1 00:00:00,000 --> 00:00:04,360 Welcome everyone to the Becker's Healthcare podcast series. I'm Ryan Mohamed, 2 00:00:04,360 --> 00:00:06,720 she her pronouns with Becker's Healthcare. 3 00:00:06,900 --> 00:00:10,200 I'm thrilled to have with me today Dr. Kara Naer, 4 00:00:11,480 --> 00:00:15,400 division Chief of Cardiovascular Prevention and Wellness at Houston Methodist. 5 00:00:15,610 --> 00:00:17,680 Dr. It's so nice to talk with you today. How are you? 6 00:00:18,800 --> 00:00:22,290 I am fantastic. Thank you so much for the invitation. Uh, 7 00:00:22,290 --> 00:00:25,410 just as we were speaking earlier, I'm a big fan of Becker Podcast, 8 00:00:25,500 --> 00:00:27,210 so thank you for having me on board. 9 00:00:27,210 --> 00:00:31,650 Today. Yes, well, we are absolutely honored to have you on today. Um, 10 00:00:31,650 --> 00:00:32,370 and to begin, 11 00:00:32,370 --> 00:00:36,130 would you mind please introducing yourself and telling us a bit about your 12 00:00:36,130 --> 00:00:36,963 background? 13 00:00:37,650 --> 00:00:41,030 Yes, absolutely. So I'm a preventive cardiologist. 14 00:00:41,270 --> 00:00:45,590 Currently I serve as the division chief of Cardiovascular Prevention and 15 00:00:45,830 --> 00:00:47,990 Wellness at Houston Methodist Deba, 16 00:00:48,050 --> 00:00:52,590 and also the professor of medicine at Whale Cornell, uh, college of Medicine. 17 00:00:52,960 --> 00:00:54,950 As far as my background is concerned, 18 00:00:54,950 --> 00:00:56,950 I received my medical degree from Pakistan, 19 00:00:57,130 --> 00:01:00,310 did my master's of public health at Johns Hopkins University, 20 00:01:00,820 --> 00:01:04,830 followed by medical training at University of Pittsburgh, 21 00:01:04,900 --> 00:01:09,270 Boston Medical Center, Yale University Mass Journal. 22 00:01:09,500 --> 00:01:14,310 I also earned a master's degree in health economics and policy management 23 00:01:14,310 --> 00:01:18,830 from London School of Economics, where I served as a visiting professor. Now, 24 00:01:18,830 --> 00:01:21,310 before joining Houston Methodist four years ago, 25 00:01:21,860 --> 00:01:25,470 I was fortunate to be engaged in various academic, 26 00:01:25,610 --> 00:01:30,270 operational and administrative leadership positions at two premium medical 27 00:01:30,370 --> 00:01:34,590 organizations, Baptist Health, south Florida, of course in Florida, 28 00:01:34,590 --> 00:01:39,040 and year New Haven Health System in Connecticut For seven years, uh, 29 00:01:39,040 --> 00:01:43,720 my interest spanned abroad portfolio ranging from clinical prevention 30 00:01:43,810 --> 00:01:48,280 to translation science, public population and digital health, 31 00:01:48,280 --> 00:01:53,040 and most reach recent ventures in healthcare equity 32 00:01:53,040 --> 00:01:55,120 and social justice initiatives. 33 00:01:55,210 --> 00:01:59,320 As we all believe this is one of the biggest needs of current times. 34 00:01:59,680 --> 00:02:00,480 Currently, 35 00:02:00,480 --> 00:02:05,120 my research projects and programs are supported by various NIH industry 36 00:02:05,430 --> 00:02:08,680 grants as well as institutional endowments. 37 00:02:09,700 --> 00:02:12,580 Wonderful. Thank you so much for giving us that background. 38 00:02:12,760 --> 00:02:16,260 And now with all your experience and degrees, 39 00:02:16,560 --> 00:02:21,100 the first question I wanted to ask you is what are the top three biggest issues 40 00:02:21,100 --> 00:02:22,740 in cardiology today, would you say? 41 00:02:23,990 --> 00:02:26,080 Well, I, I, I would give you a, 42 00:02:27,010 --> 00:02:29,360 my perspective as a preventive cardiologist, 43 00:02:29,360 --> 00:02:33,400 it gives me immense pleasure and pride that despite being the number one cause 44 00:02:33,400 --> 00:02:35,320 of mortality for so long, 45 00:02:35,340 --> 00:02:39,120 our community has made significant strides over the last three decades. 