A collaboration among the Missouri Department of Health and Senior Services

1. The Million Hearts National InitiativePreventing one million heart attacks and strokes over five years A collaboration among the Missouri Department of Health and Senior Services American Heart Association Primaris Missouri Primary Care Association Missouri Pharmacy Association

2. What the National Initiative Means in Missouri If successful over five years, it will mean Million Hearts will have saved the lives of approximately 20,000 Missourians enough people to fill up the Scottrade Center in St. Louis or the Sprint Center in Kansas City

3. Missouri Quick Facts Heart Disease continues to be the leading cause of death. Stroke is now the fifth cause of death in Missouri. Prevalence of Hypertension is 34.3 in the general population and over 40 in the African-American population. Slightly more than half of those with hypertension are being told to decrease their sodium intake. Million Hearts is described as an activity inMissouri’s CDC 1305 Grant Domain 3Strategy 1

4. Status of the ABCS Source: MMWR: Million Hearts: Strategies to Reduce the Prevalence of Leading Cardiovascular Disease Risk Factors --- United States, 2011, Early Release, Vol. 60

5. Key Components of Million Hearts™ • Community Prevention • Reduce the number of people who need treatment • Clinical Prevention • Optimize care for heart and stroke patients

6. Health System Messages • Clinicians • Emphasize power of prevention • Create systems to get an “A” in the ABCS • Use decision supports and registries to drive performance • Deploy teams • Pharmacists • Monitor and influence refill patterns • Team up • Teach adherenceby helping patients to understand the importance of taking their medications • Teach patients about the ABCS through Medication Therapy Management

7. Health System Messages • Insurers • Measure and incentivize performance on the ABCS • Collect and share data for quality improvement • Empower consumers • Individuals • Know your numbers—and goals • Get to know the ABCS • Take aspirin, if advised • Take steps to lower high blood pressure and cholesterol • Reduce sodium and trans fats • If you smoke, quit • Avoid exposure to second-hand smoke

8. Timeline of progress in 2012 February - Bi-weekly teleconference planning sessions began - Press release introducing Million Hearts to public April - Letter to professionals released - Webinar presented by Dr. Janet Wright, HHS/CDC and Dr. Whaley-Connell HTN expert - Role of Million Hearts Physician Champion defined June - Nine Missouri physician champions recruited July - Missouri Millions Hearts regions defined as BRFSS regions August - Missouri Department of Health and Senior Services compiled data on Missouri cardiovascular disease - Missouri Million Hearts committee meets to review data Sept –Dec - Continued to add partners, MPCA and MPA

9. Timeline of progress in 2013 Jan - March - Monthly teleconference planning sessions continue April - Presented at the MSMA meeting in KC - Gained interest from several physicians May - Face to Face meeting - Action Plan Developed for 2013/2014 - Created work groups for identified plan objectives - Work groups convened November - Second Face to Face meeting October - Started project with MO HIE as a data resource for TGA Present - Total Ten Missouri physician champions recruited - 19 sites recruited to demonstrate The Guideline Advantage

10. Work Groups Communications (website/newsletter/media) Team care (Pharmacists/physicians) Provider Champion Recruitment and Resources and Tools Data Capture and Analysis (TGA) Baseline Data and Success measures Advocacy (Gov. relations)

12. BRFSS Regions Behavioral Risk Factor Surveillance System (BRFSS) is a telephone health survey system of healthcare consumer

13. Million Hearts Provider Champion Serves as an expert resource for the MO Million Hearts Collaborative Promotes the Million Hearts Initiative to health professionals and patients Enhances knowledge on heart attack, stroke and related modifiable risk factors

14. Million Hearts Provider Champion • Supports local community-based patient-resources to reduce smoking prevalence, improve nutrition, reduce blood pressure • Supports and reinforces healthy choices and healthy behaviors: Is aware of barriers to patient access to healthy choices and behaviors • Promotes the use of Health Information Technology

15. Champion Resources Online • Resources available on the Million Hearts website: • www.heart.org/momillionhearts • Resource include informational articles and tools on: • Aspirin therapy • Blood pressure • Cholesterol management • Smoking cessation • And much more.

