Plenary VIII
Insight and Innovation:
How HealthPartners
Incorporated Million
Hearts®
Michael McGrail, MD, MPH
Vice President and Medical Director for Health
Solutions, HealthPartners
www.nationalforum.org
@NatForumHDSP
Alignment and Collaboration
HealthPartners and Million Hearts
PRESENTED BY
Michael McGrail MD, MPH
Vice President and Associate Medical Director
Health Solutions, HealthPartners
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Alignment
• “…The goal of Million Hearts is to reduce a
disease burden that is, by and large, unnecessary.
HealthPartners shares that goal and will continue
to search for and implement novel clinical and
community activities to achieve it. We hope our
efforts inspire others in Minnesota to do the
same….”
•
Meeting the Million Hearts goal What HealthPartners is doing and what others
can learn from our experience…” Kottke T, McGrail M, Pronk N. Minnesota
Medicine May 2013
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HealthPartners Mission Statement
To improve health and well-being in
partnership with our members,
patients and community
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The Triple Aim
The Health
of a defined population
The Experience
of the individual
Per capita Cost
for the population
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Program Design
Addressing cost drivers and reducing disease
through program design
IDENTIFY
MANAGE
CHANGE
RISK
RISK
BEHAVIOR
OUTCOMES
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Mortality (length of life): 50%
Health Outcomes
Morbidity (quality of life): 50%
Tobacco use
Health behaviors
(30%)
Diet & exercise
Alcohol use
Unsafe sex
Clinical care
(20%)
Health Factors
Access to care
Quality of care
Education
Employment
Social & economic factors
(40%)
Income
Family & social support
Community safety
Programs and
Policies
County Health Rankings model © 2010 UWPHI
Physical environment
(10%)
Environmental quality
Built environment
HealthPartners Components
• Consumer Governed
• Health Plan
• 1.4 million members
• Delivery System
• 1 million patients
• Five hospitals
• 1,700 physicians
• Research and Education Foundation
• 250 research projects annually
• Culture of Innovation
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Medical Group Practice
• Evidence Based and Publicly Reported
– Institute of Clinical Systems Improvement (ICSI)
– MN Community Measurement
• quarterly measurements of hypertension outcomes
• NCQA primary care medical home
– EMR: Continuity of care
– Team Based
– Continuous Chronic Disease Management (e.g. “the in-between visit”)
• e.g. Cardiovascular and Diabetes
• AMGA Acclaim Award
•
– 2006: Care Model Process
– 2012 Commitment to Triple Aims
Worksite Clinics: Chronic Disease Management
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Hypertension Management
•
•
•
•
Risk based outreach
Care Model Process
Diabetes/hypertension Wizard
Team based Care
– Nursing
– Nutritionist
– Pharmacist
• Hypertension Management
• Medical Therapy Management
• “In-Between Visit” Care
– Health coaches
– Nurse advocates
• Medication
• Measurement
– Optimal Care Bundles (BP, Tobacco, Cholesterol, ASA)
– Public reporting through MN Community Measurement
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Innovation
• “…We conclude that BP telemonitoring and
pharmacist case management was safe and
effective for improving BP control compared
with usual care during 12 months; and
improved BP in the intervention group was
maintained for 6 months following the
intervention (18 months)…”
– Effect of Home Blood Pressure Telemonitoring and Pharmacist
Management on Blood Pressure Control A Cluster Randomized Clinical
Trial Margolis et al. JAMA July 3, 2013
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Cycle of Learning
PRACTICE
HEALTH
SERVICES
RESEARCH
PILOT
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Mortality (length of life): 50%
Health Outcomes
Morbidity (quality of life): 50%
Tobacco use
Health behaviors
(30%)
Diet & exercise
Alcohol use
Unsafe sex
Clinical care
(20%)
Health Factors
Access to care
Quality of care
Education
Employment
Social & economic factors
(40%)
Income
Family & social support
Community safety
Programs and
Policies
County Health Rankings model © 2010 UWPHI
Physical environment
(10%)
Environmental quality
Built environment
Thomas E. Kottke, MD, MSPH, Michael P. McGrail, MD, MPH, and Nicolaas P. Pronk. PhD
Minnesota Medicine, May 2013
Community Determinants of Health
• “…This article describes efforts to promote
healthy eating in schools, reduce the stigma of
mental illness, improve end-of-life decision
making, and strengthen an inner-city
neighborhood. Although still in their early stages,
the partnerships can serve as encouragement for
organizations inside and outside health care that
are considering undertaking similar efforts in
their markets…”
Isham G, Zimmerman D, Kindig D HealthPartners Adopts Community Business
Model To Deepen Focus On Nonclinical Factors Of Health Outcomes Health Affairs,
August 2013 32, no.8 (2013):1446-1452
