Missouri Million Hearts Fall Virtual Partner Update

Sept. 15th, 2020

Host: Kris Kummerfeld, DHSS, Missouri Million Hearts Coordinator

Logistics

You have been automatically muted with video turned off.

Session is being recorded - link to the recording within 7

days along with the PowerPoint slides.

Resources from today’s session will be posted in Chat.

To ask a question, click on the Q&A icon.

You may adjust your audio by clicking Audio Settings.

Missouri Million Hearts Fall Virtual Partner Update

Sept. 15th, 2020

Host: Kris Kummerfeld, DHSS, Missouri Million Hearts Coordinator

Objectives

Presenter's name

Credentials

Million Hearts® 2022Senior Advisor Update

September 15, 2020

Judy Hannan, RN, MPH

Million Hearts® Senior Advisor

Division for Heart Disease and Stroke Prevention

Centers for Disease Control and Prevention

The opinions expressed by the speaker do not necessarily reflect the opinions of the US Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the Center for Medicare and Medicaid Services.

Disclaimer/Disclosure

• Aim: Prevent 1 million—or more—heart attacks and strokes by 2022

• National initiative co-led by:o Centers for Disease Control

and Prevention (CDC)o Centers for Medicare & Medicaid

Services (CMS)

• Partners across federal and state agencies and private organizations

Million Hearts® 2022

Relative Event Contributionsto “the Million”

Notes: Aspirin when appropriate reflects aspirin use for secondary prevention only; total does not equal sum of events prevented by risk factor type as those totals are not

mutually exclusive; applies ratios obtained from PRISM and ModelHealth:CVD to estimate the number of total events, to more closely align with the Million Hearts event

definition

Data sources: Aspirin when appropriate – 2013-14 NHANES; blood pressure control and cholesterol management – 2011-14 NHANES; smoking cessation and physical

inactivity – 2015 NHIS, sodium reduction – 2011-12 NHANES.

0

100,000

200,000

300,000

400,000

500,000

600,000

Aspirin WhenAppropriate

Blood PressureControl

CholesterolManagement

SmokingCessation

PhysicalInactivity

SodiumReduction

Estim

ate

d e

ve

nts

pre

ve

nte

d d

urin

g 2

01

7-2

02

1

Improving Outcomes for Priority Populations

Population Intervention Needs Strategies

Blacks/AfricanAmericans with Hypertension

• Improving hypertension control• Targeted protocols• Medication adherence strategies

35- to 64-year-olds• Improving HTN control and statin use• Decreasing physical inactivity

• Targeted protocols• Community-based program enrollment

People who have had a heart attack or stroke

• Increasing cardiac rehab referral and participation

• Avoiding exposure to particulate matter• Increasing influenza vaccine uptake

• Automated referrals, hospital CR liaisons, referrals to convenient locations

• Air Quality Index tools• Offer vaccination during routine health care visits and

hospitalizations

People with mental illness or substanceabuse disorders

• Reducing tobacco use

• Integrating tobacco cessation into behavioral health treatment • Tobacco-free mental health and substance use treatment

campuses• Tailored quitline protocols

Lange SJ, Ritchey MD, Goodman AB, et al. Potential Indirect Effects of the COVID-19

Pandemic on Use of Emergency Departments for Acute Life-Threatening Conditions

— United States, January–May 2020. MMWR Morb Mortal Wkly Rep. ePub: 22 June

2020. DOI: http://dx.doi.org/10.15585/mmwr.mm6925e2

Impact of Pandemic(MMWR)

Stokes EK, Zambrano LD, Anderson KN, et al. Coronavirus Disease 2019 Case

Surveillance — United States, January 22–May 30, 2020. MMWR Morb Mortal Wkly

Rep 2020;69:759–765. DOI: http://dx.doi.org/10.15585/mmwr.mm6924e2

https://www.cdc.gov/mmwr/index.html

PSAs

Ongoing promotion:

• E newsletter

• Earned promotion

• USA today insert

• Other….

Early Reach:

• HHS Digital Digest: ~700

• MH Partner List: 916

• Dear Colleague: 1,372

• Facebook: 1,902 engagements

• Instagram: 1,345 impressions

• Twitter: 230,848 impressions

• LinkedIn: 24,118 impressions

• Surgeon General Twitter & Facebook

• 120.5K tweet views

• Partner Toolkit includes:• Key messages related to

cardiovascular health and COVID-19• PSA links• Social media graphics and posts• Digital communications

• Dropbox contains the Million Hearts PSAs, Social Graphics, and Toolkit.

