The Million Hearts Initiative

>>> GOOD AFTERNOON, EVERYBODY.
LET'S BEGIN.
WANT TO WELCOME EVERYBODY TO THE CDC'S PUBLIC HEALTH GRAND ROUND.
WATCHING US LIVE HERE IN PERSON OR MANY OF THOSE WHO ARE
WATCHING US VIA INTERNET.
I WOULD LIKE SPECIALLY TO ACKNOWLEDGE A GROUP OF GEORGIA
STATE NURSES WHO HAVE COME IN PERSON TO BE WITH US TODAY AND
ALSO ACKNOWLEDGE THAT OUR PROGRAM HAS WORKED WITH A NUMBER
OF COLLEAGUES THROUGHOUT THE COUNTRY AND THERE ARE ACTUALLY
SOME TOWN HALLS AND WORKING GROUPS AND VIEWING SITES WHO
WILL BE WATCHING US LIVE, AS WELL.
THOSE WHO ARE INTERESTED CAN FOLLOW ON FACEBOOK AND TWITTER,
AS WELL.
WHEN I WAS THINKING WHAT TO SAY ABOUT THIS GROUP OF SPEAKERS, I
HOPE SOME OF YOU HAVE READ "TUESDAY'S WITH MORRIE."
THERE WAS A NEW BOOK THAT CAME OUT BEFORE THIS "THE FIVE PEOPLE
YOU MEET IN HEAVEN" AND I THINK THE FIVE PEOPLE WHO WILL BE
SPEAKING TO YOU TODAY ARE REALLY FIVE OF THE COOLEST PEOPLE THAT
CAN ACTUALLY TALK ON A TOPIC.
AND NOT ONLY THAT, THEY'RE ALL REALLY VIPS.
AND I WANTED TO VERY MUCH THANK ALL OF THEM FOR AN ENORMOUS
AMOUNT OF FLEXIBILITY AND TOLERANCE THEY HAVE SHOWN FOR A
GRAND ROUND.
DR. FRIEDENS, JANET WRIGHT, PATRICK CONWAY, CHIEF MEDICAL
OFFICER, DR. TOM FARLEY, COMMISSIONER, NEW YORK CITY
DEPARTMENT OF HEALTH AND MENTAL HYGIENE, AND DR. ANTHONY DEMARIA
WHO IS A CHAIR IN CARDIOLOGIST AT THE UNIVERSITY OF SAN DIEGO
IN CALIFORNIA.
OUR FIRST SPEAKER IS GOING TO BE DR. FRIEDENS WHO IS GOING TO
MAKE A FEW OPENING REMARKS.
>> THANK YOU VERY MUCH.
THANKS TO OUR SPEAKERS FOR BEING HERE TODAY.
THIS IS A CRITICALLY IMPORTANT TOPIC.
HEART DISEASE AND STROKE WILL KILL 8,000 AMERICANS A YEAR AND
YET MOST OF THOSE DEATHS COULD BE PREVENTED.
A MILLION HEARTS INITIATIVE IS AN ATTEMPT TO CROSS THE FEDERAL
GOVERNMENT AND WITH PRIVATE EBT ITY
ENT ENTRIES THROUGHOUT THE COUNTRY
TRO TO REACH AMBITIOUS AND ACHIEVABLE GOALS.
THE MODEL WE HAVE OF HEALTH IS SOCIOECONOMIC FACTOR, FIRST AND
FOREMOST, DRIVING HEALTH STATUS, CHAPG
CHANGING THE CONTEXT AND DOING THINGS THAT CAN CHANGE THE
DEFAULT VALUES SO INDIVIDUALS DEFAULT DECISION IS THE
HEALTHIER DECISION AND DOING THINGS LIKE MAKING THE AIR
SMOKE-FREE AND ELIMINATING TRANS FAT ARE EXAMPLES OF THIS.
LONG LASTING PROTECTIVE INTERVENTIONS THAT REQUIRE ONLY
A FEW BRIEF CLINICAL INTERVENTIONS, CLASSICALLY
VACCINATION VACCINATION.
WE DON'T YET HAVE A VACCINE AGAINST HEART DISEASE AND STROKE
BUT WE DO HAVE INTERVENTIONS THAT WORK WELL TO IMPROVE RISK
FACTORS, FOR EXAMPLE, REDUCING PROBLEM DRINKING OR REDUCING
TOBACCO USE.
CLINICAL INTERVENTIONS WHICH REQUIRE THAT CLINICAL CARE
SYSTEMS TO WORKDAY IN, DAY OUT, AROUND THE YEAR, AND WE'RE
PARTICULARLY PLEASED TO HAVE A VERY CLOSE COLLABORATION WITH
THE CENTERS FOR MEDICARE AND MEDICAID SERVICES IN THE
IMPLEMENTATION OF THE MILLION HEARTS INITIATIVE.
IN FACT, THEITYIES ARE THE TWO LEADING EPTNTITIES.
WE ALSO HAVE A LOT OF INTERVENTIONS AND INTERACTIONS
BETWEEN THE TWO AND COUNSELING AND EDUCATION TO ENCOURAGE
PEOPLE TO EAT HEALTHY AND BE ACTIVE.
OVER THE PAST FEW DECADES WE'VE SEEN PROGRESS, SO HEART DISEASE
DEATHS HAVE BEEN CUT BY ABOUT HALF, WERE CUT BY ABOUT HALF,
BETWEEN 1980 AND 2,000.
ABOUT HALF OF THAT DECREASE WAS FROM CLINICAL INTERVENTION AND
THE OTHER HALF OF THAT DECREASE WAS FROM COMMUNITY
INTERVENTIONS.
THAT, HOWEVER, IS FAR FROM GOOD ENOUGH BECAUSE OUR RATES ARE
STILL EXTREMELY HIGH.
WE NEED TO LOOK NOT TO OUR PAST, WHAT THE RATE HAS BEEN IN THE
PAST, BUT TO THE POTENTIAL OF DRASTICALLY REDUCING THAT.
YOU WILL HEAR OF ONE EXAMPLE OF ONE AMBITIOUS APPROACH IN SAN
DIEGO LATER IN THE SESSION.
THE KEY COMPONENT OF MILLION HEARTS IS TWO SPHERES.
FIRST, THE CLINICAL SPHERE TO IMPROVE THE A, B, Cs, CONTROL
BLOOD PRESSURE AND BETTER MANAGEMENT OF PEOPLE WITH
CHOLESTEROL.
AND THE THREE KEYSES WE THINK TO IMPROVING CLINICAL CARE FIRST IS
FOCUS.
AND FOR GROUPS AT CDC THAT HAVE WORKED ON THINGS LIKE
IMMUNIZATION OR RATIONAL USE OF ANTIBITE TICKSES, WE KNOW THAT
FOCUSING CLINICIAN ATTENTION TO THE MOST IMPORTANT INDICATORS IS
CRUCIAL TO IMPROVE OUTCOMES BUT IT'S NOT ENOUGH.
WE ALSO NEED INFORMATION TECHNOLOGY SO THAT THE CLINICIAN
HAS INFORMATION THAT THEY CAN USE AND ACT ON TO IMPROVE THEIR
PERFORMANCE.
AND IT'S NOT ENOUGH TO HAVE FOCUS AND INFORMATION TECHNOLOGY
WE ALSO NEED CLINICAL INNOVATION AND PARTICULARLY TEAM-BASED CARE
TO IMPROVE THE PERFORMANCE OF THE HEALTH CARE SYSTEM IN THE
SERVICE OF HELPING PATIENTS LIVE LONGER AND HEALTHIER LIVES.
IN COMMUNITY PREVENTION WE CHANGE THE CONTEXT BY REDUCING
TOBACCO USE, REDUCING SODIUM CONSUMPTION, AND ELIMINATING
ARTIFICIAL TRANS FAT.
AND WE THINK THAT WITH THESE INTERVENTIONS, WE CAN HAVE A
VERY SUBSTANTIAL IMPACT, IN FACT, PREVENT A MILLION HEART
ATTACKS AND STROKES IN THE NEXT FIVE YEARS.
HOW DO WE DO TODAY?
WELL, DESPITE SPENDING $2.5 TRILLION A YEAR PLUS ON HEALTH
CARE EACH YEAR, LESS THAN HALF OF AMERICANS WHO SHOULD GET AN
ASPIRIN, WHO WOULD BENEFIT FROM THE ASPIRIN WITHOUT ANY CLINICAL
DEBATE ARE ON IT.
ONLY 46% OF AMERICANS WITH HIGH BLOOD PRESSURE HAVEN'T
ADEQUATELY CONTROLLED.
ONLY A THIRD OF THOSE WITH HIGH CHOLESTEROL HAVE IT EFFECTIVELY
MANAGED.
AND LESS THAN A QUARTER OF SMOKERS WHO WANT TO QUIT AND GO
TO THEIR HEALTH PROFESSIONAL TO GET HELP GET EVIDENCE-BASED
ASSISTANCE TO QUIT.
TAKING BLOOD PRESSURE IS ONE EXAMPLE.
THERE ARE 37 MILLION AMERICANS WHO HAVE THEIR BLOOD PRESSURE
OUT OF CONTROL.
THAT'S MORE THAN HALF OF ALL AMERICANS WITH HIGH BLOOD
PRESSURE.
NEARLY HALF OF THOSE ARE IN-CARE BUT NOT EFFECTIVELY TREATED.
EITHER BECAUSE OF CLINICAL INERTIA OR LACK OF INFORMATION
SYSTEMS OR LACK OF ADEQUATE ACCESS OR LACK OF PACE.
ONE REASON OR THE OTHER THEY'RE NOT AFFECTIVELY TREAT PEND
ANOTHER NEAR 40% SAY WHEN ASKED AT HAND THAT THEY'RE NOT AWARE
OF HAVING HIGH BLOOD PRESSURE.
WHETHER THEY WERE TOLD AND DIDN'T REMEMBER OR WEREN'T TOLD
OR IT WASN'T MEASURED, WE DON'T KNOW BUT THEY ARE CURRENTLY
UNAWARE OF IT AND, THEREFORE, UNTREATED, AS WELL.
