran a computer experiment with their own patient database.

Archimedes predicted that a "bundled" prescription of heart protective medications would reduce the risk of heart attack and stroke for the Kaiser Permanente high-risk populations by 71 percent. They missed by a bit. Over the course of three years, the three drug program actually prevented 1,271 heart attacks and strokes. That reduced the occurrence of heart attacks and strokes for the covered population by 60 percent instead of the 71 percent projected by the system.

300 media outlets have picked up this story. The world now knows that the simple combination of medications in KP's Aspirin-Lisinopril-Lovastatin (A-L-L) initiative -- this will have a potentially greater impact on emerging nations that can’t afford interventions I suspect. It’s very interesting stuff. And, they’re spreading the option to participate across their entire population, and 250,000 have signed up to try it with disease management and/or early risk factors.

It’s impressive -- they’re using predictive modeling, targeted member outreach, and computer-supported care to get real results. Hats off to KP and Archimedes.

*** Image info: http://www.flickr.com/photos/gi/ / CC BY-SA 2.

Tony DeMaria, M.A.C.C., our JACC editor in chief, recently used his May 19 Editor’s Page to discuss the alarming frequency with which initial clinical trials for novel devices and therapies are being performed outside of the U.S. According to Dr. DeMaria, the situation "clearly raise[s] a question as to whether we in America are exploiting the rest of the world to prematurely test potentially hazardous therapies, or conversely, whether our regulatory and financial environment is stifling access to important new innovations for patients and investigators."

The piece has generated a high volume of responses. “It seems to have struck a chord,” Dr. DeMaria says. One reader notes, “Over the past two decades I have seen an unfortunate gap develop between U.S. and overseas investigations, making us in effect second-tier investigators within the international community. Devices we have invented end up being evaluated, approved and used in general practice well ahead of us ... Percutaneous valves are one the latest example of this dangerous trend/gap!”

I applaud his message. We need to turn this around. Read Dr. DeMaria’s Editor’s Page here. But having just returned from India this week, and after visiting a most amazing 1000 bed CV hospital in Bangalore that produces outcomes comparable to the US (be ready to be stunned) for about 10 % of the cost, I think we need to be aware of the astounding and frankly positive growth of research outside the US that is developing exponentially. One thing the emerging world has going for them is that in environments with no insurance or health care coverage, experimental and novel therapies can be tested in willing patients far more prevalently that in the US or Europe. This will result in a great deal more relevant manuscripts, and in application of new therapies in early stages of illness, that will be considered here only as “compassionate use” therapy in late stages of disease, and only after traditional therapy fails. They will be able to see if new therapy works when started before the patient is near terminal. We won’t. And, as health reform in the US ratchets down the screws on PHARMA, they will go abroad to innovate, taking jobs with them. I’m just trying to cheer everybody up here…

In the quest to find the money for reform, there is another semi-radical idea floating around: the VAT. A value-added tax (or VAT)--a special version of a sales tax--provides much of the funding for health coverage in Europe and other developed nations. In essence, a VAT is a tax on goods and services divided in three parts: one third to manufacturers, one third to distributors, and one third to retail sales. Ultimately, consumers pay the tax through an increase in the cost of goods and services. Some countries exclude health care and food (and sometimes rent) from the VAT, but it generally applies to all goods and services purchased or consumed. A national VAT of 10 percent similar to what is used elsewhere would ultimately pay for the entire price tag of health care reform in the US, and also leave a lot of money left over to do other impressive things.

While it’s a regressive tax (poor people pay the same tax as rich people for a given service or product), a VAT also returns a lot of resources to lower income people in the form of health care, education and other benefits to even things out. Also, rich people buy more things, and thus pay more VAT. A VAT would probably allow for the complete elimination of income tax for persons earning less than $100,000 a year (urging them to buy more), and could greatly reduce the rate of income tax payment for people making above $100,000.

Victor Fuchs, health economist at Stanford, has long argued this is the way to get both the health problem solved and financed, as well as to help reform our complicated income tax structure as well. I doubt this kind of bold move will actually turn into law, but it’s interesting to consider. It’s like shifting much of the income tax burden to a sales tax approach. I’m glad it’s at least on the table. But, we haven’t any comments on a VAT option to finance reform. No policy there at this point. But, it’s a fascinating idea--if the income tax element were also to really decline…

Kaiser Permanente has substantially improved the heart attack survival rate for its members in Colorado through an innovative program that links coronary artery disease patients and teams of pharmacists, nurses, primary care doctors and cardiologists, with an electronic health record (EHR) and advanced clinical care registry.

