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October 1, 2010  UC Berkley

3 rd Annual Dean’s Right Care Cardiovascular and Diabetes Leadership Summit Taking Action Together to Prevent Heart Attacks and Strokes Reaching 90th percentile Targets: Medical Directors Report on Health Plan Strategies, Programs, Plans, and Achievements. October 1, 2010 

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October 1, 2010  UC Berkley

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  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 Blue Shield of California

  2. Results Blue Shield of California Number of commercial HMO enrollees: 1,049,266 1. Number with Heart Disease: 9,692 • Percent with cholesterol controlled: 59.56% 2. Number with Hypertension: 95,962 • Percent with blood pressure controlled: 64.73% 3. Number with Diabetes: 46,270 • Percent with cholesterol controlled: 49.64% • Percent with HbA1c > 9: 24.09%

  3. Demographics • CAD F-00-17 13 F-18-44 251 F-45-65 2075 F-65-ov 658 M-00-17 19 M-18-44 400 M-45-65 4,773 M-65-ov 1503 Total: 9692 • HTN F-00-17 130 • F-18-44 7634 • M-45-65 33725 • M-65-ov 3636 • M-00-17 266 • M-18-44 10396 • M-45-65 36022 • M-65-ov 4153 • Total: 95962

  4. Demographics • Diabetes F-00-17 297 F-18-44 4272 F-45-65 14620 F-65-ov 1493 M-00-17 322 M-18-44 4402 M-45-65 18593 M-65-ov 2271 Total: 46270

  5. Interventions • Member “Know Your Numbers” outreach via email campaign • Migrated to primary nurse model to increase engage in DM • Pharmacy and lab data integrated with medical claims history on screen for nurse doing DM • Care gaps run automatically and show up as alerts for nurses to easily focus during member care call • Care Tips are sent to provider to draw their attention to their patients outside of clinical practice guidelines • Online Care Center with trackers and tolls

  6. Interventions • Pay 4 Performance outreach to Physician Organizations (POs) • Annual P4P reports to each PO • Third year of Fall outreach to lower performers • Twice yearly Webinars on P4P improvements, best practices • Work with medical groups to develop and use registries • Clinical Tip Sheets for POs to improve performance • HTN - Targeted member medication adherence pilot with physicians • Disease Mgmt targeted call campaign pilot for HTN, CAD, and Diabetes

  7. Pharmacy Oriented Interventions • “Pharmacist Care for Diabetes Pilot Program” with Raley’s for selected CalPERS members.  Pharmacists in a community pharmacy setting provide face-to-face consults to educate members about diabetes self-care techniques and address medication issues. UCSF to analyze outcomes. • Medication Therapy Management program with Blue Shield pharmacist/RN telephonic consultations related to polypharmacy and post-discharge medication reconciliation issues, as well as for eligible Medicare Part D members. • Member and provider clinical messaging based on identified medication adherence issues (non-adherence, early discontinuation), gaps in care and HEDIS measures. • Employer group pilot with a value-based Rx benefit design to reduce member cost-share barriers (low or $0 copay for selected drug categories)

  8. Barriers • No phone numbers for 30% of membership • Few email addresses • Members not returning the call • When we call, need to leave opaque messages due to privacy laws • Social engagement more effective than solo engagement

  9. Power of Prevention • Blue Shield Preventive Health Guidelines • Spreading the word about “Know your Numbers”

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