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3 rd Annual Dean’s Right Care Cardiovascular and Diabetes Leadership Summit Taking Action Together to Prevent Heart Attacks and Strokes Reaching 90th percentile Targets: Medical Directors Report on Health Plan Strategies, Programs, Plans, and Achievements. October 1, 2010  UC Berkley.

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October 1 2010 uc berkley

3rd Annual Dean’s Right CareCardiovascular and Diabetes Leadership SummitTaking Action Together to Prevent Heart Attacks and StrokesReaching 90th percentile Targets: Medical Directors Report on Health Plan Strategies, Programs, Plans, and Achievements

October 1, 2010 

UC Berkley


Strategies plans or programs
Strategies, Plans or Programs

Anthem Blue Cross of CA

Number of Commercial HMO enrollees: 1,249,334 member years*

* Member years represent average membership over calendar year 2009


Strategies plans or programs1
Strategies, Plans or Programs

Anthem Blue Cross of CA

*Percentage BP controlled is not a HEDIS measure for CVD population


Strategies plans or programs2
Strategies, Plans or Programs

Anthem Blue Cross of CA


Strategies plans or programs3
Strategies, Plans or Programs

Anthem Blue Cross of CA

* Age break out not available for HEDIS 2009 CA Commercial HMO


Strategies plans or programs4
Strategies, Plans or Programs

Anthem Blue Cross of CA

The 2009 medical record review root cause analysis revealed:

  • A need for provider education to perform testing before re-ordering medication

  • Providers satisfied if LDL<130, not aggressive getting LDL below 100

  • A need for Provider/Staff Education regarding testing and medication monitoring

  • A need for new strategies to engage members 31 to 50 years to control their LDL levels--the largest population target


Strategies plans or programs5
Strategies, Plans or Programs

Anthem Blue Cross of CA

  • Provider and Member education about:

    What is a normal Blood Pressure

    What is Pre-Hypertension

    What is Hypertension

    When to treat

  • Proper follow-up and documentation by MD on elevated BP readings. Ensure a return office visit, educate member to check/record BPs daily.

  • Provider office staff re-check BP during the same visit if elevated.

  • Proper cuff size use.

The 2009 medical record review root cause analysis revealed a need for:


2009 clinical quality activities
2009 Clinical Quality Activities

  • Stratify members for varying levels of Disease State Management intervention

  • Leverage technology

  • Layered interventions

    • IVR and mailing

    • Patient and physician


Evaluation of the overall effectiveness of interventions
Evaluation of the Overall Effectiveness of Interventions

CAD Program

The CAD Program realized improvement in the LDL testing, beta blocker medication use post MI as well as the beta blocker persistence metric in 2009.

LDL Screening

The number of members having at least one LDL test annually continues to trend positively with a 1.6 percentage point improvement in 2009.

My Health Advantage

46% showed increased compliance with clinical recommendations

69% refilled a high blood pressure Rx when reminded

60% went for annual lipid check when reminded it was overdue

Medication Compliance

The HMG CoA Reductase Inhibitor Compliance intervention touched a small subset of the member population though statins are among the top 25 medications prescribed.


Evaluation of the overall effectiveness of interventions1
Evaluation of the Overall Effectiveness of Interventions

ACE/ARB Compliance Outcomes

  • 4Q08 targets adding ACE/ARB therapy at 6 months (2Q09): 19.8%

  • Q09 Targets adding therapy at 6 months (# of eligible targets assessed*): 32.7%

    My Health Advantage

  • 46% showed increased compliance with clinical recommendations

  • 60% went for annual lipid check when reminded it was overdue

    Overall HEDIS performance for the State of CA

  • Slight overall improvement for the HMO/POS plan compared to the previous year. The most significant improvement was found with eye exam which had a small increase in rate by 1.52% from the previous year.


Evaluation of the overall effectiveness of interventions2
Evaluation of the Overall Effectiveness of Interventions

My Health Advantage

  • 69% refilled a high blood pressure Rx when reminded

    Overall

  • The anti-hypertensive medication compliance intervention had a potential population of 50,760 members but only 9,321 members reached.

    The reminder card was mailed to 95,064 targeted members prior to the IVR calls.


Effectiveness of interventions observations
Effectiveness of Interventions Observations

TargetedIndividualized Patient and Treating Physician Messaging

Interventions that target individuals who are noncompliant with medication fills or health screenings and send individualized messages to both the member and the treating physician show significant success rates.

Combined IVR and Mailings

Interventions that combine IVR with educational mailings have higher success rates.

Member Focused and Population Based

Future interventions need to be partly population based and member focused.


Opportunities for collaborative action
Opportunities for Collaborative Action

Understanding the problem

  • Do we need to close the gap in underserved areas?

  • Are there geographic hotspots that require customized approaches or infrastructure to improve the quality of care?

  • Is quality performance linked to health care disparities in under-performing geographic areas?

  • Are there any other barriers for preventive services, chronic disease management, patient education programs and primary care?


Opportunities for collaborative action1
Opportunities for Collaborative Action

Identify Strategic Partners and Collaborate for Population Based Quality Activities

Collaborate with medical groups, providers, other health plans and State Programs, such as the CA Diabetes Program, to link health plans, health care professionals with community resources that focus on patient education and provider programs and increase opportunities for people living with diabetes to manage their health and reduce the burden on providers.


Opportunities for collaborative action2
Opportunities for Collaborative Action

Examples of collaborative activities include:

  • Development and dissemination of resource guides to facilitate access to care and services available in the community.

  • Partner with medical groups to promote the use of evidence based clinical guidelines to drive improvement in the quality of diabetes care and hypertension management.

  • Promote statewide and local events to increase awareness on the prevention and management of diabetes and heart disease.













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