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

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

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, 20161-

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 www.CDC.gov/sixeighteen Hester, J. A., J. Auerbach, L. Seeff, J. Wheaton, K. Brusuelas, and C. Singleton 2015. CDC’s 6|18 Initiative: Accelerating evidence into action. National Academy of Medicine, Washington, DC. http://nam.edu/wp-content/uploads/2016/02/CDCs-618-Initiative-Accelerating-Evidence-into-Action.pd

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

High- burden Preventable Scalable Purchasers & payers Costly

Evidence-based Interventions

Heart Disease and Stroke are Leading Killers in the US

CDC CMS

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

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

Physician Role Considerations

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

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

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