
The Heart of Value-Based Care: Combating the Deadliest Disease in America
Heart disease tops the list of most-deadly diseases but also tops the chart for the most expensive disease in the United States. Costing an astonishing $219 billion each year, the number of conditions under the heart disease umbrella, including coronary artery disease, stroke, sudden cardiac arrest, and heart failure, continue to rise, resulting in a fast-growing demand for more cardiologists.
Proponents of the value-based care model advocate that quality primary care is key to reducing cardiovascular deaths on a global scale. Learn how one organization’s innovation with what they call “disruptive” cardiology is pushing the needle forward and saving seniors from the deadliest disease in America.
Legacy Fee-For-Service and The Cost of Unnecessary Procedures
One concern within the legacy fee-for-service system that incentivizes tests and procedures is that these tests and procedures may not be in the patient's best interest. Dr. Sachil Shah, who holds board certifications in Cardiovascular Disease and Internal Medicine, now serves as ChenMed’s Regional Medical Director of Cardiovascular Care. Being no stranger to this system, he admits he often struggled with internal conflict working in a hospital-based cardiology group where what was incentivized didn’t feel the most ethical.
“Sometimes, as physicians, we want to do what’s best for our patients, but oftentimes those incentives are misaligned with what’s best for the patients. The patient may not benefit from the procedure, but you are incentivized to do the procedure or order further testing because you or your organization gets paid. This is the reality that set in. I was disenfranchised.”
Disruptive Cardiology and Impacts on Patients’ Heart Health
A growing body of evidence points to lifestyle changes making the most significant impact on heart attack and heart disease prevention. In other words, lifestyle is medicine. However, influencing patients to make and sustain these life-saving behavior modifications proves far more complicated. Patients don’t take advice from doctors they don’t trust. And patients can’t build trust in rushed, transactional visits.
Tedious, time-consuming administrative and billing tasks, overflowing patient rosters that only allow thin-stretched, minutes-long visits with each patient, and increased occupational hazards like burnout and exhaustion all thwart any potential for building a meaningful connection, much less a flourishing trust-based relationship where patients can be adequately educated and motivated to reclaim their health and improve outcomes. This is where integrated cardiology and primary care within a value-based healthcare system prove not only beneficial for health outcomes but greatly reduce costs.
Dr. Shah makes a case for collaboration between cardiology and primary care in the geriatric population, where heart conditions are more prevalent. “The cardiologists, I believe, are one of the key aspects of providing value-based [primary] care. Why? Because the majority of patients over the age of 65 have multiple cardiology problems, and as you know, cardiology is the number-one cause for admission into hospitals. Heart failure, a development of cardiomyopathy or a weak heart, is the number one [driver of] cost and morbidity and mortality within the elderly population.”
How Can Value-Based Primary Care Drive Better Heart Health?
When you’re not held back by ordering unnecessary tests and procedures and instead have ample time to connect and build relationships with patients each visit, educating them on necessary lifestyle changes to better manage or prevent health conditions, you have the potential to reduce ER visits and hospital admissions, reduce costs, and improve your patients’ quality of life and health outcomes.
The groundbreaking common denominator here is simple: Doctors have the valuable opportunity to learn—and intimately know—their patients. This begins with decreased patient panels for PCPs.
Limited Patient Panels for PCPs
“Our PCPs panels are limited. Why? Because they can have many more touchpoints with the patients and know intrinsically what their beliefs and wishes are and what’s best for them.” Dr. Shah shares his own personal experience.
“I can [cut] some slack to the legacy healthcare industry because sometimes they do have patients that turn up on their doorstep. They don't have [that patient’s health] history; they don't know anything about them, so [they] just do everything [they] can to minimize the risk to [themselves].” Reducing the number of patients doctors see creates more time that can be spent with patients, ultimately resulting in fewer emergency room visits, hospitalizations, and readmissions.
Only Ordering Necessary Tests and Procedures
Shah believes there are only two reasons to order tests or procedures: to relieve a patient’s symptoms or increase their lifespan. “Knowing patients intimately well, when I know something will impact them positively, and if I believe that any procedure, treatment, or drug can do one of those two things given the context of the patient's wishes and family’s beliefs, of course, I will do that.”
Getting to Know Your Patients
The difference between the patient landing on legacy healthcare’s proverbial doorstep during an emergency and a patient receiving consistent value-based care: the time PCPs spend with patients and getting to know them. Shah drives this point home: “People don't spend time with their patients and don't know their wishes and position in life. So, the way you practice medicine and cardiology, in particular, has to take that into context. This is where we can be more value-based and cost-effective because we can do everything by knowing the patient better.”
Practicing Cardiology, the ChenMed Way
In a perfect world, the PCP coordinates and oversees all aspects of patient care—this includes visits with specialists such as cardiologists whose valuable insight and expertise are needed for patients with heart conditions. Rather than sending a patient to multiple specialists where a lapse in communication between providers typically follows, the PCP instead works closely with the specialist in tandem, collaborating and orchestrating the highest caliber of care for the patient. This is the “heart” of value-based care at ChenMed.
“When I heard it was a primary-care- and value-based model looking for specialists to help provide best-in-class primary care, that resonated with me. I jumped in because I was negatively affected by the job I was doing—so much so that I didn’t want to do it anymore. My values from my training in England, the way that I feel patients should be taken care of, and being able to continue to practice cardiology, all perfectly melded in this organization. And this is the reason I’m here, and I’ll continue to be here for the rest of my career,” Shah enthuses.
Listen to the full episode of Faisel & Friends, Disruptive Cardiology Care, with Dr. Sachil Shah. Together, we discuss the collaborative integration of cardiology and primary care, incentivizing beneficial patient outcomes, and the economics of value-based cardiovascular care. Faisel and Friends is a primary care podcast that discusses the state of healthcare in America. Subscribe now to receive the latest episodes!

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