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.

Conclusion

The UpToDate® Point of Care Report sheds light on the pressing issue of cardiovascular disease and the challenges providers face in managing it. By understanding these challenges, payers can proactively develop benefit designs that address the needs of both providers and patients. Enhanced benefit design, data-driven decision-making, support for social determinants of health, education, and training, and collaborative care models are all essential strategies for reducing healthcare friction and fostering better payer-provider collaboration.

As we move forward, it is crucial for payers and providers to work together to create a unified approach to healthcare that prioritizes patient outcomes. By leveraging insights from sources like the UpToDate® Point of Care Report, we can build a healthcare system that is more efficient, effective, and equitable for all.