Bridging the gap: Enhancing payer-provider collaboration to combat cardiovascular disease

The state of cardiovascular health: A crisis in the making

The UpToDate® Point of Care Report underscores the gravity of the CVD crisis. According to the World Health Organization (WHO), CVD claims approximately 17.9 million lives annually, with heart attacks and strokes accounting for more than four out of five CVD deaths globally. The report highlights that unhealthy diet, physical inactivity, tobacco use, and harmful alcohol consumption are significant behavioral risk factors for heart disease and stroke. These risk factors can be mitigated through effective interventions, yet many healthcare providers feel constrained in their ability to advise patients on lifestyle modifications.

Insights from the Point of Care Report

Healthcare administrators have a pivotal role in leading the charge toward improved cardiovascular health. The UpToDate Point of Care Report provides several key insights:

1. System-level decisions: The report offers insights to support system-level decisions, emphasizing the importance of a unified, enterprise approach to cardiovascular health.
2. Access to data: Improved access to data helps clinicians make more informed decisions, enhancing patient care and outcomes.
3. Proactive approaches: The benefits of a proactive approach to CVD prevention and management are clear, as is the need for more prevention information for clinicians.

Addressing social drivers of health

One critical aspect that the report brings to light is the impact of social drivers of health, also known as social determinants of health (SDOH). Researchers estimate that 10-20% of a patient's health is influenced by medical care, while the remaining 80-90% is impacted by SDOH. These factors include conditions in which people are born, grow, live, work, and age. Recognizing these social drivers is essential for payers and providers alike.

The role of payers in reducing healthcare friction

To foster better payer-provider collaboration and improve patient outcomes, payers need to offer preventative care opportunities to members and partner with providers to close care gaps. Here are several strategies that payers can implement based on the insights from the Point of Care Report:

1. Enhanced benefit design: Payers can design benefits that align more closely with the realities providers face. For example, incorporating coverage for preventive services, such as nutritional counseling and physical activity programs, can help address behavioral risk factors for CVD.
2. Data-driven decision-making: By leveraging the most recent and comprehensive evidence available from sources like UpToDate, payers can gain a deeper understanding of the challenges providers encounter. This data can inform the development of targeted interventions and provide evidence-based guidance for benefit designs that support providers in delivering optimal care.
3. Support for social determinants of health: Payers can develop programs that address SDOH, such as housing instability, food insecurity, and transportation barriers. By offering support in these areas, payers can help providers focus more on clinical care and less on external factors that impact patient health.

Guiding the future of collaborative care

The UpToDate Point of Care Report on Cardiovascular Health underscores the valuable and important opportunity for payers and providers to work together to combat CVD and improve health outcomes. From adopting innovative value-based care models to addressing SDOH, collaboration is key to reducing friction and achieving a more cohesive healthcare ecosystem.

Moving forward, the integration of value-based care enablers will play a crucial role in driving these efforts. These collaborative relationships streamline administrative tasks for payers and providers while offering scalable solutions to support the delivery of high-quality care. By leveraging resources like UpToDate, payers and providers can align their goals, simplify processes, and prioritize member care.

Together, we can create a healthcare system that is more efficient, effective, and equitable—improving outcomes for patients while reducing costs for all involved.