PSA Partner Toolkit

Current Challenges / Concerns / Gaps in Care

• 118 M Americans living with Hypertension

• Disruption of Ambulatory care

• Need for Medication Access and Adherence

• Impact on lifestyle implementation

• Disruption of cardiac rehabilitation

Khera A, et al, Am J Prev Cardiol 2020;1:1-10

Presenter's name

Credentials

“In the midst of difficulty lies

opportunity…”

Albert Einstein

Optimizing Opportunities

• Acceleration of New Care Models

• Telehealth/telemedicine

• Decreased use of low-value care

• Volume to value transformation

• Healthcare integration/consolidation

Poppas A, et al, JACC 2020; 75(3):2989-2991

Khera A, et al, Am J Prev Cardiol 2020;1:1-10

Flu and Cardiovascular Disease

• Studies have shown that flu is associated with an increase of heart

attacks and stroke.

• Flu vaccination is an AHA/ACC Class 1B Recommendation for Secondary

Prevention for patients with cardiovascular disease.

https://www.cdc.gov/flu/highrisk/heartdisease.htm

Smith SC, Allen J, Blair SN, et al. AHA/ACC guidelines for secondary prevention for patients with coronary and other atherosclerotic

vascular disease: 2006 update. Circulation. 2006;113:2363–2372.

MacIntyre CR, Mahimbo A, Moa AM, et al. Influenza vaccine as a coronary intervention for prevention of myocardial infarction. Heart.

2016;102:1953-1956.

• Flu vaccinations have shown to prevent

heart attacks by 15% to 45%.

• A flu vaccine recommendation makes a

difference; Together we can help fight the

flu and protect heart health.

Current Science

• Acute Cardiovascular Events Associated With

Influenza in Hospitalized Adults: A Cross-sectional

Study Annals of Internal Medicine

• Invited JAMA Cardiology article “Disparities in Influenza Vaccination: Imperative to Extend Cardiovascular Prevention to Millions of Hearts”

CVD and Flu this year

Million Hearts® Hospitals & Health Systems Recognition Program

• A new program to recognize institutions working to improve the

cardiovascular health of the population & communities they serve by:

1. Keeping People Healthy

2. Optimizing Care

3. Improving Outcomes for

Priority Populations

4. Innovating for Health

• Applicants apply online by October 31, 2020 for the third quarter.

• Million Hearts® will publicly recognize top-performing Million Hearts®

Hospitals and Health Systems

Apply today at https://millionhearts.hhs.gov/partners-progress/hospitals-health-

systems/index.html

Hypertension Control Change Package (HCCP) 2nd Edition, 2020

Access the Change Package at:

https://millionhearts.hhs.gov/tools-protocols/action-

guides/htn-change-package/index.html

• Includes 253 tools from 87 organizations

• Capitalizes on 7 years of MH Hypertension Control Champions

• Explores potentially undiagnosed hypertension

• Added new strategies that focus on chronic kidney disease (CKD) testing

and identification

• Provides more patient supports for lifestyle modifications

• Features more self-measured blood pressure monitoring (SMBP) resources

HCCP 2020

SMBP Roles

21

Million Hearts® Resources

• Hypertension Control Change Package (Second Edition) (May 2020)

• Self-Measured Blood Pressure Monitoring (SMBP) for Pregnant and Post-Partum Women (June 2020)

New Million Hearts® Partner Resources

• Topline Findings: A National Analysis of Self-Measured Blood Pressure Monitoring Coverage and

Reimbursement (March 2020)

• Self-Measured Blood Pressure Monitoring at Home: A Joint Policy Statement From the AHA and AMA

(June 2020)

• American Medical Association (AMA) Resources (June 2020)

o 7-Step SMBP Quick Guide

o ValidateBP.org

o SMBP cuff selection instructions

o SMBP CPT® coding

• Release the Pressure Campaign (June 2020): AMA/AHA/ABC/NMA/AMA Foundation with Essence

magazine consumer campaign

New SMBP Resources and Initiatives

Register for the next SMBP Forum here: http://bit.ly/SMBPRegistration and/or email

MillionHeartsSMBP@nachc.org.

Million Hearts® Hospitals & Health Systems Recognition Program

• A new program to recognize institutions working to improve the

cardiovascular health of the population & communities they serve by:

1. Keeping People Healthy

2. Optimizing Care

3. Improving Outcomes for

Priority Populations

4. Innovating for Health

• Applicants apply online by October 31, 2020 for the third quarter.

• Million Hearts® will publicly recognize top-performing Million Hearts®

Hospitals and Health Systems

Apply today at https://millionhearts.hhs.gov/partners-progress/hospitals-health-

systems/index.html

• A toolkit to help health departments and municipal organizations implement

Million Hearts® strategies at a local level.

