Leveraging technological advances to facilitate new ways of engaging patients and integrating non-invasive technology into a liver disease program not only serves to improve individual outcomes and reduce costs but also strengthens the financial performance of health systems and provider organizations that include this approach to testing.
At a time when America’s hospitals and physician groups face lost revenues due to the COVID-19 pandemic, there is a pressing need for reducing costs while maintaining high-quality patient care. Awareness is growing around the prevalence and costs associated with underdiagnosed liver disease, which is associated with over $100B in annual direct costs.
FibroScan® is a pain-free, non-invasive examination of the liver, providing liver stiffness and fat scores in a single 10-minute procedure, both of which are critically important components for the diagnosis and monitoring chronic liver diseases, including:
– Non-alcoholic fatty liver disease (NAFLD), an asymptomatic condition characterized by elevated levels of fat in the liver and the most common type of liver disease in the Western world. Over 30% of the U.S. population has some degree of NAFLD, which is linked to diabetes, obesity, insulin resistance, and other metabolic risk factors, NAFLD affects 75 to 100 million adults in the United States.
– Non-alcoholic steatohepatitis (NASH), the more severe form of NAFLD, is a potentially progressive liver disease that can lead to cirrhosis, hepatocellular carcinoma (HCC), liver cancer, liver transplantation, and death. Estimates show that 357 million people will have NASH globally by 2030.
Treatment and Patient Engagement
Because NAFLD and NASH are so tightly intertwined with obesity, diabetes, and lifestyle, a “whole person” approach to patient engagement is required to support behavioral changes that will result in better outcomes across the co-morbid conditions affecting the individual patient.
Early detection is needed because lifestyle modifications and strict control of metabolic risk factors are the most effective treatment. Because disease progression is typically slow, patients can be managed well by primary care physicians, although NAFLD patients with advanced liver fibrosis should be referred to specialist care for further assessment. While finding and managing fibrotic NASH is an important component to addressing liver disease, patients with steatosis alone are at a greater risk of cardiovascular mortality and morbidity.
Diet and exercise interventions are the first line of therapy, with the goal of decreasing bodyweight and modifying cardiometabolic risk factors related to metabolic syndrome. In the early stages of NAFLD, a healthy diet and weight loss of at least 7% might be sufficient. Patients are often treated with vitamin E as well. Aggressive management of hypertension, diabetes, and lipid disorder is also key.
A follow-up visit ensures that they are following the weight loss program, consulting with a dietician or nutritionist, and adhering to the program. It’s also useful to share the patient’s liver exam score with them to illustrate the change in liver fat and the need for adjusting their treatment.
The Need is Now
Amid the COVID-19 pandemic, the American Hospital Association (AHA) estimates a total four-month financial impact of $202.6 billion in losses for America’s hospitals and health systems, or an average of $50.7 billion per month. The drop in fee-for-service revenue for the 2020 calendar year is nearly $68,000 per physician, contributing to an estimated revenue decline of 12.5%. This loss threatens the financial viability of many practices and could top $15 billion over the year.
To overcome these fiscal challenges and play a significant role in helping to reverse the nation’s liver disease epidemic through early detection and monitoring of NAFLD/NASH, physician practices and hospitals place great value in acquiring a non-invasive tool at the point of care to examine liver health. With quantifiable information that can improve individual health outcomes, physicians also help to lower payer costs by avoiding expensive, invasive interventions such as painful liver biopsies.
As a result, a growing number of physician groups and hospital systems are introducing liver health management programs as a proactive approach to serving patients and stemming the tide of this silent epidemic that continues to rise at staggering rates. Many are incorporating non-invasive testing such as FibroScan®, an FDA-cleared technology for the diagnosis and monitoring of adult patients as part of an overall evaluation of liver health. Unlike blood tests that measure circulating markers of inflammation, such as alanine aminotransferase (ALT) and aspartate aminotransferase (AST), FibroScan directly and non-invasively measures physical properties of stiffness and fatty liver. This rapid and reliable tool provides reproducible results, allowing for both diagnosis and monitoring of liver stiffness and liver fat.
FibroScan is designed as a point of care tool – highly mobile, operated by a medical assistant, and interpreted by the healthcare professional. It produces numeric measurements and not images, allowing for simplified interpretation and consistency of measurement for monitoring changes in liver tissue over time. These liver stiffness and fat measurements have been validated against liver biopsy and MRI-based tools.
FibroScan is supported by over 2,500 peer-reviewed publications and is the reference for non-invasive tests in major international guidelines. It’s expected that rapid, non-invasive tools that provide consistent liver measurements will be performed as a routine part of patient management.
About Jon Gingrich
Jon Gingrich is the CEO at Echosens North America, a high-technology company offering the FibroScan family of products. Prior to joining Echosens, Gingrich was the chief commercial officer of AxoGen, Inc., a global, publicly-traded company that focuses on peripheral nerve repair. Previously, he served as global vice president and general manager, Skeletal Health Solutions, and as Group Global vice president, Marketing, Breast and Skeletal Health Solutions for Hologic, Inc., global health care and life science developer, manufacturer and supplier of diagnostic, medical imaging and surgical products.