2017 right care initiative data and briefs packet · overcourse the of this project, california has...

2017

Modified Mar. 6, 2017

Right Care Initiative Data and Briefs Packet Cardiovascular, Hypertension, and Diabetes Management and Prevention

Quality Indicators, Metrics and Promising Interventions

Table of Contents

Right Care Initiative Project Brief .......................................................................................................................... 3

CA vs. National Top 10 Performance Selected HEDIS Measures ...................................................................... 5

Statistics Brief: California Publicly Available Data-Heart Attack, Stroke

and Diabetes Care and Prevention .............................................. 14

University of Best Practices Project Brief... ........................................................................................................ 16

Promising Intervention: Pharmacist on the Care Team .................................................................................. 18

Promising Intervention: Power of Home Blood Pressure Monitoring ........................................................... 20

Promising Intervention: Cardio-protective Medication Bundle Protocol ...................................................... 22

Promising Intervention: Proactive Patients Improve Clinical Outcomes ....................................................... 24

San Diego Demonstration Project ....................................................................................................................... 26

Key Quality Indicators for Cardiovascular Prevention Among CA Health Plans ............................................ .7

Contact: Hattie Rees Hanley, MPP, Right Care Initiative Director, [email protected]; Assistant: Carla Pollock (916-224-0033)

Key Partners: This collaborative, expert-based, public-private bridge project draws on leadership from key partners: • USHHS Million Hearts Initiative• American Medical Group Assoc. Foundation• American College of Cardiology, CA Chapter• Med. groups, clinics, health plans & systems• University of California Schools of PublicHealth, Medicine, and Pharmacy

• RAND Corporation• Stanford School of Medicine & ClinicalExcellence Research Center

• USC Schools of Med., Pharmacy and Policy

• Sierra Health Foundation• The California Endowment• California Health Care Foundation• No More Broken Hearts Foundation• California Chronic Care Coalition• Health Services Advisory Group QIO• Air Force Medical Center• CA Medi-Cal Program• CA Dept. of Public Health (CDPH)• CA Emergency Medical Services Agency

• American Heart/Stroke Association• Integrated Healthcare Assoc. (P4P)• Pacific Business Group on Health• Local US Department of Veteran’s Affairs• Ralphs Grocery Company• AbbVie• Boehringer-Ingelheim• Genentech• Johnson & Johnson• Novo Nordisk

Objective: Reduce death and disability through enhanced practice of patient-centered, evidence-based medicine. Since 2007, The Right Care Initiative’s goal has been to apply scientific evidence and outcomes improvement strategies to reduce patient morbidity and mortality through a collaborative focus on achieving quality goals where performance metrics indicate that evidence-based, life-saving practices are not fully deployed. Data from the Integrated Health Care Association, the National Committee For Quality Assurance, the federal Agency for Health Care Quality and Research, the Commonwealth Foundation, CMS, and the Centers for Disease Control indicate that approximately 80,000 Californians die yearly from heart attacks, strokes and diabetic complications. Many of these deaths and associated disabilities and health care costs could be prevented with evidence-based patient management, clinical quality improvement and adoption of the latest medical knowledge. Our work is focused in these high-leverage areas of better management of cardiovascular disease and diabetes, with particular emphasis on control of blood pressure, cholesterol and blood sugar.

CDPH estimates Californians suffer approximately 72,000 deaths from cardiovascular disease (including heart attack and stroke) and 7,000 deaths from diabetes each year, many of them preventable according to CDC. NCQA conservatively estimates that improving California’s cardiovascular disease and diabetes measures to the national HEDIS 90th percentile could save 1,694 to 2,818 CA lives each year, while avoiding $118 million in yearly hospital costs, 766,401 sick days and $125.56 million in lost productivity. Heart disease, hypertension and diabetes are increasingly well understood scientifically, and ripe for best practices collaboration. Over the course of this project, California has outpaced the nation in improving health system performance on control of blood pressure, cholesterol and blood sugar, building on the “100,000 Lives” campaign for reducing medical errors and the Million Hearts™ national initiative launched in 2011.

California Statewide Goals—Prevention & High Quality Management of Heart Disease, Strokes, and Diabetes

Achieve National HEDIS 90th Percentile “A-grade” Targets or 75% of patients at goal, whichever is higher: 77% of hypertensive patients with blood pressure controlled: <140/90 mm Hg 69% of diabetic patients with blood sugar controlled: HbA1c <8

In absence of HEDIS cardiovascular disease lipids 90th percentile target, Right Care Initiative 2016-2017 target: 75% of patients with diabetes and/or cardiovascular conditions on appropriate cholesterol therapy (proxy, LDL controlled: LDL-C<100mg/dL)

Activities: University of Best Practices (UBPs) in three metropolitan areas to share learning and encourage adoption of

evidence-based interventions for preventing and better managing premature heart disease, strokes, and diabetes.Practical presentations from benchmark performers are geared toward medical, pharmacy and quality improvementdirectors to spur achievement of national “A-grade” performance and better disease management. Annual Leadership Summit to highlight UBP progress, new HEDIS & P4P performance data, promote adoption of

strategies used by top performers, and recognize superior performance. Next Summit: April 5, 2018 @ UC Berkeley

RIGHT CARE INITIATIVE Clinical Quality Improvement Leadership Collaborative

mailto:[email protected]

Implementation Action:

The Right Care Initiative, operated by the UC Berkeley School of Public Health, was publicly launched with the Department of Managed Health Care, NCQA and the Deans of UC Berkeley and UCLA Schools of Public Health in March 2008 at the 1st annual Clinical Quality Improvement Leadership Summit. Since then, more than a dozen Right Care summits have been held around the state, along with over 150 monthly University of Best Practices. Each Right Care gathering is a collaborative effort to close the gap between science and practice to improve patient outcomes working with medical directors, pharmacy and quality improvement directors, as well as thought leaders in evidence-based medicine.

