Maryland Implements Million Hearts® June 19, 2013 Laura Herrera, MD, MPH Deputy Secretary of Public Health Services Department of Health and Mental Hygiene

Maryland Million Hearts Infrastructure and Capacity State and Local Gov’t Institute for a Healthiest Maryland CRISP (Health Information Exchange) SHIP/ LHICs SIM Design Grant (Community Integrated Medical Home) Healthiest Maryland All-Payer Claims Database Health Enterprise Zones Health Quality Cost Council Accountable Care Organizations Chronic Disease Programs State and Local Public Health Accreditation Voluntary Community Health Center Accreditation Patient- Centered Medical Home Public and Private Payers MD Health Benefit Exchange Virtual Data Unit

Maryland Implements Million Hearts® June 19, 2013 Dr. Fredia Wadley, President and CEO of Delmarva (QIO)

Maryland Implements Million Hearts® June 19, 2013 Donald Shell, MD, MA Director, Cancer and Chronic Disease Bureau Acting Director, Center for Chronic Disease Prevention & Control Prevention and Health Promotion Administration Department of Health and Mental Hygiene

Prevention and Health Promotion Administration June 19, Burden of Heart Disease in Maryland

Heart Attack Prevalence in Adults With and Without Certain Risk Factors Source: Maryland Behavioral Risk Factor Surveillance System, 2011

Stroke Prevalence in Adults With and Without Certain Risk Factors Source: Maryland Behavioral Risk Factor Surveillance System, 2011

Prevention and Health Promotion Administration June 19, Maryland Million Hearts: Partnership Engagement Framework Mid-level management Health care providers, insurance providers, academic partners, etc. In the Grass Lt. Governor and Secretary of Health (Health Quality and Cost Council) Senior level leaders in health care systems, university systems, insurance providers, etc. Grasstops Target population Grassroots Community- and faith-based organizations Local health improvement coalitions FQHCs, community health centers, LHDs On the Ground

Prevention and Health Promotion Administration June 19, Health Quality and Cost Council University of Maryland Private Practice Learning Collaborative Patient Center Medical Home Initiative Community Health Workers Hospital & Medical School Frequently Readmission Patients “FRAP” Grand Rounds, CME, Lecture Work Site Wellness Community Mini Medical School

Prevention and Health Promotion Administration June 19, Leveraging Chronic Disease Grants Preventive Health and Health Services Reach of approx. 312,000 (10%) Marylanders in 5 largest jurisdictions ABCS Protocols in Clinics, Health Information Technology, CHWs, Worksite Wellness, Smoking Cessation Heart Disease and Stroke Prevention Program Medication Therapy Management - Clinical Pharmacists Diabetes Prevention and Control Program “ Healthy Hearts for Marylanders” - FQHC CQI Community Transformation Grant Tobacco prevention and cessation, healthy eating, and active living

Prevention and Health Promotion Administration June 19, Local Public Health Action State Health Improvement Process (SHIP) Framework for shared accountability and integration of community level efforts 39 health outcomes measures/targets, including: Reduce heart disease death rate Reduce hypertension-related emergency department visits

Prevention and Health Promotion Administration June 19, SHIP Synergies

Prevention and Health Promotion Administration June 19, Local Health Improvement Coalitions Comprised of representatives from: LHDs Hospitals Business 7 prioritized CVD/HTN Local Public Health Action Education Human Services Mental Health Housing Land Use/Planning Other Community-Based Organizations

Prevention and Health Promotion Administration June 19, Maryland Million Hearts Tools and Resources Maryland Million Hearts Implementation Guide Align statewide efforts Provides strategies, potential partners, metrics, and guidance documents for 5 core components: Local Public Health Action Public Health and Health Care Integration Expanding use of Health Information Technology Worksite Wellness Promoting Team-Based Care

Prevention and Health Promotion Administration June 19, Implementation Guide Example:

Prevention and Health Promotion Administration June 19, Maryland Million Hearts Symposium Co-hosted by DHMH and Delmarva 350+ partners in attendance: Health Care Providers Pharmacists National/State/Local Public Health Professionals Employers Health Educators/Community Outreach Workers Sessions on implementation settings: Schools & childcare Worksites Health care Community Hypertension Fact Sheet HTN control rates by insurance provider HTN prevalence HTN risk factors Heart disease and stroke mortality rates Racial, geographic, and age disparities

