Million Hearts Implementation: A 16 State Learning Collaborative to Improve Hypertension Control

In the United States, one in three Americans have high blood pressure leading to increased risk for stroke and heart attacks and costs the country 47.5 billion each year.  In an effort to reduce one million incidents of stokes or heart attacks by 2017, Million Hearts was launched by the federal government to address aspirin, blood pressure, cholesterol and smoking cessation.  ASTHO, with support from the Centers for Disease Control and Prevention, selected sixteen state health agencies (ten the first year and six the second year) to participate in a Million Hearts state learning collaborative. The states are utilizing a quality improvement process to partner across sectors to implement evidence-based strategies to identify, control, and improve blood pressure. Each state team, led by the state health agency, is made up of local public health agencies, healthcare partners, quality improvement organizations, HIT expertise, and public and private payers. ASTHO utilizes a systems-level change approach which leverages data, financing, policy, and protocols, standardizing practice, and community-clinical linkages.  States in the collaborative have made progress in each of the areas. States have partnered with payors to explore pay for performance to control hypertension,  performance measure alignment, and financing community health workers.  States have utilized data to drive change at multiple levels of the system. For example, at the population level, one state analyzed discharge data to create GIS maps to target community efforts to more local level data use such as using EHR data for panel management. Working with clinical partners, protocols were implemented by practices. These protocols included referral systems to local public health to ensure follow up and continued treatment. Utlizing a systems approach with the learning collaborative, ASTHO has supported the states leading to improved hypertension control and spread of best practices and policies.