SMARTCare holds potential to save billions in heart care costs

An innovative program focused on outcomes in patients with stable ischemic heart disease could change the cost of healthcare. On May 22, the Center for Medicare and Medicaid Innovation granted $15.8 million to the SMARTCare pilot program, which is expected to save $42.2 million over the three-year pilot program across 10 participating sites.

“If we were looking at the same results across the country, we’d [save] $1.1 to $3.8 billion on this one diagnosis alone,” Thomas Lewandowski, MD, Wisconsin national lead for SMARTCare, stated in an interview with Cardiovascular Business.

SMARTCare was developed by the American College of Cardiology in concert with clinicians, hospitals, insurers and business representatives in an attempt to bring together several large datasets, inform guidelines and provide patients with the best care for the least cost. The program has been picked up by 10 sites, five in Wisconsin and five in Florida, to give clinicians and patients tools to understand options when providing cardiac care to their patients.

The tools are a large part of the innovation. Patient Risk Information Services Manager (PRISM) is an individualized electronic patient consent protocol for stent procedures. Other tools provide individualized patient cardiac risk profiles and imaging decision support. The registries CathPCI and Practicing INNovation And CLinical Excellence (PINNACLE) help with performance benchmarking.

Together, these and other tools will allow clinicians and patients to access a large body of data from hospital and insurance electronic records, best practices and guidelines and create a better patient-clinician experience.

“Let’s be honest,” said Lewandowski, a physician at Appleton Cardiology ThedaCare. “Not everyone can keep up to date with the latest and greatest recommendations on stress testing and when to go forward and when you should use medications. Part of the importance of these tools is in bringing clinicians up to speed on what to do now. When you’re able to weed out the best care early on and perhaps avoid that angioplasty if there’s another treatment option that would work better, you can make some significant savings down the road, both for the patient and for the system.”

There are further innovations in the works, including a quantitative quality of care and quality of life system that would be linked to rating and continuous improvement of the patient experience. “This would get us to look a little differently at what we consider to be a successful outcome,” Lewandowski said.

With a data set this large, there have been some bumps in the road. “Everyone always asks if it was hard to get the clinicians on board. It wasn’t the clinicians were pushing for this. We’re getting the hospitals on board and business partners [like Blue Cross/Blue Shield and Humana]. What has been really hard is the scope of the data.”

Lewandowski emphasized that the nation cannot stay on a trajectory of increasingly costly healthcare. To achieve change quickly, many participants in the care process will need to help. “We’ve been getting patient advocates involved, getting the payers and purchasers involved, clinicians. We can get it into clinical context, but we have to leverage all of the stakeholders in the process to make it work.”

ACC Florida Chapter Governor Juan M. Aranda, Jr., MD, described the program as a platform that potentially could be distributed widely across the cardiovascular care community. “Our ability to utilize care patterns from separate states demonstrates how flexible and successful the program can be,” Aranda said in the press release. “We are hopeful that someday, patients from all over the country will be able to take advantage of the tools included in the SMARTCare program.”

While the program currently is geared toward angioplasty and the steps of care leading up to it, Lewandowski sees it providing assistance to all aspects of healthcare. “It is a process that we thought could be replicated in other areas of cardiology as well as other areas of medicine,” he said.