Prevention and Health Promotion Administration June 19, Maryland Million Hearts Electronic Newsletter Distributed monthly Maryland Million Hearts network includes 450 partners Connect and engage partners Includes information on: Recent studies/research Resources Webinars Events

Prevention and Health Promotion Administration June 19, Maryland Million Hearts ChopChop Distributed monthly Healthy, family-friendly recipes with local ingredients Features Maryland farmers Deer’s Head Hospital serving ChopChop recipes in cafeteria Outreach to MOTAs

Prevention and Health Promotion Administration June 19, Callers with Chronic Conditions 5.8% Coronary Artery Disease 10.6% Diabetes 15.6% Asthma 12.8% COPD Maryland Million Hearts: Quitline compared to only 2.2% of adults who have never smoked 7.3% of current smokers have had a heart attack… 3.7% of current smokers have had a stroke… compared to only 1.6% of adults who have never smoked Source: Maryland BRFSS, 2011

Prevention and Health Promotion Administration June 19, Quitline Callers: 27.6% Privately Insured 29.6% Medicaid 15.9% Medicare 25.4% Uninsured 1.6% Other/Don’t Know How Callers Heard about Quitline: 24.6% Family/Friends 24.3% TV Commercials Tips From Former Smokers Campaign in FY % Health Providers Fax-to-Assist Maryland Million Hearts: Quitline Source: DHMH Center for Tobacco Prevention and Control, SFY 2012

Prevention and Health Promotion Administration June 19, Maryland Million Hearts Website

Prevention and Health Promotion Administration June 19, Public Health and Health Care Integration HealthChoice Managed Care Organizations (MCO) Results from Department’s HEDIS vendor expected late summer 2014 % 18–85 year old members with a diagnosis of hypertension BP was adequately controlled (<140/90)

Prevention and Health Promotion Administration June 19, Health Information Technology Chesapeake Regional Information System for Our Patients (CRISP) Private, non-profit designated to run the Health Information Exchange in Maryland Receives real-time patient demographic data from all 46 MD hospitals, and over 90 clinical data feeds from hospitals, other large radiology centers and laboratories, and long-term care centers – expanding rapidly Providers and care coordinators notified when patients with heart disease are admitted to hospital

Prevention and Health Promotion Administration June 19, Healthy Hearts for Marylanders Expansion from 4 to 34 FQHCs, reaching over 175,000 Marylanders Started incorporating practice level data into quality improvement meeting agendas and communicating provider specific data for peer-to-peer comparisons An increase in blood pressure control (<130/80) from 17% at baseline (2009) to 44% within the participating centers Health Information Technology

Prevention and Health Promotion Administration June 19, Maryland Health Care Commission All-Payer Claims Database Maryland Health Care Commission to assess and plan expansion of All-Payer Claims Database Envision All-Payer Claims Database as supporting provider measurement on cost and quality and clinical decision- making.

Prevention and Health Promotion Administration June 19, Surveillance and Epidemiology Virtual Data Unit Community surveillance Hospital needs assessments Accountable Care Organizations Health Empowerment Zones Warehouse of social and economic determinants, population health

Prevention and Health Promotion Administration June 19, Healthiest Maryland Businesses 200 participating businesses that employ an estimated 265,000 Maryland workers Focus on Heart Disease, Stroke and Diabetes Prevention and Control Trained 575+ individuals (employers, local health departments, brokers, vendors) on best practices Featuring a new HMB success story monthly (e.g. value-based benefit design) Worksite Wellness

Prevention and Health Promotion Administration June 19, Worksite Wellness Maryland Patients Pharmacists, Partnership Program (P3) Promoting team-based care Reached 4 employers and 260 employees 88% of participants achieved the blood pressure goal of less than 140/90mmHg State Employee MTM pilot program Potential reach of 5,000 state employees

Prevention and Health Promotion Administration June 19, Changing the Heart Health of the Nation Together Reducing Heart Attacks and Strokes Individuals Pharmacists Health Care Providers Employers Institutions Physical Activity and Nutrition Public and Private Payers Community Health Workers Academic Partners Physicians

Prevention and Health Promotion Administration June 19, Prevention and Health Promotion Administration