State-Wide Right Care Technical Expert Steering Committee Chair and Co-Founders: Stephen Shortell, PhD, MPH, MBA, TEG Chairman, Emeritus Dean and Professor, UC Berkley, School of Public Health; Arnold Milstein, MD, MPH, Professor of Medicine and Director, Stanford University Clinical Excellence Research Center; PBGH Medical Director; Allen Fremont, MD, PhD, Director, RAND Q-Dart Project; Professor, Pardee RAND Graduate School; Robert M. Kaplan, PhD, Research Director, Stanford University Clinical Excellence Research Center; Jerry Penso, MD, MBA, Univ. of Best Practices Co-Founder and Chief Medical Officer, American Medical Group Association Foundation

Cardiovascul ar Disease and Diabetes Research Team: Anthony DeMaria, MD, Past Editor-in-Chief, Journal of American College of Cardiology; Founding Dir. UCSD Cardiovascular Center; David J. Maron, MD, Director of Preventative Cardiology and Clinical Professor Stanford Medicine; Karol E. Watson, MD, PhD, FACC, UCLA Prof. of Medicine/Cardiology; Co Director, UCLA Program in Preventive Cardiology; Director, UCLA Barbra Streisand Women’s Heart Health Program; William J. Bommer, MD, Executive Committee, American College of Cardiology, CA Chapter; Prof. of Cardiovascular Medicine, UC Davis; Susan L. Ive y, MD, MHSA, Dir. of Research, Health Research for Action & Professor, UC Berkeley SPH; Hector Rodri guez, PhD, MPH, Professor, Health Policy and Management, Chair, Health Policy PhD Graduate Group, UC Berkeley SPH; Brent D. Fulton, PhD, MBA, Asst. Adj. Prof, Health Economics and Policy, Assoc. Dir. UCBSPH; LaVonna Lewis, PhD, MPH, Teaching Prof., USC Sol Price School of Public Policy; Steve Chen, PharmD, Assoc. Dean for Clinical Affairs, and Assoc. Prof USC School of Pharmacy; Jan Hirsch, PhD, Professor of Clinical Pharmacy, UCSD Skaggs School of Pharmacy; Michael R. Pollock, Adjunct Prof, Rady School Management, UCSD

University of Best Practices: Thanks to an NIH GO grant (2009-July 2012), the Right Care Initiative received a special opportunity to launch a community-focused effort to reach the Right Care Initiative goals of preventing heart attacks, strokes and diabetic complications and piloted the first University of Best Practices in San Diego (subsequently renamed Be There San Diego). Since then, a Right Care University of Best Practices has been launched in two additional metro areas: Sacramento in 2012 and Los Angeles in 2013. Each University of Best Practices is comprised of the major delivery systems of the region, including medical groups, health plans, community clinics, local public health, military and VA medical leaders, together with patient advocacy groups and other subject matter experts.

Los Angeles Right Care University of Best Practices Co-Chairs: Carol Peden, MB ChB, MD, MPH, Ex. Dir., USC Center for Health System Innovation Keck Medicine of USC; Prof, Dept. of Anesthesiology Keck School of Medicine, USC; Karol E. Watson, MD, PhD, FACC, UCLA Prof. of Medicine/Cardiology; Co-director, UCLA Program in Preventive Cardiology; Director, UCLA Barbra Streisand Women’s Heart Health Program; LaVonna B. Lewis, PhD, MPH; Teaching Prof., USC Sol Price School of Public Policy; Tony Kuo, MD, MSHS, LA County Dept. of Public Health, Director, Office of Senior Health, Acting Director for the Division of Chronic Disease and Injury Prevention

Sacramento Right Care University of Best Practices Co-Chairs: Betsy L. Thompson, MD, DrPH, CAPT, U.S. Public Health Service, Deputy Regional Health Administrator, Office of the Regional Health Admin, Region 9, USHHS; José Arévalo, MD FAAFP, Chief Medical Officer, Sutter Independent Physicians Medical Group; William J. Bommer, MD, Executive Committee, American College of Cardiology, CA Chapter; Prof. of Cardiovascular Medicine, UC Davis

San Diego Be There University of Best Practices Chair: Anthony DeMaria, MD, University of Best Practices Co-Founder & Chair; Former Editor-in-Chief, Journal of American College of Cardiology; Founding Director, UCSD Cardiovascular Center; Professor UCSD School of Medicine

Patient Activation Stress reduction, medication adherence, healthy sleep, nutrition & physical activity, smoking cessation

Evidence-based patient education (e.g., Project DULCE; Stanford Patient Self-Management) Motivational interviewing and evidence-based media messaging

Promising Interventions to Reach HEDIS Control Targets for Heart Attack and Stroke Prevention

Clinical Pharmacists on Care Team

HRSA.gov/patientsafety Surgeon General’s Rpt.

Medical Home Team-Based

Un-blinded Performance Feedback Web Supported

High-Tech Enabled Timely Continuous Care—Not Episodic

Optimized Clinical Connectivity For Rapid Treatment

Patient Centered Practice Redesign

Medication Protocols Nationally Endorsed

Guidelines (JNC, ADA) European Union

Guidelines ALL/PHASE (Kaiser)

Resources: We wish to thank Right Care Initiative supporters: The Sierra Health Foundation, California Endowment, California Health Care Foundation, No More Broken Hearts Foundation, Health Services Advisory Group (federally designated Quality Improvement Organization), Ralphs Grocery Company, AbbVie, Boehringer-Ingelheim, Genentech, Johnson & Johnson, Novo Nordisk, that enables research and logistical support by University of Berkeley School of Public Health for the Right Care Initiative University of Best Practices and our annual clinical quality improvement leadership summits. A very special thank you to the NIH and the Judith and Jack White Family for initial seed funding for the University of Best Practices!Right Care Website: http://rightcare.berkeley.edu View medical group scores by county via the CA Office of the Patient Advocate: http://reportcard.opa.ca.gov/rc/medicalgroupcounty.aspxLogistical questions please contact: Carla Pollock at [email protected] or 916.224.0033 Last Updated: July 24, 2017 4:44pm.

San Diego University of Best Practices steering committee medical directors came to con-sensus that heart attacks and strokes could be reduced by 50% in 5 years by implement-ing the interventions on the Right Care Triangle. (See box to left)

Research Questions: • What are the best strategiesfor speeding the adoption ofpromising interventions forbringing patients into safecontrol?

• How can team-based care be deployed to quickly meet the Right Care goals and thebarriers to doing so?

