Hilary K. Wall, MPHHealth Scientist

Cardiac Learning and Action Networks

April 11, 2012

Introduction to Million HeartsTM

National Center for Chronic Disease Prevention and Health Promotion

Division for Heart Disease and Stroke Prevention

Burden of Heart Disease and Stroke

Cause 1 of every 3 deaths >2 million heart attacks and strokes

occur every year; 800,000 die Leading cause of preventable death

among people <65 Treatment accounts for about $1 of every

$6 spent on health care $444 B in health care costs and lost

productivity

Roger VL, et al. Circulation 2012;125:e2-e220Heidenriech PA, et al. Circulation 2011;123:933–4

Burden (cont’d)

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Improved cardiovascular care could save 100,000 lives/year in U.S.

Farley TA, et al. Am J Prev Med 2010;38:600-9.

0

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Percent eligible using service

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20% 25% 30% 35% 40% 45% 50% 55% 60% 65% 70% 75% 80% 85% 90% 95%

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Percent eligible using service

Smoking cessation

Blood pressure control

Cholesterol control

Aspirin

Status of the ABCS

Aspirin People at increased risk of cardiovascular events 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%

Valderrama AL; Loustalot F; Gillespie C; George MG; Schooley M. Million Hearts: Strategies to Reduce the Prevalence of Leading Cardiovascular Disease Risk Factors — United States, 2011. MMWR 2011;60(36):1248-1251

Hypertensive Americans

65M hypertensivesUncontrolled and/or unaware – 37M

Treated, not controlled – 17M Aware, not treated – 6M Unaware – 14M

National Health and Nutrition Examination Survey (NHANES), 2005-2008

Centers for Medicare and Medicaid Services. Chronic Conditions among Medicare Beneficiaries, Chart book. Baltimore, MD. 2011.

Percentage of Medicare FFS Beneficiaries with 15 Selected Chronic Conditions, 2008

Million HeartsTM

Goal – prevent 1M heart attacks and strokes in 5 years

Purpose – Engage public and private sector partners in a coordinated approach to: Reduce the number of people who need treatment Optimize treatment for those who need it Realize the full value of prevention in cardiovascular

health

MH Public Partners

Centers for Disease Control and Prevention (co-lead) Centers for Medicare & Medicaid Services (co-lead) Administration on Aging Agency for Healthcare Research and Quality Food and Drug Administration Health Resources and Services Administration Indian Health Service National Institutes of Health, National Heart Lung and Blood

Institute National Prevention Strategy, National Quality Strategy Office of the National Coordinator for HIT Substance Abuse and Mental Health Services Administration

MH Private Partners

American Heart Association America’s Health Insurance

Plans American Medical Association American Nurses Association American Pharmacists’

Association and the American Pharmacists’ Association Foundation

The National Alliance of State Pharmacy Associations and the Alliance for Patient Medication Safety

The National Community Pharmacists Association

Kaiser Permanente United Healthcare Walgreens The Y Association of Black Cardiologists American College of Cardiology National Committee for Quality

Assurance National Consumer League American Association of Colleges

of Pharmacy

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Key Components of Million HeartsTM

CLINICALPREVENTION

Optimizing care

Focus on ABCS

Health Information TechnologyClinical Innovations

COMMUNITYPREVENTION

Changing the context

TRANSFAT

Simple, uniform set of measures Measures with a lifelong impact Data collected or extracted in the workflow of

care Link performance to incentives

Focus on the ABCS

Alignment of Clinical Quality Measures

Million Hearts Clinical Quality

Measures

2012 PQRS

PQRS CV Prevention Measures

Group

PQRS Group Practice

Reporting Option

ACOs Meaningful Use NQF

Aspirin UsePQRS #204

Yes Yes YesS1 optional,

S2 core (prop) NQF #0068

BP ScreeningPQRS #317

Yes Yes Yes  

BP ControlPQRS #236

Yes Yes YesS1 optional,

S2 core (prop)NQF

#0018

Chol Control – Pop PQRS #316

      S2 core (prop) TBD*

Chol Cont – DMPQRS

#2Yes Yes Yes^

S1 optional, S2 optional (prop)

NQF #0064

Chol Cont – IVD PQRS #241

Yes Yes YesS1 optional,

S2 optional (prop)NQF

#0075

Smoking CessationPQRS #226

Yes Yes Yes S1 core,

S2 core (prop)NQF

#0028

* The Measure Applications Partnership recommended it be submitted to NQF for endorsement (Jan 2012)

Registries for population management Point-of-care tools for assessment of risk for

CVD Timely and smart clinical decision support Reminders and other health-reinforcing

messages

Health Information Technology

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Embed ABCS and incentives in new models Health Homes, Accountable Care Organizations, bundled

payments Interventions that lead to healthy behaviors

Mobilize a full complement of effective team members Pharmacists, cardiac rehabilitation teams Health coaches, community health workers, peer wellness

specialists

Clinical Innovation

Role for Cardiac Learning and Action Networks

Focus on the ABCS Create unique partnerships Be innovators Share best practices

Successful QI interventions

“Progress Notes”

Million Hearts Resources

http://millionhearts.hhs.gov/ Frieden TR, Berwick DM. The “Million Hearts” Initiative –

Preventing Heart Attacks and Strokes. NEJM 2011; 365:e27.

Valderrama AL, et al. Million Hearts: Strategies to Reduce the Prevalence of Leading Cardiovascular Disease Risk Factors --- United States, 2011. MMWR 2011:60(36);1248-1251.

Tomaselli GF, et al. The American Heart Association and the Million Hearts Initiative A Presidential Advisory From the American Heart Association. Circulation. 2011;124:1-5.

For more information please contact Centers for Disease Control and Prevention1600 Clifton Road NE, Atlanta, GA 30333Telephone, 1-800-CDC-INFO (232-4636)/TTY: 1-888-232-6348E-mail: cdcinfo@cdc.gov Web: www.cdc.gov

The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

Questions?

Hilary Wall – hwall@cdc.gov

National Center for Chronic Disease Prevention and Health Promotion

Division for Heart Disease and Stroke Prevention