• Includes 5 modules:1. Overview

2. Setting Goals

3. Partnerships

4. Communication

5. Evaluation and Monitoring

• Each module offers: • Key concepts, principles, and resources

• Tips and problem-solving solutions

• Readiness Assessment worksheets and the

Action Plan Template

The Toolkit and Million Hearts® Municipalities Success Stories are accessible online at: https://millionhearts.hhs.gov/tools-

protocols/tools/municipalities.html

Million Hearts® in Municipalities Toolkit

• Hypertension Control Change Package, Second

Editionhttps://millionhearts.hhs.gov/tools-protocols/action-guides/htn-

change-package/index.html

• Self-Measured Blood Pressure Monitoringhttps://millionhearts.hhs.gov/tools-protocols/smbp.html

• Cholesterol Managementhttps://millionhearts.hhs.gov/tools-protocols/tools/cholesterol-

management.html

• Medication Adherencehttps://millionhearts.hhs.gov/tools-protocols/medication-

adherence.html

• Cardiac Rehabilitationhttps://millionhearts.hhs.gov/tools-protocols/tools/cardiac-

rehabilitation.html

Million Hearts® Resources

• Million Hearts® Hypertension Control Champions

https://millionhearts.hhs.gov/partners-progress/champions/index.html

• Million Hearts® Hospitals & Health Systems Recognition Program

https://millionhearts.hhs.gov/partners-progress/hospitals-health-systems/index.html

• Cholesterol Change Package – Coming soon

• CDC Foundation Communications Campaign

• National Hypertension Roundtable

• Surgeon General Call To Action on Hypertension

Million Hearts® 2020 Update

More on Million Hearts at Millionhearts.hhs.gov

Reach us at MillionHearts@cdc.gov

Twitter @MillionHeartsUS

Facebook @MillionHearts

A Million Thanks!

Implementing Self-Measured

Blood Pressure:

7 Steps for SMBP and more

• Outline steps to use Self-Measured Blood

Pressure (SMBP)

• Review available resources to support

implementation and awareness of SMBP

Objectives

Improving Health Outcomes

1No new

preventable cases

of type 2 diabetes

2Everyone with

hypertension has their blood pressure at goal

Defining Self-Measured Blood Pressure

Self-measured

blood pressure (SMBP)

refers to blood pressure

(BP) measurements

obtained by the patient

outside of a clinical setting

“Self-monitoring alone is not associated with lower BP or better control,

but in conjunction with co-interventions (including systematic

medication titration by doctors, pharmacists, or patients; education; or

lifestyle counselling) leads to clinically significant BP reduction which

persists for at least 12 months. The implementation of self-monitoring

in hypertension should be accompanied by such co-interventions.”

Tucker KL, Sheppard JP, Stevens R, Bosworth HB, Bove A, Bray EP, Earle K, George J, Godwin M, Green BB, et al. Self-monitoring of blood pressure in hypertension: a systematic review and individual patient data meta-analysis. PLoS Med. 2017;14:e1002389.

doi: 10.1371/journal.pmed.1002389

Using SMBP in clinical practice

Using SMBP in clinical practice

HOW SMBP can be used to:• Confirm a diagnosis of sustained hypertension, white coat hypertension or

masked hypertension

• Assess BP control and effectiveness of changes in treatment

• Engage patients in self-management of BP

WHEN SMBP can be used:• Before or after a scheduled encounter

• After a medication or treatment change

• At clinician discretion

WHO Physicians, other clinical team members, patients

www.ama-assn.org/smbp-guide

7 Steps for SMBP

1 Identify patients for SMBP

2 Confirm device validation and cuff size

3 Train patients

4 Have patients perform SMBP

5 Average results

6 Interpret results

7 Document plans and communicate to patients

7 Steps for SMBP

1 Identify patients for SMBP

• Patients with a confirmed diagnosis of HTN

• Patients without a diagnosis

2 Confirm device validation and cuff size

• Automated, validated BP measurement devices with

appropriately sized upper arm cuffs

• Adequate memory storage

7 Steps for SMBP

3 Train patients

• Educate on preparing for and performing SMBP

4 Have patients perform SMBP

• Provide instructions on duration of monitoring and

number of measurements to take each day (i.e. 7 days of

monitoring with 2 sets of measurements performed twice daily)

• Determine when and how results will be shared

7 Steps for SMBP

5 Average results

• Document and use average systolic and average

diastolic blood pressures for clinical decision-making

6 Interpret results

• Initiate, intensify or continue treatment

7 Document plans and communicate to patients

7 Steps for SMBP— sample resources

www.ama-

assn.org/smbp-guide

SMBP coding resources

US Blood Pressure Validated Device Listing™

The AMA does not play a role in how devices are included on the VDL. BP measurement devices are selected for listing on the VDL through an independent review process that determines which available BP measurement devices meet established VDL Criteria for the validation of clinical accuracy and is not in any way determined or influenced by the AMA.

www.validatebp.org

SMBP Policy Statement

© 2020 American Medical Association. All rights reserved.3

Shimbo D, Artinian NT, Basile JN, et al. Self-Measured Blood Pressure Monitoring at Home: A Joint Policy Statement From the American Heart Association and American Medical Association [published online ahead of print, 2020 Jun 22]. Circulation. 2020;CIR0000000000000803. doi:10.1161/CIR.0000000000000803

Overview: The Release the Pressure (RTP) campaign brings together a diverse

coalition of health care organizations – the RTP heart health squad – who are

dedicated to partnering with the Black community to improve heart health.Campaign Goals:

• 300K take the RTP Pledge

• 75K watch SMBP training video and download the BP tracking tool

• 40K join and engage in RTP virtual events

The Release the Pressure collaboration

Our Mission: Partner with Black women to take preventive action to protect

their heart health and be part of a movement for healthy blood pressure—the

leading risk factor for heart attack and stroke.