• What strategies will quickly help close the health disparity gaps in hard hit communities?

http://www.dmhc.ca.gov/healthplans/gen/gen_rci_pbprac.aspx#Education




http://www.dmhc.ca.gov/healthplans/gen/gen_rci_pbprac.aspx#Pharmacist





http://rightcare.berkeley.edu/

California Health Plans vs. National Top 10 PerformanceRight Care Initiative: Selected HEDIS Measures

Trend Analysis Provided by the UC Berkeley School of Public Health Right Care Research Team, October 2016

Page 1 of 6

National 90th Percentile--"Grade A" 76.16 National 90th Percentile--"Grade A" 78.83California Average 63.35 California Average 67.62

Kaiser Foundation Health Plan, Inc. - Northern California 88.13 Kaiser Foundation Health Plan Inc. - Southern California 82.96Kaiser Foundation Health Plan Inc. - Southern California 83.70 Kaiser Foundation Health Plan, Inc. - Northern California 82.55Sharp Health Plan 72.56 Sharp Health Plan 76.17Western Health Advantage 70.56 Western Health Advantage 70.07Blue Shield of California 61.70 Blue Cross of California dba Anthem Blue Cross 67.64Blue Cross of California dba Anthem Blue Cross 61.27 Blue Shield of California 66.61Health Net of California, Inc. 61.17 Health Net of California, Inc. 64.48UnitedHealthcare of California 55.80 UnitedHealthcare of California 63.51Cigna HealthCare of California, Inc. 46.23 Cigna HealthCare of California, Inc. 58.97Aetna Health of California, Inc. 34.06 Aetna Health of California, Inc. 45.74

Kaiser Mid-Atlantic States, Northern California, Georgia, Colorado, Hawaii, Southern California, Northwest

91.19 - 83.70

Kaiser Mid-Atlantic States, Georgia, Northwest, Southern California, Northern California, Hawaii, Colorado

85.95-82.12

Tufts Associated Health Maintenance Organization, Inc. (MA) 84.47 Blue Cross and Blue Shield of Massachusetts HMO Blue, Inc. 83.88Health Tradition Health Plan (WI) 81.42 Security Health Plan of Wisconsin, Inc 82.85

Health New England, Inc. (MA) 80.56 Compcare Health Services Insurance Corporation dba Anthem Blue Cross and Blue Shield in Wisconsin 82.79

Sanford Health Plan (SD) 80.51 Medical Associates Health Plan, Inc. - Accred (IA) 82.17Gundersen Health Plan, Inc. (WI) 79.08 Sanford Health Plan (SD) 82.12Compcare Health Services Insurance Corporation dba Anthem Blue Cross and Blue Shield in Wisconsin 78.04 Group Health Cooperative of Eau Claire (WI) 81.61

Aultcare Insurance Company (OH) 78.01 Tufts Associated Health Maintenance Organization, Inc. (MA) 80.90Martin's Point US Family Health Plan (ME) 77.13 Harvard Pilgrim Health Care, Inc. (MA) 80.79Paramount Insurance Company (OH) 76.52 Group Health Cooperative of South Central Wisconsin 80.66


Sharp Health Plan 72.73 Sharp Health Plan 18.43Kaiser Foundation Health Plan, Inc. - Northern California 69.89 Kaiser Foundation Health Plan Inc. - Northern California 20.44Health Net of California, Inc. 64.96 Kaiser Foundation Health Plan Inc. - Southern California 23.26Blue Shield of California 64.92 Blue Cross of California dba Anthem Blue Cross 24.57Western Health Advantage 64.72 Health Net of California, Inc. 24.82Kaiser Foundation Health Plan Inc. - Southern California 63.35 Western Health Advantage 25.06Blue Cross of California dba Anthem Blue Cross 63.02 UnitedHealthcare of California 25.59UnitedHealthcare of California 62.56 Blue Shield of California 25.80Cigna HealthCare of California, Inc. 60.20 Cigna HealthCare of California, Inc. 29.24Aetna Health of California, Inc. 41.85 Aetna Health of California, Inc. 50.85

Network Health Plan (WI) 74.04 Network Health Plan (WI) 14.57Aultcare Insurance Company (OH) 73.08 Aultcare Insurance Company (OH) 16.67Sharp Health Plan (CA) 72.73 Gundersen Health Plan, Inc. (WI) 16.73Florida Health Care Plan, Inc. 72.24 Medical Associates Health Plan, Inc. - Accred (IA) 16.77Martin's Point US Family Health Plan (NH, NY, PA, VT) 72.02 Sanford Health Plan (SD) 17.15Johns Hopkins US Family Health Plan (MD) 70.95 Tufts Associated Health Maintenance Organization, Inc. (MA) 17.91Tufts Associated Health Maintenance Organization, Inc. (MA) 70.15 Sharp Health Plan (CA) 18.43Fallon Community Health Plan (MA) 70.07 Martin's Point US Family Health Plan (ME) 18.49Kaiser Foundation Health Plan, Inc. - Northern California 69.89 Harvard Pilgrim Health Care, Inc. (MA) 18.64Martin's Point US Family Health Plan (ME) 69.83 Johns Hopkins US Family Health Plan (MD) 18.69

National Top 10

(Lower Score Indicates Better Performance)

Diabetes Care: Blood Pressure Control <140/90

National Top 10

California

National Top 10

Controlling High Blood Pressure

California

Diabetes Care: Poor Blood Sugar (HbA1c) Control (>9%)

National Top 10

California California

Diabetes Care: Blood Sugar (HbA1c) Control <8%



Page 2 of 6


Kaiser Foundation Health Plan, Inc. - Southern California 93.35 Kaiser Foundation Health Plan Inc. - Southern California 94.47Kaiser Foundation Health Plan, Inc. - Northern California 92.50 Kaiser Foundation Health Plan, Inc. - Northern California 93.98Aetna Health of California, Inc. 83.17 Sharp Health Plan 92.87Blue Shield of California 83.10 Cigna HealthCare of California, Inc. 91.65United Healthcare of California 78.15 Blue Cross of California dba Anthem Blue Cross 91.48Cigna HealthCare of California, Inc. 78.05 UnitedHealthcare of California 90.28Western Health Advantage 75.56 Western Health Advantage 89.54Blue Cross of California dba Anthem Blue Cross 72.96 Blue Shield of California 88.87Health Net of California, Inc. 71.62 Health Net of California, Inc. 88.56Sharp Health Plan NA Aetna Health of California, Inc. 84.67

