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)
3
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
10000
20000
30000
40000
50000
60000
70000
80000
20% 25% 30% 35% 40% 45% 50% 55% 60% 65% 70% 75% 80% 85% 90% 95%
Nu
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of
de
ath
s p
rev
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ted
(pe
r y
ea
r)
Percent eligible using service
0
10000
20000
30000
40000
50000
60000
70000
80000
20% 25% 30% 35% 40% 45% 50% 55% 60% 65% 70% 75% 80% 85% 90% 95%
Nu
mb
er
of
de
ath
s p
rev
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ted
(pe
r y
ea
r)
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
9
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
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: [email protected] 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 – [email protected]
National Center for Chronic Disease Prevention and Health Promotion
Division for Heart Disease and Stroke Prevention
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