ReleaseThePressure.org

Take the Pledge:

Set a blood pressure goal with a

health care professional

Monitor your blood pressure at home

Activate your wellness plan

Check-in with your squad

Campaign Resources

Spread the Word

Help us make an even greater impact by sharing the RTP

campaign with your patients and networks

Kate Lichtenberg, DO, MPH, FAAFP

September 15, 2020

Missouri Million Hearts Partner Update

RESOLVED, That the American Academy of Family Physicians (AAFP) request the Centers for Medicare and Medicaid Services, National Coverage Determination for Cardiac Rehabilitation Programs rules be modified to allow for cardiac rehabilitation programs to operate with the general supervision of a physician when an Automated External Defibrillator (AED) is immediately available, and the patient is attended by nursing staff currently trained in Basic Life Support and AED use.

RESOLVED, That the American Academy of Family Physicians (AAFP) request the Centers for Medicare and Medicaid Services, National Coverage Determination for Cardiac Rehabilitation Programs rules be modified to allow for cardiac rehabilitation programs in rural counties to operate without the direct supervision of a physician when an Automated External Defibrillator (AED) is immediately available, and the patient is attended by nursing staff currently trained in Basic Life Support and AED use.

CMS 12th Statement of Work and Alignment with Million Hearts®

CMS 12th Statement of Work

What is a CMS Statement of Work (SOW)?

Every 5 Years CMS sets National Quality Improvement Healthcare Goals that are implemented by CMS designated Quality Improvement Networks /Quality Improvement Organizations (QIN/QIO’s) across the United States.

Current CMS 12th Statement of Work began November 2019 and ends November 2024.

52

Who we are: HQI/HQIN

HQI – Health Quality Innovators: CMS designated Quality Improvement Organization for state of Missouri

HQIN – Health Quality Innovation Network: CMS designated Quality Improvement Network includes VA, MO, KS, SC

53

HQI

HQI

CCME

KHC

KFMC

Health Quality Innovation Network

54

CMS Quality Improvement Priorities

55

Behavioral Health & Opioids

Patient & Resident

Safety

Chronic Disease Self-Management

Care Transitions

Nursing Home

Quality

Patient & Family Engagement, Rural Health, Vulnerable Populations

Chronic Disease Self ManagementCardiovascular Health with a Special Focus on Rural and

Vulnerable Populations

1.) Align with/support existing Million Hearts® efforts:

• Missouri Million Hearts® Partners

• Missouri Department of Health and Senior Services, Bureau of Cancer and Chronic Disease Control

• Local Public Health Agencies

• Heart Disease and Stroke Prevention Programs

• Chronic Disease Self Management/Education Programs (CDSMP/CDSMES)

• Health Care Systems, Providers, FQHC’s and RHC’s

• Partner Organizations and Stakeholders

To expand strategies for prevention, treatment and care coordination

56

Chronic Disease Self Management

Cardiovascular Health Goals:

Contribute to preventing one million Cardiovascular Events by 2024

1. Support Providers to achieve at least 80% performance on the ABCS of Cardiovascular Health (Aspirin, Blood Pressure, Cholesterol, Smoking) Clinical Quality Measures (CQM’s)

2. Promote use of Self Measured Blood Pressure (SMBP) in managing/controlling hypertension

3. Support efforts to increase referral and participation rates among those eligible for Cardiac Rehabilitation

4. Partner with existing efforts to spread/promote Chronic Disease Self Management/Education/Prevention Programs (CDSMP/CDSMES) within communities

57

2020 MIPS Clinical Quality Measures (CQMs) for Cardiovascular Health

1. Preventive Care and Screening: Screening for High Blood Pressure and Follow Up Quality ID #317

2. Controlling High Blood Pressure – Quality ID #236

3. Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention – Quality ID #226

4. Coronary Artery Disease (CAD) Antiplatelet Therapy – Quality ID #6

5. Statin Therapy for the Prevention of Cardiovascular Disease – Quality ID #438

6. New: Cardiac Rehabilitation Patient Referral from an Outpatient Setting – Quality ID #243

58

2020 UDS (eCQM) Quality of Care Measures

Cardiac and Vascular Health

1. Controlling High Blood Pressure eCQM CMS165v8

2. Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention eCQM CMS138v8

3. Statin Therapy for the Prevention and Treatment of Cardiovascular Disease eCQM CMS347v3

4. Ischemic Vascular Disease (IVD): Use of Aspirin or Another Antiplatelet eCQM CMS164v7

(Full 2020 UDS Quality of Care Measure Set available upon request)

