The Million Hearts National Initiative Preventing one million heart attacks and strokes over five years A collaboration among the Missouri Department of Health and Senior Services American Heart Association Primaris Missouri Primary Care Association Missouri Pharmacy Association

What the National Initiative Means in Missouri If successful over five years, it will mean Million Hearts will have saved the lives of approximately 20,000 Missourians enough people to fill up the Scottrade Center in St. Louis or the Sprint Center in Kansas City

Missouri Quick Facts Heart Disease continues to be the leading cause of death. Stroke is now the fifth cause of death in Missouri. Prevalence of Hypertension is 34.3 in the general population and over 40 in the African-American population. Slightly more than half of those with hypertension are being told to decrease their sodium intake. Million Hearts is described as an activity in Missouri’s CDC 1305 Grant Domain 3 Strategy 1 2012 Provisional Vital Statistics and 2012 BRFSS. Death rates are higher in Missouri than in any other state in the U.S. Missourians have a significantly higher prevalence of chronic disease risk factors and conditions compared to Americans as a whole. Research has also found that African Americans have significantly higher rates of hypertension, obesity, and diabetes.

Status of the ABCS Aspirin 47% Blood pressure 46% Cholesterol 33% People at increased risk of cardiovascular disease who are taking aspirin 47% Blood pressure People with hypertension who have adequately controlled blood pressure 46% Cholesterol People with high cholesterol who are effectively managed 33% Smoking People trying to quit smoking who get help 23% The MH initiative focuses on the ABCS of prevention and our current compliance with these measures is dismal. Source: MMWR: Million Hearts: Strategies to Reduce the Prevalence of Leading Cardiovascular Disease Risk Factors --- United States, 2011, Early Release, Vol. 60

Key Components of Million Hearts™ Community Prevention Reduce the number of people who need treatment Clinical Prevention Optimize care for heart and stroke patients Two key components of the MH initiative that will help improve compliance with the ABCS are Community Prevention and Clinical Prevention.

Health System Messages Clinicians Emphasize power of prevention Create systems to get an “A” in the ABCS Use decision supports and registries to drive performance Deploy teams Pharmacists Monitor and influence refill patterns Team up Teach adherence by helping patients to understand the importance of taking their medications Teach patients about the ABCS through Medication Therapy Management

Health System Messages Insurers Measure and incentivize performance on the ABCS Collect and share data for quality improvement Empower consumers Individuals Know your numbers—and goals Get to know the ABCS Take aspirin, if advised Take steps to lower high blood pressure and cholesterol Reduce sodium and trans fats If you smoke, quit Avoid exposure to second-hand smoke

Timeline of progress in 2012 February - Bi-weekly teleconference planning sessions began - Press release introducing Million Hearts to public April - Letter to professionals released - Webinar presented by Dr. Janet Wright, HHS/CDC and Dr. Whaley-Connell HTN expert - Role of Million Hearts Physician Champion defined June - Nine Missouri physician champions recruited July - Missouri Millions Hearts regions defined as BRFSS regions August - Missouri Department of Health and Senior Services compiled data on Missouri cardiovascular disease - Missouri Million Hearts committee meets to review data Sept –Dec - Continued to add partners, MPCA and MPA Launched by HHS in Sept 2011. Missouri Million Hearts Collaboration timeline. BRFSS = Behavioral Risk Factor Surveillance Survey (explain here) MPCA= Missouri Primary Care Association MPA = Missouri Pharmacy Association

Timeline of progress in 2013 Jan - March - Monthly teleconference planning sessions continue April - Presented at the MSMA meeting in KC - Gained interest from several physicians May - Face to Face meeting - Action Plan Developed for 2013/2014 - Created work groups for identified plan objectives - Work groups convened November - Second Face to Face meeting October - Started project with MO HIE as a data resource for TGA Present - Total Ten Missouri physician champions recruited - 19 sites recruited to demonstrate The Guideline Advantage Working on a project with Missouri Health Connections to use them as a resource for data entry into the Guideline Advantage. TGA = The Guideline Advantage™

Work Groups Communications (website/newsletter/media) Team care (Pharmacists/physicians) Provider Champion Recruitment and Resources and Tools Data Capture and Analysis (TGA) Baseline Data and Success measures Advocacy (Gov. relations) These workgroups have been established to implement the key strategic focus areas including Physician Champion Support, Patient Resource Support, Infrastructure for Communication (website, newsletters), Team Care focusing on the Physician –Pharmacist pertaining to medication adherence, Clinical Decision Support emphasizing the MH Clinical Quality Measures of the ABCS. TGA = The Guideline Advantage (American Heart Association, American Cancer Society and American Diabetes Association) quality improvement program for outpatient clinics and providers.

Released a press release announcing the physician champions who volunteered for the initiative. Since then we have some new recruits. We have also changed this term to state “Provider Champion” to encompass all healthcare providers. Since then a couple have changed. We have some new ones and a couple that have withdrawn due to time availability.