George Halvorson, CEO of Kaiser, underscored that technology and treatment innovations alone are not enough.  

“It was not newer or more expensive treatments, but an integrated approach to deliver the right care at the right time. Maximizing information for the clinician means optimizing care for the patient."

The Kaiser pilot integrated front-line nursing and pharmacy teams that worked with cardiovascular patients and their physicians. The program achieved the following results:

• Patients had an 88 percent reduced risk of dying of a cardiac-related cause when enrolled within 90 days of a heart attack, compared to those not in the program;
  
  
• The number of patients meeting their cholesterol goal went from 26 percent to 73 percent, and;
  
  
• The number of patients screened for cholesterol went from 55 percent to 97 percent.

Proof positive that technology and coordinated team-based care can make a change for the better in the quality of cardiovascular care.

This blog post comes to us from ACC President Dr. Douglas Weaver. Dr. Weaver is the Division Head of Cardiovascular Medicine, the Darin Chair of Cardiology, Director of the Henry Ford Cardiovascular Institute at the Henry Ford Health System and a professor of medicine at Wayne State University. On top of his numerous prestigious positions, Dr. Weaver is a resident ACC expert on cost-effectiveness.

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The soaring cost of health care is arguably one of the largest problems within our current system. Health care costs in the US are projected to run $2.7 trillion in 2010, up nearly 30 percent from 2004. CMS estimates that health care spending will reach $4.3 trillion by 2017. By 2082, health care’s portion of the GDP will reach 49 percent, assuming that health care grows at only one percentage point more than the GDP (which is lower than the historic average of 2.5 percentage points), according to CBO. Of course, most of us may not be here in 2082, but how do we want to be remembered?

This rate of expenditure growth is both unacceptable not sustainable. As important is the fact that despite these rising costs, there is evidence that we are actually lagging in the provision of evidence-based care — by many measures we are slipping in producing a healthier America. Because of this, there can be no doubt that we will soon have some payment reform to both physicians and hospitals. It is the view of the ACC that physicians should be amply rewarded for providing the right care, for every patient, every time, instead of a system which rewards only volume and complexity of care. As it stands now, physicians would likely lose if they worked to improve prevention, continuity of care and eliminated that of either questionable or unproven benefit.

But while Congress and CMS contemplate and plan payment reform, we want to insure that the ACC is at the table to guide them to make decisions that will work. Cardiologists must get prepared by putting together the processes and measures to demonstrate the highest possible quality care to patients at every encounter. This means making the conscious decision to choose what works best at the lowest cost and apply it until we have found something of better value and more cost-effective to replace it. That’s it. No exceptions.

Last month, Health Affairs’ featured a section focused on the ability of “disruptive innovation” to spur health care change. In one article, the authors argue:

The achievement of lower costs ... requires the health care delivery system to get off a path where every new product and process aims at improving quality, regardless of cost, and onto one where changes in care reduce expenditures. This new path is not one of paying physicians, hospitals and drug manufacturers less to do what they have been doing .... What is needed is the development of new and different products and processes ....

One of these processes must be improving our application of guidelines and appropriate use criteria to every patient. We must take what we know to work and apply it in every situation possible. Plus, we must actively seek feedback on our performance to improve the care we provide.

The authors optimistically conclude – and I wholeheartedly agreed – that cost effectiveness is indeed possible:

Other industries have demonstrated the ability to deliver higher quality at lower prices, and there is no reason why health care cannot do the same.

Reform to the system is coming, no doubt about it. And in order to work, it’s going to have to address costs and the value received. If we can increase value and slow the rate of increase in cost, say to 1% or so greater than the GDP -- the impact will be enormous and yet we will not stunt innovation and further technological advances Let’s step up to the plate now and show Congress we’re ready to take an active role in cost and quality-related changes to the system.

- By W. Douglas Weaver, M.D., F.A.C.C., ACC President

* Dr. Weaver's post is the first in a new monthly series of guest posts by ACC leadership. Check back next month to see which ACC leader is sharing his or her thoughts on health care reform!