AND A MUCH SMALLER NUMBER ARE AWARE OF IT BUT NOT BEING
TREATED.
SO WE NEED TO ADDRESS EACH OF THESE SLICES OF THE PIE IF WE'RE
GOING TO GET TO THE VERY AMBITIOUS GOALS.
FOR CLINICIANS WE SAY VERY SIMPLY, IF YOU DO ONE THING FOR
YOUR YOUR PATIENTS, MAKE IT THE
EFFECTIVE CARE OF THE A, B, Cs.
THERE ARE EVIDENCE-BASED WAYS TO PREVENT HEART ATTACKS AND
STROKES AND THIS IS THE WAY WE CAN SAVE THE MOST LIVES AND GET
THE MOST HEALTH VALUE OUT OF OUR HEALTH CARE INVESTMENTS.
THANK YOU TO YOUR SPEAKERS, AND I LOOK FORWARD TO THE REST OF
THE SESSION.
>> THANK YOU, TOM.
I'M JANET WRIGHT, EXECUTIVE DIRECTOR OF MILLION HEARTS.
AS DR. FRIEDENS MENTIONED, MILLION HEARTS IS A NATIONAL
INITIATIVE WITH VERY EXPLICIT GOALS TO PREVENT A MILLION HEART
ATTACKS AND STROKES.
IT IS CO-LED BY THE CENTERS OF DISEASE CONTROL AND PREVENTION
AND CENTERS FOR MEDICARE AND MEDICAID SERVICES.
THE CLOCK ON THIS INITIATIVE STARTED TICKING ON JANUARY 1st.
THE GOAL IS AUDICIOUS BUT IT IS ACHIEVABLE, ONLY WITH THE
COLLECTIVE EFFORTS OF EACH OF US AS INDIVIDUALS, AS MEMBERS AN
LEADERS OF THE ORGANIZATIONS IN THE COMMUNITIES AND THE
WORKPLACE WHERE'S WE LIVE.
WHILE WE'VE SEEN A GRADUAL DECLINE IN MORTALITY FROM
CARDIOVASCULAR DISEASES OVER THE LAST 40 YEARS, IT REMAINS THE
NATION'S LEADING CAUSE OF DEATH AND DISABILITY FOR WOMEN AND MEN
AND FOR ALL RACES AND ETHNICITIES.
EACH YEAR 2 MILLION PEOPLE WILL HAVE A HEART ATTACK OR STROKE.
AND 800,000 OF THEM WILL DIE.
THE TRAUMAS OF FAMILIES AND TO COMMUNITIES AND HOUSEHOLDS IS
DEVASTATING.
IT'S ALSO COSTLY FOR THE ECONOMY.
$444 BILLION, MORE THAN A BILLION DOLLARS A DAY, AND
MEDICAL COSTS AND LOST PRODUCTIVITY.
CARDIOVASCULAR DISEASE IS ALSO THE LEADING CAUSE OF HEALTH
DISPARITIES BY RACE.
THE EVIDENCE TELLS US THAT THE PATHWAY TO PREVENTING A MILLION
HEART ATTACKS AND STROKES IN A FIVE-YEAR PERIOD IS THROUGH
FOCUS OF THE A, B, Cs.
APPROPRIATE USE OF ASPIRIN, BLOOD PRESSURE CONTROL,
CHOLESTEROL MANAGEMENT, AND SMOKING CESSATION.
THE GOOD NEWS IS THAT WE KNOW WHAT WORKS, AND MEDICATIONS WHEN
THEY'RE REQUIRED ARE LOW COST.
THAT'S GOOD NEWS, AS YOU JUST HEARD FROM DR. FRIEDENS IS WE'RE
NOT HITTING 50% AS A POPULATION OF ACHIEVING THOSE
EVIDENCE-BASED TARGETS FOR THE A, B, Cs.
MILLION HEARTS IS WORKING ALONG TWO PATHWAYS.
WE EXPECT THEM TO CONVERGE OVER TIME.
BUT NOW THE COMMUNITY EFFORTS ARE TO KEEP THE POPULATION
HEALTHY AND TO REDUCE THE NUMBER OF PEOPLE WHO ACTUALLY NEED
TREATMENT.
THE CLINICAL INTERVENTIONS ARE TO OPTIMIZE CARE FOR THOSE WHO
DO NEED TREATMENT.
AT THE COMMUNITY LEVEL THE PRIME MOVERS ARE REDUCING TOBACCO USE
AND SODIUM AND ELIMINATING TRANS FATS, ARTIFICIAL TRANS FATS IN
THE FOOD SUPPLY.
AS YOU KNOW TOBACCO IS THE LEADING PREVENTABLE CAUSE OF
DEATH IN THE UNITED STATES.
THE COMBINATION OF SMOKE-FREE LAWS, CIGARETTE PRICE INCREASES,
ACCESS TO PROVEN QUITTING TREATMENTS AND SERVICES, AND
HARD-HITTING MEDIA CAMPAIGNS REDUCES HEALTH CARE COSTS AND IS
GOING TO SAVE LIVES.
THESE COMPREHENSIVE STRATEGIES ARE NOT YET BEING DEPLOYED IN
EVERY COMMUNITY ACROSS THE U.S.
ABOUT 90% OF US CONSUME MORE SODIUM THAN IS RECOMMENDED FOR A
HEALTHY DIET.
MOST OF THE SODIUM WE EAT COMES FROM PROCESSED FOODS AND FROM
FOODS PREPARED IN RESTAURANTS.
GRADUAL REDUCTION IN THE SODIUM CONTENT CAN HAVE A PROFOUND
EFFECT ON THE PREVALENCE AND THE CONTROL OF HYPERTENSION.
ARTIFICIAL TRANS FAT, THEY'RE HARMFUL.
CHANGE IN CHOLESTEROL PATTERNS FOR THE WORSE.
THE IOM RECOMMENDS REDUCEING TRANS FAT AS CLOSE TO POSSIBLE
TO ZERO.
IN 2003 THE FDA RULING REQUIRED THE LABELING OF TRANS FATS ON
FOODS AND CONSEQUENTLY THEREAFTER THE FOOD INDUSTRY
STARTED TO REFORMULATE FOODS LEADING OUT TRANS FATS.
WE KNOW THAT REDUCING ARTIFICIAL TRANS FAT IS FEASIBLE.
IT DOESN'T CHANGE THE FLAVOR OR THE TEXTURE OF FOOD.
OUR TASTE BUDS DON'T KNOW THE DIFFERENCE.
MONITORING THE TRANS FAT LEVELS IN THE POPULATION AND
ENCOURAGING THE FOOD INDUSTRY TO ELIMINATE THEM IS CRITICAL.
MOVE ON TO THE CLINICAL ARENA NOW.
MILLION HEARTS HAS CHOSEN THESE THREE PRIORITY AREAS.
FIRST, WE WANT TO DRAW THE ATTENTION OF THE HEALTH CARE
PROFESSIONALS AND ASSISTANCE IN WHICH THEY WORK TO THE A, B, Cs.
SECOND, WE WANT HEALTH INFORMATION TECHNOLOGY TO WORK
MAGIC FOR BUSY PRACTICERS AND THE PATIENTS THEY CARE FOR.
AND FINALLY, WE WANT TO DEVELOP AND TEST NEW MODELS OF CARE THAT
RECOGNIZE AND REWARD OUTCOMES AND VALUES.
SO MILLION HEARTS WORK IN CLINICAL PREVENTION IS TO
DEVELOP A SIMPLE UNIFORM MEASURE SET FOR THE ABCs AND TO ENSURE
THAT THE DATA THAT'S USED TO CALCULATE THOSE MEASURES MOVE
SEAMLESSLY WITHIN THE FLOW OF CARE, MINIMIZING THE BURDEN OF
COLLECTING AND REPORTING ON THOSE MEASURES.
HIGH PERFORMANCE ON THOSE MEASURES SHOULD BE LINKED TO
REWARD FOR CLINICIANS FOR THE HEALTH SYSTEMS AND FOR THEIR
PATIENTS.
CURRENTLY WE'RE TRACKING SOME 47 INTERVENTIONS ACROSS THE FEDERAL
FAMILY THAT INCLUDE AND REWARD PERFORMANCE ON ONE OR MORE OF
THE ABCs.
THESE INTERVENTIONS COULD RANGE FROM AN ACTION THAT TAKES PLACE
IN THE PHYSICIAN'S OFFICE TO A PROGRAM IN THE COMMUNITY, AND TO
A POLICY.
OUR SECOND STRATEGY IS TO FULLY DEPLOY HEALTH INFORMATION
TECHNOLOGY.
CLINICIANS NEED THE REGISTRY FUNCTIONALITY TO BE ABLE TO
IDENTIFY GAPS IN CARE, TO INTERVENE, AND TO TRACK PROGRESS
OF PEOPLE WITH HIGH BLOOD PRESSURE OR HIGH BLOOD LIPIDS.
POINT OF CARE RISK ASSESSMENT TOOLS ENSURE THAT THE
INTERVENTIONS ARE DESIGNED AND TARGETED TO THE INDIVIDUALS MOST
LIKELY TO BENEFIT.
CLINICAL DECISION SUPPORT, THAT IS SPECIFIC TO THE PATIENT,
ENSURES THAT THE RIGHT CARE IS DELIVERED THE FIRST TIME AND
EVERY SINGLE TIME.
AND FOR THOSE OF WHITE HOUSE TAKE MEDICATIONS AND NEED A
LITTLE HELP ADOPTING AND STICKING TO NEW HEALTH HABIT,
HIT CAN PROVIDE THE NUDGES WE NEED TO GET AND TO STAY HEALTHY.
WE LIVE IN HISTORIC TIMES.
IT'S WHEN NEW CARE DELIVERY MODELS ARE BEING TWOED AND
LAUNCHED.
MILLION HEARTS IS WORKING TO EMBED THE ABCs IN THESE NEW
MODELS AND TO RECOGNIZE AND REWARD VALUE OVER VOLUME AND
OUTCOMES.