59

2020 CMS Web Interface Measures (CWI)

10 CWI Measures Total (Same as 2019) - 3 Are Cardiovascular

1. HTN-2: Hypertension: Controlling High Blood Pressure

2. PREV 10: Tobacco Use: Screening and Cessation Intervention

3. PREV 13: Statin Therapy for the Prevention of Cardiovascular Disease

(Full 2020 CMS Web Interface Measure Set available upon request)

60

Cardiovascular Health Quality Improvement

Through the collective effort of public and private sector partners, Million Hearts® aims to prevent one million heart attacks, strokes,

and related cardiac and vascular events over 5 years.

We, at HQI, as your CMS designated Quality Improvement Organization (QIO) are committed to providing resources and support to partners, providers and communities to further the Million Hearts® initiative and to improve cardiovascular health

outcomes for the state of Missouri.

61

FOR MORE INFORMATIONCall 877.731.4746 or visit www.hqin.org

Mary Ann KimbelQuality Improvement Advisor

mkimbel@hqi.solutions

314-391-5566

www.hqin.org

CONNECT WITH USCall 877.731.4746 or visit www.hqin.org

@HQINetwork

Health Quality Innovation Network

Patient Engagement Materials

Mercy Clinic East Communities

Missouri Million Hearts Partner Update

September 15th, 2020

I L L I N O I S

I O W A

A R K A N S A SO K L A H O M A

Hospitals & Ambulatory Sites

4 acute care hospitals

1 managed/affiliated hospital

1 heart hospital

1 rehab hospital

1 children's hospital

1 virtual care center

283 physician practices

95 clinic locations

3 outpatient surgery centers

11 urgent care sites

3 convenient care centers

16,286 co-workers (incl. 707 physicians)

Utilization FY16

1,263 staffed beds

10,286 births

53,865 surgeries

58,670 inpatient discharges

3,549,921 outpatient/office visits

175,165 ED visits

East Community

| 66

Partnership - Adult Health LiteracyFunded by DHSS 1305 Cooperative Agreement

Goal: Develop Easy to Use, Patient Engagement Tools

Kris Kummerfeld

MHA

MO Million Hearts

Bureau of Cancer and Chronic Disease Control

MO Department of Health and Senior Services

Jeanette Holtmeyer

RN, MSN, CIC

Director of Quality and Safety East Community Clinics

4- Wellness Nurses

Elizabeth Brinker RN, Kelly Rogers RN, Christina Blankenship RN, and

Kathleen Schrader RN

Mercy Health System

Lakshmi Venkitachalam

PhD, FAHA

International Science Program Director, Better Hearts Better Cities

American Heart Association

75 |

Utilization of Hand-outs

– Annual Wellness Visits performed by Wellness Nurses

• If patients have health concerns which need follow-up by their primary care physicians

– Exercise

– Low salt diet

– High Cholesterol

– Hypertension

– Healthy Eating

– How to read a label

– Hand-out given for patients to bring to their physicians with questions.

– Hand-outs well received by patients, easy to use and understand

• Medicare population loves the hand-outs

– Available on the EPIC dashboard

• Downside– Unable to integrate into our EMR

– Manual process

76 |

Blood Pressure Control • 2014- 2018 -Participated in Measure Up and Pressure Down (MUPD)

– 100 Primary Care Clinics – Rate 80%

– Sustaining Metrics:

• Send out transparency reports to practices and providers

• Compelling data regarding success

• Feb. yearly myeducation (BP accuracy) for all frontline coworkers (Heart Month)

• Rounded in clinics– right location and right equipment

• Algorithm in EPIC with interactive encounter guide

• Healthwise content on after visit summary – patient involvement

• Self- Monitoring Blood Pressure

• Member of Accelerating SMBP across Missouri – Missouri Department of Health and

Senior Services

– 7 Practices participation

– 1 more practice joining Sept.

• Blood Pressure metrics during COVID – (March – August) - 78.9%

What a difference a few Percentage points can make in Hypertension

Total East Community patients with HTN: 107,315

Number of patients needed to treat for 5 years to prevent one heart attack or

one stroke: 35

Heart attacks or strokes potentially avoided: 686

81 |

2019 AHA CCCC Gold Status Award

• Check. Change. Control. Cholesterol™ is a national initiative to bring cholesterol management to the attention of patients and providers.

• Gold Status was awarded to healthcare entities who achieved ≥ 70% appropriate statin therapy use in their patient population (patients 21-75y).

