3rd Annual Right Care Summit

October 1st, 2010Stephen M. Shortell Ph.D., M.P.H.Dean, University of California, Berkeley, School of Public Health

2011 Statewide Goals: Preventing Heart Attacks and Strokes

2011 California Statewide Goals: Preventing Heart Attacks and Strokes

Achieve National HEDIS 90th Percentile Targets: o 70% of hypertensive patients with blood pressure controlled <140/90 MMHG o 70% of patients with cardiovascular conditions with lipids controlled LDL-C < 100 Mg/dl o 81% of diabetic patients with blood sugar controlled HBA1C < 9 o 52% of diabetic patients with lipids controlled LDL-C < 100 Mg/dl

San Diego Demonstration Goals

Heart attack and stroke prevention focused on heart disease and diabetes patients through lipid and blood pressure management

Promising Interventions to Reach HEDIS Control Targets for Heart Attack and Stroke Prevention

Intensive Ambulatory Care

Home Blood Pressure M

onitoring

Proa

ctive

Out

reac

h

Medical HomeTeam-Based

Web SupportedHigh-Tech Enabled

Continuous Care—Not Episodic

Patient Centered Practice Redesign

Patient Activation

-Patient Incentives for healthy diet, exercise & medication adherence

-Evidence-based patient education (e.g., Project DULCE; Stanford Patient Self-Management)

-Motivational Media Messaging

Clinical Pharmacist on Care Team

-HRSA.gov/patientsafety

-The Asheville Project

Medication Protocols

-ALL/PHASE (Kaiser)

-E.U. Guidelines

NCQA Plan Performance DataBlood Pressure Controlled (<140/90)

Source: NCQA Quality Compass® 2010

Kaiser Foundation Health Plan - Southern CA 84.23Kaiser Foundation Health Plan - Northern CA 80.37Blue Cross of California dba Anthem Blue Cross 71.16

Health Net of California 68.56

PacifiCare of California 66.75Blue Shield of California 64.73

Western Health Advantage 64.48Aetna Health of California, Inc. 62.59CIGNA HealthCare of California, Inc. 62.11National 90th 72.68

California

PersonalCare Insurance of Illinois, Inc. 87.62Kaiser Foundation Health Plan Inc. - Southern California 84.23Kaiser Foundation Health Plan, Inc. - Northern California 80.37

Grand Valley Health Plan, Inc 79.08HealthAmerica Pennsylvania, Inc./HealthAssurance Pennsylvania, Inc. 78.93

CIGNA HealthCare of Delaware, Inc. 78.09

Wellmark Health Plan of Iowa, Inc. 77.86

CIGNA HealthCare of Pennsylvania, Inc. 77.36

HealthPartners, Inc. 77.13

CIGNA HealthCare Mid-Atlantic, Inc. 76.04

National Top 10

NCQA Plan Performance DataCardiovascular LDC Control <100

Source: NCQA Quality Compass® 2010

Kaiser Foundation Health Plan - Northern CA 74.97Kaiser Foundation Health Plan - Southern CA 72.87Blue Cross of California dba Anthem Blue Cross 70.56

Health Net of California 69.87

Western Health Advantage 64.86PacifiCare of California 62.98CIGNA HealthCare of California, Inc. 60.51Blue Shield of California 59.56

Aetna Health of California, Inc. 56.27National 90th 69.63

CaliforniaHealthAmerica Pennsylvania, Inc./HealthAssurance Pennsylvania, Inc. 81.55

Grand Valley Health Plan, Inc 77.39

CIGNA HealthCare of St. Louis, Inc. 76.22CIGNA HealthCare of New Hampshire, Inc. 75.44

Martin's Point Health Care, Inc. 75.22CIGNA HealthCare of Pennsylvania, Inc. 75.00Kaiser Foundation Health Plan, Inc. - Northern California 74.97

Unity Health Plans Insurance Corporation 74.94Group Health Cooperative of Eau Claire 73.80

Security Health Plan of Wisconsin, Inc 73.72

National Top 10

NCQA Plan Performance DataDiabetes Poor HbA1c Control >9

Source: NCQA Quality Compass® 2010

Blue Cross of California dba Anthem Blue Cross 14.42Kaiser Foundation Health Plan - Northern CA 19.81

Health Net of California 21.58CIGNA HealthCare of California, Inc. 23.36Kaiser Foundation Health Plan - Southern CA 23.76Blue Shield of California 24.09

