Welcome everyone to the Becker's Healthcare podcast series. I'm Ryan Mohamed,
she her pronouns with Becker's Healthcare.
I'm thrilled to have with me today Dr. Kara Naer,
division Chief of Cardiovascular Prevention and Wellness at Houston Methodist.
Dr. It's so nice to talk with you today. How are you?
I am fantastic. Thank you so much for the invitation. Uh,
just as we were speaking earlier, I'm a big fan of Becker Podcast,
so thank you for having me on board.
Today. Yes, well, we are absolutely honored to have you on today. Um,
and to begin,
would you mind please introducing yourself and telling us a bit about your
background?
Yes, absolutely. So I'm a preventive cardiologist.
Currently I serve as the division chief of Cardiovascular Prevention and
Wellness at Houston Methodist Deba,
and also the professor of medicine at Whale Cornell, uh, college of Medicine.
As far as my background is concerned,
I received my medical degree from Pakistan,
did my master's of public health at Johns Hopkins University,
followed by medical training at University of Pittsburgh,
Boston Medical Center, Yale University Mass Journal.
I also earned a master's degree in health economics and policy management
from London School of Economics, where I served as a visiting professor. Now,
before joining Houston Methodist four years ago,
I was fortunate to be engaged in various academic,
operational and administrative leadership positions at two premium medical
organizations, Baptist Health, south Florida, of course in Florida,
and year New Haven Health System in Connecticut For seven years, uh,
my interest spanned abroad portfolio ranging from clinical prevention
to translation science, public population and digital health,
and most reach recent ventures in healthcare equity
and social justice initiatives.
As we all believe this is one of the biggest needs of current times.
Currently,
my research projects and programs are supported by various NIH industry
grants as well as institutional endowments.
Wonderful. Thank you so much for giving us that background.
And now with all your experience and degrees,
the first question I wanted to ask you is what are the top three biggest issues
in cardiology today, would you say?
Well, I, I, I would give you a,
my perspective as a preventive cardiologist,
it gives me immense pleasure and pride that despite being the number one cause
of mortality for so long,
our community has made significant strides over the last three decades.
We've cut into our losses and if you look at the trends, it appear that,
and I'm very hopeful we will soon lose the number one kilo in the us.
However,
what is less recognized that majority of what we have achieved in improving
heart disease mortality re relates to greater access,
better and safer procedures, improved processes of care,
and even medications after you had an event.
But why these are great achievements. If you look deeper,
we have not made much stride as far as preventing heart disease.
Each year, about 800,000 new heart attacks happen,
and nearly half of them are so the new heart attacks or sudden cardiac,
that now to my mind, three issues come to play.
The first is fundamental in how we identify and
assess risk,
so we can implement preventive efforts among individuals who had not yet
declared with heart disease.
And the issue is we still employ the very traditional risk factors
that was first introduced in 1961, which remain imprecise.
However,
with recent advances in technology and imaging such as a non-contrast
CT scan, which is widely available associated with minimum radiation,
easy to perform cheap,
can find out the earlie surrogate of the disease,
which is atherosclerosis without ha doing any invasive
procedure.
And now it has been adopted by the guidelines as a method to overcome the
limitations of relying on wild guesses based on risk factors.
So that's number one. Number two,
I think health disparities are clearly one of the greatest injustices in our
time.
And the well established inequalities in clear processes
and disease burden and outcomes has really hindered our,
our gains in prevention of heart disease. Now,
while it has been ignored forever,
I'm thankful that there now is a desire to address shift
not only into health disparities,
but also addressing structural changes to ensure attainment of the highest
level of health for everyone. And as a result,
we have to start looking beyond the four walls of healthcare and include
conditions where individuals grow live and age broadly called
social determinants of health. So practically,
our group has done a lot of work in trying to use census level measures as well
as at an individual level,
measures that you can accurately identify the social determinants of health,
where that can give you information much more beyond than your, uh,
overall disease risk. And finally,
I think a major issue which has left most of us
unprepared is financial toxicity, which people would, uh,
relate to potential adverse outcomes from strains from higher medical costs.
Now,
while it has been mainly considered a cancer issue,
our work has shown that almost half of the families,
if you have a member with heart disease report,
significant difficulty paying medical bills or pay it off with a credit card or
through personal loans or arrangements with the hospital. In fact,
if you look at low income families,
one in four will be spending 20% of their combined income on healthcare cost.
So clearly financial toxicity is such an unrecognized,
highly prevalent, affecting millions of patients and their families.
And unlike clinical side effects,
it's a potentially devastating consequence of heart disease treatment
that many of these patients have been left to manage on their own with
tremendous downstream consequences.
So I hope that with these clear reminders,
we can influence the policy debates about healthcare,
expanding a more precise way of detecting risk,
looking at social determinants,
and looking at the pricing of our healthcare so that
governing organizations such as ACC and other legislative bodies can take
notice. I, I think,
so those are the three major issues that from where I see
that we need urgent attention from everyone,
especially from our policy experts.
