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Right Care Initiative

Objective

To measurably improve clinical outcomes through enhancing the practice of patient-centered, evidence-based medicine.

The Right Care Initiative’s goal is to apply scientific evidence and outcomes improvement strategies to reduce morbidity and mortality among California’s 15 million managed health plan enrollees. Data from NCQA, The Integrated Health Care Association, the Agency for Health Care Quality and Research, the Commonwealth Foundation, and the Centers for Disease Control indicate three trouble spots where evidence-based patient management and clinical quality improvement will significantly enhance and save lives:

  1. Cardiovascular disease, with particular emphasis on hypertension,
  2. Diabetes, with particular emphasis on heart attack and stroke prevention

View a printable version of the Right Care Initiative Project Brief 

10/29/2013 - DMHC announces 2013 "Right Care Initiative" award recipients

10/02/2012 - DMHC announces "Right Care Initiative" award recipients

10/05/2011 - DMHC announces “Right Care Initiative” award recipients


RCI Award Criteria

California Statewide Goals—Preventing Strokes, Heart Attacks, and Diabetic Complications

  • Achieve National HEDIS 90th Percentile "A-grade" Targets (2012 Performance Year):
    • 75% of hypertensive patients with blood pressure controlled: <140/90 mm Hg
    • 73% of patients with cardiovascular conditions with lipids controlled: LDL-C < 100 mg/dL
    • 71% of diabetic patients with blood sugar controlled: HbA1c < 8
    • 59% of diabetic patients with lipids controlled: LDL-C < 100 mg/dL
    • 58% of diabetic patients with blood pressure controlled: <140/80 mm Hg

Current Focus:

  • Heart attack and stroke prevention focused on heart disease, hypertension and diabetes patients through lipid, blood pressure, and blood sugar management
  • Support for medical, pharmacy and quality improvement directors via "University of Best Practices" colloquia

Current Activities:

  • Rotating Right Care University of Best Practices in three metropolitan areas to share learning and encourage adoption of evidence-based interventions for preventing heart attacks, strokes, and complications from diabetes (e.g., amputations, blindness, kidney failure). Practical presentations from benchmark performers are geared toward medical, pharmacy and quality improvement directors, coupled with Continuing Medical Education in Sacramento and Los Angeles, to spur achievement of national “A-grade” performance.
  • Annual leadership summit to highlight newly released HEDIS & P4P performance data, award top performers and most improved, and promote adoption of strategies used by leading edge Triple Aim performers.

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

Project Inspiration

The National Committee for Quality Assurance (NCQA) estimates that improving the cardiovascular disease and diabetes measures among California’s 15 million commercial managed health plan enrollees to the national HEDIS 90th percentile could result in 1,694 to 2,818 Californian lives saved annually. It would also avoid $118 million in yearly hospital costs, 766,401 sick days and $125.56 million in lost productivity. Hospital acquired infections are estimated to kill more than 10,000 Californians per year, and are mostly preventable.

Heart disease, hypertension, diabetes, and prevention of hospital acquired infections are increasingly well understood scientifically. Like the “100,000 Lives” national campaign for reducing medical errors, this project will improve the lives of tens of thousands of California enrollees by catalyzing the work of experts and applying evidence based medicine in the coordinated, managed care model.

Key Partners

  • CA Dept. of Managed Health Care
  • CA medical groups, clinics & health plans
  • American Medical Association Foundation
  • University of California
  • California Chronic Care Coalition
  • Stanford Clinical Excellence Research Center
  • RAND
  • University of Southern California
  • Health Services Advisory Group
  • Sierra Health Foundation
  • CA Office of the Patient Advocate
  • CA Medi-Cal Program
  • CA Dept. of Public Health (CDPH)
  • Integrated Healthcare Assoc. (IHA)
  • Pacific Business Group on Health
  • US Department of Veterans's Affairs
  • American College of Cardiology
  • American Heart/Stroke Association
  • CA Endowment
  • California Health Care Foundation
  • Ralphs Grocery Company
  • Novo Nordisk
  • Genentech
  • Boehringer-Ingelheim

Research Questions

  • What are the most promising interventions for quickly bringing patients into safe control?
  • What barriers are preventing improvement, and what are the best strategies for overcoming them?
  • What are the best strategies for California to expedite a focused re-engineering effort to refine the implementation of evidence-based medicine to quickly meet these goals that are estimated to save thousands of lives annually?
  • What strategies are needed to improve clinical outcomes in light of health disparities in California’s diverse population?

