Transcript Improving Blood Pressure and Stroke Management in Utah

State-Health Plan Collaboration
to Improve Blood Pressure in
Utah
CSG Health Policy Forum on
Cardiovascular Health and Wellness
Barbara A. Larsen, RD, MPH
Program Director, Utah Heart Disease and Stroke Prevention
Program
September 29, 2006
ACKNOWLEDGEMENTS
• David L. Larsen, RN, MHA
Director, Quality Improvement
SelectHealth
• Joan Ware, RN, MSN
Consultant
National Association of Chronic Disease Directors
• Karen Warren, Director of Quality Improvement and
Health Education, Molina Health Care
• Brooke Gardner, BS
Utah Heart Disease and Stroke Prevention Program
High Blood Pressure in Utah
in 2001/2002
• Data:
– 22.3% of Utah adults report high blood pressure (2001-BRFSS)
– 59.9% of Utah adults with high blood pressure are taking
medication (2001-BRFSS)
– 59.6% of SelectHealth and 56.9% of Molina patients had blood
pressure in control (<= 140/90) (2002)
• MDs in Utah qualitative data….
– Extremely concerned about cardiovascular health of Utahns
– High blood pressure is having detrimental effects on the health of
Utahns-at younger and younger ages
– Public far underestimates the risks of cardiovascular disease
– Patients do not understand the disease and impact on health
– Patients deny their health conditions and MDs have to “scare”
them into compliance
High Blood Pressure in Utah
• MDs in Utah qualitative data…
– Physician challenges to treating hypertension:
•
•
•
•
Time
Patient denial
Prescription costs
Patients get conflicting messages-from media and
pharmacists
• Non-compliance (meds better than lifestyle)
• Paperwork/spending time on those who can’t pay
– Want patients to self-monitor blood pressure and take
responsibility
– Encourage patients to try lifestyle changes before
medications are prescribed to lower blood pressure
High Blood Pressure In Utah
• Patients’ views…
– Understand high blood pressure is serious
– Those who take it seriously are better educated and informed
– Those who show less concern say they have no symptoms and
that medication can mediate the problem
– Greatest fears center around possible loss of independence
and/or early death
– Drs fail to adequately educate patients about the specifics of the
disease; patients want more information
– Getting conflicting messages – advertising for fast food plus
admonitions to eat right and exercise
– Patients understand that untreated high blood pressure can lead
to serious consequences-stroke, heart attack, kidney disease,
early death, lower quality of life
– Cost is an issue in treatment for those who are low income
High Blood Pressure In Utah
• Patients’ views…
– Understand that high blood pressure can be controlled with
medications, diet and exercise but find it difficult to follow diet and
exercise recommendations – hard to find the will power
– Family members can be supportive or push compliance too hard
– Many believe it is their responsibility to take control
– Want more information from MDs about high blood pressure, its
ramifications and how to control it
– Confident about self (or family) monitoring blood pressure
– Like the idea of health insurance offering incentives to control high
blood pressure
– Most believe that self-management programs can work and put the
responsibility on the shoulders of the patient – where it belongs
– Very interested in a video designed for people with high blood pressure
– seemed to mitigate lack of in-depth information from MDs
– Prototype tracking booklet-received good, but not great scores
Blood Pressure Management
Program
The Utah Heart Disease
and Stroke Prevention
Program approached
Utah’s health plans to
work collaboratively to
develop a comprehensive
high blood pressure
management program for
physicians and members.
SelectHealth and Molina
Health Care agreed.
Blood Pressure Management
Program Priorities
• Improve physician care provided to Utahns
with high blood pressure
• Improve blood pressure self-management
among Utahns with high blood pressure
• Reduce rates of high blood pressure not in
control
Blood Pressure Management
Program
• SelectHealth-UHDSPP
Activities:
– Blood pressure care
guidelines developed and
served as the basis of a
statewide physician
education program
– Regional trainings for
physicians on blood
pressure management
– Patient self-management
education
“Blood Pressure (BP) Take Control”
Patient Self-Management Education Prog
• Goals:
– Improve understanding of
high blood pressure
– Improve self-management
of high blood pressure
– Monitor progress
• Components:
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–
–
–
–
–
–
–
BP Basics
BP Tracker
DASH Diet
Walking Exercise Program
Brochure
BP Cuff
Pedometer
Pill Box
BP Take control DVD
Blood Pressure Basics
• Understanding High
Blood Pressure
• Managing High Blood
Pressure
• Monitoring Your
Progress
“BP Take Control”
Lifestyle Materials
• Utahwalks.org
• Walking trails and maps
• Walking Tracker
• Pedometer
• DASH diet
“BP Take Control” DVD
• DVD produced by
Utah HDSPP and
Intermountain
Healthcare
• Visual learning tool
and patient motivator
to take action in
controlling blood
pressure.
