Ileana L. Piña, MD, MPH; Jerry Penso, MD, MBA


November 23, 2016

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Ileana L. Piña, MD, MPH: Hello. I am Ileana Piña from Montefiore Medical Center in New York and the Albert Einstein College of Medicine in the Bronx. I am a heart failure transplant specialist and I often belong to organizations focusing on or dedicated to patients with heart failure. We are all about the patients. In this blog, we have talked a lot about guidelines, and we have talked about issues having to do with transition of care. We have also talked about the National Forum [for Heart Disease & Stroke Prevention]. John Clymer, the executive director of the National Forum, has told us a little bit about their heart failure initiative. I asked Dr Jerry Penso, who has been very involved in the National Forum, to tell our audience about some of their new work.

Jerry, welcome. Tell us a little bit about yourself. What do you do?

Jerry Penso, MD, MBA: Thank you, Ileana. I am chief medical and quality officer of American Medical Group Association (AMGA), which is a trade association of over 450 prominent medical groups and health systems across the country. We work closely with them to improve healthcare for all sorts of conditions, including heart health.

Dr Piña: How do you relate to the National Forum?

Dr Penso: The National Forum, if you will, is a large coalition of like-minded organizations that is dedicated to achieving prevention of heart disease and stroke. We are all working in that same space. It includes the American Heart Association, the Centers for Disease Control and Prevention, and other like-minded organizations such as AMGA.

Rewarding Community-Based Heart Failure Programs

Dr Piña: How is the National Forum working towards improvement of heart failure?

Dr Penso: The National Forum has an exciting heart failure program called Stronger Hearts™. This year, one of their innovative programs is a best practices award. They are looking for two community-based programs that are affecting patients with heart failure.

Dr Piña: Not an academic program? Just community-based?

Dr Penso: Yes—isn't that interesting? Although lots of academic hospitals and medical groups work in the heart failure space, the National Forum wanted to recognize innovative programs that are community-based, where some of the services are provided where patients live and have to survive heart failure day to day.

Dr Piña: What size of community program is required? Does a program have to be a certain size to apply?

Dr Penso: We are looking for innovative programs that have treated at least 100 patients. They should have some experience and maybe the beginning of some evaluation and outcomes on how they are improving the care of patients with heart failure. We would like some data. We realize that these are smaller programs or projects so they may not have the scientific rigor that would be required for peer-review publication.

Dr Piña: That sounds really interesting. I think community groups would be very excited to do this. As you well know, the Centers for Medicare & Medicaid Services measures the rule of returning money, which has made it difficult for some hospitals to try to stick to that 30-day rate. Community involvement with a hospital program is a strategy that can work. What is the deadline, and how do programs apply for this?

Dr Penso: Go to the National Forum website where you can learn all about the details. The applications are due December 16, 2016. We are also working with all of our National Forum members to publicize the award. We would like many community organizations to participate. They can be nominated by academic centers or by medical groups or health systems. We want the project to have some sort of basis in the community where the patients live.

Dr Piña: The community may be a city or a town or a neighborhood?

Dr Penso: We are looking for nonclinical sites. It could be anything outside of the hospital or a medical group or clinic where some sort of services are being provided. I will give you a few examples. Patients with heart failure, many of whom are elderly, may have issues associated with adherence to their medications, transportation, food and diet, and behavioral and emotional support. There are practices out in the community that help patients stay healthy and out of the hospital.

Dr Piña: Does the applicant have to be a physician or could it be a health extender, like a nurse practitioner or a pharmacist?

Dr Penso: It definitely does not have to be a physician. This can be a community organization—say, a senior center—that is working hard with a group of patients with heart failure and trying to keep them healthy.

Dr Piña: Is the application long or is it fairly straightforward?

Dr Penso: We tried our hardest to make this application as simple as possible. We realize that community organizations may not have the time, money, or people to apply, so we did not make it like a long grant application. We tried to make it with enough information so that the judging committee—led by prominent cardiologists like Dr Clyde Yancy, who is heading up the Stronger Hearts initiative—could review it and really find these innovative programs.

San Bernardino Heart Failure Hotline

Dr Piña: I will tell you what was exciting to me from the very beginning. We had decided that we were going to have a few very focused programs for heart failure awareness. One was our phone hotline in San Bernardino. This was before the terrible tragedy. How is it going?

Dr Penso: In San Bernardino, they have a hotline called 211 that has been around for a while. The idea was, could Stronger Hearts tag on and get special information for patients with heart failure through that line? Could people on that hotline be trained to provide special resources and education? It is going really well. They are getting the information out to the hospitals, to the physician groups, and actually to the patients. By using all sorts of communication channels, including face-to-face visits with physicians, they are communicating the value of this. They are seeing their numbers grow, and they are beginning to learn what sort of information patients need.

Dr Piña: What are they asking exactly? I think we had a script but were finding that patients were asking other questions. Looking at those data is going to be absolutely fascinating, and we were hoping that if this succeeded, it could be done in other communities that are like-minded. They do have a large medical center in San Bernardino or not far away, but some communities do not have the luxury of having a large medical center. Of course, our other initiative was the grant that is finally coming through.

Stronger Hearts and Strong Programs

Dr Penso: One thing that we did not discuss is the name, Stronger Hearts. The reason that name was chosen by the National Forum is because "heat failure" sounds a little depressing, and it gives the patient the idea that nothing can be done. I know that in your field a lot can be done for these patients to keep them healthy and keep them functioning in their communities.

Dr Piña: And to keep them out of the hospital, which is so critical. This will become even more important as Medicare is changing a lot of their payment policies, and the Medicare Access and CHIP Reauthorization Act (MACRA), which I am sure you are very familiar with, is coming for quality-based programs. We want physicians to really think out of the box and come up with innovative ideas to do exactly what you said: Keep the patients well, functioning, well medicated, and out of the hospital.

I hope that some of you listening will get excited about this and I encourage my audience to apply. It is a very interesting approach. It's not for academic medical centers, so it is not for us, but it is for the community programs. There are unsung heroes in this population of health extenders, pharmacists, nursing, social services, and psychologists. I learned long ago that I cannot take care of these patients alone. I really need the team, and the team approach is the future of heart failure care.

Thank you for joining me today. I am signing off from the Transcatheter Cardiovascular Therapeutics 2016 meeting. Have a great day.


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