THUS NEW MODELS RECOGNIZE THE CONTRIBUTIONS OF A LARGE VARIETY
OF PAIN MEMBER, PHARMACIST, CARDIAC REHAB TEAMS, HEALTH
COACHES, COMMUNITY HEALTH WORKER, PURE WELLNESS
SPECIALISTS ARE ALL AMONG BEHAVIOR CHANGE AGENTS, POWER
FULL AGENTS, TO SUPPORT AND ADVISE IN THE APPROPRIATE USE OF
MEDICATIONS.
SO LET'S LOOK TO THE FUTURE WHERE THE CLINICAL AND THE
COMMUNITY WORLD CONVERGE.
IN THIS NEW WORLD, AND WE WANT IT TO THE NOT TO BE VERY LONG
FROM NOW, WE WANT -- WE WILL HAVE LOTS OF LOWER SODIUM FOODS
FROM WHICH TO CHOOSE.
OUR TASTE BUDS ACTUALLY PREFER THEM AND OUR WALLETS DON'T
SUFFER AS A RESULT.
BLOOD PRESSURE CUPS ARE EVERYWHERE.
AND READOUTS ARE SIMPLIFIED IN RED, YELLOW, AND GREEN, ALONG
WITH NUMBERS FOR THOSE OF YOU WHO WANT THEM.
A PERSON CAN DESIGNATE READINGS ARE AUTOMATICALLY SENT TO A
PROFESSAL SO ADVICE AND, IF NECESSARY, DOSE CAN BE EASILY
ACCOMPLISHED.
ACCESS TO MEDICATIONS IS NO LONGER AN OBSTACLE TO CONTROL.
THIS IS NOT A FANTASY.
IN FACT, STUDIES HAVE SHOWN THAT ADDING WEB-BASED PHARMACY CARE
TO HOME BLOOD PRESSURE MONITORING INCREASED THE CONTROL
BY OVER 50%.
AND IN HIGH RISK FOLKS.
SO HERE'S THE NATION'S CURRENT POPULATION WIDE PERFORMANCE ON
THE ABCs UNDER THE COLUMN MARKED BASELINE.
UNDER TARGET IS OUR GOAL FOR THE POPULATION, BY JANUARY 1st OF
2017, THE NUMBERS UNDER THE CLINICAL TARGET COLUMN REFLECT
THE GOALS OF ASSISTANCE CARE, THOSE ALREADY IN ASSISTANCE
CARE, AND THEY ARE HELD TO A HIGHER STANDARD.
ES THAT ARE THE AUDICIOUS GOALS THAT WILL PREVENT A MILLION
HEART ATTACKS AND STROKES BY 2017.
A GOAL THAT REQUIRES FOCUSED AT TEX
TENSION BY ALL OF US.
WE ALL HAVE A PIECE TO PLAY IN ACHIEVING THE MILLION HEARTS
GOAL AND CREATING A NEW FUTURE OF CARDIOVASCULAR HEALTH IN THE
COUNTRY.
OUR NEXT SPEAKERS WILL DESCRIBE HOW THESE GROUPS ARE BUILDING
THE NEW FUTURE.
EVERY AGENCY ON THIS SLIDE IS DEEPLY ENGAGED IN SUBSTANTIVE
WORK TO PREVENT HEART ATTACKS AND STROKES.
WE'RE DELIGHTED TO HAVE A WIDE ARRAY OF PRIVATE PARTNERS AS
WELL INCLUDING MEDICAL PROFESSIONAL SOCIETY, RETAILER,
ERER HEALTH PLAN, CONSUMER GROUPS
WITH MORE COMING IN EVERY DAY.
SO I ASK, WHAT WILL EACH OF YOUR GROUPS DO?
I ENCOURAGE YOU TO VISIT THE MILLION HEARTS WEBSITE, PLEDGE
YOUR SUPPORT, AND ENCOURAGE OTHERS TO DO THE SAME.
IF YOU'RE HOSTING A VIEWING PARTY TODAY, PLEASE WRITE US AT
MILLION HEARTS AT HHS.GOV TO TELL US ABOUT IT, AND POST YOUR
PHOTOS TO OUR FACEBOOK PAGE.
THE CONVERSATIONS ARE GOING TO KEEP ON GOING ON FACEBOOK AND
TWITTER.
WE ASK YOU TO JOIN US.
IT'S NOW MY PLEASURE TO INTRODUCE MY ESTEEMED COLLEAGUE
DR. PATRICK CONWAY.
>> THANK YOU.
I'M DR. PATRICK CONWAY.
I'M THE CMS CHIEF MEDICAL OFFICER AND DIRECTOR OF OFFICE
OF CLINICAL STAND DARDS AND QUALITY.
CMS IS VERY EXCITED TO PARTNER WITH THE CENTERS OF DISEASE
CONTROL AND OTHER AGENCIES AND COMMUNITY TO ACHIEVE OUR MILLION
HEARTS GOAL.
TODAY I WILL BRIEFLY DISCUSS CMS' OVERALL PURPOSE AND HEALTH
CARE SOCIETY, CMS' ROLE IN MILLION HEARTS AND BUILD OFF THE
CLINICAL PREVENTION YOU HEARD FROM DR. JANET WRIGHT.
CMS IS THE LARGEST PURCHASER OF HEALTH CARE IN THE WORLD AND
PROVIDES HEALTH CARE COVERAGE TO APPROXIMATELY 150 MILLION
BENEFICIARIES THROUGH MEDICARE, MEDICAID, AND THE CHILDREN'S
HEALTH INSURANCE PROGRAM.
MEDICARE ALONE PAYS OUT OVER 1.5 BILLION IN BENEFIT PAYMENTS PER
DAY, COMBINED MEDICARE AND MEDICAID PAY ONE-THIRD OF THE
HEALTH EXPENDITURE AND A SMALL PROPORTION IS FOCUSED ON
PREVENTION.
WE WANT TO INCREASE OUR FOCUS ON HEALTH TRANSPORTATION AND
PREVENTION.
THIS IS WHY A PROGRAM LIKE MILLION HEARTS IS SO IMPORTANT.
MILLIONS OF CONSUMERS WILL SEE HEALTH COVERAGE THROUGH HEALTH
CARE EXCHANGES AUTHORIZED BY THE AFFORDABLE CARE ACT AND LED OUT
OF CMS.
CM CM
CMS' AIM IS TO PROVIDE BETTER CARE FOR INDIVIDUALS AND LOWER
COSTS THROUGH IMPROVEMENT.
YOU CAN SEE THAT OUR AIM IS TIED DIRECTLY TO THE GOALS OF MILLION
HEARTS.
CMS' PARTNER WITH CDC, THE OFFICES OF NATIONAL COORDINATOR
FOR HEALTH INFORMATION TECHNOLOGY, HEALTH RESOURCES AND
SERVICES ADMINISTRATION, COMMUNITIES AND MANY, MANY MORE.
WE HAVE CONVENED MEETINGS TO IDENTIFY AGENCY WIDE STANDARDS,
MEASURE SETS FOR 201 WORKING COLLABORATIVE WITH THE CDC.
ONE OF OUR SPECIFIC CONTRIBUTIONS IS THE DEVELOPMENT
OF THE FIRST MEASURE THAT IS MONITORED ENTIRELY VIA
ELECTRONIC HEALTH RECORDS BY CHOLESTEROL SCREENING AND
CONTROL.
UTILIZES RISK FACTOR INFORMATION FOR CORONARY HEART DISEASE TO
DETERMINE THE APPROPRIATE LDL LEVELS FOR EACH PATIENT.
MANY OF OUR OFFICES INCLUDING MY OWN OFFICE OF CLINICAL STANDARDS
AND QUALITY IS SUPPORTING MILLION HEARTS THROUGH A NUMBER
OF PROGRAMS AND INITIATIVE.
IN THE NEXT FEW SLIDES I'LL HIGHLIGHT A FEW OFFICES PROGRAMS
SUPPORTING MILLION HEARTS AND CMS AND IN A LATER SLIDE YOU
WILL SEE GREATER DETAIL OF THE WORK AND QUALITY AND IMPROVEMENT
ORGANIZATIONS AROUND THE COUNTRY.
CMS' CENTER FOR MEDICAID SHIP AND STATE SERVICES ARE WORKING
ON MEDICAID SMOKING CESSATION AND MEDICAID INCENTIVES TO
PREVENT CHRONIC DISEASE THROUGH PROGRAMS LIKE MILLION HEARTS AND
THESE INITIATIVES WE CAN ENSURE SMOKERS IN THE MEDICARE SYSTEM
WILL DO THIS.
WE INCLUDE THE ESSENTIAL HEALTH BENEFITS IN INSURANCE EXCHANGES.
THROUGH THE INNOVATION CENTER WE'RE LAUNCHING THE CARE
INTERVENTION EXCHANGE.
WE RECEIVED AN ABUNDANCE OF APPLICATIONS.
WE LOOK FORWARD TO SEEING THE IMPACT OF THESE GRANTS WILL HAVE
ON OUR COMMUNITIES SUCH AN INCREASING USE OF REGISTRY,
SHARED DECISION SUPPORT TOOLS AND IMPROVING POPULATION HEALTH.
FOR THE REST OF MY SPEAKING TIME I'LL DISCUSS CMS' EFFORTS AND
CLINICAL PREVENTIONS TO OPTIMIZE CARE FOR THOSE WHO NEED IT.
THE MEASURES FOR THESE ABCs HAVE BEEN IDENTIFIED AND MORE DETAIL
IS ON THIS WEBSITE.
THERE ARE SEVERAL MEASURES USED.
THERE'S ENORMOUS VALUE IN HAVING LINE MEASURES THAT COVER THE
ABCs FOR MANY PROVIDERS.
WE NEED MEASURES TO SET GOALS, MONDAYITOR PROCESS.
CMS WAS WITH THE NATIONAL FOREIGN QUALITY MEASURE 18 FOR
BLOOD PRESSURE CONTROL AND INCLUSION OF PHYSICIAN
SUPPORTING SYSTEM AND OTHER PROGRAMS IN HOSPITALS AND
OUTPATIENT SETTINGS THROUGH RULE MAKING AND COMMENTS.
ELECTRONIC HEALTH RECORDS CAN IMPROVE THE QUALITY, SAFETY, AND
EFFICIENCY OF CLINICAL CARE.
