The Race to Value Podcast Ep 109 – Effective COPD Management to Achieve Value-Based Care Goals, with Dr. MeiLan Han
Healthcare costs due to Chronic Obstructive Pulmonary Disease (COPD) is in excess of $32 billion due to high rates of re-hospitalizations and ED visits, complex and inefficient clinical pathways during transitions of care, and intensive resource burden on clinical and administrative staff. The average cost per COPD patient readmission in the U.S. typically falls between $9,000 and $12,000. Unlike other high cost chronic conditions like CHF and diabetes, it seems that many ACOs are not as purposeful in their targeting of COPD as part of their population health playbook. This is a massive unmet need with many COPD patients experiencing fragmented and inconsistent care that drives poor clinical outcomes and high economic burden. Consequently, COPD now represents the 3rd leading cause of death and the 5th most costly chronic disease in the US. What is it about this particular chronic condition that makes it so less prone for population health management with ACOs and other risk-bearing entities? Why is this chronic disease so universally undiagnosed? How can we implement chronic care management programs that actually make an impact on patient lung health and clinical outcomes?
For anyone that wants to know more about “Effective COPD Management to Achieve Value-Based Care Goals”, look no further than this week’s episode with Dr. MeiLan Han. She is Professor and Chief of Pulmonary and Critical Care Medicine at the University of Michigan who is widely known for her expertise on Chronic Obstructive Pulmonary Disease. Dr. Han is a leading pulmonologist, researcher, lung health advocate, consultant, and national volunteer spokesperson for the American Lung Association. She is also the author of the new book, “Breathing Lessons: A Doctor’s Guide to Lung Health.”
Episode Bookmarks:
01:30 Introduction to Dr. MeiLan Han (pulmonologist, COPD researcher, lung health advocate, author, and speaker)
05:30 Origins in rural, small town America that led to a career in pulmonary medicine and research
07:00 “Many people that have lung damage and don’t know it. We don’t do a good job of diagnosing lung disease in this country.”
07:30 Only half of the 25-30M Americans with COPD even have a diagnosis!
08:00 Undiagnosed lung disease led to server morbidity and increased mortality during COVID-19 pandemic
08:30 Research continues to be under-funded due to lack of awareness of lung health importance
09:20 11M Americans suffering from long-haul COVID
09:40 Societal threats to lung health (ex: air pollution, hazardous chemicals, plastic microparticles in lungs)
10:00 “The pandemic was a golden opportunity to raise awareness for lung health, but now people are starting not to listen.”
12:00 The impact of race and socioeconomic status on COVID death rates, and overall poor lung health in marginalized communities
13:30 COPD is more common in rural communities where there is less access to care
14:20 Virtual care is not a perfect solution in areas where there is a “digital divide”
16:00 Half of adult Americans have at least one chronic condition and more than two thirds of Medicare patients have two or more.
17:00 Ambulatory Care Sensitive Conditions as an opportunity for ACOs to achieve cost savings
18:30 The challenges of developing and implementing COPD Quality Improvement Measures
19:00 Difficulties in collecting data from spirometry and PFTs in the Electronic Medical Record
20:00 Global Initiative for Chronic Obstructive Lung Disease (GOLD) recommendations and the difficulties of tracking symptoms and exacerbations
22:00 The lack of reporting requirements on COPD has limited progress of health systems and EHR companies
23:00 The relative ease of collecting Blood Pressure and A1c results and why capturing data related to COPD is so much more difficult
24:45 Diagnosis gaps of COPD in the early stages due to “therapeutic nihilism”
26:15 Lack of spirometry testing possibly due to the fact that smoking cessation is already such a big part of healthcare
27:00 More studies needed to demonstrate the absolute necessity of early COPD intervention
27:45 Managing patients with lung health exacerbations that don’t yet qualify for a COPD diagnosis
29:00 “Perfect is the enemy of good in assessing lung health screening results.”
30:30 COPD costs total $32 billion due to excessive rates of re-hospitalizations and ED visits
33:00 How limited diagnoses hinder the impact of Chronic Care Management programs to more effectively manage COPD patients
35:00 Engaging patients through medication optimization and suggested use of inhalers and how virtual care can help
36:00 The use of social workers and respiratory therapists to manage COPD on interdisciplinary care teams
36:30 The challenges of Pulmonary Rehabilitation, especially in a virtual setting
39:30 The opportunity to use remote patient monitoring of cardiorespiratory parameters for patients with COPD
42:00 Physicians being overwhelmed with data and how that may hinder adoption of RPM
43:00 The limited reduction impact of the Hospital Readmissions Reduction Program (HRRP) on COPD readmissions
45:00 Dr. Han speaks about the limited number of health system success stories in lowering COPD readmissions
46:00 Disease exacerbations are one-third of COPD readmissions (as opposed to comorbidities and psychosocial issues)
48:00 The impact of climate change and greenhouse gas emissions on people’s lung health
49:00 Children’s lung health impacted by schools being placed by highways and the excess deaths of COVID-19 due to air pollution from wildfires
50:00 The responsibility of the health sector to minimize its role as a contributor to greenhouse gases
51:00 Recommendations for patients in assessing indoor and outdoor pollution
52:30 COPD and Lower Respiratory infections as the leading causes of death globally (but they receive limited grant funding for research)
53:30 Referencing Dr. Han’s book, “Breathing Lessons: A Doctor’s Guide to Your Lungs”
54:30 “Our society doesn’t focus on keeping lungs healthy – we instead focus on diagnoses. This is why lung disease was the #1 cause of death in the US last year.”
56:00 The need for health policy and public health funding for promoting improved lung health