3 rd Annual Dean’s Right Care Cardiovascular and Diabetes Leadership Summit Taking Action Together to Prevent Heart Attacks and Strokes Reaching 90th percentile Targets: Medical Directors Report on Health Plan Strategies, Programs, Plans, and Achievements October 1, 2010 October 1, 2010 UC Berkley October 1, 2010 October 1, 2010 UC Berkley

Strategies, Plans or Programs Please fill in: Western Health Advantage Number of commercial HMO enrollees: __67,808Number of commercial HMO enrollees: __67,808 Demographic profile of enrollees (age, sex, ethnic distribution) for total, and for each of the following:Demographic profile of enrollees (age, sex, ethnic distribution) for total, and for each of the following: 1. Number with Heart Disease:__352_(HEDIS Measure) –Percent with blood pressure controlled:_no measure –Percent with cholesterol controlled:_____64.86_______ 2. Number with Hypertension______4,516 (HEDIS Measure) –Percent with blood pressure controlled:___ Number with Diabetes:_____2,663_(HEDIS Measure)_ –Percent with blood pressure controlled:____69.71 –Percent with cholesterol controlled____47.81_____ –Percent with HbA1c > 9: _____24.64_____

Demographics of Plan AgeMaleFemale 0-199,2538, ,87414, ,38111,

Demographics - CAD Gender –Female % –Male – 77.3% Age Groups –20-44 – 4.3% –45-64 – 77.6% – %

Demographics - Hypertension Gender –Female – 48.4% –Male – 51.6% Age Groups –<20 – 0.1% –20-44 – 17.8% –45-64 – 73.7% – %

Demographics - Diabetes Gender –Female – 48.6% –Male – 51.4% Age Groups –<20 – 0.4% –20-44 – 22.2% –45-64 – 70% – % –(HEDIS Diabetes Measure is an Adult Measure)

HbA1c <9.0 Result improved from What’s Working –Medical Group Diabetes Programs in 5 of 6 groups (some programs more advanced than others) –Alere DM Program when member engaged –P4P – registries and related activities –Mailers/Newsletters What’s Not Working –Small Groups challenged

LDL-C <100 in Diabetics Result previously What’s Working/Not working –Not much improvement on this measure –Same strategies as Diabetes –Programs may place more emphasis on other indicators –Fasting tests create additional barrier –Programs need to make sure focus is maintained on LDL-C.

LDL-C in CAD Result improved from What’s Working –Major Program at CHW –Alere DM Program –Mailers/ newsletters What’s Not Working –Hard to say what is not working, but would like to see things work quicker.

Blood Pressure <140/90 Result previously (Result for Diabetics up from 60.34) What’s working –Focus on Chronic Illness and awareness of need for control –Direct mailers to members with HTN. What’s not working –Those without co-morbidities particularly year olds. (Lost to follow up) –Challenge of building effective registries and staff to manage the large case load.

Issues noted with BP Lack of P4P measure Considerable “rounding” of BP Lack of follow up on “younger patients” Disease Management Programs or registries are problematic because of the large number of patients We have not focused on Home BP monitors at this point and have left that to the physicians and medical groups.

Future Plans Hypertension –WHA was able to run numbers for each medical group and has started a P4P measure for BP control. –Communicate findings from BP chart review. –Bonus to groups based on NCQA percentile rankings. –Subsequent years will reward improvement. Diabetes – Additional P4P incentive for Pharmacist run medication clinic and hypertension registries. Exploring ways to “dovetail” Alere programs with Medical Group DM programs. (started with Alere and CHW on CAD programs) Evaluating ideas to help small medical groups. –Possible grants for medical groups related to QI.