CMS ARE WORKING TOGETHER TO INCENTIVIZE WORKING TOGETHER.
THEY REQUIRE PROVIDERS TO SUBMIT DATA AND INCLUDES A NUMBER OF
PROVEN FEATURES SUCH AS PATIENT REGISTRIES AND COMPUTERIZED
SUBSCRIPTIONS.
CMS INCLUDED THE MILLION HEARTS ABC AS PART OF THE REPORTING
REQUIREMENT WHICH WILL ALLOW US TO MONITOR THE QUALITY OF CARE
PROVIDED TO PATIENTS CAN CARDIOVASCULAR DISEASE.
WE'RE ALSO LOOKING AT THESE AS CORE MEASURE REQUIREMENTS.
THEY WILL REDUCE REDUNDANCY AND IMPROVE POP PLAR HEALTH ALL IN A
PROTECTED AND SECURE FASHION.
ONE POWERFUL REQUIREMENT IS THE USE OF CLINICAL DECISIONS
SUPPORT TOOLS.
THESE TOOLS MAKE USE OF SPECIFIC CLINICAL INFORMATION THAT IS
ENTERED DURING A PATIENT'S VISIT AND PROVIDE REALTIME
RECOMMENDATIONS THAT SUPPORT DECISION MAKING.
AMP XAMPLLES ARE ALERTS FOR HIGH
BLOOD PRESSURE OR CHOLESTEROL AND REQUIRE THEM TO ACT ON THOSE
VALUES.
THESE ARE EFFORTS GOING ON AS PART OF THE MILLION HEARTS TO
DEVELOP EVIDENCE AND GUIDELINES-BASED CLINICAL
SUPPORT TOOLS THAT SUPPORT THE ABCs.
WE LOOK FOR MORE WORK IN THIS AREA IN THE FUTURE.
NOW LET'S TALK ABOUT LAUNCHING NEW MODELS OF INNOVATION AND
CARE DELIVERY.
IN WORKING WITH CLINICIANS WE'RE MEASURING AND ENCOURAGING I
PROVEMENT?
MEASURES SUCH AS TOBACCO USE AND CIGARETTE CESSATION.
MEDICATION RECONCILIATION, PROVIDERS MAY EARN AN INCENTIVE
FOR REPORTING.
AS A REMINDER, CLINICAL PREVENTION STRATEGIES WILL FOCUS
ON ACCESS OF CARE AND OUTCOMES.
WE ARE LAUNCHING MODELS OF CARE THROUGH THE CENTER AND PAYMENT
PROGRAM SUCH AST AS BUNDLING.
THE FOSTERED TEAM-BASED CARE COORDINATION AND PATIENT
CENTERED CARE INCLUDING CARE OUTSIDE OF THE TRADITIONAL
OFFICE VISIT.
THROUGH THE QIO PROGRAM WE'RE LAUNCHING LEARNING IN ACTION
NETWORKS.
THESE ARE DRIVERS OF QUALITY AND IMPROVEMENT AND COLLABORATIVE
LEARNING.
THE QUALITY IMPROVEMENT ORGANIZATIONS RUN AND WILL
CONVENE IN INNOVATIVE LEARNING AND ACTION NETWORK LOCALLY AND
EVERY STATE THEY SERVE AND MAY BE ACCOMPLISHED OR IN PERSON
MEETINGS, WEB ACCESS, PHONE CONFERENCES AND OTHER MODALITIES
THAT QIOs WORK WITH BENEFICIARIES AND PROVIDERS.
WE JUST INCLUDED THE MECHANISM AND WE LOOK FORWARD TO REPORT TO
THINK COLLABORATIVE IMPROVEMENT MODEL IN IS REALLY A KNEW PHASE
IN THE QIO PROGRAM.
CMS CALLS UPON QIO TOSS SERVE ON THE BOOTS ON THE GROUND AND
IMPORTANT ROLE AS CONVENERS, ORGANIZERS, CHANGE AGENTS.
BY PROVIDING A CALL OF ACTION THROUGHOUT TO REACH EDUCATION
AND SOCIAL MARKETING, SERVING AS A TRUSTED PARTNER WITH
FEBRUARYBENEFICIARYIES AND STAKEHOLDERS.
EXECUTION OF THE FOLLOWING THREE DRIVERS OF QUALITY, FIRST,
SUPPORTING AND CONVENING LEARNING IN ACTION NETWORKS.
SECOND, PROVIDING TECHNICAL SAYS TANS INCLUDING QUALITY
IMPROVEMENT EXPERTISE, FEEDBACK AND DATA SHS AND SUPPORTING
CLINICIANS.
THIRD, PARTNERING WITH BENEFICIARIES AND PROVIDERS TO
APPROVE CARE AND ACHIEVE BETTER HEALTH AT A LOWER COST.
WE ARE LOOKING AT ADDITIONAL IDEAS SUCH AS TESTING CHANGES TO
MEDICATION COPAYS OR ALLOWING NURSES AND PHARMACISTS TO
ACHIEVE BLOOD PRESSURE GOALS.
WE'VE ALREADY IN THE HOSPITAL SETTING LOWERED REGULATORY
BURDENS SO PEOPLE CAN PRACTICE THE FULL EXTENT AND PROPOSED
RULE ARE WORKING TO FINALIZE THAT RULE.
THIS ALL BOILS DOWN TO COMMUNICATIONS SUPPORT
PARTNERSHIPS.
EVERYONE WORKING TOGETHER TO ACHIEVE THE MILLION HEARTS GOAL
OF PREVENTING ONE MILLION HEART ATTACKS AND STROKES.
IT IS CRITICAL THAT WE WORK TOGETHER AS PARTNERS.
SOME WAYS AT MILLION HEARTS CAN HELP IS SUPPORT EXISTING AND
ALREADY RELEASED ENTER VEPGSINTERVENTION,
PROPOSED NEW INTERVENTIONS THAT CMS SHOULD WORK ON, ALIGN
EXISTING CMS INTERVENTIONS ACROSS THE FEDERAL FAMILY, AND
INCLUDE MILLION HEARTS AND ABCs AND OUTREACH AND COMMUNICATIONS.
AS A PRACTICING CLIN NGS I CAN'T TELL YOU HOW PROUD I AM TO BE
WORKING WITH THE CDC AND ON BEHALF OF CMS, WE REALLY VALUE
OUR PARTNERSHIP AND OUR ABILITY TO TRANSFORM CARE IN THE U.S.
THANK YOU.
I'LL WELCOME DR. THOMAS FARLEY.
>> GOOD AFTERNOON.
I'M TOM FARLEY, THE COMMISSIONER OF THE NEW YORK CITY DEPARTMENT
OF HEALTH AND MENTAL HYGIENE.
HAPPY MARDI GRAS.
I'LL BE DESCRIBING INITIATIVES UNDERTAKEN BY THE NEW YORK CITY
HEALTH DEPARTMENT.
SINCE 2002 REDUCED CARDIOVASCULAR DISEASE.
I'LL BE INCLUDING THE ENVIRONMENTAL INITIATIVES,
SMOKING PREVENTION, TRANS FAT RESTRICTION, AND SODIUM
REDUCTION AND CLINICAL INITIATIVES FOCUSING ON A
PREVENTION OR SORRYORIENTED RECORD AND
QUALITY IMPROVEMENT AND TECHNICAL ASSISTANCE.
FIRST, OUR SMOKING PROGRAM.
THE KEY POLICY CHANGE IN OUR SMOKING PROGRAM HAS BEEN THE
SMOKE FREE AIR POLICY.
IN 2002 NEW YORK CITY PASSED THE SMOKE FREE AIR ACT WHICH
PROHIBITS SMOKING IN INDOOR WORKPLACES INCLUDING RESTAURANTS
AND BARS.
NO 2011 IT WAS EXTENDED TO OUTDOOR
PARKS AND BEACHES.
IN THIS YEAR, 2012, THE UNIVERSITY OF NEW YORK WILL MAKE
ALL OF THE 23 CAMPUSES IN THE CITY COMPLETELY TOBACCO FREE.
ANOTHER IMPORTANT POLICY CHANGE HAS BEEN INCREASE IN CIGARETTE
PRICES THROUGH TAX INCREASESES.
IN 2002 THE CITY PASSED A TAX INCREASE OF $1.50 PER PACK.
BRINGING THE TOTAL TAX ON A PACK OF CIGARETTES IN 2003 TO OVER
$3.
ADDITIONAL STATE AND FEDERAL TAX INCREASES THAT OCCURRED BETWEEN
2002 AND 2010 BROUGHT THE TOTAL TAX ON A PACK OF CIGARETTES TO
$6.86.
A PACK OF CIGARETTES IN NEW YORK CITY NOW COSTS ABOUT $11, THE
HIGHEST PRICE IN THE NATION.
WE'VE ALSO EXTENSIVELY USED MASS MEDIA.
WE DEVELOPED MANY OF OUR OWN MESSAGES IN WHICH WE KEEP FRESH
BY PROVIDING NEW INFORMATION OR DEVELOPING NEW WAYS OF
PREVENTING OLD INFORMATION, AND IN SOME CASES PROVIDING
TESTIMONIALS TESTIMONIALS.
WE HAVE FOCUS GROUPS OF SMOKERS AND PLACE THEM ON TELEVISION AND
ON SUBWAYS.
ONCE A YEAR WE LINK A NEW CAMPAIGN WITH THE DISTRIBUTION
OF FREE NICOTINE PATCHES AND GUM.
THIS THIS IS AN EXAMPLE OF A RECENT CAMPAIGN.
IT EMPHASIZES THE SUFFERING THAT SMOKERS WILL ENDURE, RATHER THAN
DEATH, WHICH SMOKERS DON'T FEAR VERY MUCH.
THIS PARTICULAR CAMPAIGN HAS AN EMPHASIS ON EMPHYSEMA AND
STROKE.
POTENTIAL OF FAMILY MEMBERS MAY HAVE TO PROVIDE CARE FOR SMOKER
WHICH IS SOMETHING WE FOUND PARTICULARLY DISTURBING TO
SMOKERS.
LET ME SEE IF I CAN SHOW YOU THIS, ONE OF THESE ADS.
