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Plenary VIII Insight and Innovation: How HealthPartners Incorporated Million Hearts® Michael McGrail, MD, MPH Vice.

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Presentation on theme: "Plenary VIII Insight and Innovation: How HealthPartners Incorporated Million Hearts® Michael McGrail, MD, MPH Vice."— Presentation transcript:

1 Plenary VIII Insight and Innovation: How HealthPartners Incorporated Million Hearts® Michael McGrail, MD, MPH Vice President and Medical Director for Health Solutions, HealthPartners

2 Alignment and Collaboration HealthPartners and Million Hearts P RESENTED BY Michael McGrail MD, MPH Vice President and Associate Medical Director Health Solutions, HealthPartners 2

3 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

4 HealthPartners Mission Statement To improve health and well-being in partnership with our members, patients and community 4

5 The Triple Aim The Experience of the individual The Health of a defined populati on Per capita Cost for the population

6 6

7 Program Design Addressing cost drivers and reducing disease through program design 7 I DENTIFY RISK M ANAGE RISK C HANGE BEHAVIOR O UTCOMES

8 Community safety Education Family & social support Employment Built environment Environmental quality Income Unsafe sex Alcohol use Diet & exercise Tobacco use Access to care Quality of care Physical environment (10%) Social & economic factors (40%) Health behaviors (30%) Clinical care (20%) Health Factors Programs and Policies Health Outcomes Mortality (length of life): 50% Morbidity (quality of life): 50% County Health Rankings model © 2010 UWPHI

9 HealthPartners Components 9 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

10 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 10

11 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 11

12 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,

13 Cycle of Learning 13 H EALTH S ERVICES R ESEARCH P RACTICE P ILOT

14 Community safety Education Family & social support Employment Built environment Environmental quality Income Unsafe sex Alcohol use Diet & exercise Tobacco use Access to care Quality of care Physical environment (10%) Social & economic factors (40%) Health behaviors (30%) Clinical care (20%) Health Factors Programs and Policies Health Outcomes Mortality (length of life): 50% Morbidity (quality of life): 50% County Health Rankings model © 2010 UWPHI

15 Thomas E. Kottke, MD, MSPH, Michael P. McGrail, MD, MPH, and Nicolaas P. Pronk. PhD Minnesota Medicine, May 2013

16 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 FactorsOf Health Outcomes Health Affairs, August , no.8 (2013):

17 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/) 17

18 Communities of Learning 18 H EALTH S ERVICES R ESEARCH P RACTICE P ILOT W ORKPLACE S CHOOLS G OVERNMENT A GENCIES Associations Chambers

19 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) 19

20 A Community of Health and Wellbeing and Learning 20 H EALTH S ERVICES R ESEARCH P RACTICE P ILOT W ORKPLACE S CHOOLS G OVERNMENT A ND A GENCIES

21 21

22 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; 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):

23 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, 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): ;doi: /j.cct 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, doi: /archinternmed 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:

24 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): 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, ;29(9): 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): Epub 2010 Nov 19. Community Preventive Services Task Force. CVD prevention and control: Team-based care to improve blood pressure control. See: 24

25 Plenary VIII Insight and Innovation: How HealthPartners Incorporated Million Hearts® Q and A


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