BRFSS Regions Behavioral Risk Factor Surveillance System (BRFSS) is a telephone health survey system of healthcare consumer The Behavioral Risk Factor Surveillance System (BRFSS) is the world's largest, on-going telephone health survey system

Million Hearts Provider Champion Serves as an expert resource for the MO Million Hearts Collaborative Promotes the Million Hearts Initiative to health professionals and patients Enhances knowledge on heart attack, stroke and related modifiable risk factors

Million Hearts Provider Champion Supports local community-based patient-resources to reduce smoking prevalence, improve nutrition, reduce blood pressure Supports and reinforces healthy choices and healthy behaviors: Is aware of barriers to patient access to healthy choices and behaviors Promotes the use of Health Information Technology

Champion Resources Online Resources available on the Million Hearts website: www.heart.org/momillionhearts Resource include informational articles and tools on: Aspirin therapy Blood pressure Cholesterol management Smoking cessation And much more. Million Hearts group developed a resource packet for providers and patients

Behavioral Risk Factor Surveillance System (BRFSS) BRFSS is a state-level health survey that annually collects information on a range of issues including health conditions, risk behaviors, and preventive practices. BRFSS is used to: Indentify emerging health problems; Establish health objectives and track progress; Justify funding requests and report progress.

Behavioral Risk Factor Surveillance System (BRFSS) MO Department of Health and Senior Services (DHSS) conducts the annual BRFSS with assistance and support of the Centers for Disease Control and Prevention(CDC) How is BRFSS conducted? Telephone interviews with adults over 18 Only with those not living in institutions How many Missourians are interviewed? Approximately 6,360 are interviewed throughout the year.

MISSOURI MILLION HEARTS 2012 BASELINE MEASURES These five measures are highlighted in Missouri to underscore the burden of heart disease and stroke, raise awareness of the ABCS for the prevention of heart attack and stroke and ultimately encourage the actual use of the ABCS for preventing heart attack and stroke by Physician Champion and all other health professionals. Our targets pertain only to heart attack and stroke ( reducing heart attack and stroke by 20, 000 by 2017) . 2012 Provisional Vital Statistics and 2012 BRFSS . Death rates are higher in Missouri than in the U.S. Missourians have a significantly higher prevalence of chronic disease risk factors and conditions compared to Americans as a whole. African Americans have significantly higher rates of hypertension, obesity, and diabetes. 4/5/2017

MISSOURI MILLION HEARTS 2012 BASELINE MEASURES

Role of Missouri Dept. of Health and Senior Services Produce data from available sources such as BRFSS for Million Hearts. Provide Strategic Doing Expertise which enabled Missouri to establish strategic focus areas and workgroups for implementation.

Role of Missouri Dept. of Health and Senior Services Partner with organizations representing disparate populations. (Missouri Primary Care Association for quality improvement initiatives on related measures e.g. high blood pressure, A1c, cholesterol. Initiate implementation of evidence based initiatives for quality improvement focusing on medication adherence. (e.g. add pharmacists to team based care)

Role of Missouri Dept. of Health and Senior Services Promote Missouri Tobacco Quitline for quitting smoking, smoke-free policies, safe walking areas, and access to healthy food. Serve as the key leader in establishing the Sodium in Knowledge in Practice which is enabling Missourians to make better lower sodium food choices by focusing on education, policy change and environmental interventions.

Role of Health Depts. and Community Organizations Work with health care systems to monitor national quality indicators, including “controlling high blood pressure,” and carry out quality improvements. Encourage health systems to use health information technology to identify patients who have high blood pressure and establish follow up systems to monitor those patients. CDC VITAL SIGNS SEPTEMBER 2013

Role of Health Depts. and Community Organizations Promote Missouri Tobacco Quitline for quitting smoking, smoke-free policies, safe walking areas, and access to healthy food. CDC VITAL SIGNS SEPTEMBER 2013

Role of American Heart Association Provide evidence based guidelines for the treatment and prevention of stroke and heart disease Provide a multitude of resources for both consumers and providers Educational materials Health tracking tools Tools for professionals Quality improvement programs

Role of American Heart Association Provide link to physicians for support and expert opinion Utilize connections with the community to disseminate information Gain interest and support due to AHA brand name and credibility

Role of Primaris Pilot Project with physician practices Develop a systems-level, data-driven approach to quality improvement Promote reporting and use of metrics to identify areas for clinical improvement Advance Patient-Centered Medical Home efforts with emphasis on care management & transitions of care

Role of Missouri Pharmacy Association Pilot Project with pharmacists Inform the public of the benefits of pharmacists as members of the health care team Promote medication adherence as a key factor in health.

Role of Missouri Primary Care Association One of our functions is assisting Federally Qualified Health Centers (a.k.a Community Health Centers) with quality enhancement and networking support of efforts to develop, implement, and sustain community health improvements.

Role of Missouri Primary Care Association Quality Improvement/Performance Improvement Best Practices Data Collection Research and Analysis Technical Assistance Network Development Patient Centered Medical Home efforts with emphasis on population health and individual care management and care coordination

Program Model Program model for the Guideline Advantage (TGA). The MH task force Created a Missouri specific program module and are in the process of identifying funding for a pilot project using TGA.

Tool for Population Health Management On-demand access to quality improvement data using a web-based tool Available physician-level reporting Clinic and system aggregation Tools for creating action lists The Guideline Advantage Population Management Tool

Tool for Population Health Management Alignment with key national initiatives National and State benchmarking Practice network opportunities, including virtual workshops and national recognition

Contacts Robin Hamann American Heart Association Phone: (618) 402-5393 robin.hamann@heart.org Kris Kummerfeld Heart Disease and Stroke Prevention Phone:  (573) 522-2879  Kris.Kummerfeld@health.mo.gov Abhi Ray Primaris Phone: (816) 588 1848 aray@primaris.org

Thank You for Your Attention! Questions?