Cardiology eConsult
Chronic Systolic Heart Failure
SPECIALTY
Cardiology
CHIEF COMPLAINT
Chronic Systolic Heart Failure
COMMENTS TO SPECIALIST
This is a 67-year-old female with morbid obesity, seizure, chronic systolic heart failure, and chronic stage II kidney disease. Recently, in the hospital with urosepsis, pneumonia, and acute, chronic heart failure with brain natriuretic peptide (pro-BNP) of 26,800. Elevated troponins due to type II myocardial infarction.
She was ultimately started on furosemide 40 mg a day, carvedilol 6.25 mg twice a day, and spironolactone 25 mg a day. During her hospital stay, she had episodes where she was on pressure support as well as Diamox for metabolic acidosis. While there, she had an echocardiogram that showed a left ventricular ejection fraction of 30% to 35%. The patient remains a full code.
Cardiology considered Entresto but wanted to wait until her blood pressure and sepsis improved. Her blood pressure is now 120 systolic.
MAIN QUESTION
Is it safe to start Entresto?
How Value-based Payment Models Strengthen Primary Care
By: Chris Jaeger, Advisor for ACO and Health System Strategy
The CMS Primary Cares Initiative provides new value-based payment models to enhance primary care delivery to promote efficiency and quality while decreasing healthcare costs. In the second part of this two-part blog series, we explore how eConsults directly support this new initiative across several key metrics. It represents the most recent push for enhancing primary care within healthcare systems, alongside previous models such as Patient-Centered Medical Home (PCMH), the Comprehensive Primary Care (CPC+) program, and the Medicare Advantage Value-based Insurance Design (VBID).
Yet as programs continue to emphasize primary care providers as a locus of optimal care, the question becomes: how can PCPs best work within initiatives such as this to enhance care delivery efficiency and effectiveness and what kinds of services and technologies can support this? A clear answer lies within telehealth technologies, such as eConsults, which is an asynchronous peer-to-peer platform that directly supports primary care capabilities by improving appropriate access to specialist care and improving healthcare outcomes for low- and high-acuity patients alike.
eConsults directly support the Primary Cares Initiatives by maximizing primary care’s value in healthcare delivery, having demonstrated direct benefits in outcomes, costs, and patient and provider satisfaction.
A continuing challenge in maximizing the efficiency and effectiveness of primary care relates to specialist referrals. As more health systems look toward creating PCMH models and consider adopting new value-based payment models under the CMS Primary Cares Initiative, eConsult platforms will be instrumental in improving team-based care coordination and communication.