Target specific populations for hypertension DM

HYPERTENSION, THE UNITED STATES' leading medical condition, has gripped the lives of at least 58 million Americans-one in five-and an estimated $54 billion to $63 billion in costs is directly or indirectly tied to hypertension. If disease management could achieve best-practice blood pressure control levels, potential savings in medical costs and productivity could reach $5.6 billion, according to NCQA.

The gaps in treatment, as they pertain to specific populations, struck a chord with Aetna officials, who began to address a previously unrecognized race-related gap in 2002, in response to an Institute of Medicine report detailing variations in treatment of hypertension among certain racial populations.

The Aetna initiative built a specialized disease management program that focused on African Americans with hypertension more specifically than DM programs that target patients by diagnosis only.

"It's a culturally competent disease management program that actually allows us to see the impact of blood pressure control on this population compared with the standard program," Dr. Rawlins says. "What we discovered was that there was a larger percentage of members who reached targeted blood pressure, compared with those in the standard program."

Identifying target members was the challenge in the beginning, according to Michelle Toscano, business program manager, Aetna. The plan didn't have an automated system to capture demographic information related to race. However, once the information was collected in later efforts, Aetna created a rigorous process to safeguard the data and make sure it's applied appropriately, Toscano says.

In the demographic-capturing effort, 5.8 million members to date have self-identified by race, which represents 25% to 28% of total membership.

"There certainly was a lot of worry and consternation about getting this information," Dr. Rawlins says. "Jack Rowe, CEO at the time, pointed out accurately that the only way to find out who the population is, is to ask."

He says health insurers have a growing responsibility to address healthcare disparities in specific populations.

At APS Healthcare in Brookfield, Wisc., a Healthy Together hypertension-specific DM model has been in place since 2003.

"We take a holistic approach by not just focusing on the individual's hypertension," says Helene Forte, vice president of medical operations for APS Healthcare. "You can't separate out the different medical conditions, nor the mind/body connection."

For example, someone who is dealing with particularly stressful life circumstances would not likely benefit as much from treatment. In a sense, APS Healthcare wants to know each patient's medical history plus a bit more.

"What keeps them up at night?" Forte says. "You want to engage them in wanting to make change."

Consider the patient with insomnia who also has hypertension. She recommends providing strategies that can address the sleep issues so the member is in a better state of mind to focus on blood pressure. Forte says it's also important not to focus on too many issues at one time. Overwhelming a member is unlikely to produce improved outcomes.

The number of people with hypertension is continually climbing, according to Forte, who said prevalence rose 10% over the last decade. She cites the Framingham Study, which states that 50% of people over age 55 will acquire hypertension.

"Early identification is absolute key," Forte says.