Implementing a Quality Improvement Collaborative to Improve Hypertension Control and Advance Million Hearts Among Low-Income Californians, 2014-2015

Backman DR, Kohatsu ND, Yu Z, Abbott RE, Kizer KW
Source: Prev Chronic Dis
Publication Year: 2017
Patient Need Addressed: Chronic Conditions
Population Focus: Low income, Medicaid beneficiaries
Intervention Type: Education
Type of Literature: White

From January through December 2015, the California Department of healthcare Services, which administers Medi-Cal, the nation’s largest Medicaid program, conducted a quality improvement collaborative (QIC) with 9 Medi-Cal managed care plans (MCPs) aimed at improving hypertension control consistent with the Million Hearts initiative. The QIC included quarterly webinars and links to local, state, and national resources that consisted of materials and consultations with subject matter experts. Participating MCPs demonstrated an average increase of 5.0 %age points in their rates of controlled hypertension. Collaboratives can achieve substantial quality improvement in Medicaid managed care plans.

Insights Results

Overview intervention

  • Study objective was to determine the effect of a quality improvement collaborative (QIC) on hypertension control, which remains a major risk factor for deaths associated with heart disease, among 9 managed care plans (MCPs) in California whose baseline was below the Million Hearts Initiative target of preventing 1 milling heart attacks and strokes by 2017
  • The QIC involved attending quarterly 1.5 hour webinars with MCPs in which local, state, and national leaders presented hypertension control best practices and provided evidence-based tools and resources. The intervention also included exposure to an effective quality improvement program, the Right Care Initiative, and consultation with subject matter experts at the Department of Health Care Services. After each webinar, participants were sent a survey to garner feedback that was used to tailor subsequent webinars
    Methods intervention
  • To assess success, researchers used the Healthcare Effectiveness Data and Information Set (HEDIS) controlled blood pressure (CBS) measure, which assesses percentage of those diagnosed with hypertension whose blood pressure was adequately assessed in the measurement year


    • Results demonstrate that during the QIC intervention year, CBP rates improved significantly in 7 of 9 participating MCPs. Prior to intervention, participating MCPs had a multi-year history of declining hypertension rates during the study period. Nonparticipating plans also showed decreasing CBP rates. The mean CBP rate improved by 5%

    Key takeaways/implications

    • Participation in the QIC was associated with improved hypertension control; 7 of 9 MCPs demonstrated improved control in the intervention period compared with baseline. This improvement was notable because all plans had a multiyear history of declining hypertension control rates before the intervention
    • Several factors may explain the positive association. First, there were high participation rates for each of the quarterly 1.5-hour webinars. Second, there was broad involvement of MCP staff and the active engagement of DHCS quality consultants. Third, there was ongoing sharing among MCP peers of best practices and barriers
    • Findings suggest that QIC helped to improve CBP outcomes at the MCP level and that learning collaborative can advance health care quality metrics with a moderate investment of resources. Shared learning during webinars may have contributed to the improved outcomes at the systems level compared to individual health plans attempting to improve CBP outcomes before the QIC
    • Limitations to the study include lack of causality, studied MCPs volunteered, and lack of evaluation of long-term effects