46 00:02:39,600 --> 00:02:43,240 We've cut into our losses and if you look at the trends, it appear that, 47 00:02:43,240 --> 00:02:47,840 and I'm very hopeful we will soon lose the number one kilo in the us. 48 00:02:48,020 --> 00:02:48,720 However, 49 00:02:48,720 --> 00:02:53,170 what is less recognized that majority of what we have achieved in improving 50 00:02:53,170 --> 00:02:57,290 heart disease mortality re relates to greater access, 51 00:02:57,290 --> 00:03:00,880 better and safer procedures, improved processes of care, 52 00:03:00,880 --> 00:03:03,160 and even medications after you had an event. 53 00:03:03,160 --> 00:03:07,360 But why these are great achievements. If you look deeper, 54 00:03:07,490 --> 00:03:12,000 we have not made much stride as far as preventing heart disease. 55 00:03:12,000 --> 00:03:15,280 Each year, about 800,000 new heart attacks happen, 56 00:03:15,300 --> 00:03:20,160 and nearly half of them are so the new heart attacks or sudden cardiac, 57 00:03:20,160 --> 00:03:23,520 that now to my mind, three issues come to play. 58 00:03:23,520 --> 00:03:28,160 The first is fundamental in how we identify and 59 00:03:28,160 --> 00:03:29,080 assess risk, 60 00:03:29,490 --> 00:03:34,360 so we can implement preventive efforts among individuals who had not yet 61 00:03:34,680 --> 00:03:35,680 declared with heart disease. 62 00:03:36,300 --> 00:03:40,680 And the issue is we still employ the very traditional risk factors 63 00:03:41,310 --> 00:03:46,200 that was first introduced in 1961, which remain imprecise. 64 00:03:46,870 --> 00:03:47,703 However, 65 00:03:48,210 --> 00:03:53,180 with recent advances in technology and imaging such as a non-contrast 66 00:03:53,350 --> 00:03:57,660 CT scan, which is widely available associated with minimum radiation, 67 00:03:57,660 --> 00:03:59,420 easy to perform cheap, 68 00:03:59,720 --> 00:04:03,060 can find out the earlie surrogate of the disease, 69 00:04:03,060 --> 00:04:07,900 which is atherosclerosis without ha doing any invasive 70 00:04:07,900 --> 00:04:08,560 procedure. 71 00:04:08,560 --> 00:04:13,460 And now it has been adopted by the guidelines as a method to overcome the 72 00:04:13,460 --> 00:04:17,060 limitations of relying on wild guesses based on risk factors. 73 00:04:17,150 --> 00:04:18,740 So that's number one. Number two, 74 00:04:19,170 --> 00:04:23,820 I think health disparities are clearly one of the greatest injustices in our 75 00:04:23,820 --> 00:04:24,640 time. 76 00:04:24,640 --> 00:04:29,220 And the well established inequalities in clear processes 77 00:04:29,320 --> 00:04:32,980 and disease burden and outcomes has really hindered our, 78 00:04:33,760 --> 00:04:37,160 our gains in prevention of heart disease. Now, 79 00:04:37,200 --> 00:04:38,920 while it has been ignored forever, 80 00:04:39,100 --> 00:04:43,800 I'm thankful that there now is a desire to address shift 81 00:04:43,800 --> 00:04:46,320 not only into health disparities, 82 00:04:46,340 --> 00:04:50,800 but also addressing structural changes to ensure attainment of the highest 83 00:04:51,040 --> 00:04:54,400 level of health for everyone. And as a result, 84 00:04:54,410 --> 00:04:58,280 we have to start looking beyond the four walls of healthcare and include 85 00:04:58,280 --> 00:05:03,240 conditions where individuals grow live and age broadly called 86 00:05:03,240 --> 00:05:05,840 social determinants of health. So practically, 87 00:05:05,840 --> 00:05:10,760 our group has done a lot of work in trying to use census level measures as well 88 00:05:10,760 --> 00:05:11,920 as at an individual level, 89 00:05:11,920 --> 00:05:16,880 measures that you can accurately identify the social determinants of health, 90 00:05:16,880 --> 00:05:21,840 where that can give you information much more beyond than your, uh, 91 00:05:21,840 --> 00:05:24,760 overall disease risk. And finally, 92 00:05:24,990 --> 00:05:29,360 I think a major issue which has left most of us 93 00:05:29,360 --> 00:05:34,040 unprepared is financial toxicity, which people would, uh, 94 00:05:34,040 --> 00:05:38,720 relate to potential adverse outcomes from strains from higher medical costs. 