Kaiser Foundation Health Plan, Inc. - Colorado 98.69 Aetna Health Inc. (Maine) 97.33Capital District Physicians' Health Plan, Inc. (CDPHP) 97.53 Sanford Health Plan (SD) 96.90CareFirst of Maryland, Inc. - Maryland - CFMI - MD Only 96.67 Martin's Point US Family Health Plan (ME) 96.59Fallon Community Health Plan (MA) 96.25 Harvard Pilgrim Health Care, Inc. (MA) 96.33

Security Health Plan of Wisconsin, Inc 95.00 Anthem Health Plans of Maine, Inc. dba Anthem Blue Cross and Blue Shield in Maine 96.11

Independent Health Association, Inc. (NY) 94.62 Network Health Plan (WI) 95.98Group Health Options, Inc. (WA) 93.48 Group Health Cooperative of Eau Claire (WI) 95.98Kaiser Foundation Health Plan, Inc. - Southern California 93.35 Tufts Associated Health Maintenance Organization, Inc. (MA) 95.82Health New England, Inc. (MA) 92.86 Grand Valley Health Plan, Inc. (MI) 95.82Kaiser Foundation Health Plan, Inc. - Northern California 92.50 Gundersen Health Plan, Inc. (WI) 95.77


Sharp Health Plan 94.59 Kaiser Foundation Health Plan Inc. - Southern California 81.25Kaiser Foundation Health Plan, Inc. - Southern California 94.32 Kaiser Foundation Health Plan, Inc. - Northern California 67.88Cigna HealthCare of California, Inc. 93.61 Sharp Health Plan 58.48Kaiser Foundation Health Plan, Inc. - Northern California 93.43 Cigna HealthCare of California 50.86Health Net of California, Inc. 92.21 Western Health Advantage 50.36UnitedHealthcare of California 92.18 Health Net of California, Inc. 49.88Blue Cross of California dba Anthem Blue Cross 91.00 Blue Shield of California 48.74Blue Shield of California 90.73 UnitedHealthcare of California 47.63Aetna Health of California, Inc. 90.02 Blue Cross of California dba Anthem Blue Cross 44.77Western Health Advantage 88.32 Aetna Health of California, Inc. 33.58

Grand Valley Health Plan, Inc. (MI) 97.91 Kaiser Foundation Health Plan of the Mid-Atlantic States, Inc. 85.22Community Insurance Company dba Anthem Blue Cross and Blue Shield in Ohio 97.62 Blue Cross and Blue Shield of Massachusetts HMO Blue, Inc. 84.48

Aetna Health Inc. (Connecticut) 97.17 Martin's Point US Family Health Plan (ME) 84.43Kaiser Foundation Health Plan of the Mid-Atlantic States, Inc. 95.99 Johns Hopkins US Family Health Plan (MD) 83.11Capital Health Plan, Inc. (FL) 95.86 Kaiser Foundation Health Plan, Inc. - Southern California 81.25Health New England, Inc. (MA) 95.80 Grand Valley Health Plan, Inc. (MI) 79.92

Humana Wisconsin Health Organization Insurance Corporation 95.13 Anthem Health Plans of Maine, Inc. dba Anthem Blue Cross and Blue Shield in Maine 78.89

Kaiser Foundation Health Plan, Inc. - Hawaii 95.13 Harvard Pilgrim Health Care, Inc. (MA) 77.12

Blue Cross and Blue Shield of Massachusetts HMO Blue, Inc. 94.93 Anthem Health Plans, Inc. dba Anthem Blue Cross and Blue Shield - Connecticut 76.50

Vantage Health Plan, Inc. (LA) 94.71 Health New England, Inc. (MA) 76.42

California

National Top 10 National Top 10

California

National Top 10 National Top 10

Diabetes Care: Eye ExamsDiabetes Care: Medical Attention for Nephropathy

Persistence of Beta Blocker Treatment After a Heart Attack

California California

Diabetes Care: Blood Sugar (HbA1c) Testing

California Health Plan Trends: Performance Years 2006-2015Right Care Initiative Selected Cardiovascular and Diabetes Care HEDIS Measures

Source: NCQA's Quality Compass (R) 2016, Performance Year 2015Page 4 of 6

Health Plan HEDIS Measure 2006 2008 2009 2010 2011 2012 2013 2014 20152015

90th %ile

2006-2015%age Point

ChangeAetna Health of California Inc. Controlling High Blood Pressure 61.06 62.59 62.59 65 04 65.04 59.43 59.43 41.46 34 06 76.16 -27.00Aetna Health of California, Inc. Diabetes Care: Blood Pressure <140/90 NA NA NA NA 61.76 61.76 57.92 57.92 45.74 78.83 -16.02Aetna Health of California, Inc. Diabetes Care: Blood Sugar (HbA1c) Control <8 NA NA NA NA NA 52.13 49.65 48.18 41 85 67.22 -10.28

Aetna Health of California, Inc.Diabetes Care: Poor Blood Sugar (HbA1c) Control >9 (*Lower number & negative variance indicates better performance) 30.22 29.98 32.57 26 53 33.02 37.44 42.32 44.28 50 85 20.07 20.63

Aetna Health of California Inc. Persistence of Beta-Blocker Treatment after a Heart Attack 60.47 64.46 69.23 59 30 65.99 81.75 84.30 83.20 83.17 92.31 22.70Aetna Health of California, Inc. Diabetes Care: Blood Sugar (HbA1c) Testing 85.85 88.06 89.08 90 85 86.70 85.07 85.34 86.62 84 67 94.89 -1.18Aetna Health of California, Inc. Diabetes Care: Medical Attention for Nephropathy 83.21 84.69 83.45 89.44 82.42 84.36 84.16 84.67 90 02 93.79 6.81Aetna Health of California, Inc. Diabetes Care: Eye Exams 57.79 55.74 50.00 50.94 39.90 48 34 43.50 45.74 33.58 71.53 -24.21

-73.93-69.81


90th %ile

2006-2015%age Point

ChangeBlue Cross of California dba Anthem Blue Cross Controlling High Blood Pressure 60.04 71.16 71.16 NR 63.02 60.16 64.56 60.00 61 27 76.16 1.23Blue Cross of California dba Anthem Blue Cross Diabetes Care: Blood Pressure <140/90 NA NA NA NA 72.33 72.33 73.48 73.48 67 64 78.83 -4.69Blue Cross of California dba Anthem Blue Cross Diabetes Care: Blood Sugar (HbA1c) Control <8 NA NA NA NA NA 62.33 63.50 63.50 63 02 67.22 0.69

