9 th Annual Right Care Initiative Summit Blue Shield Participation Scott Flinn, MD Regional Medical Director Blue Shield of California 1
Care Worthy of our Family and Friends 2
Bottom Line Up Front Blue Shield of California has historically been in the middle of the pack on the RCI metrics DMHC recently required Blue Shield to develop a plan to improve its performance with a goal of achieving the 90 th percentile in RCI metrics by 2018 Blue Shield of California has developed that plan and has begun the process of implementation; this presentation is a review of progress to date 2016 Ultimately, the goal is the elimination of preventable strokes and heart attacks for all Californians 3
Where we have been RCI metrics 2014 Percentile 4
Where we are now Developed a plan which includes engaging partner Provider Organizations with enough membership to allow us to reach 90 th percentile. Currently 6 organizations agreeing to participate - 80,000 members Developed Best Practices assessment for Diabetes and Hypertension care based on RCI and other work Conducting gap analysis with partner POs using Best Practices assessment tool, and development of plan of action based on the gap analysis 5
Where we are now Expanding Pharmacy programs Implementing quality goals in ACO contracts Attending University of Best Practices in all 3 locations 6
Best Practices Include: Engaging Providers and Patients Adopting and Implementing a treatment algorithm Intensifying treatment rapidly Implementing a care team which includes a pharmacist and Certified Diabetic Educator Continuously measuring success - registry Publicly reporting inside the Provider Organization 7
Decrease Deaths over 17% (1 in 6) in 2 years Treat them NOW 8
What have we learned so far Many provider organizations have efforts towards RCI goals at various levels RCI synergizes with other programs e.g. CDC/CMS Million Hearts, AMGF Measure Up Pressure Down and Together2Goal, AHA Target BP, Know Your Numbers Participation in RCI gives a framework for the effort Hypertension control has the biggest near term effects 9
Where do We Want to Go Continue to enlist Provider Organizations in effort Continue to refine approach based on experience with partner Provider Organizations and through participating in UBP and other venues Reach 90 th percentile in RCI Metrics Eliminate preventable strokes and heart attacks 10
Care Worthy of our Family and Friends 11
What is the intervention that has the greatest near term impact on reducing strokes and heart attacks? A. Lipid Management B. Diabetes Management C. Hypertension Management D. Medication Reconciliation 25% 25% 25% 25% A B C D 12 12
What has been shown as the best ways to motivate providers to improve performance? A. Cash B. Public reporting comparing providers to peers C. Medical Director conversations D. Point of Care reminders in the HER 25% 25% 25% 25% A B C D 13 13
Discussion 14
Appendix 15
Based on the Be There San Diego Simplified Hypertension Treatment Approach ACE-Inhibitor* / Thiazide Diuretic Lisinopril / HCTZ (Advance as needed) 20 / 25 mg X ½ daily 20 / 25 mg X 1 daily 20 / 25 mg X 2 daily Pregnancy Potential: Avoid ACE-Inhibitors * If not in control Calcium Channel Blocker Add amlodipine 5 mg X ½ daily 5 mg X 1 daily 10 mg daily If not in control Beta-Blocker OR Spironolactone Add metoprolol succinate ER 25 mg daily 50 mg daily 100 mg daily (Keep heart rate > 55) OR IF on thiazide AND egfr 60 ml/min AND K < 4.5 Add spironolactone 12.5 mg daily 25 mg daily For those with high cardiovascular risk consider adding a statin according to guidelines which can result in an additional 25% reduction 16 in cardiovascular events. Reference: The Lancet, Volume 376, Issue 9753, Pages 1670-1681,
Pharmacist on the care team Report on HTN medication prescriptions surrogate for HN control Medication Therapy Management using Collaborative Practice Agreements, intensification of therapy per protocol while keeping Primary Care Physician informed Medication Adherence and patient outreach 17
AMGF Together2 Goal program Program to address diabetes care http://together2goal.org/assets/pdf/toolkit/gettingstarted.pdf Four essential planks Adopt an algorithm Measuring A1C every 3-6months Rapid intensification of treatment every 30 days Evaluate CVD risk and treat Quick wins If DM and no A1C get them in A1C >9 and no visit in 6 months get them in A1C > 6.5 and no Dx of DM get them in 18
From ADA published 2015 19
DM and CVD risk Diabetic patients - Measure their CVD risk ALL treatment Aspirin Lisinopril Lipitor 20
Reporting and Rewarding - Registry Provides actionable data for identifying clinical opportunities Provides means of tracking progress, and providing feedback, and reporting and recognizing 21
Tools http://www.uspreventiveservicestaskforce.org/page/document/updat esummaryfinal/aspirin-to-prevent-cardiovascular-disease-andcancer?ds=1&s=aspirin http://www.capg.org/modules/showdocument.aspx?documentid=44 http://clincalc.com/cardiology/ascvd/pooledcohort.aspx http://together2goal.org/assets/pdf/toolkit/adopttreatmentalgorithm. pdf 22