AS YOU CAN SEE WE FIND IT WITH SUBTLETY.
SO WHAT'S BEEN THE EFFECT OF OUR SMOKING PREVENTION PROGRAM?
THIS SLIDE SHOW TRANSITS SMOKING PREVALENCE IN NEW YORK CITY FROM
1993 TO 2010.
BEFORE 2002 FOR ABOUT A DECADE THE SMOKING PREVALENCE IN NEW
YORK CITY WAS STEADY AT 21%.
SINCE THEN THE PREVALENCE HAS FALLEN MORE THAN A THIRD TO 14%.
NOW REPRESENTS 450,000 FEWER SMOKERS IN NEW YORK CITY.
NEXT ARE OUR EMPHASIS ON TRANS FAT.
WE RESTRICTED THE USE OF TRANS FAT BASED UPON THE RATIONAL THAT
TRANS FAT IS AN ARTIFICIAL CHEMICAL THAT INCREASES HEART
DISEASE RISK.
FOUR GRAM CONSUMPTION OF TRANS FAT OR TYPICAL AMOUNT IN A
PORTION OF FRENCH FRIES INCREASES HEART DISEASE RISK BY
23%.
IN 2006 THE NEW YORK CITY BOARD OF HEALTH PROHIBITS THE USE OF
TRANS FATS BY RESTAURANT.
IN 2007 THEY BEGAN ENFORCING IT BY ISSUING VIOLATION FINES
DURING RESTAURANT INSPECTIONS.
BY 2008, MORE THAN 90% OF RERANTS WERERERANT
RESTAURANTS WERE IN COMPLIANCE.
THIS IDEA HAS NOW SPREAD TO OTHER CITIES.
THIS SLIDE SHOWS OTHER CITIES AND STATES WHICH ARE CONSIDERED
TRANS FAT RESTRICTIONS SINCE THAT TIME IF STATES AND CITIES
ARE SHOWN IN BLUE AND THE STATES AND CITIES THAT HAVE CONSIDER
RESURGENCE IS SHOWN IN RED.
FOLLOWING THE APPROVAL OF NEW YORK CITY HEALTH CODE AMENDMENT
MORE THAN 50 RESTAURANT CHAINS HAVE ANNOUNCED OR REITERATED
THEIR INTENTION TO DISCONTINUE THE USE OF ARTIFICIAL TRANS FATS
IN THEIR FOODS.
NEW YORK CITY ALSO LED TO INITIATIVE TO REDUCE SODIUM
CALLED THE NATIONAL SALT REDUCTION INITIATIVE.
IT'S FAR TOO HIGH AND REDUCTION OF 1200 MILLIGRAMS PER DAY ON
AVERAGE IN AN AMERICAN CONSUMPTION COULD SAVE TENS OF
THOUSANDS OF LIVES PER YEAR NATIONALLY.
THE GOAL OF THIS INITIATIVE IS TO REDUCE SODIUM INTAKE BY 20%
OVER FIVE YEARS.
THROUGH MEETINGS WITH FOOD COMPANIES WE HAVE CLASSIFIED
PACKAGED FOOD IN THE 65 CATEGORIES.
RESTAURANT FOOD IN 424 CATEGORIES.
WE SET REDUCTION TARGETS FOR EACH OF THE CATEGORIES IN 20120
12 AND 2014.
WITH THE AVERAGE DEDUCTION OF 25%.
WE THEN ASKED FOOD COMPANIES TO MEET THESE TARGETS THIS THEIR
SALES WEIGHTED AVERAGES.
SO FAR 28 COMPANIES REPRESENTED BOTH PACKAGE FOOD COMPANIES AND
RESTAURANT COMPANIES HAVE COMMITTED TO MEETING AT LEAST
ONE OF OUR SODIUM REDUCTION TARGETS.
THIS INCLUDES FOOD GIANT, SUCH AS UNILEVER, KRAFT, CAMPBELL'S,
AND MAJOR RERANTSTAURANT CHAINS INCLUDING SUBWAY AND STARBUCKS.
NOW I'LL TURN TO OUR CLINICAL INITIATIVE.
OUR MAIN APPROACH IS WHAT WE CALL THE PRIMARY CARE
INFORMATION PROJECT.
THE GOAL OF THIS PROJECT IS TO IMPROVE THE QUALITY OF CARE
THROUGH HEALTH INFORMATION TECHNOLOGY.
THIS PROJECT WE HAVE DEVELOPED WITH A VENDOR, PREVENTION
ORIENTED ELECTRONIC HEALTH RECORD, AND EMPLOYED IT TO MORE
THAN 3,000 PROVIDERS SERVING 3 MILLION PATIENTS.
KEY PREVENTION SYSTEMS OF THIS HEALTH RECORD INCLUDE CLINICAL
DECISION SUPPORT SYSTEM WHICH GIVES ALERT TO PROVIDERS ABOUT
THE SERVICES NEEDED THAT ARE ACTIONABLE.
THAT IS THEY LEAD A SPECIFIC RESPONSES OF THE PROVIDERS.
AND THE ABILITY TO GENERATE CONDITION-SPECIFIC LIST OF
PATIENTS IN NEED OF SPECIFIC CARE SUCH AS BLOOD PRESSURE
CONTROL.
IN ADDITION, THE PROVIDERS GET QUALITY DASHBOARDS, THEY CAN USE
TRACK PERFORMANCE AND COMPARE IT TO THEIR PEERS.
TRANSFER PERFORMANCE OF HYPERTENSION AND BLOOD PRESSURE
IS CONTROLLED SHOWN HERE COMPARED TO PEER PROVIDERS IN
GRAY.
AND PERCENT OF PATIENTS WHOSE SMOKING STATUS OVER TIME IS
SHOWN HERE.
IN THIS CASE COMPARED TO THE MEANINGFUL YOUTH TARGET IN
GREEN.
IT ALSO PRESENTS AUTOMATIC RECOMMENDATIONS.
IN THIS CASE, IMPROVING THE PERCENT OF PATIENTS WITH
TESTING.
PROVIDERS RECEIVE THESE DASHBOARDS BY E-MAIL WITH THE
LINK OF THE HEALTH DEPARTMENT WEBSITE, WHICH HAS INFORMATION
ON ALL OF THE MEASURES INCLUDED IN THE DASHBOARDS.
WE'RE TRACKING THE INFORMATION FOR SERVICES ACROSS ALL PCIP
PROVIDERS AND TRENDS ARE POSITIVE.
WE HAVE SEEN AS YOU CAN SEE HERE INCREASES OVER TIME AND THE
PERCENT OF ELIGIBLE PASHS RECEIVING ASPIRIN, THE% OF
PATIENTS WITH HYPERTENSION WHOSE BLOOD PRESSURE IS CONTROLLED AND
THE PERCENT OF SMOKERS RECEIVING SMOKER CESSATION INTERVENTION.
WHAT IS THE IMPACT OF ALL OF THESE ACTIONS STAND ON
CARDIOVASCULAR DISEASE?
DURING THE TIME PERIOD WE'VE SEEN SUBSTANTIAL DECREASES IN
MORTALITY FROM CARDIOVASCULAR DISEASE IN NEW YORK CITY.
INCLUDING 33% DECREASE AND A 16% DECREASE IN CEREBRAL VASCULAR
DISEASE MORTALITY.
I CAN'T SAY TO A DEGREE THIS WHICH IT CAUSED THE CHANGE BUT
IT CERTAINLY IS ENCOURAGING.
OVER THE SAME TIME PERIOD LIFE EXPECTANCY AT BIRTH IN NEW YORK
CITY HAS BEEN INCREASEING AND INCREASING FASTER IN THE U.S. AS
A WHOLE.
IN 2009 EXPECT TAPS SI IN NEW YORK CITY WAS .4 YEARS HIGHER
THAN IT WAS NATIONALLY.
NOW, THIS SLIDE SHOWS LIFE EXPECTANCY AT AGE 40.
UNLIKE LIFE EXPECTANCY AT BIRTH THIS MEASURE REFLECTS
IMPROVEMENT OF MORTALITY IN OLDER ADULTS.
THIS MEASURE ALSO SUBSTANTIALLY OUTPACED IN THE UNITED STATES,
ESPECIALLY IN THE LAST FIVE YEARS.
IN SUMMARY, NEW YORK CITY, OUR EFFORTS TO ADDRESS
CARDIOVASCULAR DISEASE ARE SHOWING SIGNS OF SUCCESS.
THE INTERVENTIONS WE USE ARE CHARACTERISTICS OF
IMPLEMENTATION ON A MASS SCALE WHICH IS WHAT WE NEED BECAUSE
CARDIOVASCULAR DISEASE IS SO COMMON.
LET ME JUST FINISH WITH A THOUGHT THAT MASS DISEASE
REQUIRE MASSIVE REMEDIES.
THANK YOU VERY MUCH.
>> AND NOW I'LL TURN IT OVER TO DR. MARIA FROM SAN DIEGO.
>> THANK YOU VERY MUCH.
IT'S A PLEASURE TO BE HERE TO TELL YOU WHAT WE'VE BEEN DOING
TO ERADICATE HEARTATTACKS AND STROKES.
THERE'S A NUMBER OF MEDICAL FACTORS THAT UNDERLIE WHAT WE'RE
TRYING TO DO AND THEY'RE WELL-KNOWN, TOO.
THEY'VE BEEN COVERED ALREADY IN THE DISCUSSIONS.
CARDIOVASCULAR DISEASE CONTINUES TO BE THE NUMBER ONE CAUSE OF
DEATH IN OUR SOCIETY.
IN FACT, IN SAN DIEGO, DERTS FROM HEART ATTACK ALONE ACCOUNT
FOR NEARLY 5,000 PERSONS PER YEAR.
NOW, THERE ARE A NUMBER OF RISK FACTORS THAT PREDISPOSE THE
CARDIOVASCULAR DISEASE.
YOU'VE HEARD ABOUT THEM ALREADY.
IN FACT, THERE ARE SEVERAL THERAPIES THAT HAVE BEEN
DOCUMENTED TO BE EFFECTIVE IN REDUCING HEART ATTACKS.