Contact

Hattie Rees Hanley, MPP, Right Care Initiative Project Director, hattie.hanley@dmhc.ca.gov, (916) 323-2704

Implementation Action:

DMHC publicly launched the Right Care Initiative with NCQA and the Deans of UC Berkeley and UCLA Schools of Public Health in March 2008 at the 1st annual Clinical Quality Improvement Leadership Summit. Since then, ten Right Care summits have been held around the state. Each Right Care gathering is a collaborative effort among medical, pharmacy and quality improvement directors, as well as thought leaders in evidence-based medicine.

State-Wide Right Care Technical Expert Steering Committee Chair, Founding Principal Investigator and University of Best Practices Co-Founder:

Stephen Shortell, PhD, MPH, Professor and Dean, Emeritas, University of California, Berkeley, School of Public Health;

Robert Kaplan, PhD, Associate Director for Behavioral and Social Sciences Research, National Institutes of Health

* View a presentation on the California Right Care Initiative given by Robert Kaplan, PhD: http://videocast.nih.gov/summary.asp?live=10001&debug=0 . Dr. Kaplan formerly led the Right Care Initiative as its Principal Investigator. He is currently the NIH Office of Behavioral and Social Sciences Research (OBSSR) Director.

Jerry Penso, MD, MBA, University of Best Practices Co-Founder and Chief Medical Officer, American Medical Group Association

Cardiovascular Disease and Diabetes Research Team:

Susan L. Ivey, MD, MHSA, Director of Research, Health Research for Action & Associate Professor, UC Berkeley School of Public Health;

Carol Mangione, MD, MSPH, Professor of Medicine & Public Health, UCLA Schools of Public Health & Medicine

Hector Rodriguez, PhD, MPH, Associate Professor, UC Berkeley School of Public Health

Jan Hirsch, PhD, Assistant Professor of Clinical Pharmacy, UCSD Skaggs School of Pharmacy and Pharmaceutical Sciences

Steve Chen, PharmD, Associate Professor of Clinical Pharmacy, USC

Mary Fermazin, MD, MPA, Chief Medical Officer, Health Services Advisory Group (CMS-QIO)

Thanks to an NIH GO grant (2009-July 2012), the Right Care Initiative received a special opportunity to launch a community-focused effort in San Diego to reach the Right Care Initiative goals of preventing heart attacks, strokes and diabetic complications and piloted the first University of Best Practices. Since then, a Right Care University of Best Practices has been launched in two additional metro areas: Sacramento in 2012 and Los Angeles in 2013. Each UCP is comprised of the major delivery systems of the region, including community clinics, the VA, health plans, and medical groups.

Los Angeles Right Care University of Best Practices Chairs:

Stephen C. Deutsch, MD, Chief Medical Officer, Cedars-Sinai Medical Care

Robin Clarke, MD, UCLA Medical Director for Quality Improvements

(Hosted at USC School of Pharmacy)

Sacramento Right Care University of Best Practices Chair:

José Arévalo, MD FAAFP, Senior Medical Director, Sutter Independent Physicians Medical Group; President, Latino Medical Society of California

(Hosted at Sierra Health Foundation)

San Diego Right Care University of Best Practices and San Diego Demonstration Project Steering Committee Leaders:

Scott Flinn, MD, Univ. of Best Practices Chair and Medical Director, Arch Health Partners

Anthony DeMaria, MD, Univ. of Best Practices Co-Chair; Editor in-Chief, Journal of American College of Cardiology; Founding Director, UCSD Cardiovascular Center

Judith and Jack White, Heart Attack and Stroke Prevention Patient Champions

Jim Dudl, MD, Vice-Chair; Clinical Lead, Care Management Institute, Kaiser

(Hosted at UC San Diego Scripps Forum)

Resources

We wish to thank Right Care Initiative supporters: The Sierra Health Foundation, The CA Health Care Foundation, The California Endowment, Judith and Jack White, The CA Office of the Patient Advocate, Novo Nordisk, Genentech, Boehringer-Ingelheim, The Health Services Advisory Group, and Ralphs Grocery Company, which enables research and logistical support by the University of CA, the CA Chronic Care Coalition; as well as our University of Best Practices and our annual leadership summit.

* The views and content expressed in documents by presenters to the Department of Managed Health Care should not be interpreted as an endorsement by the Department.