Vision 2023: Developing the College’s Next Strategic Plan and Shaping Its Future As the ACC heads into the final year and a half of its current Strategic Plan, College leaders and staff have already begun the process to build an effective and comprehensive strategy that will chart the course from 2019 through 2023. To date, the College has designed a development approach and established a governance structure with member and staff planning teams; developed a foundational briefing document to help guide and inform the process; and worked with member committees and staff to identify the top strategic issues from their perspective. The next phase of the plan’s development involves determining the College’s key focus areas and desired outcomes, resulting in a clear depiction of ACC’s strategic direction. ACC’s existing Strategic Plan, which began in 2014 and culminates at the end of 2018, was designed to address the challenges and opportunities associated with rapid advances in science and technology, uncertainty about systems of medical care delivery, growing demand for cardiovascular care at a time of workforce transition, shifting practice settings and more. These issues, coupled with the need to help members meet the “triple aim” of improved health, better outcomes and lower costs, necessitated a plan that leveraged the ACC’s core competencies like education, advocacy and quality improvement, while also focusing on enhancing member value and developing new skills and competencies that better fit the changing environment. “When we began developing the current Strategic Plan, around the time of the ACC’s 65th anniversary, the health care environment was – as it is today – experiencing rapid changes in science and care delivery that mandated a dynamic approach to strategic planning,” says Past President John Gordon Harold, MD, MACC. “The plan that we developed leveraged the College’s strengths, but also allowed for flexibility to address the inevitable changes in the landscape of health care over the life of the plan.” Over the last several years, the ACC has made significant progress in addressing the core strategies identified in the current Strategic Plan, including increasing member value and engagement, facilitating transformation of care, managing population health and providing purposeful education. The College has played an active role in shaping health policy through more focused advocacy, and leveraging data and information to improve knowledge and clinical practice. The College has also experienced tremendous growth in both size and revenue. Membership has increased by 21 percent over the last five years, from 43,000 in 2013 to 52,000 in 2017. Much of this growth (84 percent) is fueled by an increase in international members. The College’s cardiovascular team membership has also expanded. And ACC saw a 40 percent growth in revenue from 2012 to 2016, largely fueled by its National Cardiovascular Data Registry®. “The progress the ACC has made in these and other areas of our Strategic Plan is due to the commitment of ACC members and leaders to do what is best for patient care,” says Immediate- Past President Rick Chazal, MD, MACC. “Our value is in our mission statement, which is ultimately all about the patient. Collaboration with each other, as well as with our counterparts in the U.S. and around the world, is key to our success.” As the ACC develops its next Strategic Plan, many of the critical issues that were relevant during the development of the current Strategic Plan are still in play, while several new issues have emerged. Cardiovascular disease continues to be the leading cause of death around the globe. Given a growing and aging population, preventing and treating cardiovascular disease will need to continue to be a major priority if the College hopes to change this statistic. Major health care policy changes in the U.S. and globally have transformed the health care landscape with a range of practice management implications. At the same time, ACC members continue to be challenged with time management, workforce shortages as the burden of cardiovascular disease increases, maintenance of professional certification, and much more. “As these factors and others continue to evolve, it will be important to understand and consider the impact to ACC’s stakeholders over the new Strategic Plan horizon,” says Trustee and Past Board of Governors Chair, Dipti Itchhaporia, MD, FACC. Ensuring a cardiovascular workforce that can meet these demands also remains a concern. The ACC has made significant headway over the last decade in recognizing the importance of team-based care, but there is still work to be done in this area. “Working in health care teams is perhaps more important now than it has ever been as health care laws are changing and are moving reimbursement models from a volume-driven system to a value-driven one,” says ACC President Mary Norine Walsh, MD, FACC. “Teams are no longer optional in this new health care landscape and luckily the ACC recognized the value of the care team early on.” Additionally, there is a strong need to address diversity in the cardiovascular workforce. Recent studies have highlighted not only substantial salary differences between male and female practicing cardiologists, but also dramatically different job descriptions – despite sharing the same specialty. A workforce diverse in job function, sex, specialty, and race and ethnicity is necessary to meet the needs of an increasingly diverse and growing cardiovascular patient population. “The ACC is working on many fronts to identify, foster and grow diverse leaders in cardiology,” says Past President Kim Allan Williams, Sr., MD, MACC, who also serves as chair of the ACC’s Task Force on Diversity. “Diversity helps improve and ensure the crucial relationships between caregivers, communities and patients.” Rapid growth in technology and the speed and volume of information is also an ongoing issue on many different fronts, including how clinicians learn, how new science and research is shared, how – and which – patients are managed and treated and how individuals communicate in general. Interoperability and health information technology also pose challenges for practices, hospitals and the ACC in terms of its data registries. In the United States, health reform efforts continue. The transition from a volume-driven to value-based system is forcing clinicians to rethink how they provide care. Changes in the White House and Congress have only increased uncertainty for both patients and health care providers in areas such as access to care, medical liability, federal funding for research and education