95 00:05:38,720 --> 00:05:39,360 Now, 96 00:05:39,360 --> 00:05:43,800 while it has been mainly considered a cancer issue, 97 00:05:44,260 --> 00:05:47,040 our work has shown that almost half of the families, 98 00:05:47,570 --> 00:05:50,680 if you have a member with heart disease report, 99 00:05:50,680 --> 00:05:55,400 significant difficulty paying medical bills or pay it off with a credit card or 100 00:05:55,400 --> 00:05:58,920 through personal loans or arrangements with the hospital. In fact, 101 00:05:59,050 --> 00:06:01,080 if you look at low income families, 102 00:06:01,620 --> 00:06:06,080 one in four will be spending 20% of their combined income on healthcare cost. 103 00:06:06,850 --> 00:06:10,840 So clearly financial toxicity is such an unrecognized, 104 00:06:11,110 --> 00:06:14,800 highly prevalent, affecting millions of patients and their families. 105 00:06:16,060 --> 00:06:18,080 And unlike clinical side effects, 106 00:06:18,080 --> 00:06:22,240 it's a potentially devastating consequence of heart disease treatment 107 00:06:22,750 --> 00:06:26,480 that many of these patients have been left to manage on their own with 108 00:06:26,480 --> 00:06:29,160 tremendous downstream consequences. 109 00:06:29,650 --> 00:06:32,440 So I hope that with these clear reminders, 110 00:06:32,440 --> 00:06:35,520 we can influence the policy debates about healthcare, 111 00:06:35,720 --> 00:06:39,720 expanding a more precise way of detecting risk, 112 00:06:39,720 --> 00:06:41,520 looking at social determinants, 113 00:06:41,900 --> 00:06:46,400 and looking at the pricing of our healthcare so that 114 00:06:46,960 --> 00:06:51,920 governing organizations such as ACC and other legislative bodies can take 115 00:06:51,920 --> 00:06:53,640 notice. I, I think, 116 00:06:53,640 --> 00:06:58,240 so those are the three major issues that from where I see 117 00:06:58,430 --> 00:07:01,480 that we need urgent attention from everyone, 118 00:07:01,480 --> 00:07:03,480 especially from our policy experts. 119 00:07:04,030 --> 00:07:08,680 Absolutely. Thank you so much for those great insights into cardiology today. 120 00:07:09,130 --> 00:07:12,160 Um, you gave some great statistics too. Uh, 121 00:07:12,160 --> 00:07:14,920 and since you have a good grasp on the space today, 122 00:07:15,220 --> 00:07:19,640 how do you see heart care evolving over the next 18 months or so? 123 00:07:20,700 --> 00:07:25,030 I, I would say over the next 18 to 24 or slightly longer, I, 124 00:07:25,030 --> 00:07:29,870 I would see a shift inevitably towards value-based, uh, 125 00:07:30,180 --> 00:07:31,350 I would say healthcare. 126 00:07:31,380 --> 00:07:36,030 That adoption of these is becoming a reality across health 127 00:07:36,030 --> 00:07:40,710 systems in the country as we transition from volume to value. 128 00:07:41,720 --> 00:07:42,070 Uh, 129 00:07:42,070 --> 00:07:46,510 thankfully majority of the healthcare organizations are increasingly seeking to 130 00:07:46,870 --> 00:07:51,830 transform their existing business model so they can strengthen capacity and 131 00:07:51,830 --> 00:07:56,710 deliver a high value care with coordination and population health 132 00:07:56,710 --> 00:07:57,870 management. Now, 133 00:07:57,870 --> 00:08:01,990 it's also important to realize that the path to clinical integration for 134 00:08:01,990 --> 00:08:06,590 population health management in our systems, which as you know, 135 00:08:06,590 --> 00:08:08,110 are extremely siloed. 136 00:08:08,110 --> 00:08:12,110 There is no clear one right strategy, 137 00:08:12,850 --> 00:08:17,550 and it should be approached cautiously mindful of all the options. Now, 138 00:08:17,550 --> 00:08:21,910 where I'm coming from, I hope in growing markets such as Texas and Houston, 139 00:08:22,070 --> 00:08:23,110 where I'm from, 140 00:08:23,820 --> 00:08:28,110 I see less emphasis yet on these value-based programs. 