Teamwork across Medicaid health plans can — even with moderate resources — improve the quality of health care compared to efforts by individual health plans alone, a new study shows.
A report released Thursday by the Centers for Disease Control and Prevention found that a year-long collaboration between nine of California’s 23 Medi-Cal managed care plans helped increase the number of patients who controlled their high blood pressure rates.
“It’s a message to a much larger audience that quality improvement can work, and here are some elements we learned along the way that can translate” in other areas, said Desiree Backman, chief prevention officer with the Department of Health Care Services, and one of the study’s five authors.
The study was conducted from January through December 2015 by the department, which administers Medicaid, called Medi-Cal in this state.
By the end of the year, after implementing a range of ideas presented during quarterly webinars and access to materials and experts in the field, the nine plans showed an average increase of 5 percentage points in rates of controlled blood pressure.
The largest gain was posted by the Alameda Alliance for Health, where the rate of enrollees who controlled their high blood pressure increased by 14.6 percentage points. The Partnership Health Plan of California, which serves 14 Northern California counties including Marin, Napa, Sonoma and Solano, was the next highest, jumping 11.2 percent, while the Health Plan of San Mateo ranked fourth highest, with a rate increase of 7.1 percent.
Medi-Cal is the health care program for low-income residents and includes about 14 million Californians, more than one-third of the state’s population. Almost four million have enrolled under a provision of the Affordable Care Act that expanded the program to adults without dependent children.
Backman said the goal of the study was consistent with the nation’s Million Hearts initiative, which aims to prevent one million heart attacks and strokes in 2017 through strategies like achieving blood pressure control among 70 percent of those who have high blood pressure, also called hypertension.
Hypertension is a major risk factor for deaths related to coronary heart disease and stroke. About one-third of U.S. adults have the disorder, but only about half, or 52 percent, have it under control.
The federal government’s threshold for high blood pressure control in adults varies by age and diabetes status, but ranges from blood pressure readings that are less then 140/90 mm Hg to less than 150/90 mm Hg.
How did the state increase the number of enrollees who controlled their high blood pressure rates?
Over the 2015 calendar year, each of the nine plans committed personnel to attend the state’s four scheduled 90-minute webinars, offering links to local, state and national resources that included materials and consultation with experts.
“We did roll call at each webinar so we knew who was on the phone,” said Dr. Neal Kohatsu, medical director of the Department of Health Care Services. “We did an assessment of the plans, what they wanted up front and tailored it to their needs.”
Backman also noted that the plans were able to tap the insights of national experts who “are well-schooled in hypertension control and brought a lot of good, very practical advice to the plans.”
After the Medi-Cal plans shared what they learned with each other, the rates of controlled hypertension improved, said Kohatsu and Backman, who considered the study a success
The state, they said, could adopt a similar process to address other priorities facing the Medi-Cal population, including diabetes, post-partum care for new mothers, and immunization goals, among other topics.
The department intends to remain vigilant about its success with hypertension rates, said Kohatsu.
“When you make these changes, they tend to go forward and perpetuate in a positive way,” the medical director said. “Which is not to say you don’t have to keep paying attention. If you take your eye off the ball, the improvement you achieved can regress.”
Adam Weintraub, a department spokesman, said the state can’t tie any California cost-savings numbers to the study. But, he noted, national costs of cardiovascular disease are estimated at $316 billion annually in the U.S., accounting for $1 out of every $7 spent on U.S. health care.
“Because hypertension is a risk factor for cardiovascular disease,” said Weintraub, “the collaboration helps to show the scope of the problem the plans are working to reduce.”