Western Health Advantage 24.64PacifiCare of California 25.04

Aetna Health of California, Inc. 32.57National 90th 19.16

California

Medical Associates Health Plan, Inc. 9.60

Gundersen Lutheran Health Plan, Inc. 11.17

PersonalCare Insurance of Illinois, Inc. 11.20

Martin's Point Health Care, Inc. 12.93

Capital Health Plan, Inc. 13.14Harvard Pilgrim Health Care of New England (NH) 13.14

Florida Health Care Plan, Inc. 13.17HealthAmerica Pennsylvania, Inc./HealthAssurance Pennsylvania, Inc. 13.44CIGNA HealthCare of New Hampshire, Inc. 13.63

HMO Colorado, Inc. 14.42

National Top 10

NCQA Plan Performance DataDiabetes LDL-C Control <100

Source: NCQA Quality Compass® 2010

Kaiser Foundation Health Plan - Northern CA 66.42Kaiser Foundation Health Plan - Southern CA 62.57Health Net of California 54.50

PacifiCare of California 50.94Blue Shield of California 49.64CIGNA HealthCare of California, Inc. 49.64

Western Health Advantage 47.81Blue Cross of California dba Anthem Blue Cross 47.81Aetna Health of California, Inc. 45.95National 90th 54.95

CaliforniaKaiser Foundation Health Plan of Colorado 73.91HealthAmerica Pennsylvania, Inc./HealthAssurance Pennsylvania 66.67Kaiser Foundation Health Plan, Inc. - Northern California 66.42

PersonalCare Insurance of Illinois, Inc. 64.75Kaiser Foundation Health Plan of the Northwest, Inc. 64.19Group Health Cooperative of Eau Claire 62.59

Kaiser Foundation Health Plan Inc. - Southern California 62.57US Family Health Plan at Pacific Medical Centers 62.35

Martin's Point Health Care, Inc. 62.11

Grand Valley Health Plan, Inc 60.55

National Top 10

NCQA Plan Performance DataPersistence of Beta Blocker Treatment

Source: NCQA Quality Compass® 2010

Geisinger Health Plan 100.00

Federal Plan 87 97.96Blue Cross Blue Shield of Delaware, Inc. 93.48

Medical Mutual of Ohio 90.98Horizon Healthcare of New Jersey, Inc. d/b/a Horizon HMO 90.85CHRISTUS Health US Family Health Plan 89.74Anthem Health Plans of New Hampshire, Inc. d/b/a/ Anthem Blue Cross and Blue Shield in NH 89.36Hawaii Medical Service Association (HMSA) 89.29

HealthPlus of Michigan, Inc. 89.02Unity Health Plans Insurance Corporation 88.89

National Top 10

Kaiser Foundation Health Plan - Northern CA 88.2Kaiser Foundation Health Plan - Southern CA 83.83Health Net of California 75.39

Blue Shield of California 73.84PacifiCare of California 72.99

Aetna Health of California, Inc. 69.23Blue Cross of California dba Anthem Blue Cross 64.61CIGNA HealthCare of California, Inc. 63.74Western Health Advantage NANational 90th 83.83

California

NCQA Plan Performance DataCardiovascular LDL-C Screening

Source: NCQA Quality Compass® 2010

Kaiser Foundation Health Plan - Southern CA 95.12Kaiser Foundation Health Plan - Northern CA 93.68Health Net of California 92.8Blue Cross of California dba Anthem Blue Cross 91.94PacifiCare of California 89.97

Western Health Advantage 89.71

Blue Shield of California 89.22CIGNA HealthCare of California, Inc. 88.86Aetna Health of California, Inc. 87.71National 90th 92.11

CaliforniaTotal Health Care, Inc. 96.77Empire HealthChoice HMO, Inc. dba Empire BlueCross BlueShield HMO 96.24CIGNA HealthCare of Pennsylvania, Inc. 96.21

CIGNA HealthCare Mid-Atlantic, Inc. 96.11HealthAmerica Pennsylvania, Inc./HealthAssurance Pennsylvania 95.72

Grand Valley Health Plan, Inc 95.65

Security Health Plan of Wisconsin, Inc 95.38Aetna Health Inc. (Pennsylvania) - Massachusetts 95.31Kaiser Foundation Health Plan Inc. - Southern California 95.12

Martin's Point Health Care, Inc. 94.93

National Top 10

NCQA Plan Performance DataDiabetes HbA1c Testing

Source: NCQA Quality Compass® 2010

Kaiser Foundation Health Plan - Southern CA 92.57Kaiser Foundation Health Plan - Northern CA 92.26CIGNA HealthCare of California, Inc. 91.48Health Net of California 91.19Blue Shield of California 90.4Aetna Health of California, Inc. 89.08