– Mercy Clinic Four Rivers

– Mercy Clinic St. Louis

– Mercy Clinic Jefferson

– Mercy Clinic Lincoln

82 |

2019 TARGET: BP Recognition for Gold Level Status is awarded to:

Mercy Clinic East Community

Mercy Clinic Four Rivers is one of just 542 physician practices and health systems to be recognized nationwide for achieving blood pressure control rates of 70 percent or more in their adult patient population with high blood pressure. A total of 1,183 physician practices and health systems

nationwide were recognized by the program for their commitment to help patients improve blood pressure control. The recognized organizations represent 29.8 million adult patients, with more than 8 million patients diagnosed with hypertension, across 46 states and territories.

Helping Healthcare Get Better | mpro.org

Elise DeYoung, MPH

Missouri Self-Measured

Blood Pressure Program

Who is MPRO?

• Nonprofit organization based in Michigan

• CMS-designated Quality Improvement

Organization

• Committed to improving the quality, safety and

efficiency of health care

QUALITY

IMPROVEMENT

REVIEW

SERVICESCONSULTING

SERVICES

Purpose

• MPRO & MO DHSS have partnered to increase the utilization of self-measured blood pressure (SMBP) monitoring in the clinical setting

• Focus on metro areas of St. Louis, Kansas City, and Springfield

• Through this initiative, clinics have received free one-on-one assistance with implementing an SMBP program along with free digital blood pressure monitors and cuffs

SMBP Initiative

Purpose

To support clinics with implementing and

sustaining SMBP monitoring programs for at least

100 patients

Patient Impact

Improve outcomes for patients with hypertension,

improve patient knowledge, improve clinic

processes, enhance medication adherence, and

enhance the quality and accessibility of care for

people with high blood pressure

SMBP Monitoring

• SMBP monitoring involves a patient’s regular

use of personal blood pressure monitoring

devices to assess and record blood pressure

across different points in time outside of a

clinical, community, or public setting, typically at

home (CDC)

SMBP Initiative Year 1

Structure

• On-site partnership meetingo Commit to the initiative

• Data monitoring and bi-weekly check-ins

o Personalized technical assistance

• SMBP training session – early November o 1-day face-to-face training for clinical staff

• Six-week teleECHO to spread knowledge and

best practices – January-March

• Sustainability of SMBP program

Year 1 Summary

• Clinics enrolled: 23/19

• Number of patients enrolled to date: 261

• Number of HTN protocols changed to

incorporate SMBP: 17

SMBP Initiative Year 2

• Virtual focusStructure

• Virtual partnership meetingo Commit to the initiative

• Data monitoring and bi-weekly/bi-monthly check-ins

o Personalized technical assistance

• Virtual SMBP training session – Septembero 6-week, 1 hour/week virtual training for clinical staff

• Six-month, 1 hour/month teleECHO to spread knowledge and best practices – January-June

• Sustainability of SMBP program

Other Activities• Community Health Worker teleECHO – SMBP and

Cholesterol Management: https://www.youtube.com/playlist?list=PLfBz2fAm9MGo7e1UEfVGUZwGs7Can_vlV– SMBP Session 1: The CHW’s Role in SMBP

– SMBP Session 2: Continuous Engagement of Patients in SMBP

– SMBP Session 3: Motivational Interviewing Strategies

– Cholesterol Session 1: Engaging Patients in Cholesterol Management

– Cholesterol Session 2: Medication Adherence

– Cholesterol Session 3: How CHWs Can Support Patients with High Blood Cholesterol

• COVID-19 SMBP Clinic Calls

Helping Healthcare Get Better22671 Haggerty Road, Suite 100

Farmington Hills, MI 48335

248-465-7300 | mpro.org

Elise DeYoung, MPH: edeyoung@mpro.org

Questions?

95

AMERICAN HEART ASSOCIATION

Community Impact Team

Rachelle Bartnick Erin Gabert

Rachelle.Bartnick@heart.org Erin.Gabert@heart.org

St. Louis Kansas City

96

Advocacy/Voices

Quality & Systems

Improvement

Resuscitation Quality

Improvement

Health and Safety/CPR

Community Impact Staff Communications Staff

Social Impact Fund

Mission Advancement

National and Field CR

Driving Equitable Health Impact for Communities

Revenue Generation Staff

Communi-cations

Our Local Feet on the Ground

Nationwide Activities Impacting Community Health

Office of Health Equity Provides Technical Assistance Association-Wide

Volunteers

97

9898

AMBULATORY PROGRAMS

When healthcare providers apply the most up-to-date evidence-based treatment guidelines, outpatient outcomes improve and lives can be saved! That’s the simple truth behind our drive for continuous quality improvement.

