How Young Cardiologists Can Succeed in the Era of Population Health

“Every successful organization has to make the transition from a world defined primarily by repetition to one primarily defined by change.”— Bill Drayton (1)

For young cardiologists, this adage may be concerning, as the fee-for-service healthcare system most familiar to us is transformed into one that emphasizes population health management and value-based care (2). Here we argue, however, that population health has always been integral to cardiovascular medicine, and that the ongoing changes can be highly advantageous to young cardiologists. We further offer suggestions for how young cardiologists can seize potential opportunities to thrive during this transformative period.

Cardiovascular medicine has long been a pioneer in population health (3), defined as “the health outcomes of a group of individuals, including the distribution of such outcomes within the group” (4). Seminal cardiovascular studies, like the Framingham Heart Study, elucidated the population burden of cardiovascular risk factors such as tobacco use, hypertension, and hyperlipidemia (5), leading to their better management and to a reduction in the toll of cardiovascular diseases (6). Undertakings sponsored by the American College of Cardiology and/or the American Heart Association, such as the Get With The Guidelines registries and the National Cardiovascular Data Registry (7,8), are early examples of large-scale data collection and quality improvement that have become key features of population health management. As cardiovascular disease remains the leading cause of death in the United States as well as the health condition with the highest cost (9), its management will remain a prime focus of any population health strategy. This emphasis is reflected in new payment models such as accountable care organizations, which continue to rely on cardiovascular outcomes and quality metrics to assess performance and calibrate incentives through measures such as heart failure readmission rates, evidence-based medication prescriptions for ischemic heart disease and heart failure, and screening and control of cardiovascular risk factors such as hypertension and diabetes (10).

Nonetheless, the new focus on population health has led to some uncertainty and anxiety for young cardiologists. Expectations for future clinical roles have changed, as cardiology practices are increasingly acquired by hospitals and converted to salaried positions (11). We have often heard concerns from our peers and colleagues that payment reforms will result in decreased reimbursement and that increasing reporting mandates will result in physicians being held responsible for outcomes that are more determined by care team processes or by patient engagement. However, although approaches to care delivery transformation and payment reform remain an imperfect science, it is our firm belief that young cardiologists should be more encouraged than concerned by the shift toward population health.

One fundamental reason for our confidence is that young cardiologists receive rigorous, evidence-based training that allows them to deliver high-quality cardiovascular care, which, as highlighted previously, is a key aspect of population health. In addition, part of this training involves immersion within team-based, metrics-driven care processes, as any cardiology fellow rushing an ST-segment elevation myocardial infarction patient from the emergency department to the cardiac catheterization laboratory might attest. Our training also requires familiarity with the electronic health records and their benefits and limitations, and thus young cardiologists are likely to intuitively grasp how ordering and documentation can be tightly integrated with decision support and with reporting to data registries and payers. Young cardiologists, therefore, will be prepared with the essential tools to adapt to the transforming healthcare system and are poised to succeed in the new world in which rewards will be on the basis of better patient care and outcomes rather than volume. Future disruptions that could affect population health, such as mobile health, telemedicine, or wearable patient monitor devices, only further play to the generational strengths of young cardiologists who tend to be more technology and data savvy.

This is not to say, however, that the transition toward a healthcare system focused on population health management will always be smooth or seamless. Considerable challenges remain that will require innovative approaches to identify high-risk patients and to deliver efficient, effective, and patient-centered care so that patients receive the right care at the right time in the right setting. As Louis Pasteur once remarked, “fortune favors the prepared mind” (12). We, therefore, offer the following suggestions, partly on the basis of our own experiences, for young cardiologists to learn, engage, and lead, so as to invest in their own future career success in the era of population health.

• American College of Cardiology Foundation