WEBINAR: Check. Change. Control. Cholesterol April 4, 2018

WEBINAR: Check. Change. Control. Cholesterol April 4, 2018 Good afternoon, everyone. My name is Alberta I am from the New England QIN-QIO and I will be your moderator for today s webinar, Check. Change. Control, Cholesterol. Before we get started, I wanted to review a few housekeeping items This call will be recorded for training purposes I ll provide you with details on accessing the recording at the end of this webinar. The phone lines will be on mute for the duration of the presentation. We will take questions at the end of the presentation. At that time, I will provide you instructions on how you can ask a question over the phone. You can also pose a question in the chat box throughout the presentation. Please make sure to send question to All Participants. At this time, I'm going to pass the microphone it over to Karen Evans. Good Afternoon. This is Karen Evans with the New England QIN-Q-I-O, which is administered by Healthcentric Advisors in partnership with Qualidigm. Welcome to the Check. Change. Control. Cholesterol Webcast, highlighting a brand-new program from the American Heart Association. Improving cholesterol levels decreases the risk for heart disease which can reduce unplanned hospital admissions, re-admissions, and Emergency Dept. visits. In addition to negatively impacting the quality of life for people, avoidable hospitalizations contribute to escalating healthcare costs. The Centers for Medicare and Medicaid (CMS) continues to create Value Based Payment systems that enable them to pay more for care given by providers who can demonstrate higher quality and lower costs, by improving rates for specific measures. We are grateful to Stefanie Barba and Cherelle Rozie with the American Heart Association to share some practical evidence-based resources that can be used to improve Cholesterol outcomes, which can help you target related MIPS, ACO, and even the C in the Million Hearts measures. You will find Stefanie and Cherelle s contact information just before the Questions slide toward the end of the presentation. The NE QIN-QIO along with QIOs across the country provide no-cost support to providers to help them with their quality reporting in general and to improve specific measures that make sense for each

organization. We offer focused interventions for several areas, including diabetes and cardiac related outcomes, as these are two of the top drivers of avoidable hospitalizations. At the end of todays presentation, we give you links to some helpful resources and contacts in each of the New England states who are here for you. Stefanie Barba is the Community Health Director for the Greater Boston region of the American Heart Association American Stroke Association, and works to bring wellness and quality improvement programs to corporate work-sites, the community, and healthcare practices. She is the lead for the Board of Directors' community health priorities with a focus on food access, blood pressure and cholesterol control. Stefanie received her Bachelor of Science in Business Administration and Marketing from the College of Charleston. She strongly believes in educating and working with groups and building networks of volunteers and community partners to increase awareness of the impact that access to healthy food and nutrition has on overall health. Cherelle Rozie is the Director of Multicultural Initiatives & Health Equity for the American Heart Association American Stroke Association in Greater Boston. Cherelle received her Master of Public Health degree with a concentration in Community & International Health, from New York University. She is passionate about public health and disease prevention and specifically social determinants, health disparities and inequities in communities of color and other underserved populations. Her personal interests include youth development and health equity/civil rights community work. Welcome to you both! Stefanie, I ll turn it over to you. Thank you, Karen for the introduction. Good afternoon, everyone. This is Stephanie. I will start us off today. Cherelle and I will alternate roles throughout the presentation. To start a little bit about the Check Change Control (CCC) Cholesterol initiative. This is a national initiative by the American Heart Association (AHA) to reduce the number of Americans who have heart attacks and strokes by urging medical practices, health service organizations, and patients to prioritize high cholesterol tracking and treatment. CCC cholesterol seeks to support health providers across the country to screen and treat at risk patients at a rate of 70% or greater among the patients they serve. To help achieve this goal CCC cholesterol empowers registrants with a dedicated website featuring a free evidence-based improvement program that includes tools and resources to help them track their cholesterol diagnosis management and practice. A little bit about the Heart Association and why the focus on cholesterol. The mission of the American Heart Association is to build healthier lives free of cardiovascular diseases and stroke. AHA has set a goal of improving the cardiovascular health of all Americans by 25% by 2020 and decreasing the mortality from cardiovascular disease by 20% by 2020. We know high cholesterol is one of the major controllable risk factor yours for heart attack and stroke. When combined with other risk factors such as smoking, high blood pressure or diabetes the risk increases even more. We recognize that if we are going to reach our 2020 goal we have to look at high cholesterol. As a part of the 2020 goal the AHA aims to move 9.3 million adults to cholesterol control. Currently in adult total cholesterol level should be at or below 200 mg/dl. This indicates that, at this time, 40 % of all adults are at higher risk. Overall cholesterol levels