Blue Cross of California dba Anthem Blue CrossDiabetes Care: Poor Blood Sugar (HbA1c) Control >9 (*Lower number & negative variance indicates better performance) 30.12 24.50 14.42 14.42 28.00 28.00 25.79 25.79 24 57 20.07 -5.55

Blue Cross of California dba Anthem Blue Cross Persistence of Beta-Blocker Treatment after a Heart Attack 75.06 67.87 64.61 62 22 71.04 82.18 76.08 79.31 72 96 92.31 -2.10Blue Cross of California dba Anthem Blue Cross Diabetes Care: Blood Sugar (HbA1c) Testing 85.54 89.62 87.41 87.41 88.00 88.00 87.83 89.05 91.48 94.89 5.94Blue Cross of California dba Anthem Blue Cross Diabetes Care: Medical Attention for Nephropathy 77.59 86.09 83.94 84.12 85.00 85.00 83.70 87.10 91 00 93.79 13.41Blue Cross of California dba Anthem Blue Cross Diabetes Care: Eye Exams 59.76 56.95 52.55 52.55 49.00 49 00 49.39 49.39 44.77 71.53 -14.99

2.785.04


90th %ile

2006-2015%age Point

ChangeBlue Shield of California Controlling High Blood Pressure 58.60 63.55 64.73 64.79 66.33 60.50 60.50 65.20 61.70 76.16 3.10Blue Shield of California Diabetes Care: Blood Pressure <140/90 NA NA NA NA 64.97 68.73 56.20 71.09 66 61 78.83 1.64Blue Shield of California Diabetes Care: Blood Sugar (HbA1c) Control <8 NA NA NA NA NA 61.45 63.14 61.56 64 92 67.22 3.47

Blue Shield of CaliforniaDiabetes Care: Poor Blood Sugar (HbA1c) Control >9 (*Lower number & negative variance indicates better performance) 24.70 28.44 24.09 24 09 26.32 27.09 27.55 26.56 25 80 20.07 1.10

Blue Shield of California Persistence of Beta-Blocker Treatment after a Heart Attack 70.60 74.48 73.84 73 54 75.13 78.55 80.58 82.73 83.10 92.31 12.50Blue Shield of California Diabetes Care: Blood Sugar (HbA1c) Testing 86.20 86.97 90.40 90.40 88.57 86.36 90.33 89.69 88 87 94.89 2.67Blue Shield of California Diabetes Care: Medical Attention for Nephropathy 80.39 83.65 87.14 87.14 90.20 87.82 84.49 89.84 90.73 93.79 10.34Blue Shield of California Diabetes Care: Eye Exams 59 32 62.32 64.49 64.49 58.80 58 80 49.45 50.94 48.74 71.53 -10.58

7.1122.04


90th %ile

2006-2015%age Point

ChangeCigna HealthCare of California, Inc. Controlling High Blood Pressure 64.23 62.11 62.11 68 04 68.04 52.22 57.80 59.80 46 23 76.16 -18.00Cigna HealthCare of California Inc. Diabetes Care: Blood Pressure <140/90 NA NA NA NA 63.96 67.64 66.67 67.40 58 97 78.83 -4.99Cigna HealthCare of California, Inc. Diabetes Care: Blood Sugar (HbA1c) Control <8 NA NA NA NA NA 63.26 55.72 55.72 60 20 67.22 -3.06

Cigna HealthCare of California, Inc.Diabetes Care: Poor Blood Sugar (HbA1c) Control >9 (*Lower number & negative variance indicates better performance) 28.47 28.71 23.36 23 36 26.50 25.55 31.14 30.17 29 24 20.07 0.77

Cigna HealthCare of California, Inc. Persistence of Beta-Blocker Treatment after a Heart Attack 54.76 64.29 63.74 75 00 68.75 73.81 75.00 71.70 78 05 92.31 23.29Cigna HealthCare of California Inc. Diabetes Care: Blood Sugar (HbA1c) Testing 88.08 88.56 91.48 91.48 89.75 90.75 90.51 89.78 91 65 94.89 3.57Cigna HealthCare of California, Inc. Diabetes Care: Medical Attention for Nephropathy 79.32 87.35 87.83 87 83 84.81 90 51 89.05 89.05 93.61 93.79 14.29Cigna HealthCare of California, Inc. Diabetes Care: Eye Exams 57.18 57.42 55.23 56.20 52.12 53 04 49.15 56.20 50.86 71.53 -6.32

-26.828.01

Total %age Point ChangeControl Measures %age Point Change

Control Measures %age Point Change Total %age Point Change

Total %age Point ChangeControl Measures %age Point Change

Control Measures %age Point ChangeTotal %age Point Change




90th %ile

2006-2015%age Point

ChangeHealth Net of California, Inc. Controlling High Blood Pressure 62.23 63.11 68.56 65 82 67.93 65.03 70.80 65.96 61.17 76.16 -1.06Health Net of California, Inc. Diabetes Care: Blood Pressure <140/90 NA NA NA NA 67.41 67.41 62.77 63.75 64.48 78.83 -2.93Health Net of California Inc. Diabetes Care: Blood Sugar (HbA1c) Control <8 NA NA NA NA NA 62.44 60.83 59.37 64 96 67.22 2.52

Health Net of California, Inc.Diabetes Care: Poor Blood Sugar (HbA1c) Control >9 (*Lower number & negative variance indicates better performance) 22.01 23.60 21.58 21 58 24.87 24.87 26.76 31.39 24 82 20.07 2.81

Health Net of California, Inc. Persistence of Beta-Blocker Treatment after a Heart Attack 73.11 72.56 75.39 72 26 79.95 86.20 79.06 76.49 71 62 92.31 -1.49Health Net of California, Inc. Diabetes Care: Blood Sugar (HbA1c) Testing 92.34 91.36 91.19 91.19 87.99 87.99 88.32 87.35 88 56 94.89 -3.78Health Net of California Inc. Diabetes Care: Medical Attention for Nephropathy 82.78 84.58 86.15 86.15 85.25 85.25 87.83 86.62 92 21 93.79 9.43Health Net of California, Inc. Diabetes Care: Eye Exams 61.24 60.98 60.97 60 97 58.32 58.32 46.47 46.47 49 88 71.53 -11.36

