Strategies to reduce costs with PCP-prescribed therapies in HF

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Ryan Haumschild, Doctor of Pharmacy, MS, MBA: Dr. Murillo, when you think of the people who prescribe these therapies earlier—often primary care providers because there aren’t enough specialists for everyone—how do we incorporate best practices? What do you think are some of the cost savings that managed care executives will see if everyone prescribes these agents more appropriately? Are you seeing a drop in readmissions? Do you see further reductions in the total cost of care? I’m curious to hear your thoughts.

Jaime Murillo, MD: The obvious answer is yes. In randomized clinical trials and, interestingly, in some subgroups, we have done analyzes where we see an even larger effect. Who will benefit most from what? This is yet another future opportunity. On the side of private physicians, we have seen significant efforts if we talk about managed care in the ACOs [accountable care organizations]. ACOs tend to have a larger part of the team dedicated to identifying at-risk patients and ensuring that the transition of hospitalizations is more adequate, that these doctors are in contact with patients more quickly after discharged from the hospital, that they are being cared for and that they have guidelines – directed medical therapy. Because they realize that there is a clear opportunity for savings from this point of view. This is why I was talking about the possibility of engaging in a closer collaboration with the specialist.

As a cardiologist, I remember seeing many patients in the office that I thought I could resolve with a phone call. Wouldn’t it be great if the primary care physician or hospitalist, like Dr. [Rohit] Uppal can tell you, might pick up the phone and ask, “What do you think of this patient? You can take care of more people this way. I tell you these stories to get more providers to start thinking: can we together come to a system where there is more value-based care? Because it’s the future. Then we don’t have to worry about the cost of the drugs, whether it will be enough.

Heart failure patients are not well served when we use what I called the Walmart approach: “Which drug was the cheapest?” That’s what we’re going to launch them on. Doctor [Jim] Januzzi likes to put these patients on sacubitril/valsartan. There are groups that take advantage of these, probably most of them. Or SGLT2s. But most people say, “Only beta-blockers and ARMs [mineralocorticoid receptor antagonists], because that’s all we can afford. But if you’re in an environment where there’s more of a team approach, it’s not about how much you’re charged for a visit or a procedure. It’s about whether this person in front of me will be healthier in 6 to 12 months. The patient is better, but also the total cost of care will be lower.

Transcript edited for clarity.

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