The Central Role of Physician Leadership for Driving Change in Value-Based Care Environments.

BACKGROUND: In 2013, it was reported that about 1 of every 3 U.S. adults has hypertension. Of these 70 million individuals, approximately 50% have their blood pressure under control. Achieving hypertension control, especially in at-risk populations, requires a multipronged approach that includes lifestyle modifications and pharmacological treatment. As provider groups, hospital systems, and integrated delivery networks optimize their care processes to promote population health activities in support of the accountable care organization (ACO) model of care, managing hypertension and other chronic diseases will be essential to their success. A critical aspect of managing populations in an ACO environment is optimization of care processes among providers to increase care efficiency and improve patient outcomes. PROGRAM DESCRIPTION: Launched in 2013, Measure Up/Pressure Down is a 3-year campaign developed by the American Medical Group Foundation (AMGF) to reduce the burden of high blood pressure. The goal of the campaign is for participating medical groups, health systems, and other organized systems of care to achieve hypertension control for 80% of their patients with high blood pressure by 2016, according to national standards. The role of physician leadership at Cornerstone Health Care (CHC) and Summit Medical Group (SMG) in facilitating organizational change to improve hypertension management through the implementation of the Measure Up/Pressure Down national hypertension campaign is examined. OBSERVATIONS: Using patient stratification via its electronic health record, SMG identified 16,000 patients with hypertension. The baseline percentage of hypertension control for this patient population was 66%. Within 7 months, SMG was able to meet the 80% goal set forth by the AMGF's Measure Up/Pressure Down campaign. CHC diagnosed 25,312 patients with hypertension. The baseline percentage of hypertension control for this subgroup of patients was 51.5% when the initiative was first implemented. To date, the organization has achieved 72% hypertension control for at-risk patients and continues work towards the 80% campaign goal. The implementation of the Measure Up/Pressure Down campaign by CHC and SMG provides some valuable lessons. To further explore important aspects of successfully implementing the Measure Up/Pressure Down campaign in real-world settings, 6 key themes were identified that drove quality improvement and may be helpful to other organizations that implement similar quality improvement initiatives: (1) transitioning to value-based payments, (2) creating an environment for success, (3) leveraging program champions, (4) sharing quality data, (5) promoting care team collaboration, and (6) leveraging health information technology. IMPLICATIONS: The strategies employed by SMG and CHC, such as leveraging data analysis to identify at-risk patients and comparing physician performance, as well as identifying leaders to institute change, can be replicated by an ACO or a managed care organization (MCO). An MCO can provide data analysis services, sparing the provider groups the analytic burden and helping the MCO build a more meaningful relationship with their providers. DISCLOSURES: No outside funding supported this project. The authors declare no conflicts of interest. The authors are members of the Working Group on Optimizing Medication Therapy in Value-Based Healthcare. Odgen is employed by Cornerstone Health Care; Brenner is employed by Summit Medical Group; and Penso is employed by American Medical Group Association. Lustig, Westrich, and Dubois are employed by the National Pharmaceutical Council, an industry-funded health policy research organization that is not involved in lobbying or advocacy. Study concept and design were contributed by Lustig, Penso, Westrich, and Dubois. Lustig, Ogden, Brenner, and Penso collected the data, and data interpretation was performed by all authors. The manuscript was written primarily by Lustig, along with the other authors, and revised by Lustig, Penso, Westrich, and Dubois, assisted by Ogden and Brenner.

Coordination of multidisciplinary resources for vaccination of egg-allergic individuals during an H1N1 (novel) influenza pandemic.

Egg allergy is a contraindication for influenza vaccination because of the presence of trace egg protein. Although recent reports suggest that egg-allergic individuals can be safely immunized with seasonal influenza vaccine, the safety of H1N1 influenza vaccine in this context has not previously been reported. This study was designed to investigate how to safely immunize high-risk populations during the H1N1 influenza pandemic for whom the vaccine would be contraindicated. Vaccination of egg-allergic children was conducted at a large, multispecialty practice. Pediatricians raised awareness of vaccination and referred egg-allergic individuals to allergists. Allergists performed skin testing to H1N1 vaccine and, if negative, performed graded vaccine desensitizations in the office. Mass immunization of egg-allergic individuals was achieved within a 3-week period after receipt of vaccine. Sixty-three children (average age, 3.7 years) were evaluated and skin tested to the H1N1 influenza vaccine. All had a clinical history of egg allergy and recent positive skin-prick to egg. All had negative skin-prick test to the H1N1 vaccine and received graded challenge with three divided doses. All 62 children were successfully immunized without allergic reactions. Vaccination of egg-allergic individuals during a pandemic can be safely and efficiently accomplished with the coordination of multidisciplinary resources. Although this was conducted at a multispecialty practice, we believe that this invaluable public health service can be done outside of this context. Allergists, with the help of local pediatricians and urgent care centers or hospitals, can effectively mobilize to help protect the most vulnerable populations during pandemics.