above 200 mg/dl are considered to be linked to increased health risk. One in three adults have high levels of LDL and overall 12% of Americans have total cholesterol levels over 240 mg/dl. A little more about the link between cholesterol and cardiovascular disease. In 2013 the American Heart Association's clinical practice guidelines moved away from treatment of a specific cholesterol level to a treatment based on a 10-year risk of having an atherosclerotic cardiovascular disease (ASCVD) or stroke event. This risk is calculated using the evidence-based ASCVD Risk Estimator (provider tool) or the Check. Change. Control. Calculator (patient tool). We will discuss both of these tools in more in depth. The ASCVD Risk calculator is a peer-reviewed online calculator that calculates the 10-year risk among patients without pre-existing cardiovascular disease who are between 40 years and 79 years of age. Patients are considered to be at elevated risk if the risk calculator is greater or equal to 7.5%. The estimator takes, in consideration, things like age, gender, smoking status, history of diabetes cost cholesterol, blood pressure, and current treatment for hypertension. This is Cherelle. Hi, everyone. I'm going into why using the ASCVD risk calculator is beneficial. This is a starting point for assessing ASCVD risk calculator by identifying patients and at-risk populations who might benefit from preventive treatment. This provides a baseline to initiate an open discussion with patients as well as guiding decision-making regarding treatment options to prevent ASCVD including lifestyle changes, risk factor management and pharmacologic treatment. At the AHA, when developing programs, we want to focus most on educating as well as working with individuals to make lifestyle changes focusing more on risk factor management and ultimately, focusing on a pharmacologic treatment. We want to focus on the lifestyle changes and risk factor management piece first. When to use the calculator? We want patients 40 to 79 years of age who do not have ASCVD, as well as patients with LDL levels between 70 to 189 mg/dl without ASCVD and who are not on statin therapy. When NOT to use the calculator? Patients <40 years of age or > 79 years of age should not use the ASCVD calculator. It is not for patients with d established ASCVD or with symptom suggestive of cardiovascular disease. On this next slide you will see the patient calculator as well as the provider calculator. Another thing that AHA does when we develop programs we allow patients to be proactive with their own health. We want patients to be empowered to take care of themselves before relying on a Doctor or Physician or Care Taker. The patient calculator allows patients to estimate their risk for a heart attack or stroke event by using the link below where it says www.ccccalculator.ccctracker.com. Additionally, you have the Provider ASCVD Risk Calculator. Some practices use this calculator through their own electronic health records. The link is www.professional.heart.org/ascvd. Sometimes, if they are not already using it, this feature is available through the electronic health records. We also have some practices that may not have this feature yet but they may be able to apply it through their EHR vendor over time. Because we are in the beginning stages when it comes to prioritizing and controlling cholesterol, you are not required to utilize the calculator feature yet. We are mainly asking practices to prioritize cholesterol with the intentions of utilizing this calculator in the future. If you do not have access to a risk calculator

through your EHR you are welcome to use the one provided by the AHA at no cost to you or your Practice. You can get the link through Check.Change.Control.Cholesterol. The calculator is also available on that site as well. Here you have Check.Change.Control.Cholesterol the goal of this program is aligned with all of the recognition programs to improve the health of the nation. Check.Change.Control.Cholesterol does seek to reduce the number of Americans who have heart attacks and strokes by urging medical practices, patients and the health services to prioritize cholesterol recognition and treatment. The Check.Change.Control.Cholesterol program has two levels of recognition. Again, to get started you can go to the website www.heart.org\cholesterol and navigate to registration to get started. The first level of recognition is the Participant award. This recognizes organizations simply for registering with CCC Cholesterol and confirming that their practice will incorporate the ASCVD risk regulator into their EHR. The goal of the Participant Award is to incorporate ASCVD risk calculator and identify high risk patients. In order for providers to start tracking high risk patients in their EHR's patient population, the EHR must be able to document and track the results of the ASCVD risk calculator into the practice (attestation). Therefore, in the beginning, we are asking participants to commit to incorporating the risk registration into their practice however possible. The Gold Award is reserved for organizations that submit numerator and denominator information for MIPS measure #438 cholesterol management data and achieve control rates of 70% or greater within the adult patient populations. This is closely aligned with AHA guideline. Other quality measures only adjust small portions of the guideline and would require sites to collect multiple measures to get close to what MIPS collects. You do not need to submit the data to CMS for numerator and denominator the numbers for CCC cholesterol. How much data is required to participate? This maps out some of what you will see when you go into register for recognition. For registration you will need to know your organization's total adult population count that is greater than or equal to 21 years of age and the total number of clinical providers in your organization. The total number of clinical locations in your health system and what electronic health record (EHR) system you are using. Recognition for Participation is available once you go through registration and commit to continuously improving use data to capture of ASCVD risk estimations into workflow and EHR systems in 2018. For gold, it is submitting the numerator and denominator data for MIP measures 438: Statin Therapy for the Prevention and Treatment of Cardiovascular Disease. There are three submission criteria for MIPS 438: Denominator (Submission Criteria) 1. Patients older than or equal to 21 years at the beginning of the measurement period with a clinical diagnosis as of ASCVD OR 2. Patients aged 21 years or older, at the beginning of the measurement period, who have ever had a fasting or direct laboratory LDL-C 190 mg/dl or previously diagnosed with or currently have an actively diagnosis with familial or pure hypercholesterolemia OR 3. Patients aged 40 to 75 years, at the beginning of the measurement period, with Type 1or Type 2 diabetes within LDL-C result of 72 189 mg/dl recoded as the highest fasting or direct laboratory test

