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

Maryland Implements Million Hearts®Maryland Implements Million Hearts®

June 19, 2013June 19, 2013

Laura Herrera, MD, MPHDeputy Secretary of Public Health ServicesDepartment of Health and Mental Hygiene


June 19, 2013June 19, 2013

Dr. Fredia Wadley,President and CEO of Delmarva (QIO)


June 19, 2013June 19, 2013

Donald Shell, MD, MADirector, Cancer and Chronic Disease Bureau

Acting Director, Center for Chronic Disease Prevention & Control

Prevention and Health Promotion AdministrationDepartment of Health and Mental Hygiene

Prevention and Health Promotion AdministrationJune 19, 2013

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Burden of Heart Disease in MarylandBurden of Heart Disease in Maryland

Heart Attack Prevalence in Adults Heart Attack Prevalence in Adults With and Without Certain Risk Factors With and Without Certain Risk Factors

Source: Maryland Behavioral Risk Factor Surveillance System, 2011

Stroke Prevalence in Adults With and Stroke Prevalence in Adults With and Without Certain Risk FactorsWithout Certain Risk Factors

Source: Maryland Behavioral Risk Factor Surveillance System, 2011


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Maryland Million Hearts:Maryland Million Hearts:Partnership Engagement FrameworkPartnership 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


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Health Quality and Cost CouncilHealth 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


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Leveraging Chronic Disease Leveraging Chronic Disease GrantsGrants

• 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


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Local Public Health Action 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


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SHIP SHIP SynergiesSynergies

PRIORITY

Maryland Million Hearts/CTG STRATEGIES

Behavioral Health MH

Cardiovascular Disease Comp Med Therapy Mang (5.2) HTN

Reproductive Health/ Birth Outcomes

Diabetes Comp Med Therapy Mang (5.2)

Cancer

I nfectious Disease Chlamydia HIV/STI

Chronic Disease Comp Med Therapy Mang (5.2) D, CA, CVD

Respiratory Disease

Obesity

Healthy eating, active living childcare, schools, worksites (3.1-3.3, 4.1-4.5) Youth

Health Access MH, SA

Tobacco

SF multi-unit housing (1.1 a/ b), SF outdoor areas (1.2 a/ b), youth cigar use awareness (2.1 a/ b) Youth Youth

DisparitiesSF multi-unit housing (1.1 a/ b), Childcare (4.5), FQHC QI (5.3)

Safe Environments Healthy stores (4.6) CMI njury/ Violence K Ready

Oral Health

Health Literacy

Immunizations

CA = Cancer; CM = Child Maltreatment; CVD= Cardiovascular Disease; D= Diabetes; HTN = Hypertension; K-Ready = Kindergarten Readiness; MH = Mental Health; SA = Substance Abuse

PRIORITY

Health Outcomes

Health Determinants


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18 Local Health Improvement Coalitions •Comprised of representatives from:

• LHDs• Hospitals• Business

•7 prioritized CVD/HTN

Local Public Health Action Local Public Health Action

• Education• Human Services• Mental Health

• Housing• Land Use/Planning• Other Community-Based Organizations


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Maryland Million Hearts Maryland Million Hearts Tools and ResourcesTools 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


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Implementation Guide Example:Implementation Guide Example:


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Maryland Million Hearts Maryland Million Hearts SymposiumSymposium

• 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


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Maryland Million Hearts Maryland Million Hearts Electronic NewsletterElectronic Newsletter

• Distributed monthly• Maryland Million Hearts

network includes 450 partners

• Connect and engage partners

• Includes information on:• Recent studies/research• Resources• Webinars• Events


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Maryland Million Hearts Maryland Million Hearts ChopChopChopChop

• Distributed monthly• Healthy, family-friendly

recipes with local ingredients

• Features Maryland farmers

• Deer’s Head Hospital serving ChopChop recipes in cafeteria

• Outreach to MOTAs


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Maryland Million Hearts: Maryland Million Hearts: QuitlineQuitline

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


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• 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 FY2013

• 19.3% Health Providers• Fax-to-Assist

Maryland Million Hearts: Maryland Million Hearts: QuitlineQuitline

Source: DHMH Center for Tobacco Prevention and Control, SFY 2012


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Maryland Million Hearts WebsiteMaryland Million Hearts Website

http://phpa.dhmh.maryland.gov/hdsp/SitePages/Million%20Hearts.aspx


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Public Health and Health Care Public Health and Health Care IntegrationIntegration

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)


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Health Information TechnologyHealth 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


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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 TechnologyHealth Information Technology


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Maryland Health Care CommissionMaryland 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.


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Surveillance and EpidemiologySurveillance and Epidemiology

Virtual Data Unit•Community surveillance

• Hospital needs assessments• Accountable Care Organizations• Health Empowerment Zones

•Warehouse of social and economic determinants, population health


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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 WellnessWorksite Wellness


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Worksite WellnessWorksite 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


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Changing the Heart Health of the Changing the Heart Health of the Nation TogetherNation Together

http://phpa.dhmh.maryland.gov


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Prevention and Prevention and Health Promotion Health Promotion

AdministrationAdministration

Documents

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