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Right Care Initiative
The views expressed in the documents by the presenters to the Department of Managed Health Care should not be interpreted as an endorsement by the Department.
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 commercial 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:
California Statewide Goals—Preventing Strokes, Heart Attacks, and Diabetic Complications
- Achieve National HEDIS 90th Percentile Targets (2011 Performance Year):
- 76% 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
- 58% of diabetic patients with lipids controlled: LDL-C < 100 mg/dL
- Reduce Hospital Acquired infections
- Median of zero central line infections
Significantly reduce infections designated by the Right Care Initiative work group
Demonstration Goals
- 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
Thanks to an NIH GO grant, the Right Care Initiative and its partners have initiated a community focused effort in San Diego centered on the Right Care goals of preventing heart attacks, strokes, and diabetes related complications. This grant provided a special opportunity to launch intensive efforts toward achieving the national 90th percentile of HEDIS performance in hypertension, cardiovascular disease, and diabetes prevention. For more information, view the statistical brief, the San Diego: Preventing Heart Attacks, Strokes and Diabetes-Related Complications.
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 NIH GO Grant Principal Investigator. He is currently the NIH Office of Behavioral and Social Sciences Research (OBSSR) Director.
Promising Interventions to Reach HEDIS Control Targets for Heart Attack and Stroke Prevention
Project Inspiration
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
- California health plans and medical groups
- CA Chronic Care Coalition
- University of California
- RAND
- Stanford University
- American College of Cardiology
- American Diabetes Association
- American Heart/Stroke Association
- CA Hospital Association
- CA Medical Association Foundation
- CA Pharmacy Foundation
- CA Quality Collaborative
- Veteran’s Affairs, SD Medical Center
- Integrated Healthcare Association
- Pacific Business Group on Health
- Ralphs Grocery Company
- Pharmaceutical Companies
- Sierra Health Foundation
- Office of the Patient Advocate
- Our colleagues in public health
Implementation Action and Goals
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 first annual Clinical Quality Improvement Leadership Summit. Since then, eight Right Care summits have been held around the state. Thanks to an NIH GO grant (Nov. 2009-July 2012), the Right Care Initiative was given a special opportunity to launch intensive efforts toward quickly achieving national 90th percentile HEDIS hypertension and cardiovascular disease performance targets in a community-focused effort to reach the Right Care Initiative goals of preventing heart attacks and strokes. Each Right Care gathering is a collaborative effort among medical, pharmacy and quality improvement directors, as well as thought leaders in evidence-based medicine. Through quality improvement support for medical groups, clinics and plans, the Right Care Initiative’s current goal is to reach Grade-A performance (national 90th percentile) in CVD and diabetes HEDIS control measures of blood pressure, lipids, and glucose, thereby reducing disability and death due to strokes, heart attacks and diabetic complications.
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, hattiehanley@post.harvard.edu, (916) 323-2704
State-Wide Right Care Technical Expert Steering Committee Chair, and Founding Principal Investigator:
Stephen Shortell, PhD, MPH, Professor and Dean, University of California, Berkeley, School of Public Health;
Robert Kaplan, PhD, Associate Director for Behavioral and Social Sciences Research, National Institutes of Health
Sacramento Right Care University of Best Practices Co-Chairs:
Parag Agnihotri, MD, Center for Medicaid and Medicare Innovation Advisor and Medical Director Mercy Medical Group;
Jose Arevalo, MD FAAFP, Medical Director, Sutter Independent Physicians Medical Group
San Diego Right Care University of Best Practices and Demonstration Project Steering Committee Co-Chairs:
Anthony DeMaria,Co-Chair University of Best Practices and Steering Committee Chair; Editor-in-Chief, Journal of American College of Cardiology; UCSD Judith and Jack White Chair in Cardiology; Founding Director, UCSD Sulpizio Family Cardiovascular Center.
Scott Flinn, MD, Medical Director, Arch Medical Group, Chair, University of Best Practices;
Jerry Penso, MD, MBA, Chief Medical Officer, American Medical Group Association & Co-founder University of Best Practices;
Judith and Jack White, Steering Committee Co-Chairs & Heart Attack and Stroke Prevention Champions;
Jim Dudl, MD, Vice-Chair; Clinical Lead, Care Management Institute, Kaiser Permanente
Cardiovascular Disease and Diabetes Principal Investigators:
Susan L. Ivey, MD, MHSA, Director of Research, Health Research for Action, UC Berkeley;
Carol Mangione, MD, MSPH, Professor of Medicine and Public Health, UCLA Schools of Public Health & Medicine
Allen Fremont, MD, PhD, RAND Corporation
Funding
This project has been generously supported by National Institutes of Health, Judith and Jack White, Johnson & Johnson, Office of the Patient Advocate, Sierra Health Foundation, CA Health Care Foundation, Ralphs Grocery Company, Eli Lilly, Novartis, and Sanofi to enable The University California, The CA Chronic Care Coalition and RAND to provide research and logistical support.