• 10 min
Interactive Voice Response High Blood
Pressure Outreach Calls
• Outreach Goals
– Engage more health plan
members in conversations
about their blood pressure
– Identify health plan
members with uncontrolled
high blood pressure
– Identify motivating factors
to self-monitor
– Inspire healthy behavior
change in health plan
members at a lower cost
Interactive Voice Response High Blood
Pressure Outreach Calls
• Program Tactics
– Computerized-voice response
system
– Interact with health plan
members over the phone, at
their convenience
– Distribute self-management
tools (i.e. blood pressure diary,
walking program, pedometer,
and blood pressure cuffs) to
those who will use them
– Provide tailored information
and tips for achieving optimal
blood pressure levels
– Transfer members to
customer service or a nurse, if
needed
Interactive Voice Response High Blood
Pressure Outreach Calls
• Interactive voice
response telephone
calls have been
placed to members
with hypertension, biannually.
“BP Take Control”
Post Intervention Results
• Follow-up with members who received cuffs:
– 84% remembered the original outreach call
– 85% were using the cuff at least once a
week
– 94% felt that the tools and information sent
to them will help them improve their health
– 96% have seen their MDs about their
condition as a result of the call
– 73% reported that their blood pressure
improved since the initial outreach
“BP Take Control”
Sample member comments post intervention
• “I really appreciated the program. I have changed
because of the program and my BP is down.”
• “Being able to monitor my BP instead of going to the
doctor has helped me quite a bit. I am not worried
because I am feeling bad. I just check my BP and it puts
my mind at ease.”
• "That was a nice package you sent me. I sure enjoy it. It
is a constant reminder that I need to watch my BP.“
Blood Pressure Management Prog
HEDIS Measures (2002, 2004, 2005)
80
Percent in Control
70
60
71.78
70.78
67.50
61.5
55.96
66.84
62.2
66.18
59.61
58.19
55.41
52.96
50
40
30
20
10
0
Molina
Med Bmrk
SelectHealth Comm Bmrk
Year
High Blood Pressure in Utah in
2005
• 71.8% of SelectHealth and 70.8% of Molina
patients had blood pressure in control
• 19% of Utah adults reported high blood pressure
(22.3% in 2001) (BRFSS)
• 27.1% Of Utah adults with high blood pressure
are making lifestyle changes (BRFSS)
• 69% of Utah adults with high blood pressure are
taking medication alone or making lifestyle
changes in addition to taking medication (59.9%
in 2001) (BRFSS)
Getting Health Plans to the Table
• Health Plan “Carrots”:
– What gets measured gets managed, focus on chronic diseases
associated with HEDIS measures.
– Facilitation at the State level allows competing health plans to meet on
neutral ground and agree to collaborate.
– Pass through funds are valued by health plans to help mature or start
chronic disease quality improvement programs.
– NCQA Quality Plus Accreditation Standards (Physician and Hospital
Quality)(2008) call for health plans to enter into collaborative
associations with other plans to measure care provided by physicians.
– Collaboration looks good in the public eye.
• State Program “Do’s”:
– Try to work with the Health Plan Quality Improvement Coordinator.
– Look at health plan data across plans and develop collaborative
interventions based on the data.
– Be open and willing to develop initiatives to meet the health plans’
needs.
Lessons Learned From Collaboration
• Health plans have access to members and
families.
• Health plans have access to providers.
• Matching dollars and resources from health
plans expands the impact of State programs.
• A consistent message from health plans to
health care providers has more impact.
• Health plans have access to data for evaluation
and monitoring – HEDIS.
• Health plans can be excellent partners with state
programs.
Thank You!
www.hearthighway.org
[email protected]