and physician reimbursement. Additionally, there are concerns related to the ability for international cardiovascular trainees to study in the U.S., as well as the need to share and exchange knowledge globally. The ACC’s new governance structure is also expected be fully in place in 2018, presenting new opportunities for a more strategic focus, as well as the emergence of new leaders. “Keeping strategic decision-making at the Board level, ACC’s governance transformation allows for tactical, operational and management decision-making at committee and staff levels,” says ACC Vice President C.Michael Valentine, MD, FACC. “This makes room for more member volunteers to take on leadership opportunities at the College and provides a prime opportunity for leadership growth, development and innovation.” Implementing these governance changes has been a priority of the ACC under its current Strategic Plan since 2016. Over the course of the development of ACC’s next Strategic Plan, members and staff will continue to work together to ensure that these and other relevant issues are surfaced and to identify strategies to address these issues. “Development of the ACC’s next Strategic Plan provides an opportunity for members to help the College evolve effectively,” says Walsh. “The ACC exists because of the talented professionals who have committed their lives to improving and saving the lives of others. Working together we will succeed in realizing the ACC’s full potential for its members, the patients they serve and the global cardiovascular community.” Passionate about the direction of your professional home? Looking to provide feedback into the development of ACC’s 2019 – 2023 Strategic Plan? E-mail your comments to email@example.com. The Global Burden of Cardiovascular Disease The Global Burden of Diseases (GBD), Injuries, and Risk Factors 2015 study published in the Journal of the American College of Cardiology provides an updated snapshot of the state of cardiovascular disease over the last 25 years – and reaffirms that it continues to be a significant public health concern worldwide despite impressive advances in technical capacity for preventing and treating cardiovascular diseases. The GBD is an international consortium of more than 2,300 researchers in 133 countries that employed a wide range of data sources and methods to produce age-, sex- and country-specific results for the years 1990 to 2015. The study offers “a unique platform for tracking rapidly evolving patterns in cardiovascular disease epidemiology and their relationship to demographic and socioeconomic change,” write the study authors, led by Gregory Roth, MD, MPH, FACC. They note that “future updates of the GBD study can be used to guide policymakers who are focused on reducing the overall burden of noncommunicable disease and achieving specific global health targets.” Scan the QR code for more on the GBD study. 4 2 2 .7 million The number of prevalent cases of cardiovascular disease around the world in 2015. Prevalence varied significantly by country. 8.92 million The number of deaths due to ischemic heart disease (IHD) in 2015, making it the leading cause of death in the world. The highest IHD death rates were observed in Central Asia and Eastern Europe. IHD was the leading cause of all health loss globally as well as in each world region. 5.33 million The number of additional people who died from cardiovascular disease in 2015 compared with 1990. The total number of deaths from cardiovascular disease worldwide increased from 12.59 million in 1990 to 17.92 million in 2015. 33.3 million The estimated number of prevalent cases of atrial fibrillation (AFib) globally in 2015. The death rate from AFib was nearly five times higher in people over the age of 80. 6.33 million The number of deaths due to stroke in 2015, of which 57 percent were due to ischemic stroke. Stroke and ischemic stroke are the second and third leading cause of disabilityadjusted life years.. 57% ischemic stroke 25 years The time period between 1990 and 2015 in which researchers show an alarming plateau in CVD mortality. They note that mortality rates are no longer declining even for high income regions. 2000 The year in which South Africa experienced a “mortality crisis” due to “colliding” epidemics of HIV/AIDS and non-communicable diseases. Researchers suggest these events, as well as economic crises in Eastern Europe in the 1990s, demonstrate how political and social unrest may lead not only to outbreaks of communicable disease but also dramatic changes in cardiovascular health. 74-79 The five-year age group in which the prevalence of stroke was the highest globally (4,201 cases per 100,000). The rate of stroke began increasing above age 40, but declined by half after age 80. 25 x 25 The goal set by the World Health Assembly to achieve a 25 percent relative reduction in overall mortality from noncommunicable diseases, including cardiovascular disease, by 2025. 6.09 million The number of prevalent cases of hypertensive heart disease in 2015, making it the fourth highest ranked cardiovascular disease cause for disability-adjusted life years. More Reasons to Address NCDs? One of the suggestions from the GBD study is for countries to consider further investment in cardiovascular disease surveillance and population-based registries to benchmark their efforts towards reducing the burden of cardiovascular disease. In a related editorial comment, Dariush Mozaffarian, MD, FACC, agrees, describing a shift in the noncommunicable diseases (NCDs) plaguing the global population. “These findings confirm that the epidemiologic ‘transition’ away from infectious and maternal-child diseases and toward noncommunicable chronic diseases has already occurred globally – a sobering reality as countries around the world consider their priorities for health care, public health prevention, and economic growth,” he writes. Moving forward, he suggests the implementation of policies targeting lifestyle behaviors, particularly smoking, suboptimal diet and physical inactivity. As a member of the World Heart Federation and NCD Alliance, the ACC is working with other medical societies around the world to support the “25 by 25” target, as well as corresponding NCD targets focused on high blood pressure, smoking cessation, diabetes, obesity and reliable access to medicines. Thomas A.Gaziano, MD, FACC, and John Gordon Harold, MD, MACC, recently represented the ACC in Geneva, Switzerland, at the 70th session of the World Health Assembly where NCDs were a focus of discussions. Read their accounts of the meeting at ACC.org/International.
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