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Community Health Initiatives
•
•
•
•
•
•
•
•
•
yumPower: nutrition
EBAN Experience
Jump Jam
Frequent Fitness/10,00steps
YMCA Collaboration
Childhood Obesity
Diabetes Prevention Program
St. Paul Promise Neighborhood
“Make it OK”
–
(http://tptmn.org/2013/07/01/tpt-partners-to-help-make-it-ok/)
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Communities of Learning
WORKPLACE
HEALTH
SERVICES
RESEARCH
PRACTICE
GOVERNMENT
AGENCIES
Associations
Chambers
SCHOOLS
PILOT
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Collaborations
•
•
•
•
•
•
•
Members and patients
Business
Municipalities and School Districts
YMCA
Minnesota Community Measurement (MNCM)
Institute of Clinical Systems Improvement (ICSI)
American Medical Group (AMGA): (Measure Up,
Pressure Down) with Million Hearts
• Institute for Healthcare Improvement (IHI)
• Million Hearts
• National Association of Mental Illness (NAMI)
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A Community of Health and Wellbeing and Learning
WORKPLACE
HEALTH
SERVICES
RESEARCH
PRACTICE
GOVERNMENT
AND
AGENCIES
SCHOOLS
PILOT
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HealthPartners Institute for Education and Research
•
•
•
•
•
A Comparison Between Antihypertensive Medication Adherence and Treatment
Intensification as Potential Clinical Performance Measures Vigen R,. Shetterly S,
Magid D, O’Connor P, Margolis K, Schmittdiel J, Ho M, Circulation Cardiovascular
Quality and Outcomes May 2012; 276-282
Combined intensive blood pressure and glycemic control does not produce an
additive benefit on microvascular outcomes in type 2 diabetic patients Ismail-Beigi
F, Craven T, . O’Connor P, Karl D, Calles-Escandon J Hramiak I, Genuth G, Cushman
W, Gerstein H, Probstfield J, Katz L, Schubart U, ACCORD Study Group Kidney
International (2012) 81, 586–594
Benefits Of Early Hypertension Control On Cardiovascular Outcomes in Patients
with Diabetes O'Connor, P. Vazquez-Benitez G, SchmittdhielJ, Parker E, Trower N,
Desai , Margolis K, Magid D. Diabetes Care September 10, 2012 pp1- 6
The Comparative Effectiveness of Heart Disease Prevention and Treatment
Strategies Kottke T, Faith D, Jordan C, Pronk N, . Thomas R, Capewell S, Am J
Prev Med 2009;36(1)
Disparities in tobacco cessation medication orders and fills among special
populations. Solberg LI, Parker ED, Foldes SS, Walker PF. Nicotine Tob Res. Feb
2010;12(2):144-151
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HealthPartners Institute for Education and Research
•
•
•
•
Outcomes at six months of a randomized trial of home blood pressure
telemonitoring with pharmacist case management. Margolis KL, Bergdall AR, Asche
SE, Sperl-Hillen JM, Maciosek MV, Schneider NK, Kerby TJ, Pritchard RA, Sekenski
JL, O’Connor PJ. Oral presentation at AHA Quality of Care and Outcomes Research
2012 Scientific Sessions. May 5-11, 2012. Atlanta, GA. Circ Cardiovasc Qual
Outcomes 2012;5:A7.
Design and rationale for Home Blood Pressure Telemonitoring and Case
Management to Control Hypertension (HyperLink): A cluster randomized trial.
Margolis KL, Kerby T, Asche SE, Bergdall AR, Maciosek MV, OConnor PJ, Sperl-Hillen
JM. Contemp Clin Trials. July 2012; 33(4):794-803;doi:10.1016/j.cct.2012.03.014
Comparative effectiveness of two beta blockers in hypertensive patients. Parker
ED, Margolis KL, Trower NK, Magid JD, Tavel HM, Shetterly SM, Ho PM, Swain BE,
O'Connor PJ. Arch Intern Med Published online August 27, 2012.
doi:10.1001/archinternmed.2012.4276.
Quality improvement in primary care: the role of organization, systems and
collaboratives. Solberg L . In: Sollecito WA, Johnson JK, eds. McLaughlin and
Kaluzny’s continuous quality improvement in health care Fourth ed. Burlington,
MA Jones and Bartlett Learning: 2011: 399-419
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HealthPartners Institute for Education and Research
•
•
•
•
Effect of Calcium and Vitamin D Supplementation on Blood Pressure in
Postmenopausal Women: Results from the Women's Health Initiative Clinical Trial of
Calcium-Vitamin D Supplementation. Margolis KL, Ray RM, Van Horn L, Manson JE,
Allison MA, Black HR, Beresford SAA, Connelly SA, Curb JD, Grimm RH, Kotchen TA,
Kuller LH, Wassertheil-Smoller S, Thomson CA, Torner JC. Hypertension 2008; 52(5):
847-855.
Greater Use Of Preventive Services In U.S. Health Care Could Save Lives At Little Or
No Cost. Maciosek MV, Coffield AB, Flottemesch TJ, Edwards NM, Solberg LI. Health
Aff. September 1, 2010 2010;29(9):1656-1660
Pronk NP, Lowry M, Kottke TE, Austin E, Gallagher J, Katz A. The association between
optimal lifestyle adherence and short-term incidence of chronic conditions among
employees. Population Health Management 2010;13(6):289-95. Epub 2010 Nov 19.
Community Preventive Services Task Force. CVD prevention and control: Team-based
care to improve blood pressure control. See:
http://www.thecommunityguide.org/cvd/teambasedcare.html
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Plenary VIII
Insight and Innovation:
How HealthPartners
Incorporated Million
Hearts®
Q and A
www.nationalforum.org
@NatForumHDSP