141 00:08:29,000 --> 00:08:31,710 Uh, Howard that's fine because at the same time, 142 00:08:31,780 --> 00:08:33,670 I see this as an opportunity to, 143 00:08:33,670 --> 00:08:38,250 for us to start repairing the roof when the sun is shining. So for that, 144 00:08:38,250 --> 00:08:40,810 I'm hoping that within Texas Medical Center, 145 00:08:40,870 --> 00:08:43,570 the largest medical center in the world, 146 00:08:44,030 --> 00:08:48,330 our executive leadership can come up with the vision to 147 00:08:48,330 --> 00:08:52,490 collectively commission a population health management consortium. 148 00:08:52,780 --> 00:08:54,530 So we can develop strategies, 149 00:08:54,660 --> 00:08:58,800 roadmap that can clearly articulate a joint vision, 150 00:08:59,290 --> 00:09:02,600 options, challenges, investment, 151 00:09:03,060 --> 00:09:07,000 and also creation of a sustainable financial mechanism. Now, 152 00:09:07,000 --> 00:09:10,720 there are many components in this process, governance, incentives, 153 00:09:10,880 --> 00:09:12,720 processes of care. However, 154 00:09:13,630 --> 00:09:18,590 I feel the most important piece will be leveraging data via 155 00:09:18,590 --> 00:09:19,950 robust infrastructure, 156 00:09:20,300 --> 00:09:25,110 having a very mature analytic platform that can employ all 157 00:09:25,110 --> 00:09:28,030 of these data assets, uh, 158 00:09:28,030 --> 00:09:32,510 and produce information which is critical for successful implementation of 159 00:09:32,510 --> 00:09:37,030 population health and clinical integrated, uh, programs. 160 00:09:37,660 --> 00:09:41,160 Now, one thing is clear about the future of healthcare. 161 00:09:41,160 --> 00:09:46,040 B it is the next 18, 24 months or beyond that our ability 162 00:09:46,090 --> 00:09:48,160 to deliver high quality, 163 00:09:48,960 --> 00:09:53,720 economically sustainable care will depend upon how we manage the health of 164 00:09:53,720 --> 00:09:56,480 population we exist to serve. 165 00:09:56,900 --> 00:10:01,560 And I just want to remind our listeners that clinical integration is not the end 166 00:10:01,560 --> 00:10:06,080 point, but it's a journey that will require vision leadership, 167 00:10:06,790 --> 00:10:10,320 a very supportive business model, and more importantly, 168 00:10:10,320 --> 00:10:14,560 attention to maximizing data and digital 169 00:10:15,280 --> 00:10:20,080 capacity for building a most robust population health management foundation. 170 00:10:21,320 --> 00:10:25,000 Great. Thank you so much, doctor, for sharing those thoughts. Uh, 171 00:10:25,000 --> 00:10:28,760 before I let you go, the last thing I wanted to ask you is what are you, 172 00:10:28,790 --> 00:10:32,800 what are you excited about today? And also what is making you nervous, 173 00:10:32,850 --> 00:10:37,160 whether you know it's something that you're working on in your health system or 174 00:10:37,160 --> 00:10:40,240 something that you're seeing just in a cario cardiology space, 175 00:10:41,000 --> 00:10:41,833 anything like that? 176 00:10:42,570 --> 00:10:43,420 I, I, I think, 177 00:10:43,420 --> 00:10:48,420 so the thing that makes excites me the most and at the same time make me 178 00:10:48,420 --> 00:10:49,700 nervous is the promise, 179 00:10:50,020 --> 00:10:54,180 which we discussed of the role of big data in transforming medical enterprise. 180 00:10:54,760 --> 00:10:59,380 And the thing that it makes me nervous is are would we be able to quickly 181 00:10:59,380 --> 00:11:03,660 and effectively adopt it and learn from our prior misadventures? 