16. Behavioral Risk Factor Surveillance System (BRFSS) • BRFSS is a state-level health survey that annually collects information on a range of issues including health conditions, risk behaviors, and preventive practices. • BRFSS is used to: • Indentify emerging health problems; • Establish health objectives and track progress; • Justify funding requests and report progress.

17. Behavioral Risk Factor Surveillance System (BRFSS) • MO Department of Health and Senior Services (DHSS) conducts the annual BRFSS with assistance and support of the Centers for Disease Control and Prevention(CDC) • How is BRFSS conducted? • Telephone interviews with adults over 18 • Only with those not living in institutions • How many Missourians are interviewed? • Approximately 6,360 are interviewed throughout the year.

18. MISSOURI MILLION HEARTS 2012 BASELINE MEASURES

19. MISSOURI MILLION HEARTS 2012 BASELINE MEASURES

20. Role of Missouri Dept. of Health and Senior Services Produce data from available sources such as BRFSS for Million Hearts. Provide Strategic Doing Expertise which enabled Missouri to establish strategic focus areas and workgroups for implementation.

21. Role of Missouri Dept. of Health and Senior Services Partner with organizations representing disparate populations. (Missouri Primary Care Association for quality improvement initiatives on related measures e.g. high blood pressure, A1c, cholesterol. Initiate implementation of evidence based initiatives for quality improvement focusing on medication adherence. (e.g. add pharmacists to team based care)

22. Role of Missouri Dept. of Health and Senior Services Promote Missouri Tobacco Quitline for quitting smoking, smoke-free policies, safe walking areas, and access to healthy food. Serve as the key leader in establishing the Sodium in Knowledge in Practice which is enabling Missourians to make better lower sodium food choices by focusing on education, policy change and environmental interventions.

23. Role of Health Depts. and Community Organizations • Work with health care systems to monitor national quality indicators, including “controlling high blood pressure,” and carry out quality improvements. • Encourage health systems to use health information technology to identify patients who have high blood pressure and establish follow up systems to monitor those patients.

24. Role of Health Depts. and Community Organizations Promote Missouri Tobacco Quitline for quitting smoking, smoke-free policies, safe walking areas, and access to healthy food.

25. Role of American Heart Association • Provide evidence based guidelines for the treatment and prevention of stroke and heart disease • Provide a multitude of resources for both consumers and providers • Educational materials • Health tracking tools • Tools for professionals • Quality improvement programs

26. Role of American Heart Association Provide link to physicians for support and expert opinion Utilize connections with the community to disseminate information Gain interest and support due to AHA brand name and credibility

27. Role of Primaris • Pilot Project with physician practices • Develop a systems-level, data-driven approach to quality improvement • Promote reporting and use of metrics to identify areas for clinical improvement • Advance Patient-Centered Medical Home efforts with emphasis on care management & transitions of care

28. Role of Missouri Pharmacy Association Pilot Project with pharmacists Inform the public of the benefits of pharmacists as members of the health care team Promote medication adherence as a key factor in health.

29. Role of Missouri Primary Care Association One of our functions is assisting Federally Qualified Health Centers (a.k.a Community Health Centers) with quality enhancement and networking support of efforts to develop, implement, and sustain community health improvements.

30. Role of Missouri Primary Care Association • Quality Improvement/Performance Improvement • Best Practices • Data Collection • Research and Analysis • Technical Assistance • Network Development • Patient Centered Medical Home efforts with emphasis on population health and individual care management and care • coordination

31. Program Model

32. Tool for Population Health Management • On-demand access to quality improvement data using a web-based tool • Available physician-level reporting • Clinic and system aggregation • Tools for creating action lists

33. Tool for Population Health Management • Alignment with key national initiatives • National and State benchmarking • Practice network opportunities, including virtual workshops and national recognition

34. Contacts Robin HamannAmerican Heart AssociationPhone: (618) 402-5393robin.hamann@heart.org Kris KummerfeldHeart Disease and Stroke Prevention Phone:  (573) 522-2879  Kris.Kummerfeld@health.mo.gov Abhi Ray Primaris Phone: (816) 588 1848 aray@primaris.org

35. Thank You for Your Attention! Questions?