1. CDC’s 6|18 Initiative: Accelerating Evidence into Action American College of Preventive Medicine Utilizing the 6|18 Initiative to Address High Blood Pressure June 27, 2017
Christa-Marie Singleton, MD, MPH, Senior Medical Advisor
Office of Health Systems Collaboration
Office of the Associate Director for Policy

2. CDC Strategic Directions
Improve health security at home and around the world
Better prevent the leading causes of illness, injury, disability, and death
Strengthen public health/ health care collaboration

3. Opportunity Knocks: The Transforming Health System
“Other” Insurance Coverage:
Other Private – 7%
Other Public – 2%
Over 91% of All Americans are Insured
as of 20161
Change in health care coverage
Payment reform: volume → value
Clinical care models more patient-centered
Opportunities to deliver prevention
"Health Insurance Coverage of the Total Population." State Health Facts. The Kaiser Family Foundation,
1-Robin A. Cohen, Ph.D., Emily P. Zammitti, M.P.H., and Michael E. Martinez, M.P.H., M.H.S.A Division of Health Interview Statistics, National Center for Health StatisticsHealth Insurance Coverage: Early Release of Estimates From the National Health Interview Survey,

4. Collaboration between public health, health care purchasers, payers, and providers to promote adoption of evidence-based interventions 6 | 18
Evidence-based interventions that can improve health and save money
High-burden health conditions
Hester, J. A., J. Auerbach, L. Seeff, J. Wheaton, K. Brusuelas, and C. Singleton CDC’s 6|18 Initiative: Accelerating evidence into action.
National Academy of Medicine, Washington, DC.

5. 6|18 Initiative Goals Improve health and control costs using
specific evidence-based interventions
Establish sustainable cross-sector
partnerships between public health and
health care purchasers, health plans, and
providers to address shared health priorities

6. High- burden
Preventable
Scalable
Purchasers & payers
Costly

7. Evidence-based Interventions

9. Heart Disease and Stroke are Leading Killers in the US

10. CDC CMS

11. Early Findings – capacity building
Complementary public health and health care roles
Evaluation
Dissemination
webinars, conferences, publications
AHIP, USATODAY, Pharmacy Today, National Association of Community Health Centers, ACPM, ASTHO, NACCHO

12. Expanding 6/18 to commercial payers
Payer-specific/multi-payer initiatives
Initial focus: DPP, HTN & asthma control
Shared learning system
Behavioral economics, provider engagement, targeted member engagement

13. Physician Role Considerations

14. vv Intervention Payer Considerations Provider Considerations
Improve access and adherence to asthma and blood pressure medications
Formulary changes, pricing strategies, co-location of asthma medications and devices
Use standardized treatment protocols, e.g. for hypertension treatment, asthma management, and tobacco cessation
Expand access to evidence-based tobacco cessation treatments, promote utilization of covered tobacco treatment
Identify tobacco users, cover all cessation treatment and counseling
Screen, refer tobacco users to cessation services
Promote a team-based approach to hypertension control (e.g. physician, pharmacist, lay health worker, and patient teams)
Increase use of teams through payment incentives or use global payment to teams that include pharmacists
Consider workflow redesign, use Medication Therapy Management Programs multiple chronic conditions, including hypertension
Provide access to self-measured blood pressure monitoring
Reimburse for ambulatory cuff and time to train in use
Prescribe cuff, provide training, consider workflow redesign vv

15. Provider Considerations
Intervention
Payer Considerations
Provider Considerations
Promote 2007 NAEPP guidelines for evidence-based asthma medical management
Include guidelines as part of clinical practice guidelines; incentivize use
Follow 2007 NAEPP guidelines as an asthma standard of care
Expand access to home visits by licensed lay health workers to improve self-management education/reduce home triggers
Reimburse for asthma self-management education, home assessment, and lay health worker time
Refer patients for asthma self-management and home assessment for asthma triggers
Reimburse providers for the full range of contraceptive services
Reimburse providers for full of contraceptive services; unbundle the device’s payment from the post-partum payment
Receive education and training in use of contraceptive devices and contraceptive counseling
Expand access to the National Diabetes Prevention Program (NDPP)
Pay for CDC-certified DPP provider programs
Screen for diabetes and pre-diabetes, refer to CDC-certified DPP programs once identified

16. Visit the 6|18 Website CDC.gov/SixEighteen Evidence Summaries
Detailed summaries of the 6|18 interventions, based on scientific studies and expert consultations
FAQs
Answers to common questions about the 6|18 Initiative including goals, strategy, and the intervention selection process
Coming soon!
Additional Tools:
Readiness checklist
How to be a 6|18 Partner