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Right Care Initiative

Objective

Measurably reduce death and disability through enhanced practice of patient-centered, evidence-based medicine.

Since 2007, The Right Care Initiative’s goal has been to apply scientific evidence and outcomes improvement strategies to reduce patient morbidity and mortality through a collaborative focus on achieving quality goals where performance metrics indicate that evidence-based, life-saving practices are not fully deployed. Data from the Integrated Health Care Association, the National Committee For Quality Assurance, the federal Agency for Health Care Quality and Research, the Commonwealth Foundation, CMS, and the Centers for Disease Control indicate that approximately 81,000 Californians die yearly from heart attacks, strokes and diabetic complications. Many of these deaths, disabilities and associated health care costs could be prevented with evidence-based patient management and clinical quality improvement to adopt up-to-date medical knowledge. Our work is focused in these high-leverage areas of better management of cardiovascular disease and diabetes, with particular emphasis on control of blood pressure, cholesterol and blood sugar.

CDPH estimates Californians suffer approximately 72,000 deaths from cardiovascular disease (including heart attack and stroke) and 7,000 deaths from diabetes each year.  According to the CDC, many of these deaths are preventable.  NCQA conservatively estimates that improving California’s cardiovascular disease and diabetes measures to the national HEDIS 90th percentile could save 1,694 to 2,818 CA lives each year, while avoiding $118 million in yearly hospital costs, 766,401 sick days and $125.56 million in lost productivity. Heart disease, hypertension and diabetes are increasingly well understood scientifically and ripe for best practices collaboration. Over the course of this project, California has outpaced the nation in improving health system performance by controlling blood pressure, cholesterol and blood sugar.  Our project builds on the “100,000 Lives” campaign for reducing medical errors and the Million Hearts™ national initiative launched in 2011.

 

View a printable version of the Right Care Initiative Project Briefs and Data.

RCI Awards

Awards are given annually to California health plans and medical groups who meet clinical performance standards for controlling blood pressure, blood sugar and/or cholesterol.

RCI Award Winners



 RCI Award Criteria

California Statewide Goals—Preventing Heart Attacks, Strokes, and Diabetic Complications

 Achieve National HEDIS 90th Percentile “A-grade” Targets:

  • 77% of hypertensive patients with blood pressure controlled: <140/90 mm Hg
  • 69% of diabetic patients with blood sugar controlled: HbA1c <8

  In absence of HEDIS cardiovascular disease 90th percentile target, Right Care Initiative's 2016 target:

  • 75% of patients with cardiovascular conditions and/or diabetes placed on appropriate statin (Proxy, LDL controlled:  LDL-C < 100 mg/dL)

Current Activities:

  • University of Best Practices in three metropolitan areas to share learning and encourage adoption of evidence-based interventions for preventing heart attacks, strokes, and complications from diabetes (e.g., amputations, blindness, kidney failure, etc.). Practical presentations from benchmark performers are geared toward medical, pharmacy and quality improvement directors to spur achievement of national “A-grade” performance.
  • Annual Leadership Summit to highlight UBP progress, new HEDIS & P4P performance data, promote adoption of strategies used by top performers, and give performance awards. 

* The views and content expressed in documents by presenters to the Department of Managed Health Care should not be interpreted as an endorsement by the Department.

Key Partners

  • CA Dept. of Managed Health Care
  • CA medical groups, clinics & health plans
  • University of California schools of public health,
    medicine, and pharmacy
  • California Chronic Care Coalition
  • Health Services Advisory Group QIO
  • Stanford Clinical Excellence Research Center
  • Stanford School of Medicine
  • University of Southern California
  • Sierra Health Foundation
  • American Medical Group Association Foundation
  • Integrated Healthcare Association (IHA)
  • Pacific Business Group on Health
  • CA Medi-Cal Program (DHCS)
  • CA Dept. of Public Health (CDPH)
  • CA Emergency Medical Services Agency
  • No More Broken Hearts Foundation
  • California Health Care Foundation
  • The California Endowment
  • American Heart/Stroke Association
  • Local US Department of Veterans Affairs
  • Local Air Force Medical Center
  • Ralphs Grocery Company
  • Abbvie
  • Boehringer-Ingelheim
  • Genentech
  • Johnson & Johnson
  • Novo Nordisk

Research Questions

  • What are the promising interventions for bringing patients into safe control?
  • How can implementation of evidence-based medicine be refined to quickly meet the Right Care goals, and what are the barriers for doing so?
  • What strategies are needed to improve clinical outcomes in light of health disparities in California’s diverse population?