I OFTEN THINK OF WHAT KEN COOPER USED TO SAY.
EVERYONE'S GOT TO DIE AT SOMETHING, BUT THERE'S NO SENSE
OF DYING SOMETHING STUPID.
AND, IN FACT, IF WE KNOW THAT THERE ARE RISK FACTORS THAT WE
CAN REDUCE AND WE HAVE METHODS TO REDUCE THEM, IT SEEMS TO US
THAT IF WE JUST IMPLEMENTED THE STRATEGY IN SAN DIEGO THAT WE
COULD, IN FACT, REDUCE, IF NOT TOTALLY ELIMINATE, THE NUMBER OF
HEART ATTACKS.
AND SO OUR EFFORT IN SAN DIEGO FALLS UNDER THE UMBRELLA, THE
OVERALL EFFORT OF THE SAN DIEGO COUNTY HEALTH AND HUMAN SERVICES
DEPARTMENT THAT HAS HAD A LONG-STANDING IMPROVEMENT TO
IMPROVE THAT LONG-STANDING COMMITMENT TO IMPROVE THE HEALTH
OF THE CITIZENS OF SAN DIEGO THAT'S CALLED LIVE WELL SAN
DIEGO.
SAN DIEGO COUNTY HAS BEEN, WE BELIEVE, UNIQUELY EFFECTIVE IN
TRANSLATING FEDERAL INITIATIVES INTO LOCAL ACTION.
AND WE'VE BEEN FORTUNATE ENOUGH TO ACQUIRE A COUPLE OF GRANTS TO
HELP US IN THIS REGARD.
TWO OF THEM FUNDED BY THE CDC, THE COMMUNITIES PUTTING
PREVENTION TO WORK GRANT, WHICH IS PARTICULARLY FOCUSED ON
REDUCING CHRONIC DISEASES BY INCREASING HYGIENIC LIFE STYLES
WITH PHYSICAL ACTIVITIES, NUTRITION, AND WORKING IN THE
SCHOOLS.
AND THE COMMUNITY TRANSFORMATION GRANT ALSO FUNDED BY CDC FOCUSED
UPON MAKING SAN DIEGO TOBACCO-FREE AND REDUCING
HYPERTENSION AND CHOLESTEROL LEVELS.
SAN DIEGO HAS ALSO BEEN BLESSED WITH THE BEACON GRANT, HEALTH
INFORMATION GRANT.
AND THE BEACON GRANT IS AN AWARD GIVEN TO COMMUNITIES TO INITIATE
HEALTH INFORMATION TECHNOLOGY TO IMPROVE THE QUALITY OF HEALTH
CARE.
SO HOW DID WE GET STARTED IN WELL, IT ACTUALLY STARTED AS
ACHIEVE THE 90 PERCENTILE GOALS AS REGARDS TO OPTIMAL BLOOD
PRESSURE AND OPTIMAL LIPID LEVELS.
TO DO THIS WE ORIGINATED SOMETHING WE CALLED THE
UNIVERSITY OF BEST PRACTICES.
THE UNIVERSITY OF BEST PRACTICES IS A GATHERING OF
REPRESENTATIVES OF VIRTUALLY EVERY MEDICAL ORGANIZATION IN
SAN DIEGO.
IT'S NOT ONLY PHYSICIANS BUT NURSES AND ADMINISTRATORS AND
HEALTH CARE WORKERS AND PHARMACISTS WHO ATTEND THIS AND
AT MONTHLY MEETINGS WE FOCUS ON DISCUSSING STRATEGIES THAT HAVE
BEEN MOST SUCCESSFUL IN ACHIEVING THE GOALS.
NOW, FOR THE FIRST TIME WE ARE ABOUT TO SHARE DATA BETWEEN
GROUPS.
WE FEEL THIS IS REALLY AN ENORMOUS STEP FORWARD.
YOU KNOW, WE JOKE THAT THESE UNIVERSITY OF BEST PRACTICE
MEETINGS, THE ONLY PLACE THAT PEOPLE CAN COME AND LEAVE THEIR
GUNS AT THE DOOR.
THESE ARE ALL COMPETING MEDICAL GROUPS, AND WE GET TOGETHER TO
ENHANCE THE HEALTH OF SAN DIEGANS.
THE WRIGHT CARE INITIATIVES SOON GREW TO SOMETHING CALLED THE BE
THERE CAMPAIGN.
IN THIS BE THERE CAMPAIGN WE DEVELOPED WHAT WE THINK IS A
REALLY AUDICIOUS GOAL OF ELIMINATING HEART DISEASE AND
STROKE AND SOMETHING WE CALLED MAKING SAN DIEGO A HEART ATTACK
AND STROKE-FREE ZONE.
WHAT WOULD MAKE US CONSIDER SUCH AN AUDICIOUS GOAL?
WE THOUGHT BY GOING FOR A GOAL AND MAKING SAN DIEGO HEART
ATTACK AND STROKE FREE THAT WE WOULD CAPTURE THE ATTENTION OF
THE PUBLIC, WE WOULD CUT THROUGH THE BACKGROUND OF HEALTH
ORIENTED MESSAGES THAT PEOPLE ARE ALWAYS RECEIVING.
WE EXTEND OUR PROGRAM TO EVERY CITIZEN OF SAN DIEGO.
AND WE WOULD INVOLVE THEM IN THEIR OWN HEALTH CARE.
IN FACT, OUR STRATEGY WAS TO CONTAIN OWNERSHIP OF THIS
PROGRAM TO THE COMMUNITY AT LARGE RATHER THAN TO THE DOCTORS
AND NURSES.
AND WE WANTED TO EXPLOIT THE COMMUNITY THE ARROGANCE OF SAN
DIEGOIANS WHO BELIEVE THEY LIVE IN THE VERY BEST PLACE IN THE
WORLD AND THEY ARE UNIQUELY BLESSED.
AND SO EXPLOIT THAT ARROGANCE TO GET INFORMATION TO WORK TOGETHER
TO REDUCE HEART ATTACKS AND STROKES.
AND OUR PROGRAM WAS AIMED AT ACTIVATING PATIENTS TO BECOME
SCREENED AND THEN IN LISTENING AND RECRUITING PHYSICIANS TO
IMPLEMENT THE OPTIMAL MEDICAL CARE AND TO ENSURE COMPLY
ANSPLINS OVER A LONG PERIOD OF TIME.
WE HAD FUNDING FROM JACK AND JUDY, $660,000.
WE FORMED A COMMITTEE BETWEEN THE PRIVATE SECTOR AND BETWEEN
GOVERNMENT, ESPECIALLY SAN DIEGO COUNTY, TO MOVE FORWARD IN THIS
PROJECT.
WE UNDERSTOOD FROM THE BEGINNING THAT FACTS ALONE ARE NOT OFTEN
ENOUGH TO GET PEOPLE TO CHANGE BEHAVIOR.
TO BE MOST EFFECTIVE THE CHANGING BEHAVIOR YOU NEED AN
EMOTIONAL TOUCH.
AND SO WE -- WE WERE FOCUSED ON A SAYING BY ROBERT SOME TIME
AGO, WHEN SOMETHING IS MISSING IN YOUR LIFE, IT USUALLY TURNS
OUT TO BE SOMEONE.
AND SO WE FELT THAT WE WOULD BE MORE EFFECTIVE IN DRIVING CHANGE
IN BEHAVIOR BY APPEALING TO INDIVIDUAL'S CHOICE TO BENEFIT A
LOVED ONE THAN TO BENEFIT THEMSELVES
THEMSELVES.
SO THAT DOING THINGS FOR A LOVED ONE WOULD BE MORE LIKELY TO
HAPPEN THAN DOING THINGS PER YOURSELF.
AND THAT GENERATED THE BE THERE CAMPAIGN.
NOW, I UNDERSTAND THAT NAMES ARE NOT USUALLY ALLOWED AT THIS
MEETING, BUT WE'VE BEEN GRANTED THIS EXCEPTION BECAUSE WE THINK
WE HAVE AN UNUSUAL CONVERGENCE OF VIRTUALLY EVERY HEALTH CARE
PROVIDER IN SFAENG.AN DIEGO.
AS YOU CAN SEE FROM THE LIST OF OUR STEERING COMMITTEE, IF YOU
SEE SAN DIEGO, THE CRYPTS OF THE AMERICAN HEART ASSOCIATION, THE
HEALTH PLAN.
WE HAVE REPRESENTATIVES OF THE NAVAL HOSPITAL, ON THE VA
HOSPITAL, THE CALIFORNIA CRIME AND CARE COALITION, AND VERY
IMPORTANTLY, THE SAN DIEGO MEDICAL SOCIETY.
PERHAPS OF GREATEST IMPORTANCE, WE HAVE THE FULL PARTICIPATION
OF THE SAN DIEGO COUNTY PUBLIC HEALTH AND HUMAN SERVICES
DEPARTMENT.
SO OUR BE THERE CAMPAIGN IS AIMED ALSO AT EXPLOITING THE
ROBUST TECHNOLOGY INDUSTRY WE HAVE IN SAN DIEGO.
WE HAVE A VERY, VERY VIBRANT WIRELESS MEDICAL TECHNOLOGY.
AND WE PLAN TO JOIN WITH THEM IN THIS EFFORT SO THAT OUR BE THERE
CAMPAIGN CAN ACT AS A TEST TUBE OF DEVELOPMENT AND EVALUATION OF
SOME OF THESE TECHNOLOGIES AND TO ENHANG PATIENTCE PATIENT
COMPLIANCE.
CARDIOGRAM THROUGH WIRELESS TECHNOLOGY OR UTILIZING PILLS
THAT AFTER FOLLOWING COULD EMITT A SIGNAL THAT WOULD BE DETECTED.
OR VARIOUS DENLGS WEDEPARTMENTS THAT WE COULD ENSURE IN
LONG-TERM COMPLYIANCECOMPLIANCE.
WE'VE ALREADY BEGAN AND WE HAVE A VARIETY OF ACTIVITIES THAT ARE
UNDER WAY.
I TOLD YOU ABOUT YOUR UNIVERSITY OF BEST PRACTICES, WHICH IS OUR
VEHICLE TO ENLIST PHYSICIANS.
