HJAR Jul/Aug 2023

HEALTHCARE JOURNAL OF ARKANSAS I  JUL / AUG 2023 31 visibility into BP lability, where multiple read- ings can be easily collected across different dates and times. The team can also seamlessly communicate changes and findings with both the patient and the patient’s PCP. The patient doesn’t have to physically come into the of- fice to benefit from remote patient manage- ment, which not only saves them time and expense, but also enables their provider to be more efficient with their own use of time. As stated in the last article, the most impor- tant of these variables is trust . Patient adher- ence to medical advice in general and to a multi-drug anti-hypertensive regimen more specifically becomes a function of several im- portant variables. These include communica- tion effectiveness among care team members, between care team and patient, patient aware- ness of the types and nature of side effects (specifically which ones should generate con- cern and which ones should not; which ones are permanent and which ones are not), and, most importantly, patient goals and expecta- tions. Invariably, it all boils down to trust — “I am willing to be led by you and to do as you recommended because I trust you.” And to that end, if a patient’s proportion of days cov- ered — a measure of how many days a patient is taking their medication, reportable through a pharmacy database that tracks when and how often they are refilling their medications — dips below 80 or 90%, it should involve a proactive outreach effort to discover the reasons why. Are they having difficulty affording or remem- bering their medication? Are they experiencing a side effect that they were too embarrassed to report? Did we communicate effectively? Did they understand the instructions? Did we set expectations and manage them appro- priately? Are they possibly depressed or anx- ious? Do they trust us? In other words, before blaming the patient for “noncompliance,” we should be looking at ourselves in the mir- ror and asking these important questions. And as we progress through the stages of bet- ter managing chronic conditions, in addition to simple process measures like rates of hyperten- sion control, it will be imperative that we transi- tion more toward measuring the outcomes that matter most to patients. Only by understanding all variables that co-produce our outcomes and by tracking them can we learn from the instanc- es when we get something wrong. And only by doing so will we generate the continuous loops of clinical improvement that will ultimately tran- sition the performance of U.S. healthcare to a state of high performance and affordability. If we are not measuring outcomes, how can we ever improve what we don’t measure? In the next article, we will continue with the theme of better managing chronic conditions, where next up is improving diabetes management. n prior articles: cultural mindset change among providers where practice patterns are adopted that lead to improved outcomes and where they bear accountability for those outcomes, standardization of care where explicit knowl- edge can be captured through sequential care processes, talent allocation to solving prob- lems where advanced practice providers can and should be achieving identical results as physicians for hypertension control (because tacit knowledge plays a much less important role in hypertension management than, say, diagnosing a fever of unknown origin), and sev- eral other important variables previously dis- cussed, like time, team, technology, and trust. The above strategies can all be executed within current economic models of healthcare, but once you embrace new economic models that create and capture value differently, you really unleash the power of innovation. In the case of hypertension management, it is build- ing out a centralized team of clinical phar- macists and health coaches, who help guide patients on their journey to controlling hyper- tension. Utilizing the technology of a wireless, validated BP cuff that can capture readings and upload them to a cloud-based server, a team of health coaches and pharmacists can moni- tor the readings and make dosage adjustments in real time according to a structured protocol. These care team members have incredible “Innovating the future requires designing newmethods of creating and capturing value and development of new operating and performance metrics.”