The Population-health Revolution

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Cat VaskoAny community under duress is likely to find itself plagued by disagreements, infighting, and polemicizing. It’s a normal response to a difficult situation—especially one in which there are no easy answers to the challenges being faced. I think of this each time that I attend management-focused meetings (such as those of the AHRA or the RBMA) in which nonclinician businesspeople point to radiologists as the source of imaging’s current problems; at clinical conferences, physician thought leaders cite the increased focus on business-based priorities, such as productivity and efficiency, as the real issue. The truth is doubtless somewhere in the middle, and members from both sides of our community could be forgiven for tiring of the constant scoldings and accusations. We’ve published our fair share in this journal, but I, too, get tired of the pessimism. This month, I wanted, instead, to focus on something positive: the exciting news that CT screening for lung cancer works, can be accomplished cost effectively, does not expose patients to too much radiation, and has the potential to change countless lives. Much research has validated the use of this widespread technology to prevent deaths from one of the most insidious cancers; in the August 2013 issue of the Journal of the American College of Radiology: JACR, investigators¹ have moved on from proving that CT screening for lung cancer works to addressing the fact that until a reimbursement mechanism for the procedure is in place, only high-income patients will be able to access the service. The authors conclude, “To eliminate health-care disparities, a vigorous lobbying effort will be needed to expedite reimbursement and make CT lung screening equally available to all patients at high risk.”¹ The fact that the screening is tremendously effective is already old news to them. It’s easy to become blasé about the incredible things that can be accomplished using imaging, so it’s worth taking a moment to appreciate what this means. For the businesspeople, it’s a new service line with tremendous potential for both future growth and downstream revenue from associated services. For the physicians, it’s nothing less than an indicator of the powerful role that radiology can play in the era of accountability to come. By identifying, screening, and counseling patients at high risk for lung cancer and other diseases associated with smoking, radiologists can easily take steps into the patient-interaction and care-coordination roles that are so widely discussed. Further, this is an excellent example of population-health management, which thought leaders in imaging (and elsewhere) have called the highest possible form of health care; with more and more data about the incidence of lung cancer among smokers and the outcomes at different stages of the disease, radiologists can play a pivotal role in creating behavior changes at the population level. All this potential—and more—comes from something so simple: taking an existing technology and expertise and using them in a new way. It’s nothing new to observe that imaging is life saving, but sometimes, it needs to be said anyway: Imaging is revolutionary, and the people who provide it, on the business and clinical sides, are changing lives for the better, every day. Even when we disagree on how to continue doing so, your worst day of fighting for the ability to help others more is better than your best day of fighting for just about anything else. Cat Vasko is editor of and associate editor of Radiology Business Journal.