Contact

Hattie Rees Hanley, MPP, Right Care Initiative Director, hattie.hanley@dmhc.ca.gov, hattiehanley@berkeley.edu

Implementation Action:

DMHC publicly launched the Right Care Initiative with NCQA and the Deans of UC Berkeley and UCLA Schools of Public Health in March 2008 at the 1st annual Clinical Quality Improvement Leadership Summit. Since then, more than a dozen Right Care summits have been held around the state. Each Right Care gathering is a collaborative effort to close the gap between science and practice to improve patient outcomes by working with medical directors, pharmacy and quality improvement directors, as well as thought leaders in evidence-based medicine.

State-Wide Right Care Technical Expert Steering Committee Chair, Founding Principal Investigator and University of Best Practices Co-Founder:

Stephen Shortell, PhD, MPH, Professor and Dean, Emeritus, University of California, Berkeley, School of Public Health;

Arnold Milstein, MD, MPH, Professor of Medicine and Director, Stanford University Clinical Excellence Research Center; PBGH Medical Director

 

Jerry Penso, MD, MBA, University of Best Practices Co-Founder and Chief Medical Officer, American Medical Group Association

*The views and content expressed in documents by presenters to the Department of Managed Health Care should not be interpreted as an endorsement by the Department.

Cardiovascular Disease and Diabetes Research Team:

Arnold Milstein, MD, MPH, Professor of Medicine and Director, Stanford University Clinical Excellence Research Center; PBGH Medical Director

Anthony DeMaria, MD, Immediate Past Editor-in-Chief, Journal of American College of Cardiology; Founding Director, UCSD Cardiovascular Center

Susan L. Ivey, MD, MHSA, Director of Research, Health Research for Action and Associate Professor, UC Berkeley School of Public Health;

Hector Rodriguez, PhD, MPH, Associate Professor, Health Policy and Management, Chair, Health Policy PhD Graduate Group, UC Berkeley School of Public Health

 

Brent D. Fulton, PhD, MBA, Asst. Adjunct Professor of Health Economics and Policy, Assoc. Director, Petris Center on Health Care Markets and Consumer Welfare, UC Berkeley

 

Jan Hirsch, PhD, Assistant Professor of Clinical Pharmacy, UCSD Skaggs School of Pharmacy and Pharmaceutical Sciences

Steve Chen, PharmD, Associate Professor of Clinical Pharmacy, USC

Mary Fermazin, MD, MPA, Chief Medical Officer, Health Services Advisory Group (CMS-QIO)

Thanks to an NIH GO grant (2009-July 2012), the Right Care Initiative received a special opportunity to launch a community-focused effort in San Diego to reach the Right Care Initiative goals of preventing heart attacks, strokes and diabetic complications and pilot the first University of Best Practices in San Diego. Since then, a Right Care University of Best Practices has been launched in two additional metro areas: Sacramento in 2012 and Los Angeles in 2013. Each University of Best Practices is comprised of the major delivery systems of the region, including medical groups, health plans, community clinics, the VA, Navy and Air Force, along with subject matter experts.

Los Angeles Right Care University of Best Practices Co-Chairs:

Carol Peden, MB-ChB, MD, MPH, Executive Director, USC Center for Health System Innovation, Keck School of Medicine, University of Southern California (USC); Professor, Department of Anesthesiology, Keck School of Medicine, USC

Karol E. Watson, MD, PhD, FACC, UCLA Professor of Medicine/Cardiology; Co-Director, UCLA Program in Preventive Cardiology; Director, UCLA Barbra Streisand Women’s Heart Health Program

Sacramento Right Care University of Best Practices Chairman:

José Arévalo, MD, FAAFP, Senior Medical Director, Sutter Independent Physicians Medical Group; President, Latino Medical Society of California

(Hosted at Sierra Health Foundation)

San Diego University of Best Practices Chair:

Anthony DeMaria, MD, Univ. of Best Practices Chair; Immediate Past Editor-in-Chief, Journal of American College of Cardiology; Founding Director, UCSD Cardiovascular Center

(Hosted at UC San Diego)

Resources

We wish to thank Right Care Initiative supporters: The Sierra Health Foundation, The California Chronic Care Coalition, The No More Broken Hearts Foundation, The Health Services Advisory Group (a federally designated Quality Improvement Organization), Ralphs Grocery Company, Abbvie, Boehringer-Ingelheim, Genentech, Johnson & Johnson, Novo Nordisk, The California Endowment, and The California Health Care Foundation that enables research and logistical support by the University of California for the Right Care Initiative University of Best Practices, and our annual clinical quality improvement leadership summits.