WE PLANNED A NUMBER OF SCREENING EVENTS AT SHOPPING MALLS,
PHARMACIES, SCHOOLS.
AND ESPECIALLY IN THE FAITH-BASED GROUPS THAT EXIST IN
SAN DIEGO WILL DISTRIBUTE PAMPHLETS, PENS, AND OTHER TYPES
OF MATERIALS.
IN FACT, WE PLAN TO HAVE AN EXTENSIVE MULTIMEDIA CAMPAIGN
THAT WILL INVOLVE ALL MEETIA PLATFORMS AND ESPECIALLY THE
SOCIAL MEETIA PLATFORMS.
SO WE'VE CREATED A PATIENT ACTIVATION CAMPAIGN THAT WE PLAN
TO BE THE CENTERPIECE OF OUR EFFORT, THAT WILL BE THE
CENTERPIECE OF OUR ADVERTISING IN THE MEDIA, IN THE SHOPPING
PAUL, ONES BUSES AND WHAT NIGHT.
I WOULD LIKE TO SHOW A BU OF THEM HERE WITH YOU.
FIRST, A GRANDFATHER AND GRANDSON.
TEACHING HIM HOW TO SERVE, VERY SAN DIEGO APPROPRIATE PENDANT
AND THE SAYING READS "HIS FIRST PERFECT WAVE, BE THERE."
WE ALSO PLAN TO FOCUS VERY CLOSELY UPON MINORITIES AND
UNDERSERVED AND HERE YOU SEE AN AFRICAN AMERICAN FATHER SDANSING
WITH HIS DATHER AT HER WEDDING.
THE SAYING READS "IT'S HER TIME TO SHINE, BE THERE."
>> WE INTEND TO GET MORE INTENTION IN OUR MESSAGING AS WE
WE GO ALONG.
HERE YOU SEE A PICTURE OF A DAUGHTER SITTING NEXT TO HER
FATHER WHOSE PICTURE IS GHOSTED OUT, INDICATE THAT HE'S
DECEASED.
THE BRING READS, THE TRING I MESS MOST IS OUR HEART TO
HEARTS.
THERE'S A LITTLE SAYING ON THE FATHER THAT SAYS EVERY FIVE
HOURS SOMEONE IN SAN DIEGO DIES OF STROKE.
THE LAST EXAMPLE HERE SHOWS THE SON PLAYING CHESS WITH HIS
FATHER WHO IS GHOSTED OUT.
AND THE SAYING READS "DAD, YOU NEVER LET ME WIN.
NOW I WOULD DO ANYTHING TO HAVE YOU BEAT ME JUST ONE MORE TIME."
AND THE SAYING ON THE BOTTOM, "HEART DISEASE KILLS OVER 100
CALIFORNIANS EACH YEAR."
WE HOPE THAT THESE KINDS OF MESSAGES WILL INCENTIVIZE PEOPLE
TO TAKE CARE OF THEMSELVES SO THAT THEY CAN BE THERE FOR LOVED
ONES.
SO, TO SUMMARIZE, WE HAVE INITIATED A CALL TO ACTION TO
ELIMINATE CARDIOVASCULAR DISEASE FROM SAN DIEGO, ALTHOUGH WE AIM
FOR HEART ATTACK AND STROKE-FREE ZONE, A MORE REALISTIC BUT STILL
AUDICIOUS GOAL WOULD BE TO REDUCE HEART ATTACKS AND STROKE
BY 50% IN FIVE YEARS.
THUS FAR, THE ENTIRE MEDICAL COMMUNITY HAS BEEN ORGANIZED.
WE'VE BEEN FORTUNATE TO RECEIVE PHILANTHROPIC SUPPORT.
ACTIVATION CAMPAIGN IS FULLY DEVELOPED AND WE HAVE A STRONG
INTEGRATION WITH SAN DIEGO COUNTY HEALTH PROGRAMS.
WE HOPE THAT WHAT WE'RE DOING IN SAN DIEGO AND THE PROGRAM THAT
WE ARE CREATING WILL BE ONE THAT CAN BE TRANSLATED TO OTHER
COMMUNITIES THROUGHOUT THE COUNTRY AND, IN FACT, THROUGHOUT
THE WORLD.
THANK YOU VERY MUCH FOR GIVING ME THE OPPORTUNITY TO BRING YOU
UP TO DATE ON WHAT WE'VE BEEN DOING TO ERADICATE HEART DISEASE
IN SAN DIEGO.
NOW BACK TO JANET.
>> I WANT TO THANK ALL OUR SPEAKERS AND ENCOURAGE THOSE OF
YOU WHO HAVE QUESTIONS TO GO TO THE MICROPHONE AT EITHER END AND
ASK YOUR QUESTION.
AND TONY, I SPENT MORE THAN A COUPLE OF DECADES IN NORTHERN
CALIFORNIA.
YOU SPENT TIME THERE, TOO.
I JUST HAVE A TIP FOR YOU GUYS IN SOUTHERN CALIFORNIA.
THAT SURF BOARD LESSON, IT ACTUALLY WORKS BETTER IN THE
OCEAN THAN THE BEACH.
SO, ANYONE HAVE A QUESTION?
I DO -- WHILE YOU'RE THINKING OF YOURS, YOU KNOW, IT STRIKES ME
THAT YOU ALL, EACH IN YOUR OWN WAY, TOUCHED ON THIS CONCEPT OF
BEHAVIOR CHANGE, THE THE NEED FOR BEHAVIOR CHANGE.
INDIVIDUAL LEVEL, SYSTEM LEVEL.
WHERE I'M GOING HERE IS TO ASK YOUR THOUGHTS FOR THE GROUP
ABOUT THE INVENTIVES, EITHER THE CARROTS OR STICKS THAT YOU'VE
SEEN IN YOUR WORK SO FAR OR YOUR BUILDING INTO YOUR WORK.
HOW DO WE SHAKE BEHAVIOR THROUGH INCENTIVES
INCENTIVES.
[ INAUDIBLE QUESTION ] >> JUST, TWO INCENTIVES WE'RE
LOOKING AT WITH PHYSICIANS, ONE OF THEM IS HAVING THE FEEDBACK.
THE SECOND IS WHETHER REIMBURSEMENT ACTUALLY MAKES A
DIFFERENCE OR PHYSICIANS ARE MOTIVATED NOT TO I'M PROFIT
THEIR QUALITY OF CARE THE PATIENTS, FINANCIAL INCENTIVE
DOESN'T MAKE A DIFFERENCE.
WE HAVE A STUDY GOING ON NOW.
WE DON'T HAVE THE RESULTS YET.
LOOKING AT THE EARLY DATA IT LOOKS LIKE WE WILL NEED BOTH.
THERE MAY BE ADDITIONAL BENEFIT WITH FINANCIAL INCENTIVES AROUND
QUALITY IMPROVEMENT.
>> QUICKLY NAME FOUR THINGS.
ONE, REPORTING AND FEEDBACK, SO WE THINK THIS IS CRITICAL FOR
CLINICIANS ALSO INFORMING PATIENTS.
TWO, PATIENT INCENTIVES, SO WE'RE MOVING AWAY FROM A FEE FOR
SERVICE MODEL.
THREE, AND I WAS REMISS NOT TO HIT ON THIS MORE DURING THE
TALK.
MAKE A LINING THE PUBLIC HEALTH AND THE MEDICAL CARE ENTERPRISES
COME FROM A BACKGROUND OF COLLABORATIVE IMPROVEMENT MODEL,
THINKING ABOUT COMMUNITY AND POPULATION HEALTH.
I THINK THE MORE CMS, CDC AND OTHERS CAN BRING THAT PUBLIC
HEALTH AND CLINICAL CARE TOGETHER AS DR. FRIEDENS ALLUDED
TO IS CRITICALLY IMPORTANT.
I THINK THE LAST, WHICH I -- IS, I THINK, BASICALLY ALIGNING WITH
PROFESSIONALISM.
I THINK WE HAVE A LOT OF ABILITY TO WORK WITH PROFESSIONALS,
WHETHER IT BE PUBLIC HEALTH PROFESSIONALS OR CLINICAL
PROFESSIONALS AND UTILIZING THAT INTRINSIC MOTIVATION FOR
IMPROVEMENT.
>> THANKS, PATRICK.
IF YOU WOULD IDENTIFY YOURSELF FIRST AND THEN ASK YOUR
QUESTION.
>> SURE.
CHRONIC DISEASE CENTER.
I HAD A QUESTION FOR DR. FARLEY.
FIRST OF ALL, VERY IMPRESS IIVE SERIES OF PRESENTATIONS AND
AMBITIOUS CAMPAIGN.
DR. FARLEY, COULD YOU TALK MORE ABILITY
ABOUT HOW YOU BUILT COMMUNITY SUPPORT IN NEW YORK CITY FOR
WHAT IS OBVIOUSLY VERY IMPRESSIVE SERIES OF TAX
INCREASES AROUND TOBACCO.
I THINK THERE WAS SORT OF A COLLECTIVE AH IN THE ROOM WHEN
YOU SAID $11 A PACK.
TALK TO US A LITTLE BIT ABOUT THAT, WOULD YOU, PLEASE?
>> MOST OF THE TAX INCREASES OCCURRED BEFORE I GOT THERE.
BUT I WILL SAY THAT ONCE A GROUP HAD A PART IN IT.
LET ME SAY THAT IT GOT BEYOND A CERTAIN POINT WHERE LEGISLATURE
SAW THERE WASN'T THAT MUCH RESISTANCE TO RAISING TOBACCO
TAXES AND IT WAS A GOOD SOURCE OF REVENUE.
SO THE LAST TAX INCREASE THAT OCCURRED IN NEW YORK STATE
HAPPENED WITHOUT A LOT OF PUBLIC HEALTH ENCOURAGEMENT.
THEY JUST SAW IT AS PURE REVENUE MOVE, WHICH IS SURPRISING.
IT'S GOOD IN MANY WAYS.
IT'S NOT GOOD IF THAT MEANS THEY DON'T ALSO USE SOME OF THAT
FUNDING TO SUPPORT TOBACCO CONTROL PROGRAMS.