182 00:11:04,590 --> 00:11:08,460 Uh, uh, I think the feature, a feature that is unique to our generation, 183 00:11:08,460 --> 00:11:12,140 that we are fortunate to be in the most remarkable age of data and medical 184 00:11:12,140 --> 00:11:16,460 information generation each year. We produce more data than last year, 185 00:11:16,460 --> 00:11:19,300 and we'll continue to do in the next year's two. 186 00:11:19,560 --> 00:11:23,620 And it's no longer a secret to everyone that, and you, I, 187 00:11:23,620 --> 00:11:25,620 and you don't have to look into a crystal ball. 188 00:11:25,620 --> 00:11:29,420 That data has become the biggest commodity. And more importantly, 189 00:11:29,960 --> 00:11:34,940 our ability to convert into meaningful information at a integrated speed 190 00:11:34,940 --> 00:11:38,540 is transforming all industry across us. However, 191 00:11:39,270 --> 00:11:43,260 if you look in healthcare enterprise, which we are used to performing miracles, 192 00:11:43,880 --> 00:11:48,300 unfortunately I haven't seen any meaningful translation in how we practice 193 00:11:48,620 --> 00:11:51,460 medicine and utilize the data now for inspirational, 194 00:11:51,910 --> 00:11:54,080 as per my dear friend Harlan Comel. 195 00:11:54,080 --> 00:11:57,720 We don't have to look beyond examples such as Google's learning with every 196 00:11:57,720 --> 00:11:59,400 click, Amazon with every purchase, 197 00:12:00,240 --> 00:12:02,560 Facebook with every post and Tesla with every mile. 198 00:12:02,590 --> 00:12:07,200 I think adoption of this big data application will fundamentally 199 00:12:07,840 --> 00:12:09,760 transform how we deliver care, 200 00:12:10,620 --> 00:12:15,040 how we create the next generation of, uh, 201 00:12:15,310 --> 00:12:19,400 physicians, and also how we generate newer knowledge, 202 00:12:20,050 --> 00:12:20,530 uh, 203 00:12:20,530 --> 00:12:25,440 to find out what is lacking and where we need to do so at 204 00:12:25,440 --> 00:12:27,880 Houston Methodist, thinking about the future, uh, 205 00:12:27,880 --> 00:12:30,640 rather than waiting for others and following, 206 00:12:30,640 --> 00:12:35,560 we are taking the destiny in our own hand and we are creating an amazing 207 00:12:35,700 --> 00:12:36,560 infrastructure, 208 00:12:36,790 --> 00:12:41,760 a most comprehensive data platform that's harmonizing as much data 209 00:12:41,760 --> 00:12:45,880 as possible in a very durable, efficient manner. And I, 210 00:12:45,880 --> 00:12:48,480 I'm glad to tell you that over the last 12 months, 211 00:12:49,130 --> 00:12:54,040 we have been blessed to create this unique infrastructure 212 00:12:54,040 --> 00:12:57,720 that's making use of every data point in our emr. 213 00:12:58,570 --> 00:13:03,520 We have harmonized of more than 1.3 million individuals with more than 7 million 214 00:13:03,520 --> 00:13:07,760 encounters every lab vital medication procedure 215 00:13:08,420 --> 00:13:12,190 linked to more than 0.6 million ED and inpatient visit, 216 00:13:12,200 --> 00:13:15,230 as well as capturing social and environmental factors. 217 00:13:15,800 --> 00:13:20,710 So I sincerely hope that the future can pave ways and things get simpler 218 00:13:20,710 --> 00:13:25,070 for other groups learning from what we have been done across their enterprise, 219 00:13:25,070 --> 00:13:29,590 and they can overcome their barriers and set themselves on a fast track learning 220 00:13:29,590 --> 00:13:34,470 health system because we all share our goals of 221 00:13:34,470 --> 00:13:36,750 making this huge leap, I think, 222 00:13:36,750 --> 00:13:39,990 in transforming medicine from the current model of disease care, 223 00:13:40,040 --> 00:13:44,550 to one that emphasize more on healthcare. And in that journey, 224 00:13:44,620 --> 00:13:49,350 I cannot emphasize more on the role of precision medicine and how data will 225 00:13:49,350 --> 00:13:51,870 help us get there in an accelerated fashion. 226 00:13:52,930 --> 00:13:56,820 Absolutely. Thank you so much for final thoughts. Dr. Naser. 227 00:13:56,970 --> 00:13:58,940 This has been an amazing discussion. 228 00:13:58,940 --> 00:14:03,140 So I wanna thank you again for coming on Becker's Healthcare and I look forward 229 00:14:03,140 --> 00:14:04,620 to connecting with you again soon. 230 00:14:05,520 --> 00:14:09,600 Thank you so much again for the opportunity and we look forward to 231 00:14:09,990 --> 00:14:12,080 touching back again. Thank you so much. 232 00:14:12,410 --> 00:14:12,960 Of course.