WHA’s Annual Integrated Healthcare Association’s (IHA) Align. Measure. Perform. (AMP) assessment of Performance Results.
NCQA Measure: Controlling High Blood Pressure (CBP)
Healthcare providers and Health Plans can help individuals manage their high blood pressure by prescribing medications, encouraging low-sodium diets, increased physical activity and smoking cessation.
Numerator Criteria: HEDIS MY2022
The percentage of members 18-85 years of age who had a diagnosis of HTN and whose BP was adequately controlled during the measurement year based on the following:
- Members 18-59 years of age with a diagnosis of HTN whose BP was <140/90 mm Hg.
- Both a representative systolic BP <140 mm Hg and a representative diastolic BP of <90 mm Hg.
- The most recent BP reading during measurement year on or after the second diagnosis of HTN.
The CBP rate results for MY2022 by Medical Group/IPA are shown in the table below with results from the previous three years for comparison.
|
CONTROLLING
HIGH BLOOD PRESSURE |
WHA MY2020
|
WHA MY2021
|
WHA MY2022
|
NCQA
MY2022 %tile Rank |
NCQA MY2022
90TH PERCENTILE RANK GOAL |
|---|---|---|---|---|---|
|
Commercial
|
66.18
|
69.62
|
69.54
|
50th
|
75.67
|
|
Covered California
|
58.15
|
59.12
|
58.29
|
N/A
|
N/A
|
|
Medicare Advantage*
|
|
69.67
|
68.97
|
N/A
|
N/A
|
*MY2021 first year reporting Medicare Advantage
Medical Ratings Group:
|
CBP RESULTS BY MEDICAL GROUP
|
CBP
RATE MY MY2019 |
MY2019
SAMPLE |
CBP RATE MY 2021
|
MY2021 SAMPLE
|
CBP RATE MY 2022
|
MY2021 SAMPLE
|
|---|---|---|---|---|---|---|
|
A
|
66.47
|
4,670
|
65.79
|
3,842
|
79.03
|
3,858
|
|
B
|
62.23
|
4,083
|
78.66
|
3,694
|
62.10
|
3,541
|
|
C
|
14.01
|
842
|
26.84
|
585
|
70
|
278
|
|
D
|
66.07
|
952
|
66.12
|
735
|
77.50
|
702
|
|
E
|
|
|
40.97
|
393
|
72.73
|
384
|
|
F
|
57.23
|
1,459
|
65.41
|
1,009
|
53.85
|
4,090
|
|
WHA Total
|
58.53
|
13,534
|
64.98
|
10,397
|
64.98
|
10,397
|
Note: The results are reported by Medical Group/IPA, with names removed to maintain confidentiality. For questions regarding specific Medical Group results contact your PMG/IPA Medical Director or WHA’s Chief Medical Officer, Dr. Khuram Arif.
Each of WHA’s Medical Groups/IPAs participates in the American Medical Group Foundation program. The “Controlling Blood Pressure for People with Hypertension” measure is included in the Clinical Domain. http://www.measureuppressuredown.com/
IMPROVEMENT ACTIVITIES
WHA’s QI Committee identified factors that may contribute to poor Hypertension management. The “Measure Up -- Pressure Down” Provider Toolkit from the American Medical Group Foundation (AMGF) has been recommended for quality improvement activities.
MEASURE UP – PRESSURE DOWN” CAMPAIGN PLANKS
Based on best practices from the AMGF hypertension collaborative and consultation with the campaign’s National Steering Committee and Scientific Advisory Council, AMGF has identified eight Process Planks for achieving optimum hypertension outcomes. Each participating organization is asked to implement as many of the Primary Process Planks as possible to achieve the campaign goal of 80% of hypertension patients at goal according to JNC 7. To achieve breakthrough results, organizations may find it necessary to implement one or more of the Value-Add Process Planks.
PRIMARY PROCESS PLANKS:
- Direct Care Staff Trained in Accurate BP Measurement
- Hypertension Guide Used and Adherence Monitored
- BP Addressed for Every Hypertension Patient, Every Primary Care Visit
- All Patients Not at Goal or with New Rx Seen within 30 Days
- Prevention, Engagement, and Self-Management Program in Place
PRIMARY PROCESS PLANKS:
- Direct Care Staff Trained in Accurate BP Measurement
- Hypertension Guide Used and Adherence Monitored
- BP Addressed for Every Hypertension Patient, Every Primary Care Visit
- All Patients Not at Goal or with New Rx Seen within 30 Days
- Prevention, Engagement, and Self-Management Program in Place
POTENTIAL BARRIERS AND INTERVENTIONS INCLUDE:
|
BARRIERS
|
INTERVENTIONS
|
|---|---|
|
Office staff lack of knowledge may contribute to inaccurate BP monitoring and BP documentation, with inconsistent information to patients.
|
“Measure Up -- Pressure Down” Provider Toolkit Plank 1, Training Direct Care Staff in Accurate BP Measurement
|
|
Providers or mid-level AHP staff may have limited knowledge of Hypertension CPGs.
|
Provide the CPG, Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7) on the website, in newsletter. “Measure Up -- Pressure Down” Provider Toolkit Plank 2, Hypertension Guide Used and Adherence Monitored.
|
|
BPs may not be taken or not documented at every visit. Transition to EHR may create confusion as to where to enter the BP, repeat BPs, and/or how to use the VS flow sheets.
|
Review documentation practices and retraining after implementation or upgrade of EHR.
Ensure consistent use of VS flow sheets. “Measure Up -- Pressure Down” Provider Toolkit Plank 3, BP Addressed for Every HTN Patient at Every PCP Visit. |
|
Patients not meeting BP goal, or with new Rx therapy, may not have timely follow-up scheduled.
|
“Measure Up -- Pressure Down” Provider Toolkit Plank 4, All Patients Not at Goal or with New Rx are seen within 30 days.
|
|
Member’s may have limited knowledge of hypertension, risk factors, prevention, symptoms, treatment, and self-management goals.
|
Provide patient education materials on controlling hypertension in targeted mailings. Include articles on controlling hypertension in the member magazine.
“Measure Up -- Pressure Down” Provider Toolkit Plank 5, Prevention, Engagement, and Self-Management Program in Place. |
|
Patients may be non-compliant with follow-up visits and/or non-adherent with anti-hypertensive medication. Lack of provider systems/processes to track HTN patients.
|
Use of follow-up, recall system for failed or cancelled appointments.
“Measure Up -- Pressure Down” Provider Toolkit Plank 6, Use of Hypertension Registry. |
Resources: The American Medical Group Foundation (AMGF) “Measure Up -- Pressure Down” Provider Toolkit to Improve Hypertension is available at measureuppressuredown.com; click on the Health Care Professionals button.
Centers for Disease Control and Prevention. (2021, March 22). Hypertension Management Program (HMP) toolkit. Centers for Disease Control and Prevention. Retrieved September 8, 2022, from https://www.cdc.gov/dhdsp/pubs/toolkits/hmp-toolkit/index.htm
O'Neill, A. (2021, December 17). Controlling high blood pressure. NCQA. Retrieved September 8, 2022, from https://www.ncqa.org/hedis/measures/controlling-high-blood-pressure/
Wihi: Measure up, (blood) pressure down: 80% by 2016: IHI. Institute for Healthcare Improvement. (n.d.). Retrieved September 8, 2022, from http://www.ihi.org/resources/Pages/AudioandVideo/WIHIMeasureUpPressureDown.aspx
Last review date: February 16, 2024