-4.28-11.48


90th %ile

2006-2015%age Point

ChangeKaiser Foundation Health Plan, Inc. - Northern CA Controlling High Blood Pressure 73.31 80.37 80.37 83.70 87.08 85.71 90.41 87.44 88.13 76.16 14.82Kaiser Foundation Health Plan, Inc. - Northern CA Diabetes Care: Blood Pressure <140/90 NA NA NA NA 80.47 82.85 82.18 83.76 82 55 78.83 2.08Kaiser Foundation Health Plan Inc. - Northern CA Diabetes Care: Blood Sugar (HbA1c) Control <8 NA NA NA NA NA 63.14 69.89 69.89 69 89 67.22 6.75

Kaiser Foundation Health Plan, Inc. - Northern CADiabetes Care: Poor Blood Sugar (HbA1c) Control >9 (*Lower number & negative variance indicates better performance) 22.55 20.99 19.81 18 61 19.89 19.89 18.25 18.25 20.44 20.07 -2.11

Kaiser Foundation Health Plan, Inc. - Northern CA Persistence of Beta-Blocker Treatment after a Heart Attack 84.28 87.76 88.20 83 63 86.63 86.13 89.77 89.87 92 50 92.31 8.22Kaiser Foundation Health Plan, Inc. - Northern CA Diabetes Care: Blood Sugar (HbA1c) Testing 90.43 91.42 92.26 93 61 95.80 95.80 94.71 94.71 93 98 94.89 3.55Kaiser Foundation Health Plan Inc. - Northern CA Diabetes Care: Medical Attention for Nephropathy 91.28 93.07 90.75 91.79 94.16 94.16 94.15 94.53 93.43 93.79 2.15Kaiser Foundation Health Plan, Inc. - Northern CA Diabetes Care: Eye Exams 66 37 69.53 71.32 71.32 68.80 68 80 68.98 68.98 67.88 71.53 1.51

25.7641.19


90th %ile

2006-2015%age Point

ChangeKaiser Foundation Health Plan Inc. - Southern CA Controlling High Blood Pressure 73.97 79.08 84.23 83.70 85.64 85.64 88.81 85.64 83.70 76.16 9.73Kaiser Foundation Health Plan Inc. - Southern CA Diabetes Care: Blood Pressure <140/90 NA NA NA NA 83.72 84.60 85.07 84.50 82 96 78.83 -0.76Kaiser Foundation Health Plan Inc. - Southern CA Diabetes Care: Blood Sugar (HbA1c) Control <8 NA NA NA NA NA 66.59 66.69 61.64 63 35 67.22 -3.24

Kaiser Foundation Health Plan Inc. - Southern CADiabetes Care: Poor Blood Sugar (HbA1c) Control >9 (*Lower number & negative variance indicates better performance) 28.47 25.99 23.76 21.76 21.98 21.14 20.98 24.00 23 26 20.07 -5.21

Kaiser Foundation Health Plan Inc. - Southern CA Persistence of Beta-Blocker Treatment after a Heart Attack 84.89 85.26 83.83 83 52 88.18 89.73 89.16 89.72 93 35 92.31 8.46Kaiser Foundation Health Plan Inc. - Southern CA Diabetes Care: Blood Sugar (HbA1c) Testing 86.13 89.71 92.57 93 53 93.73 94.13 94.20 94.45 94.47 94.89 8.34Kaiser Foundation Health Plan Inc. - Southern CA Diabetes Care: Medical Attention for Nephropathy 92.94 92.47 97.66 95 88 93.87 93.87 93.59 93.64 94 32 93.79 1.38Kaiser Foundation Health Plan Inc. - Southern CA Diabetes Care: Eye Exams 75 67 73.24 73.39 79.12 75.19 77 87 81.69 81.40 81.25 71.53 5.58

10.9434.70


90th %ile

2006-2015%age Point

ChangeSharp Health Plan Controlling High Blood Pressure NA NA NA NA 69.54 67.78 67.78 72.98 72 56 76.16 3.02Sharp Health Plan Diabetes Care: Blood Pressure <140/90 NA NA NA NA 68.86 68.86 76.21 76.21 76.17 78.83 7.31Sharp Health Plan Diabetes Care: Blood Sugar (HbA1c) Control <8 NA NA NA NA NA 73.48 66.75 66.75 72.73 67.22 -0.75

Sharp Health PlanDiabetes Care: Poor Blood Sugar (HbA1c) Control >9 (*Lower number & negative variance indicates better performance) NA NA NA NA 18.49 18.49 18.20 18.20 18.43 20.07 -0.06

Sharp Health Plan Persistence of Beta-Blocker Treatment after a Heart Attack NA NA NA NA NA NA NA NA NA 92.31 NASharp Health Plan Diabetes Care: Blood Sugar (HbA1c) Testing NA NA NA NA 91.48 91.48 93.20 93.20 92 87 94.89 1.39Sharp Health Plan Diabetes Care: Medical Attention for Nephropathy NA NA NA NA 90.51 90.51 89.81 89.81 94 59 93.79 4.08Sharp Health Plan Diabetes Care: Eye Exams NA NA NA NA 56.20 56.20 55.10 55.10 58.48 71.53 2.28

9.6417.39








90th %ile

2006-2015%age Point

ChangeUnitedHealthcare of California Controlling High Blood Pressure 53.81 66.75 66.75 66 83 66.83 64.10 64.10 65.63 55 80 76.16 1.99UnitedHealthcare of California Diabetes Care: Blood Pressure <140/90 NA NA NA NA 70.22 70.22 64.68 66.11 63 51 78.83 -6.71UnitedHealthcare of California Diabetes Care: Blood Sugar (HbA1c) Control <8 NA NA NA NA NA 64.44 59.67 63.74 62 56 67.22 -1.88

UnitedHealthcare of CaliforniaDiabetes Care: Poor Blood Sugar (HbA1c) Control >9 (*Lower number & negative variance indicates better performance) 32.94 25.87 25.04 25 04 25.45 25.45 30.07 26.78 25 59 20.07 -7.35

UnitedHealthcare of California Persistence of Beta-Blocker Treatment after a Heart Attack 69.39 72.80 72.99 75 30 77.89 75.44 83.33 76.19 78.15 92.31 8.76UnitedHealthcare of California Diabetes Care: Blood Sugar (HbA1c) Testing 85.75 89.15 88.51 88 51 91.70 91.70 88.31 90.76 90 28 94.89 4.53UnitedHealthcare of California Diabetes Care: Medical Attention for Nephropathy 81.54 85.91 84.91 84 91 85.74 85.74 86.63 87.44 92.18 93.79 10.64UnitedHealthcare of California Diabetes Care: Eye Exams 55.61 58.80 55.40 55.40 56.58 56 68 50.60 50.60 47.63 71.53 -7.98

