Ken Cohen, MD, FACP

Ken Cohen, MD, FACP, discusses how new cognitive assessment tools are improving Alzheimer disease diagnosis.

Ken Cohen, MD, FACP, discusses how clinicians can support patients after a cognitive screening to identify meaningful next steps.

Panelists discuss how diuretics serve as necessary “bailout therapy” for volume management in heart failure but should not substitute for guideline-directed medical therapy, with emerging evidence supporting more nuanced approaches to diuresis, including urinalysis monitoring and novel formulations like intranasal furosemide, while noting that effective heart failure therapies actually reduce diuretic requirements.

Panelists discuss how β-blockers remain foundational therapy for heart failure with reduced ejection fraction (using evidence-based agents like carvedilol, metoprolol succinate, or bisoprolol) with proven mortality benefits, while their role in heart failure with preserved ejection fraction is more questionable and potentially overused unless atrial fibrillation is present.

Ken Cohen, MD, FACP, discusses the importance of expanding cognitive screening for seniors.

Panelists discuss how guideline-directed medical therapy has evolved to include 4-pillar treatment for heart failure with reduced ejection fraction (angiotensin-converting enzyme inhibitors/angiotensin receptor‐neprilysin inhibitors, β-blockers, mineralocorticoid receptor antagonists, SGLT2 inhibitors) that can reduce mortality by up to 60% and extend life by 6 years, though significant implementation gaps remain, with only about one-third of eligible patients receiving appropriate therapy, necessitating rapid initiation of all 4 drug classes within weeks rather than sequential titration.

Panelists discuss how effective heart failure management requires collaborative care across multiple specialties (primary care, cardiology, endocrinology, nephrology) with advanced practice providers serving as dedicated coordinators, utilizing multidisciplinary teams and algorithm-driven care protocols to optimize patient outcomes and prevent the hot potato approach to complex comorbidities.

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.