NEWS | July 31, 2017

Health plans that shared best practices improved hypertension control for low-income Californians


Health plans that collaborated to share best practices and successful strategies for treating patients diagnosed with hypertension saw significant improvement in controlling high blood pressure, a study by the California Department of Health Care Services (DHCS) and UC Davis Institute of Population Health Improvement (IPHI) has found.

The study was published online July 27 in the peer-reviewed journal Preventing Chronic Disease, an electronic journal by the U.S. Centers for Disease Control and Prevention (CDC).

“Hypertension is a major risk factor for deaths from coronary heart disease, the leading cause of death among men and women in the U.S.,” said Desiree Backman, first author of the study, DHCS chief prevention officer and IPHI senior scientist. “Approximately one-third of adults in the U.S. have hypertension, but only about half of these persons have their hypertension under control. We need to find better ways to share information and best practices among health plans so that low-income Californians and other high-risk populations can receive better quality of care.”

The study is part of the Million Hearts initiative, an effort co-led by the CDC and the Centers for Medicare & Medicaid Services (CMS) that aims to prevent a million cardiovascular events by 2022. Major goals of the initiative include controlling blood-pressure rates for at least 80 percent of adults with hypertension and using information technology and evidence-based practices to optimize delivery of health care.

For the study, researchers worked with health plans that participate in California’s Medicaid program (Medi-Cal), which DHCS administers. Approximately 14 million Californians are enrolled in Medi-Cal, and nearly 11 million are eligible to receive full health care services provided by a network of 23 managed care health plans. Ten Medi-Cal managed care plans volunteered to participate in this quality improvement collaborative; nine of them had performed below the Million Hearts target controlled-hypertension rate for 2012-2017 of 70 percent..

“We found that participating in quarterly webinars, and having access to evidence-based tools and resources, improved the rate of hypertension control among nine managed care plans with performance below the Million Hearts goal,” said Neal D. Kohatsu, medical director of DHCS.

Control rates improved significantly in seven of nine Medi-Cal managed care plans. Participating plans demonstrated an average increase of five percentage points in their rates of controlled hypertension; the highest improvement was an increase of 14.6 percentage points.

“This improvement was notable because all plans had a multiyear history of declining hypertension control rates before the intervention,” said IPHI Director Kenneth W. Kizer, senior author on the study “In addition, among those plans that did not participate, 9 of 10 continued to show declining rates of hypertension control during the study period.

“Our results demonstrate that structured learning collaboratives can improve health plan performance with a modest investment of resources,” Kizer said

The study, “Implementing a quality improvement collaborative to improve hypertension control and advance Million Hearts among low-income Californians, 2014–2015,” was published online July 27 in Preventing Chronic Disease. Published by the National Center for Chronic Disease Prevention and Health Promotion, one of eight centers within the CDC, the journal provides a forum for public health researchers and practitioners to share study results and practical experience.

Other study authors include Zhiwei Yu and Rachel E. Abbott of the California Department of Health Care Services and UC Davis Institute for Population Health Improvement.