Ravish Sachar, System Chief, Heart and Vascular Service Line, UNC Health

In an interview with Invest:, Ravish Sachar, system chief, heart and vascular service line at UNC Health, discussed UNC Health’s efforts to build a more coordinated healthcare system centered on patients. By aligning providers and facilities through service lines, the organization aims to expand access, improve care pathways, and support patients across North Carolina. “Patients do not care which part of the system is interacting with them; they simply want to know they will be taken care of,” Sachar said

Looking back over the past year, what changes have had the greatest impact on UNC Health?

UNC Health is a state institution with a twofold mission. The first pillar is providing excellent clinical care to patients across North Carolina, regardless of where they live, their socioeconomic status, or their disease state. The second pillar is our academic mission: ensuring that the next generation of physicians and providers is well trained through the medical school in Chapel Hill and our residency and fellowship programs across the state.

The UNC system has grown rapidly over the past two decades to provide care in different parts of North Carolina. Some of that growth has been organic through new hospitals, clinics, and medical office buildings. We have also partnered with institutions that were seeking support with quality, education, logistics, or management. Many of those partnerships eventually became integral parts of the UNC system.

Rapid growth can create differences in electronic medical records, care pathways, and approaches among facilities. Some variation is important because unique populations may require distinct treatment, but a lack of standardization can also produce inefficiencies and affect patient care. Patients do not care which part of the system is interacting with them; they simply want to know they will be taken care of.

A patient may enter a clinic with a heart problem and later discover a vascular or gastrointestinal issue. Some services may be available locally, while others require a transfer to another hospital. After treatment, that patient may need rehabilitation or a nursing facility. Care can become difficult to navigate when different specialists, facilities, tests, records, and bills are involved.

Our goal is to create a seamless experience with the patient at the center, providing the best and most efficient care as locally as possible. To accomplish that, we created service lines that align the different parts of the system around a patient’s journey. Rather than requiring patients to navigate everything themselves, we want to coordinate the providers, facilities, and processes involved in their care.

Which emerging technologies or treatment advances will have the greatest impact on patient outcomes?

We can look at this across the spectrum, beginning with people who do not yet know they are patients. We live in a remarkable time when wearable devices can gather an extraordinary amount of information. People can collect data through watches, rings, and other tools, and artificial intelligence can summarize that information and draw conclusions much faster than was previously possible.

Even if someone is young and does not currently have cardiovascular problems, those data sets can help identify how to optimize individual health over the long term. We have seen diet, diabetes, and other factors negatively affect the health of young people, but greater access to personal data can give individuals more agency over their health. When information is presented in a digestible format, people can better understand what is happening and act on it. I think we’re just on the cusp of individualized medicine, where patients will be empowered to take care of their own health. Ideally, they can intervene before a disease state develops.

Technology can also support people who already have conditions. Patients with arrhythmias can monitor abnormal heart rhythms that may increase their risk of stroke or passing out. People with diabetes can use devices that continuously track blood sugar and connect to a pump, creating a cycle that monitors and treats them in the background.

For patients who have already been hospitalized, connected monitoring can continue at home. A person with heart failure, for example, may track their weight and transmit that information directly to the health system. If the weight increases beyond an expected level, an AI-based protocol can issue an alert and prompt someone to contact the patient. That allows us to address the problem before it becomes serious enough to require hospitalization. Implantable devices can similarly provide continuous information before patients experience symptoms.

Within hospitals, treatment options are increasing exponentially. Clinical trials are creating access to pharmaceutical, implantable, and device-based therapies for patients who may have had no options a decade ago. These advances are allowing people to live longer and more functional lives.

Technology will augment physicians rather than replace them. Years ago, some predicted that AI’s ability to analyze images would eliminate the need for radiologists. Instead, these technologies have helped radiologists diagnose conditions faster and more accurately, enabling them to care for more patients and visualize things they could not see before. Patients still want a physician they can speak with who can bring all the information together.

How do partnerships among hospitals, researchers, educators, and care providers strengthen your mission?

One of our major advantages is the breadth of our footprint and the range of interests among our physicians. Some focus primarily on basic research, working with molecules in laboratories, pursuing NIH grants, and helping to understand the underlying causes of disease or design the next generation of therapies.

Others are clinical educators whose passion is training residents and fellows. We also have physicians heavily involved in clinical research with devices or therapies that are ready to be studied in humans. Through carefully controlled research processes and regulatory oversight, we can partner with innovative companies to provide access to cutting-edge technologies, sometimes before or after FDA approval. That relationship helps move innovation toward patients through clinical trials.

Other physicians share advances nationally and internationally, communicate clinical trial results, and help identify areas of unmet need. UNC Health has many physicians working on the leading edge of new therapies and trial development.

The community side is equally important. Cardiovascular disease is a significant and growing need in this region, particularly as the population expands. Some physicians are passionate about maintaining large patient panels and providing one-on-one care. That relationship is ultimately what helps patients move from being unwell to well again.

Care delivery also depends on teams. Nurses, physician assistants, advanced practice providers, and physicians work together so patients have someone they can reach as needs arise. We want people to thrive in whichever area they are passionate about, whether that is direct patient care, education, research, or clinical trials. Creating that environment also helps us attract the smartest and brightest people coming out of fellowship.

What are your key goals and priorities for the coming years?

Our priority is to continue building a coordinated heart and vascular network across North Carolina. We care for patients throughout the state, but access is not equal in every community. We want a network of hospitals and clinics that can deliver the best care possible in each area, supported by the physicians, infrastructure, laboratories, and facilities those communities need.

Most patients should be able to receive care locally. When someone has an advanced disease that cannot be treated in that setting, there should be a simple pathway to a larger center, such as the medical center in Chapel Hill or REX Hospital. After receiving specialized care, the patient should be able to return seamlessly to the original community, with coordination between physicians across the system.

Achieving that requires common pathways, processes, and approaches to disease while preserving individualized treatment. We must coordinate quality, operations, financial performance, and strategy through a cohesive plan and shared vision. That does not mean every area must do the same thing. Each community should do what is right for its population, but in a coordinated manner.

On the academic side, we will continue training the next generation of physicians and supporting research. There is a significant physician shortage projected over the next 15 to 20 years, making that educational mission essential. We also want to expand participation in basic and clinical research so emerging discoveries can eventually be made available more broadly to our patients.