Absolutely. Thank you so much for those great insights into cardiology today.
Um, you gave some great statistics too. Uh,
and since you have a good grasp on the space today,
how do you see heart care evolving over the next 18 months or so?
I, I would say over the next 18 to 24 or slightly longer, I,
I would see a shift inevitably towards value-based, uh,
I would say healthcare.
That adoption of these is becoming a reality across health
systems in the country as we transition from volume to value.
Uh,
thankfully majority of the healthcare organizations are increasingly seeking to
transform their existing business model so they can strengthen capacity and
deliver a high value care with coordination and population health
management. Now,
it's also important to realize that the path to clinical integration for
population health management in our systems, which as you know,
are extremely siloed.
There is no clear one right strategy,
and it should be approached cautiously mindful of all the options. Now,
where I'm coming from, I hope in growing markets such as Texas and Houston,
where I'm from,
I see less emphasis yet on these value-based programs.
Uh, Howard that's fine because at the same time,
I see this as an opportunity to,
for us to start repairing the roof when the sun is shining. So for that,
I'm hoping that within Texas Medical Center,
the largest medical center in the world,
our executive leadership can come up with the vision to
collectively commission a population health management consortium.
So we can develop strategies,
roadmap that can clearly articulate a joint vision,
options, challenges, investment,
and also creation of a sustainable financial mechanism. Now,
there are many components in this process, governance, incentives,
processes of care. However,
I feel the most important piece will be leveraging data via
robust infrastructure,
having a very mature analytic platform that can employ all
of these data assets, uh,
and produce information which is critical for successful implementation of
population health and clinical integrated, uh, programs.
Now, one thing is clear about the future of healthcare.
B it is the next 18, 24 months or beyond that our ability
to deliver high quality,
economically sustainable care will depend upon how we manage the health of
population we exist to serve.
And I just want to remind our listeners that clinical integration is not the end
point, but it's a journey that will require vision leadership,
a very supportive business model, and more importantly,
attention to maximizing data and digital
capacity for building a most robust population health management foundation.
Great. Thank you so much, doctor, for sharing those thoughts. Uh,
before I let you go, the last thing I wanted to ask you is what are you,
what are you excited about today? And also what is making you nervous,
whether you know it's something that you're working on in your health system or
something that you're seeing just in a cario cardiology space,
anything like that?
I, I, I think,
so the thing that makes excites me the most and at the same time make me
nervous is the promise,
which we discussed of the role of big data in transforming medical enterprise.
And the thing that it makes me nervous is are would we be able to quickly
and effectively adopt it and learn from our prior misadventures?
Uh, uh, I think the feature, a feature that is unique to our generation,
that we are fortunate to be in the most remarkable age of data and medical
information generation each year. We produce more data than last year,
and we'll continue to do in the next year's two.
And it's no longer a secret to everyone that, and you, I,
and you don't have to look into a crystal ball.
That data has become the biggest commodity. And more importantly,
our ability to convert into meaningful information at a integrated speed
is transforming all industry across us. However,
if you look in healthcare enterprise, which we are used to performing miracles,
unfortunately I haven't seen any meaningful translation in how we practice
medicine and utilize the data now for inspirational,
as per my dear friend Harlan Comel.
We don't have to look beyond examples such as Google's learning with every
click, Amazon with every purchase,
Facebook with every post and Tesla with every mile.
I think adoption of this big data application will fundamentally
transform how we deliver care,
how we create the next generation of, uh,
physicians, and also how we generate newer knowledge,
uh,
to find out what is lacking and where we need to do so at
Houston Methodist, thinking about the future, uh,
rather than waiting for others and following,
we are taking the destiny in our own hand and we are creating an amazing
infrastructure,
a most comprehensive data platform that's harmonizing as much data
as possible in a very durable, efficient manner. And I,
I'm glad to tell you that over the last 12 months,
we have been blessed to create this unique infrastructure
that's making use of every data point in our emr.
We have harmonized of more than 1.3 million individuals with more than 7 million
encounters every lab vital medication procedure
linked to more than 0.6 million ED and inpatient visit,
as well as capturing social and environmental factors.
So I sincerely hope that the future can pave ways and things get simpler
for other groups learning from what we have been done across their enterprise,
and they can overcome their barriers and set themselves on a fast track learning
health system because we all share our goals of
making this huge leap, I think,
in transforming medicine from the current model of disease care,
to one that emphasize more on healthcare. And in that journey,
I cannot emphasize more on the role of precision medicine and how data will
help us get there in an accelerated fashion.
Absolutely. Thank you so much for final thoughts. Dr. Naser.
This has been an amazing discussion.
So I wanna thank you again for coming on Becker's Healthcare and I look forward
to connecting with you again soon.
Thank you so much again for the opportunity and we look forward to
touching back again. Thank you so much.
Of course.