Ken Cohen, MD, FACP

Panelists discuss how heart failure classification involves HFrEF vs HFpEF distinctions and staging systems (A through D), with the greatest prevention opportunities existing in early stages A and B, where patients have risk factors or subclinical dysfunction but haven’t yet developed overt clinical symptoms.

Panelists discuss how quality metrics should focus on keeping patients out of hospitals through core medical therapies, measuring all-cause hospitalizations and days spent at home in the community, while tracking both process metrics (guideline-directed medical therapy prescriptions, comorbidity management) and outcome metrics (mortality, readmissions, quality of life) with financial incentives through Medicare Accountable Care Organization programs.

Panelists discuss how heart failure affects 1 in 4 people over their lifetime with 7 million current cases in the US, while Optum Health has implemented an innovative screening program using symptom questionnaires, BNP testing, and echocardiograms for patients over age 60 years during wellness visits.

Panelists discuss how heart failure creates a massive economic burden of approximately $30 billion annually (expected to reach $70 billion to $80 billion by 2030), driven by hospitalizations, readmissions, expensive multidrug regimens costing over $20,000 to $30,000 per patient, and high-cost interventions like ablations and advanced therapies.

Panelists discuss how bronchiectasis is more common than previously thought, with growing awareness, research, and specialized centers improving diagnosis and treatment options, though challenges remain in standardizing care and securing insurance coverage for therapies.

Panelists discuss how future bronchiectasis research will focus on precision medicine, identify treatable traits, and expand networks of Centers of Excellence to provide advanced care and clinical trial access for patients.

Panelists discuss how emerging DPP1 inhibitor therapies target neutrophil serine proteases to reduce neutrophilic inflammation and neutrophil extracellular trap formation in bronchiectasis.

Panelists discuss how surgical approaches for bronchiectasis have evolved from open thoracotomy to minimally invasive techniques (VATS or robotic assisted), reducing hospital stays from 5 to 7 days to 1 to 3 days and recovery time from 6 to 8 weeks to 2 to 6 weeks.

Panelists discuss how the heterogeneity of bronchiectasis requires precise phenotyping and a treatable traits approach to address varying symptom profiles, from cough-predominant to shortness of breath–predominant presentations.

Panelists discuss how preventing bronchiectasis exacerbations involves understanding a patient’s past exacerbation pattern, implementing comprehensive airway clearance, patient education, and early intervention.

Panelists discuss how ideal candidates for bronchiectasis surgery have localized disease on CT scan and bronchoscopy, adequate pulmonary function (orced expiratory volume in 1 second > 40%), and whose infections are controlled prior to surgery.

Panelists discuss how reducing bronchiectasis exacerbations requires standardized definitions, tailored antibiotic approaches, and increased airway clearance, while addressing underlying conditions and ongoing research into optimal treatment protocols.

Panelists discuss how airway clearance devices and techniques, including chest physical therapy, active cycle breathing, exercise, hypertonic saline, and oscillatory positive expiratory pressure devices, are the mainstay of bronchiectasis management.

Panelists discuss how evaluating potential causes of bronchiectasis is important despite many cases being idiopathic, as identifying treatable traits can lead to specific interventions, such as CFTR modulators for those with CF mutations or IgG supplementation.

Panelists discuss how managing bronchiectasis exacerbations involves targeted antibiotics based on sputum cultures, augmenting mucus clearance with devices, and considering surgical intervention when medical management fails.

Panelists discuss how bacterial infections, environmental triggers, and microbiome imbalances cause bronchiectasis exacerbations, leading to increased cough, phlegm, fatigue, and hemoptysis.

Panelists discusses how the "vicious vortex model" explains bronchiectasis pathophysiology, where airway dilatation leads to mucus stagnation, chronic infections, and neutrophilic inflammation, worsening the condition.

Panelists discusses how bronchiectasis differs from other respiratory diseases like asthma and COPD through symptoms, imaging findings, and pathophysiological mechanisms.

Experts discuss how to evaluate the cost-effectiveness of continuous glucose monitoring (CGM) compared to traditional monitoring, considering both clinical and quality outcomes, and what combination of economic and quality data would most effectively support broader CGM adoption across health systems and payer organizations.

Experts share specific examples of how continuous glucose monitoring (CGM) technology has impacted diabetes-related health care costs and quality performance metrics, and discuss the methods used to measure and track CGM's long-term impact on diabetes complications, associated costs, and quality outcomes.

Experts discuss the metrics used to evaluate continuous glucose monitoring (CGM)'s comprehensive return on investment, including both cost savings and quality measure performance, and identify which patient populations demonstrate the strongest combined benefits in costs, quality measures, and outcomes, along with how these groups are prioritized for CGM access.

Experts discuss the impact of continuous glucose monitoring (CGM) implementation on emergency department utilization, hospitalizations, and quality measures including Healthcare Effectiveness Data and Information Set (HEDIS)/Medicare Star ratings, and how CGM adoption has influenced patient encounter patterns, care coordination efficiency, and achievement of quality benchmarks.

Experts discuss how to evaluate and communicate the return on investment for continuous glucose monitoring (CGM) coverage to overcome cost-related barriers, explore strategies other payers could adopt based on the success of Metro Nashville Public Schools' initiative to provide CGM devices without prior authorization, and examine the impact of removing prior authorization requirements on appropriate patient selection and utilization, along with which aspects of this model could be adopted by other employers and the resources needed to implement similar programs.

Experts discuss the disparities observed in continuous glucose monitoring (CGM) access and utilization with Healthcare Effectiveness Data and Information Set (HEDIS) now stratifying 22 measures by race and ethnicity, and how these insights can inform strategies to improve health equity, along with successful strategies implemented to improve CGM access and technology literacy in underserved communities.

Experts discuss how current coverage policies and prior authorization requirements affect continuous glucose monitoring (CGM) access and adoption rates, and how coverage barriers impact the ability to provide timely CGM access, particularly for patients who could benefit most.

Experts discuss the most significant barriers to continuous glucose monitoring (CGM) implementation encountered in their respective roles and how these barriers vary across different patient populations and care settings.

Experts discuss how the integration of continuous glucose monitoring (CGM) data into electronic health record (EHR) systems enhances clinical decision-making and care coordination, how primary care providers (PCPs) can leverage CGM data integration to provide more comprehensive diabetes care in the context of a shortage of endocrinologists, and the impact of varying coverage policies for CGM across different payers on patient access and outcomes, particularly for patients on basal insulin.

Experts discuss the role of continuous glucose monitoring (CGM)-derived metrics, particularly glucose management indicator (GMI), in the new Healthcare Effectiveness Data and Information Set (HEDIS) diabetes care measures and ACO quality targets, and how CGM-specific metrics are being incorporated into the National Committee for Quality Assurance (NCQA)’s quality measures and the implications for health plans.

Experts discuss the relative value of different continuous glucose monitoring (CGM) metrics (glucose management indicator [GMI], time in range, glucose variability) in assessing glycemic control and how these outcomes vary across different patient populations.

Experts discuss the clinical and practical factors that guide decision-making when recommending continuous glucose monitoring (CGM) vs traditional glucose monitoring for patients with type 2 diabetes.