The American Heart Association’s comprehensive suite of ambulatory care quality improvement initiatives can help you advance further and faster in the quest for better outpatient care. Our initiatives work together to reduce cardiovascular deaths, heart attacks, and strokes among the 100 million+ Americans living with hypertension, cholesterol , and/or Type 2 Diabetes.

99

RESOURCES AVAILABLE

• M.A.P. FRAMEWORK

• MANAGEMENT GUIDE

• WEBINARS

• PODCAST SERIES

• PATIENT & PROVIDER RESOURCES

• CME/CE OPPORTUNITIES TRANSLATING THE LATEST EVIDENCE INTO PRACTICE

• NATIONAL RECOGNITION WITH ANNUAL DATA SUBMISSION

100

RESOURCES AVAILABLE

• ASVD RISK CALCULATOR

• MANAGEMENT GUIDE

• WEBINARS

• PODCAST SERIES

• PATIENT & PROVIDER RESOURCES

• CME/CE OPPORTUNITIES TRANSLATING THE LATEST EVIDENCE INTO PRACTICE

• NATIONAL RECOGNITION WITH ANNUAL DATA SUBMISSION

101

RESOURCES AVAILABLE

• ASCVD RISK CALCULATOR

• IMPLEMENTATION GUIDE

• WEBINARS

• PODCAST SERIES

• PATIENT & PROVIDER RESOURCES

• CME/CE OPPORTUNITIES TRANSLATING THE LATEST EVIDENCE INTO PRACTICE

• NATIONAL RECOGNITION WITH ANNUAL DATA SUBMISSION

102

REGISTRATION

ALL REGISTRATIONS MUST BE COMPLETED ONLINE. TO REGISTER, YOU WILL NEED TO KNOW THE FOLLOWING:

• YOUR ORGANIZATION’S CONTACT INFORMATION

• YOUR ORGANIZATION’S TOTAL ADULT (18-85 YEARS) PATIENT POPULATION COUNT

• YOUR ORGANIZATION’S TOTAL ADULT PATIENTS (18-85 YEARS) THAT ARE A RACE OTHER THAN WHITE AND/OR IDENTIFY AS HISPANIC OR LATINO ETHNICITY

• THE TOTAL NUMBER OF CLINIC LOCATIONS IN YOUR HEALTH SYSTEM. NOTE: YOU MAY REGISTER EACH OF YOUR HEALTH CENTER LOCATIONS INDIVIDUALLY OR AS A SYSTEM OVERALL.

• YOUR ORGANIZATION’S CHARACTERISTICS, SUCH AS MULTI-SPECIALTY, FEDERALLY QUALIFIED HEALTH CENTER, ETC.

REGISTER FOR ALL THREE AT:

HTTP://AMERICANHEART.CO1.QUALTRICS.COM/JFE/FORM/SV_9RGQY2CIMBOTBEF

103

POLICY, SYSTEMS, ENVIRONMENTAL CHANGES FOR BLOOD PRESSURE CONTROL

Measure AccuratelyPost the red graphic (positioning poster) in every exam room

Require all clinical team members to complete a training on how to measure blood pressure accurately

Institute monthly or quarterly technique quick checks to ensure compliance with accurate measurement

standards

Act RapidlyEmploy population health software to identify and outreach to patients with uncontrolled high blood

pressure Develop and implement a protocol for notifying clinical team lead if a patient in for a visit presents with a

high blood pressure readingAdopt a standardized treatment protocol (using existing protocols or one custom developed)

Partner with PatientsEstablish a self-monitoring bp loaner programSet up an in-clinic self-monitoring bp station

Require all clinical team members to complete a training on evidence-based collaborative communication

Formally integrate bi-directional lifestyle modification referrals or interventions into protocols (e.g., Y

BPSM; Rx for tobacco cessation, weight management, physical activity, fruit and veggies)

Announcements• Million Hearts® PSAs Million Hearts® has released two PSAs to help promote and protect

heart health during and beyond the COVID-19 pandemic. These include the “Emergency Care for Heart Disease During COVID-19” PSA and the “Maintaining Heart Health During COVID-19” PSA. See the attached Partner Activation Toolkit which provides sample social media posts, digital communications copy and messaging to support your dissemination. Send questions to millionhearts@cdc.gov, with “Million Hearts® PSAs” in the subject line.

• Release the Pressure Campaign AMA, AMA Foundation, Association of Black Cardiologists, American Heart Association (AHA), Minority Health Institute and National Medical Association, in collaboration with ESSENCE – one of the most trusted media outlets for Black women, have launched the “Release the Pressure” Campaign.

• The campaign begins with a feature in the 50th anniversary edition of ESSENCE magazine, a press release announcement, and website featuring a variety of patient-facing resources, with additional virtual events to roll out over 2020-2021. We expect to reach more than 300,000 Black women through the campaign and virtual events. We encourage you to visit the campaign microsite to take the pledge, check out our campaign resources and spread the word to your networks.

