October 1, 2010 UC Berkley

1. 3rd Annual Dean’s Right CareCardiovascular and Diabetes Leadership SummitTaking Action Together to Prevent Heart Attacks and StrokesReaching 90th percentile Targets: Medical Directors Report on Health Plan Strategies, Programs, Plans, and Achievements October 1, 2010  UC Berkley

2. Strategies, Plans or Programs Please fill in: Western Health Advantage • Number of commercial HMO enrollees: __67,808 • 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:___64.48 3. 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_____

3. Demographics of Plan

4. Demographics - CAD • Gender • Female - 22.7% • Male – 77.3% • Age Groups • 20-44 – 4.3% • 45-64 – 77.6% • 65+ - 18.1%

5. Demographics - Hypertension • Gender • Female – 48.4% • Male – 51.6% • Age Groups • <20 – 0.1% • 20-44 – 17.8% • 45-64 – 73.7% • 65+ - 8.4%

6. Demographics - Diabetes • Gender • Female – 48.6% • Male – 51.4% • Age Groups • <20 – 0.4% • 20-44 – 22.2% • 45-64 – 70% • 65+ - 7.3% • (HEDIS Diabetes Measure is an Adult Measure)

7. HbA1c <9.0 • Result 24.64 improved from 28.95 • 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

8. LDL-C <100 in Diabetics • Result 47.81 previously 47.93 • 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.

9. LDL-C in CAD • Result 64.86 improved from 60.44 • 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.

10. Blood Pressure <140/90 • Result 64.48 previously 63.99 • (Result for Diabetics 69.71 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 20-50 year olds. (Lost to follow up) • Challenge of building effective registries and staff to manage the large case load.

11. 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.

12. 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.