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Can healthcare data lessen disease burden for aging Americans? | Lonny Reisman


We need a level of care between preventative medicine and catastrophic case management: preemptive care.

It’s a far too common scenario.

A patient exhibits multiple risk factors for disease: they smoke, have diabetes and hypertension, and maybe they also have a family history of heart disease. If we could intervene here, we could manage the stable chronic condition to keep it from becoming an irreversible, catastrophic disease, such as heart failure. Most vascular conditions start as much less serious health concerns.

As the patients age, the cost of their care becomes exorbitant. Following the most common course, a physician’s first time seeing a patient is when their disease has reached an advanced stage. If we know that patients’ conditions will deteriorate, we can anticipate the inevitable deterioration of these patients and in advance of permanent damage, preempt their disease progression.

Rather than limiting our focus to the efficient cost and care management in patients with advanced and irreversible disease, we should direct our attention to an earlier point in the disease continuum. At this point, before an advanced disease sets in, we have an opportunity to intervene with lifestyle changes and early intervention. How do we get to these patients before their situation becomes irreversible and catastrophic?

The classic rubric of population health management focuses on preventative care at one end of the illness spectrum, and catastrophic case management at the other. Along that continuum are high-risk patients who are developing new disease states due to inadequate management of modifiable risk factors.

With proper management of common risk factors, we could significantly reduce the suffering and costs associated with complications such as heart attack, heart failure, stroke, and kidney failure.

We need a level of care between preventative medicine and catastrophic case management: preemptive care. The notion of preemptive care highlights the need to effectively use the therapeutic and diagnostic tools at our disposal to stop the progression of chronic disease to irreversible end stage consequences.

The disease burden is borne by aging Americans

In far too many cases, the people being treated for the advanced diseases are elderly. The disease burden people 65 and over carry is staggering. Consider:

  • Approximately 82.6 million people in the U.S. have cardiovascular disease. Nearly 50% of those people are older than 60. As our population ages, the resources needed to support these patients will be enormous. (Roger V, Go A, Lloyd-Jones D, Benjamin E, et al. Heart Disease and Stroke Statistics–2012 Update. Circ. 2012; 125(1): e2-e220.)
  • More than 10,000 people turn 65 in the United States every day, and many older adults face myriad and advanced illnesses. For providers and payors, delivering compassionate relief for these patients is daunting.
  • One in four physicians feel that lack of technology to accurately diagnose coronary artery disease (CAD) and peripheral artery disease (PAD) is a barrier to early and accurate diagnosis. Diagnostic delays result in avoidable suffering and costs.
  • One in three healthcare leaders feel that a lack of standardization in diagnosing CAD/PAD is a barrier to accurate diagnosis.

We can personalize care to fit the patient

We know that poorly managed chronic diseases like hypertension and diabetes are associated with, for example, heart failure and renal failure. We also know that life-style changes coupled with proven diagnostic and therapeutic modalities can reduce the incidence and severity of these complications.

Given these facts, programs directed at these chronic diseases could have a significant impact on mitigating costs and the burden of disease. Extending the notion of prevention or preemption of complications by optimizing management to multiple disease states, could help in addressing societal goals around health equity and harnessing cost increases for our aging populations.

Without personalized consideration of patient needs, prudent advice will be ignored, trust will erode, and outcomes will deteriorate.

Currently we don’t have a system that accounts for the social determinants of health. We need to find a way of incorporating a patients’ socioeconomic status, as well as their comfort with, and ability to access, technology. If we cannot remediate social economic drivers to health, patients will be hindered in following through on medical advice.

Physicians need a team to help crunch available data

We have the data necessary to personalize care, and see the potential for using this data to improve patient care. However, the data is vast, comprehensive, and effectively uninterpretable by individual physicians and caregivers, who want to focus on patient care rather than data analysis. We need to find a way to analyze and interpret the data and turn it into personalized interventions.

Analytic and artificial intelligence (AI) expertise can be used to convert those data to personalized insights and interventions. This challenge underscores the opportunity for AI to play a transformative role in advancing personalized and precise care.

We see a future where we can overcome the barriers created by differing social economic determinants of health, and bridge the technological divide. With proper tools and the right team, we can use the vast data AI and machine learning provide to reach patients before their chronic conditions are irreversible, and ease the disease burden on aging Americans.

Lonny Reisman is the founder and former CEO of HealthReveal

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