• Contact Lauren Barbian of the American Medical Association at Lauren.Barbian@ama-assn.org for information about getting involved in the Release the Pressure Campaign. The Release the Pressure BP Measurement Training is available at: https://youtu.be/qObBwGZPLkU. Also see the attachment about the Campaign’s social media toolkit.

Announcements (Cont):

• Million Hearts® Hospitals & Health Systems Recognition Program The Million Hearts® Hospitals & Health Systems Recognition Program launched on February 12th. This program recognizes institutions working systematically to improve the cardiovascular health of the population and communities they serve through the priority areas of (1) keeping people healthy, (2) optimizing care, (3) improving outcomes for priority populations, and (4) innovating for health. Top performing hospitals and health systems will receive public recognition. The next quarterly submission deadline is October 31, 2020. To apply, please visit https://hospitals.millionhearts.hhs.gov/. Check out the spotlight on Eisenhower Health, the first Million Hearts® Hospital & Health System designee at https://millionhearts.hhs.gov/partners-progress/hospitals-health-systems/eisenhower-health.html.

• Mid-America Coalition on Health Care - 8th Annual 2020 Health & Productivity Forum, October 1 – 2, 2020 Virtual Event 8-Noon each day. Member Registration fee $50.00 Non-Member Registration Fee $175.00 https://www.machc.org/2020-workforce-well-being-forum

• Advancing the Response to COVID-19: Sharing Promising Programs and Practices for and Ethnic Minority Communities, is a virtual symposium hosted by the HHS Office of Minority Health (OMH) on September 17. Register today to learn from national, state, tribal and local experts leading these efforts to confront the disproportionate impact of the pandemic on racial and ethnic minority populations.

Announcements (Cont):

• AAFP story on removing barriers for cardiac rehab in rural areas The letter referenced in the article is the result of a resolution that the Missouri Academy of Family Physicians submitted to the AAFP Congress of Delegates in 2019. AAFP seeks change in NCD for cardiac rehab programs The AAFP asked the CMS to change the National Coverage Determination for Cardiac Rehabilitation Programs for Chronic Heart Failure allowing programs to operate with a physician's "general supervision," even if the physician is not immediately accessible, under certain conditions. The Academy wants the change to help ensure access to cardiac rehab in rural areas. Full Story: AAFP News (8/19)

• AHA POLICY STATEMENT• Self-Measured Blood Pressure Monitoring at Home: A Joint Policy Statement From the

American Heart Association and American Medical Association Daichi Shimbo, MD, Chair, Nancy T. Artinian, PhD, RN, FAHA, Jan N. Basile, MD, FAHA, Lawrence R. Krakoff, MD, FAHA, Karen L. Margolis, MD, MPH, Michael K. Rakotz, MD, FAHA, Gregory Wozniak, PhD, and On behalf of the American Heart Association and the American Medical Association https://doi.org/10.1161/CIR.0000000000000803

• National Forum for Heart Disease and Stroke Annual Meeting Thursday, October 15th 10:00 am – 2:30 pm CST https://www.nationalforum.org/collaborations/2020-annual-meeting/

Blood Pressure Magnets Available from DHSS

Blood Pressure Magnet Order Form

Catalog # 239 Blood Pressure Magnets Form Link

https://health.mo.gov/warehouse/e-l-ccdc.html

Please use the Request for Literature form provided

Limit is 100 per organization

Upcoming Calls/Events

• Million Hearts Partners Call -Sept 22nd, 10:30 – 11:30 AM (Monthly) Email millionhearts@cdc.gov to subscribe to the Million Hearts® Partner Call.

• To stay up-to-date on the latest Million Hearts® tools, resources and updates,

subscribe to the e-Update at https://millionhearts.hhs.gov/news-media/news.html. Click “Subscribe Today”.

• Million Hearts SMBP Forum -Dec 10th 12:00 PM – 1:00 PM (Quarterly) E-mail: MillionHeartsSMBP@nachc.org

• Million Heart Cardiac Rehab Collaborative – Nov 18th 11:00 am-12:30 pm (Quarterly) E-mail: MillionHeartsCRC@cdc.gov

• TAKEheart Cardiac Rehab Affinity Group: Safely reopening During COVID 19 -Sept 16th, 12:00 – 1:00 PM (Monthly) https://takeheart.ahrq.gov/join-takeheart/join-million-hearts-collaborative

• MO MH Cardiac Rehab Collaborative Roundtable -Oct (TBD), 2020

Questions??

Thank You!

Next Meeting:

Missouri Million Hearts Partner Call: December 8th, 2020 10:00 am -11:30 am

Additional Partner Updates will be sent out with slides and recording

Contact: Kris Kummerfeld: Kris.Kummerfeld@health.mo.gov or

Mary Ann Kimbel: mkimbel@hqi.solutions