BUT I THINK WE'VE GOTTEN PAST A CERTAIN POINT NOW WITH TOBACCO
TAX INCREASES, IT'S LIMITED.
>> THIS QUESTION IS FOR DR.
FARLEY, AS WELL.
GOOD TO SEE THAT WHAT YOU TAUGHT US IN THE CLASSROOM HAS ACTUALLY
BEEN IMPLEMENTED IN PRACTICE.
I DO HAVE ONE QUESTION I AM A BIG PROPONENT OF STRUCTURAL
INFORMATION AND POLICY CHANGES, INTRODUCING IN LAW.
WE SAW IN NEW YORK, TAXES THAT CAME IN THE FORM OF POLICY
CHANGE, TAX INCREASES.
BUT OUR NATIONAL AGENDA, WE FOCUSED A LOT ON EDUCATION.
DO YOU THINK WE NEED LIKE A SHIFT IN OUR FOCUS AND WE SHOULD
SHIFT MORE -- SHIFT OUR FOCUS MORE TOWARDS STRUCTURAL
INTERVENTION AND, AS YOU STATE IN THE PREVENTION, FOCUS ON
CHANGING THE SHIFTING THE COST INSTEAD OF CUTTING THE COST.
WHAT DO YOU THINK ABOUT THAT?
>> I DO THINK THAT POLICY AND ENVIRONMENTAL CHANGE IS THE BEST
WAY TO REDUCE RATES OF DISEASE THAT ARE POPULATION WIDE.
CARDIOVASCULAR DISEASE.
I THINK WE NEED TO LOOK MUCH MORE AT THAT.
NOW, I WILL SAY THIS, IT'S A LOT EASIER AT THE LOCAL LEVEL THAN
IT IS AT THE STATE LEVEL.
AT THE STATE LEVEL AND NATIONAL LEVEL.
OUR EXPERIENCE IS THAT THE PUSHBACK FOR THE RESISTANCE FROM
INDUSTRY LOBBIES ARE LESS AT THE LOCAL LEVEL AND AT THE STATE OR
NATIONAL LEVEL.
WE HAVE OPPORTUNITIES IN NEW YORK CITY THAT WE SIMPLY DON'T
HAVE AT THE NATIONAL LEVEL BUT WE CERTAINLY WANT TO TAKE ALL
THE OPPORTUNITIES AND HOPEFULLY SET EXAMPLES FOR THE REST OF THE
COUNTRY.
AND THEN IT MAKES IT EASIER FOR OTHER PLACES TO DO IT.
>> DR. CONWAY, OR ANYONE, WHAT DO YOU THINK WE CAN DO TO HELP
THE HEALTH CARE SYSTEM IMPROVE THEIR PERFORMANCE RAPIDLY,
BECAUSE WE KNOW HOW DIVERSE THE PAVERS ARE, PROVIDERS,
CHALLENGES OF CLINICAL INERTIA.
HOW DO YOU THINK WE COULD GET AS RAPID AN IMPROVEMENT ADDSS
POSSIBLE?
WHERE SHOULD WE FOCUS OUR ATTENTION IN IMPROVEMENTS IN OUR
HEALTH?
>> FIRST, ALIGNED INCENTIVES WHICH YOU'RE ALREADY WORKING ON
IN DOING, BUT I THINK FURTHER THAT ALIGNMENT ACROSS PAYERS,
ACROSS PRIVATE HEALTH AND MEDICAL SYSTEM TO FOCUS, WHAT
YOU'RE DOING, FOCUS ON PRIORITIES.
I USED TO DO EXTESH -- TERNAL REPORTING.
THEY ALL WANTED DIFFERENT THINGS.
FOCUS AND ALIGNMENT GO TOGETHER.
THIRD, I THINK WE HAVEN'T FULLY HARNESSED THE MODELS.
I APPLAUD PLACES LIKE MILLION HEARTS, DRIVE IMPROVEMENT, SET
GOALS THAT ARE ALIGNED AND MEASURES THAT ARE ALIGNED BUT
THEN ALLOW LOCALITIES, STATES, ET CETERA, TO INNOVATE TO
ACHIEVE THOSE GOALS.
>> THANK YOU.
I AM GOING TO ASK A FINAL QUESTION, IF I DON'T -- ANY
ENVISION QUESTIONS?
NOPE.
I'LL WARN THE SPEAKERS, THIS QUESTION IS GOING TO BE ABOUT
SCALEABILITY.
I'LL GIVE YOU A CHANCE TO THINK ABOUT THAT AS I RATTLE FOR A
MOMENT MORE.
WE KNOW THAT THERE IS A CHUNK OF THE COUNTRY THAT IS BETWEEN SAN
DIEGO AND NEW YORK CITY.
AND FOR THOSE OF US WHO LIVE AND WORK THERE, I'D LIKE FOR EACH OF
YOU TO ADDRESS EITHER WHAT YOU THINK -- HOW YOUR MODELS CAN GET
SCALED TO THE REST OF THE COUNTRY OR WHAT'S IN THE WAY OF
THAT SCALEABILITY.
? DING DING DING DING ?
>> I GUESS I GO FIRST.
EVERYBODY ISSING INGLOOKING.
I WASSING LOOKING INGLOOKING BACK, BUT EVERYONE
ELSE WAS LOOKING AT ME.
SO, WE HAD HOPED FROM THE VERY BEGINNING THAT WHAT WE WERE
DOING WOULD BE APPLICABLE TO EXPORT.
AND SO WE TRIED TO DESIGN THE PROGRAM THAT WAY.
I THINK THAT THERE'S NOTHING THAT WE'VE DONE IN SAN DIEGO TO
THIS POINT IN TIME THAT COULDN'T BE ADOPTED BY EVERY OTHER
COMMUNITY.
THE UNIVERSITY OF BEST PRACTICES IS A GREAT MODEL FOR COMMUNITIES
TO RALLY AROUND, AND THERE IS EVIDENCE THAT A SIMILAR GROUP
THAT'S STARTING UP IN SACRAMENTO NOW THAT'S BEEN IN TOUCH WITH
US, AND THEY'RE NOT CLOSE TO THE OCEAN, ALTHOUGH NOT IN THE GREAT
FLYOVER.
YOU KNOW, I THINK WE'VE BEEN FORTUNATE IN TERMS OF
PHILANTHROPY, BUT OUR PATIENT ACTIVATION CAMPAIGN, WE WILL
SHARE WITH ANYONE WHO WANTS IT.
WE THINK IT'S -- WE THINK IT'S A GOOD STRATEGY.
WE THINK THAT THE MATERIAL THAT'S BEEN PREPARED IS VERY
EFFECTIVE.
SO EVERYTHING WE'VE DONE IS TO SHARE WITH OTHER PEOPLE OR
ANYONE WHO IS INTERESTED.
>> I WANT TO ADDRESS SOME OF THE POLICY CHANGES AND THE
SCALEABILITY OF THOSE.
I THINK WE LEARNED IN TOBACCO CONTROL YOU CAN BE FAR MORE
INNOVATE INNOVATIVE, MOVE MORE QUICKLY AT
THE LOCAL LEVEL THAN NATIONAL LEVEL.
SMOES MOST SMOKE FREE AIR IS AT THE
LOCAL AREA.
TRANS FATS, STATE HEALTH DEPARTMENTS REGULATE RESTAURANTS
SO THEY HAVE THE ABILITY TO HAVE A HAND IN OUR FOOD SUPPLY RIGHT
NOW.
AND SO THOSE LOCALITIES SHOULDN'T WAIT FOR CHANGES AT
THE NATIONAL LEVEL BECAUSE JUST THE POLITICS ARE FAR MORE
DIFFICULT AT THE NATIONAL LEVEL.
I WOULD ENCOURAGE THEM TO LOOK AT WHAT THE BEST EXAMPLES ARE
ANYWHERE IN THE COUNTRY AND PICK THEM UP LOCALLY.
>> I LITERALLY THINK THAT'S THE CENTRAL QUESTION OF TRANS
FORRING HEALTH CARE IN AMERICA, SO THAT WILL BE A SHORT ANSWER.
CAROLYN CLANCY AND I WROTE A COUPLE OF PAPERS IN
TRANSFORMATION FRONT LINE.
MORE OF A MEDICAL CARE FRAMEWORK, BUT I THINK APPLY
MORE BROADLY, AS WELL.
ESSENTIALLY, I THINK THE QUESTION IS HOW DO YOU DECREASE
THE CYCLE TIME OF LEARNING.
HOW DO YOU TEST NEW APPROACHES, RAPIDLY EVALUATE WHAT WORKS, AND
THEN SCALE THAT.
AND I THINK IN THIS CASE, YOU KNOW, IT IS -- IT'S NOT EASY OR
WE WOULD HAVE DONE IT BEFORE.
BUT I THINK THE CENTRAL QUESTION IS THAT CYCLE TIME OF LEARNING,
I THINK WITH THE INNOVATION CENTER AT THE CMS LEVEL WE'RE
TRYING TO THINK ABOUT HOW WE THINK ABOUT THE CYCLE TIME IN
OUR OFFICE AND QUALITY IMPROVEMENT AND I WOULD
ENCOURAGE ALL OF THOSE IN THE AUDIENCE AND CDC TO WORK WITH US
AND HOW DO WE REALLY RAPIDLY EVALUATE PROGRAMS AND SCALE AND
PROGRAM AND LEARN WHEN THEY DON'T WORK IN LOCAL -- DIFFERENT
LOCAL CONTEXTS, WHY DON'T THEY WORK AND WHY DO THEY NEED TO BE
MODIFIED AT A LOCAL AND A STATE LEVEL.
>> THANK YOU ALL FOR JOINING US.
I'M GOING PUT ONE LAST PITCH IN TO GO TO THIS WEBSITE AND SHOW
YOUR SUPPORT BY TAKING THE PLEDGE.
>> I THINK THIS WAS A SCIENTIFIC HEAVEN, SO I AM ASKING YOU TO
GIVE ONE MORE APPLAUSE TO THE FIVE PEOPLE YOU MET AT CDC.
AND WE'LL SEE YOU IN FOUR WEEKS, SAME TIME, SAME PLACE.
THANK YOU.