How an integrated care group turns the tide against cardiometabolic disorders

Key Points

The 108-physician multispecialty practice in Kingsport, Tennessee, officially launched its Integrated Health Management Services department last year, but it has employed a team-based strategy to treat its patients with cardiometabolic disorders-prediabetes, type 2 diabetes, high blood pressure, elevated blood lipids, and obesity-for two years, since the arrival of William Bestermann, MD, an internist and renowned vascular medicine specialist.

United with Bestermann are two other primary care physicians, three pharmacists (two of them certified diabetes educators), a dietitian, a physician assistant, an RN, and an endocrinologist, each of whom works with each patient's primary care doctor to focus the treatment plan and sort out the laundry list of medications and lifestyle changes.

"We're trying to create a cardiometabolic medical home," says Bestermann, a former president of the South Carolina affiliate of the American Heart Association. "We're focused on that thing that's going to kill half the people in this region."

In this rural, mountainous nook where northeast Tennessee meets southwest Virginia, their efforts are joined at an ideal time.

AN OMINOUS TREND

In 1998, the Centers for Disease Control and Prevention classified less than 20 percent of Tennessee residents as obese. Ten years later, more than 31 percent were considered obese, with another 36 percent overweight. Likewise, in 1995, hypertension had been diagnosed in 25 percent of all Tennessee residents; by 2007 the incidence had risen past 33 percent.

Of the 295,000 people in the Kingsport-Bristol-Johnson City metropolitan area, one-third have high cholesterol and another third have hypertension, according to the CDC.

Diabetes has doubled in Tennessee since 1998, and incidence among Kingsport residents is nearly 50 percent higher than the national average.

Holsten's president, family physician Jerry Miller, MD, founded the practice in 1977 with four family physicians in one location. He's expanded it to 19 locations, 891 employees, 281,000 active patients, and $81 million in revenue last year. In December 2008, he opened the $50 million Holston Medical Plaza, a six-story, 270,000 square foot office complex including more than a dozen specialty offices and departments, including Integrated Health.

Despite the added resources, the core of Holston remains its 73 primary care physicians, who in recent years have noticed cardiometabolic disorders striking more of their patients-and striking earlier in their lives.

"The lifestyles in northeast Tennessee, southwest Virginia are leading to unbelievable outcomes," Miller says in a leisurely Southern drawl. "Our life expectancy is seven years less than if you live in the Midwest, and it has a lot to do with lifestyle, obesity, smoking, and lack of access to what I call 'the new facet of medicine.' "

This new facet, according to Miller, includes education, physician collaboration, and patient-provider communication. Hence, the creation of Integrated Health Management, where patients can better understand their treatment plan, make adjustments if necessary, and ensure better adherence. It means an end to doctors working in silos, unaware of what other providers are advising, and the dawn of primary care physicians, nurses, pharmacists, and specialists working side-by-side, communicating harmoniously-in person and electronically-and collaborating in the best interests of the patient.