0.7516.70


90th %ile

2006-2015%age Point

ChangeWestern Health Advantage Controlling High Blood Pressure 60.83 63.99 64.48 68 61 68.61 70.80 70.80 68.13 70 56 76.16 9.73Western Health Advantage Diabetes Care: Blood Pressure <140/90 NA NA NA NA 75.36 75.36 73.97 73.97 70 07 78.83 -5.29Western Health Advantage Diabetes Care: Blood Sugar (HbA1c) Control <8 NA NA NA NA NA 68.07 65.21 65.21 64.72 67.22 -3.35

Western Health AdvantageDiabetes Care: Poor Blood Sugar (HbA1c) Control >9 (*Lower number & negative variance indicates better performance) 34.06 28.95 24.64 22 99 21.53 21.53 25.55 25.55 25 06 20.07 -9.00

Western Health Advantage Persistence of Beta-Blocker Treatment after a Heart Attack 74.36 82.86 NA 75 68 82.93 NA NA 86.67 75 56 92.31 1.20Western Health Advantage Diabetes Care: Blood Sugar (HbA1c) Testing 86.13 86.62 87.04 88 69 90.33 90.33 90.02 90.02 89 54 94.89 3.41Western Health Advantage Diabetes Care: Medical Attention for Nephropathy 76.89 79.81 85.58 87 04 90.15 90.15 86.86 86.86 88 32 93.79 11.43Western Health Advantage Diabetes Care: Eye Exams 46.72 51.34 53.47 55 29 58.58 58.58 52.80 52.80 50 36 71.53 3.64

10.0929.77





Page 3 of 6

Measure

Controlling High Blood Pressure **

Diabetes Care: Blood Sugar (HbA1c) Control <8%**

Diabetes Care: High Blood Pressure Control <140/90**

Diabetes Care: Poor Blood Sugar (HbA1C) Control (>9%)**

Persistence of Beta Blocker Treatment After a Heart Attack

Diabetes Care: Blood Sugar (HbA1c) Testing**

Diabetes Care: Medical Attention for Nephropathy**

Diabetes Care: Eye Exams**

Definition

This HEDIS measure is the percentage of members 18–75 years of age with diabetes (type 1 and type 2) who had an eye exam (retinal) performed. In 2016, the conversion to ICD-10 codes affected how diabetics are identified in the event/diagnosis and optional exclusions. Trending between 2016 and prior years should be considered with caution. In 2015, the ED visit requirement was revised when identifying the event/diagnosis of the eligible population. Trending between 2015 and prior years’ should be considered with caution.

This HEDIS measure is the percentage of members 18–75 years of age with diabetes (type 1 and type 2) who had poor HbA1c control (>9.0%). A lower rate indicates better performance. In 2016, the conversion to ICD-10 codes affected how diabetics are identified in the event/diagnosis and optional exclusions. Trending between 2016 and prior years should be considered with caution. In 2015, the ED visit requirement was revised when identifying the event/diagnosis of the eligible population. Trending between 2015 and prior years’ should be considered with caution.

This HEDIS measure is the percentage of members 18 years of age and older during the measurement year who were hospitalized and discharged from July 1 of the year prior to the measurement year to June 30 of the measurement year with a diagnosis of AMI and who received persistent beta-blocker treatment for six months after discharge.

This HEDIS measure is the percentage of members 18–75 years of age with diabetes (type 1 and type 2) who had received Hemoglobin A1c (HbA1c) testing. In 2016, the conversion to ICD-10 codes affected how diabetics are identified in the event/diagnosis and optional exclusions. Trending between 2016 and prior years should be considered with caution. In 2015, the ED visit requirement was revised when identifying the event/diagnosis of the eligible population. Trending between 2015 and prior years’ should be considered with caution.

This HEDIS measure is the percentage of members 18–75 years of age with diabetes (type 1 and type 2) who received medical attention for nephropathy (kidney disease).In 2016, the conversion to ICD-10 codes affected how diabetics are identified in the event/diagnosis and optional exclusions. Trending between 2016 and prior years should be considered with caution. In 2015, the ED visit requirement was revised when identifying the event/diagnosis of the eligible population. Trending between 2015 and prior years’ should be considered with caution

This HEDIS measure is the percentage of members 18–85 years of age who had a diagnosis of hypertension (HTN) and whose blood pressure (BP) was <140/90 mm Hg for members 18-59 years of age and whose BP was <140/90 mm Hg for members 60-85 years of age with a diagnosis of diabetes or whose BP was <150/90 mm Hg for members 60-85 years of age without a diagnosis of diabetes.

This HEDIS measure is the percentage of members 18–75 years of age with diabetes (type 1 and type 2) who had HbA1c control of less than 8%. In 2016, the conversion to ICD-10 codes affected how diabetics are identified in the event/diagnosis and optional exclusions. Trending between 2016 and prior years should be considered with caution. In 2015, the ED visit requirement was revised when identifying the event/diagnosis of the eligible population. In addition, changes were made to General Guideline 41: Measures That Require Results from the Most Recent Test that affect the HbA1c indicators. Trending between 2015 and prior years’ should be considered with caution.

This HEDIS measure is the percentage of members 18–75 years of age with diabetes (type 1 and type 2) who had a most recent blood pressure measurement <140/90 mm Hg. In 2016, the conversion to ICD-10 codes affected how diabetics are identified in the event/diagnosis and optional exclusions. Trending between 2016 and prior years should be considered with caution. In 2015, the ED visit requirement was revised when identifying the event/diagnosis of the eligible population. Trending between 2015 and prior years’ should be considered with caution

Purpose Share ways to replicate successful strategies by

catalyzing the uptake of best practices with presentations by expert speakers experienced in achieving benchmark outcomes

Provide an educational, interactive setting for exchanging proven clinical quality strategies

Build esprit de corps and enthusiasm among medical directors, pharmacy directors and quality improvement teams across a region to meet the goals for preventing heart attacks, strokes, and diabetic complications

Participants Include: All major health delivery systems, representing more than

80% of medical care provided in a given metro area Medical, quality improvement and pharmacy directors from

medical groups and pharmacies (and, in Sacramento and LA, from health plans)