PacifiCare of California 88.51Blue Cross of California dba Anthem Blue Cross 87.41Western Health Advantage 87.04National 90th 92.94

CaliforniaGrand Valley Health Plan, Inc 98.24HealthAmerica Pennsylvania, Inc./HealthAssurance Pennsylvania, Inc. 96.51

US Family Health Plan at Pacific Medical Centers 96.41

Medical Associates Health Plan, Inc. 96.01

AmeriHealth HMO, Inc. (Delaware) 96.00

CIGNA HealthCare Mid-Atlantic, Inc. 95.86Tufts Associated Health Maintenance Organization, Inc. 95.83

Harvard Pilgrim Health Care, Inc. 95.62CIGNA HealthCare of New Hampshire, Inc. 95.62

CIGNA HealthCare of Maine, Inc. 95.38

National Top 10

NCQA Plan Performance DataDiabetes LDL-C Screening

Source: NCQA Quality Compass® 2010

Kaiser Foundation Health Plan - Southern CA 92.98Kaiser Foundation Health Plan - Northern CA 92.08CIGNA HealthCare of California, Inc. 88.32Aetna Health of California, Inc. 86.97Health Net of California 86.51Blue Shield of California 85.69Blue Cross of California dba Anthem Blue Cross 85.40

Western Health Advantage 84.85PacifiCare of California 84.73National 90th 89.14

CaliforniaGrand Valley Health Plan, Inc 97.24

McKinley Life Insurance Company 95.22HealthAmerica Pennsylvania, Inc./HealthAssurance Pennsylvania, Inc. 94.94

Capital Health Plan, Inc. 94.16US Family Health Plan at Pacific Medical Centers 93.64Kaiser Foundation Health Plan Inc. - Southern California 92.98

Harvard Pilgrim Health Care, Inc. 92.94CIGNA HealthCare of Pennsylvania, Inc. 92.21

Medical Associates Health Plan, Inc. 92.21

Martin's Point Health Care, Inc. 92.17

National Top 10

NCQA Plan Performance DataDiabetes Monitoring: Diabetes Nephropathy

Source: NCQA Quality Compass® 2010

Kaiser Foundation Health Plan - Southern CA 97.66Kaiser Foundation Health Plan - Northern CA 90.75CIGNA HealthCare of California, Inc. 87.83Blue Shield of California 87.14Health Net of California 86.15Western Health Advantage 85.58

PacifiCare of California 84.91Blue Cross of California dba Anthem Blue Cross 83.94Aetna Health of California, Inc. 83.45National 90th 88.27

CaliforniaKaiser Foundation Health Plan Inc. - Southern California 97.66

Kaiser Foundation Health Plan of Colorado 94.89

Group Health Cooperative 94.14Kaiser Foundation Health Plan of the Mid-Atlantic States, Inc. 93.98

Grand Valley Health Plan, Inc 93.47

Harvard Pilgrim Health Care, Inc. 93.43US Family Health Plan at Pacific Medical Centers 92.91

Martin's Point Health Care, Inc. 92.53Kaiser Foundation Health Plan of the Northwest, Inc. 92.52

Gundersen Lutheran Health Plan, Inc. 92.36

National Top 10

NCQA Plan Performance DataDiabetes Eye Exams

Source: NCQA Quality Compass® 2010

Kaiser Foundation Health Plan - Southern CA 73.39Kaiser Foundation Health Plan - Northern CA 71.32Blue Shield of California 64.49Health Net of California 60.97PacifiCare of California 55.40CIGNA HealthCare of California, Inc. 55.23Western Health Advantage 53.47Blue Cross of California dba Anthem Blue Cross 52.55Aetna Health of California, Inc. 50.00National 90th 70.79

CaliforniaGrand Valley Health Plan, Inc 88.94US Family Health Plan at Pacific Medical Centers 83.78Martin's Point Health Care, Inc. 83.42Capital Health Plan, Inc. 82.73Group Health Cooperative of South Central Wisconsin 82.12Harvard Pilgrim Health Care of New England (NH) 80.05Anthem Health Plans of Maine, Inc. dba Anthem Blue Cross and Blue Shield in Maine 79.04CIGNA HealthCare of Maine, Inc. 78.83Tufts Associated Health Maintenance Organization, Inc. 78.63Kaiser Foundation Health Plan, Inc. - Hawaii 77.92

National Top 10