May 10, 2012

BSSR Lecture: The California Right Care Initiative

Efforts to improve the quality of chronic disease care have often failed to improve patient outcomes. Averaged across all practices, patients receive the recommended care only about half the time. In California the performance rates for many standard chronic care quality measures, such as control of high LDL cholesterol or blood pressure, rank substantially below those of other states.

Although protocols for managing these risk factors are known to be effective, the major problem is in achieving application of the protocols by providers and adherence among patients. Not all plans are poor performers and there is substantial variability across California medical plans. The best performing California health plans are among the national quality performance leaders and we have been focusing on high performing plans with the goal of spreading their practices to plans performing less well. This presentation reviews efforts from the NHLBI funded California Comparative Effectiveness and Outcomes Improvement (CEOI) Center, an entity that is developing a sustainable statewide infrastructure for Comparative Effectiveness Research on primary and secondary prevention of cardiovascular disease (CVD) for the 15 million people enrolled in California managed care plans.

Partners in the effort include the State of California, three campuses of the University of California, RAND, and most of the major health plans serving California (Kaiser, Blue Cross, United, Atena). Results from a community wide project in San Diego demonstrate the effects of medical practice design changes on outcome systolic blood pressure, LDL cholesterol, and glycosylated hemoglobin. Methodologies for monitoring high and low performing groups will also be presented.