Community clinics The Veterans Administration and military medical centers Government officials:

− The CA Department of Managed Health Care − CA Department of Health Care Services (Medi-Cal);

OPA and CA Department of Public Health − County Health Officials

Right Care research team (UC Berkeley, UCLA, UCSD, RAND, and USC)

Examples of UBP Presentations Include:

Treatment Disparities in Women’s Cardiovascular Disease (Data from one Health Plan) – Chloe E. Bird, PhD, MA, Senior Sociologist, RAND Corporation, Professor of Sociology and Policy Analysis Pardee RAND Graduate School Kaiser’s Approach to Reducing Disparities in Controlling

Blood Pressure, HbA1C and Cholesterol – Winston F. Wong, MD, MS, Medical Director, Community Benefits; Director, Disparities Improvement and Quality Initiatives, Kaiser Permanente Bringing it All Together: Evidence-Based Prevention and

Treatment of Atherosclerotic Cardiovascular Disease – Gregg C. Fonarow, MD FACC, FAHA, Eliot Corday Professor of Cardiovascular Medicine and Science. Director, Ahmanson-UCLA Cardiomyopathy Center. Co-Director Preventative Cardiology Program and Clinical Co-Chief Division of Cardiology at David Geffen School of Medicine at UCLA “Measure Up, Pressure Down” AMGA Hypertension

Management Campaign – Jerry Penso, MD, MBA, Chief Medical Officer, American Medical Group Association How the American Heart Association and Emergency Medical

Services Can Help You Save Lives and Money—Jim Dunford, MD, City EMS Medical Director and President of the Board of the Greater SD American Heart Association Kaiser ALL Medication Protocol - Proactive Reduction of Risk

of Heart Attack and Stroke for Diabetes and Heart Disease Patients—Jim Dudl, MD, National Community Benefits and Diabetes Clinical Lead, Kaiser Permanente Care Management Institute San Diego Beacon Community Grant to Strengthen Health

Information Technology—Ted Chan, MD & Anupam Goel, MD, Principal Investigators of the Beacon Project UCSD & SD Achieving Benchmark Results through Collaboration with

Pharmacists—Jan Hirsch, RPh, PhD, Associate Professor of Clinical Pharmacy, UC San Diego & Rebecca Cupp, RPh, Vice President of Pharmacy, Ralphs Grocery Company Patient Centered Care: Practical Lessons—Diane

Stollenwerk, MPP, VP of Community Alliances, National Quality Forum Quality Improvement for Diverse Populations: Place and Race

Matters—Rodney Hood, MD, Chief Medical Officer, Multicultural Primary Care Medical Group San Diego Strategies to Improve the Care of Patients with Diabetes and

Vascular Disease--Dr. Bruce D. McCarthy, MD, MPH, President, Physician Division Columbia-St. Mary's Ascension Health

The Right Care Initiative has worked since 2007 to improve clinical outcomes by catalyzing uptake of patient-centered, evidence-based best practices among medical groups, clinics, and health plans. This public-private partnership includes clinicians, health systems, patients, the University of California, USC, Stanford Clinical Excellence Research Center, Health Services Advisory Group (CMS QIO), the Chronic Care Coalition; RAND; and the CA Department of Managed Health Care. We collaborate intensively with local leaders in three major metro areas to work on improving critical metrics for heart attack, stroke and diabetes complications prevention. Speakers are invited from organizations with breakthrough clinical quality success to share their strategies for improving patient outcomes. The first University of Best Practices (UBP) launched in San Diego in 2011, the second in Sacramento in 2012, and the third in Los Angeles in 2013.

California Right Care Initiative Program Description

University of Best Practices Colloquium

Right Care Initiative

California Right Care Initiative Program Description

The University of Best Practices Colloquium Page 2 The University of Best Practices in More Detail Monthly Meetings

Clinical quality benchmark performer and/or expert presents for the first hour

A break out session or discussion in the round follows in the second hour to consider how to apply the speaker’s ideas in the local setting and to problem-solve how to overcome barriers

Lessons Learned A collaborative, “non-combat zone” spirit among local clinical

leaders is the essential ingredient, following the Warren principle: In this room we compete against disease, not against each other

Lecture should be scheduled for 50% or less of allotted time to allow for sufficient discussion on achievable, locally applicable action plans

Informal time before and after the formal schedule facilitates one-on-one conversations and builds cohesive relationships

Many hours of behind-the-scenes planning and organizing are needed for a successful collaborative

Resources An NIH-GO (National Institutes of Health - Grand Opportunity)

grant, awarded to the Right Care research team in 2009, supported launch of the initial University of Best Practices in San Diego by the UC Berkeley research team

Charitable contributions are continuing this important endeavor now that the NIH-GO grant is concluded

The California Health Care Quality Report Card The California Health Care Quality Report Card compares performance for the largest California health plans and over 220 medical groups. It is published each spring by the CA Office of the Patient Advocate. These HEDIS and pay for performance metrics provide key benchmarks for the Right Care Initiative’s quality improvement effort. See example for San Diego here. San Diego Medical Group Cholesterol Control for People with Heart Disease (Based on the California Health Care Quality Report Card 2009 - 2015 Editions—data from performance years 2007 - 2013)

Right Care Measures for Preventing Heart Attacks, Strokes, and Diabetic Complications

Hypertension control (<140/90 mmHg) Cholesterol control for heart care patients (LDL-C <100) Cholesterol control for diabetes care patients (LDL-C <100) Blood sugar control for diabetes care patients (HbA1c <8) Blood pressure control for diabetes care patients (<140/90 mmHg)

Looking Forward The learnings from the University of Best Practices

dedicated to prevention of heart attack and stroke are expected to be spread statewide as they evolve

Steering committee medical directors from the San Diego University of Best Practices came to consensus that heart attacks and strokes could be reduced by 50% in 5 years by implementing the interventions on the Right Care Triangle (see Right Care Initiative Project Brief)

This program description was written by the Right Care Initiative team at the University of California, Berkeley, with support from the California Office of the Patient Advocate—Last updated February 18, 2017. For more information visit: rightcare.berkeley.edu

71%= 90th Percentile HMO/POS Performance for Heart Disease Patient Cholesterol Control in 2013

2017 right care initiative data and briefs packet · overcourse the of this project, california has...

Documents