Transforming Healthcare. Morey Menacker

competitive advantage for being recognized regionally as “cutting edge and ahead of the curve”.

In contrast, High Blood Pressure (HBP), a major risk factor for MACE, results in billions of dollars of waste from reduced worker productivity and absenteeism as well as significant increased per capita healthcare costs. Clearly, reducing the risk of major cardiovascular events by controlling HBP, and thereby improving health‐related quality of life, can significantly lower attributable excess annual per capita health costs. High quality scientific evidence from large scale population‐based studies published in the 2017 Hypertension Clinical Practice Guidelines of the American Heart Association (AHA) and the American College of Cardiology (ACC) documents the significant blood pressure lowering effects from six specific critically important lifestyle modifications: tobacco cessation, regular physical exercise, restriction of dietary sodium, dietary intake of potassium, moderate alcohol consumption and a “healthy heart” diet. Assessments of Social Determinants of Health (SDoH), Shared Decision Making (SDM) conversations between patients and their physicians, and Team‐Based Care (TBC) delivered by nurses, pharmacists and other health professionals are now known to result in significant improvement in BP control and other health risk reduction targets through effective, evidence‐based lifestyle modifications.

      Nonetheless, recent data reveals that over 115 million Americans have diagnosed or undiagnosed HBP, and that more than half are inadequately controlled to guideline‐based BP targets published by AHA and ACC. Worst of all, blood pressure is almost always measured incorrectly, resulting in innumerable inaccurate readings obtained in both health care settings and at home. Inadequately controlled HBP is but one of many major unmet public health challenges that can be directly traced to the diffuse health system inertia so elegantly addressed by Dr. Menacker in Chapter 5 of Transforming Healthcare that is at the heart of this matter. No doubt, the healthcare delivery infrastructure for the care of major acute and chronic CVD is vastly different than what is needed to achieve health promotion, maintenance, and prevention necessary to reduce MACE and hence the need for acute care.

      I recently asked some health system senior managers, governing board members and primary care physicians to informally describe the barriers to achieving optimal BP control. Their comments were remarkably consistent and focused on time and resource constraints, process limitations and a general lack of urgency regarding HBP as a top organizational priority. The clinicians described control of HBP as "just another metric" within constantly expanding externally imposed quality requirements. Administrative demands remain overly burdensome, leading to too many "clicks" to add home BP readings to the electronic health record (EHR). In addition, the team is understaffed and overworked, leaving no time to properly address Social Determinants of Health (SDoH) and effective lifestyle modifications. Traditional practices do not ensure consistent and accurate BP measurement technique with validated and certified devices in accordance with standardized guideline‐based scientific methods. Patients often present other pressing concerns, which can lead to deferment of BP control until the next annual examination or ignoring it altogether. Not surprisingly, control of HBP for patients and employees is nowhere to be found as a key performance indicator on any governance or managerial accountability “dashboards”.

      Of course, it is certainly much easier for us to describe these “wicked” problems like control of HBP than to find and implement cogently clear pathways to solving them. And while Dr. Menacker's strong recommendation for global payments to health systems to simultaneously manage the associated clinical and financial risks is not new, it comes at just the right time in our history. What is urgently needed today to achieve the goals outlined in this book are stronger health system alliances and congruent alignment with insurers, employers, public health, community health safety net organizations, large and small biopharmaceutical and device firms, digital health Information technology companies and governmental health agencies. “Moving the Needle” of improved health status of the US population will require a major reprioritization of both capital and human resource allocation by all of these stakeholders. Transforming Healthcare is henceforth our Call to Action.

Principal & Founder, IPO 4 Health (Improving Patient Outcomes4 Health)Associate Professor of Medicine, Rush Medical CollegeSenior Associate Editor,
American Journal of Medical Quality	Donald E. Casey Jr MD, MPH, MBA, FACP, FAHA, CPE, DFAAPL, DFACMQ

About the Companion Website

      This book is accompanied by a companion website.

      www.wiley.com/go/menacker/transforminghealthcare

      This website includes:

       Test Banks

       PowerPoint Lecture Slides

Introduction

One may ask, “Why would a physician who has worked for years in our current healthcare system want to transform said system?” While there is no easy answer, I will try to explain. My postgraduate training took place in an inner city environment, where the majority of patients were hospitalized due to complications of their environment. This included drug addiction, poorly controlled hypertension, diabetes, hyperlipidemia, food insecurity, homelessness, and trauma. It became obvious early in my career that prevention was infinitely cheaper, and more rewarding, than treatment. The conundrum was in developing a method to pay for prevention.

      It is imperative that those of us who work in a particular field, and benefit financially from that work, must give back in some way as gratitude for the opportunity, and to preserve these opportunities for future generations. It is also much easier to comment and suggest change in a field that has defined your entire life. We all have a responsibility to leave this world a better place than we found it.

      It is common occurrence that when an international celebrity, or a wealthy foreigner, becomes ill, they automatically fly to the United States for their healthcare. These individuals would not come here if they thought the medical care was inferior. However, we are constantly bombarded by the media with tales of inadequate care, greed, malpractice, and refusal to provide needed services. Is it possible for these two disparate stories to both be true? The answer is a resounding YES. We are blessed with the best technology, the best treatments, the best research, the best hospitals, and the best physicians, yet the care provided can be disjointed, inadequate at times, cost prohibitive, and occasionally inappropriate.

      This book attempts to explain how we got to this place and how we can get better.