result in the measurement period or during the two years prior to the beginning of the measurement period. Numerator (Submission Criteria): 1. Patients who are actively using or who receive an order (prescription) for statin therapy at any point during the measurement period. All of this information will be provided to you. What you see here is a screenshot of the Check Change Control Cholesterol website. You can see by the doctor there is a tab that says LEARN HOW. That tab will take you to learn more about the program, and the recognition piece of the program, as well as how to participate in this program. Then on the bottom left in red the link will take you to cholesterol initiative and how it relates to cardiovascular disease as well as how Check Change Control Cholesterol can make a difference in your practice. If you look in the middle at the bottom where it says STAND AND BE COUNTED that were you register for this program. Then where you see say Stay In The Know in the bottom right-hand corner LEARN HOW in blue will take you to resources for providers. Many of the programs at AHA when working with practices will always have toolkit and many resources for providers that you can utilize. They are available using the link below. At the bottom of those three tabs you will see the ASCVD calculator that will take you to the actual calculator available for use. Lastly, I would encourage you to visit this website. There is a lot of useful information you should look to see what might be beneficial for your specific practice. This slide is the welcome page of the survey. It is very similar to survey monkey. It is a survey that you will use when you are going to submit the data portion for this program. When you see this welcome page, it will let you know you are in the right place. It provides the different steps needed to submit data as well as telling you some more about the program. I encourage you to download the full survey beforehand if you plan on submitting data. There is a full download of the survey available on the Check Change Control website. In terms of the submission process, it is a one-time application for each site. Once you login and enter all your information there is no way to save the information. We would want to make sure that you have all of the information beforehand, that way you can easily put all of the information into the survey online and complete the data submission. Program Benefits: There are quite a few benefits that come with the Check Change Control Program. One is receiving National recognition annually and as Stephanie mentioned, the recognition you receive is for the information you entered for the previous calendar year. The Check Change Control Cholesterol program empowers clinics with a free evidence-based program and that includes both patient provider tools and resources to help track practice management. As you can see AHA often has some type of toolkit for both the provider as well as the patient. It assists the provider to improve the patient/provider relationship. The patient toolkit helps to educate the patient on the importance of being on top of their cholesterol and general health. There are also opportunities for continuing education for the provider as well, ASCVD Risk calculator which we went over previously. FYI, most resources will be available in English and Spanish, specifically patient toolkit's. We can cater to patients that speak English or Spanish.

On this slide you see recognition benefits. Many of our programs we have a recognition piece. On the CCC website we want to recognize risk factors among patient populations and some of that includes Check Change Control Cholesterol program. National Recognition at the AHA Scientific Sessions in 2018 with signage and printed collateral. Certificates can be delivered electronically and displayed within their practice for both the Participation and Gold Levels. Either way, participating in the program will get you nationally recognized on our website. Also, an icon badge with the AHA proclaimer statement which you can use internally or externally. There are also local press release templates for clinics to use in addition to local recognition opportunities. We want to recognize those practices prioritizing controlling cholesterol. On this slide you see the time line for the program. The recognition program period will be open February 5 th through June 1, 2018. For those you familiar with our target BP program this falls in line with that program as well. They have the same exact time line. We encourage sites to register before June 1 st. The sooner the better so we can make sure all information and data is correct and so you can receive recognition. After the June 1 st submission deadline, sites can still register on a rolling basis. We want to make sure sites are recognized for participating in the program so remember to register before the June 1st date you can receive recognition. Next steps: The next step is to register at www.check.org/cholesterol. You can reach out to myself Cherelle Rozie (cherelle.rozie@heart.org) or Stefanie Barba (stefanie.barba@heart.org) with any questions. We cover the greater Massachusetts region. If you are in another state we ask that you reach out to Stephanie or myself and we will put you in contact with your local AHA representative. That concludes our presentation. I am going to pass it to Alberta to help facilitate questions today. Thank you, everyone. Now, we will take some questions. If you would like to ask a question over the phone, please press #6 to ask a question over the phone. You can also pose your question in the chat box by sending your message to all participants. No. If you would like to ask a question over the phone please press pound and the number six. To pose a question chat box, in the lower right corner of your screen, you can pose your question there but make sure it is sent to all participants. This is Karen. While we're waiting for questions would you mind advancing to the next slide for resources and tell people how they can access the slide deck. In the chat box you will see the link to today slides. The screen currently on right now will be accessible through that. We do have a question. Is there a plan for this to be translated into any language is?

The materials will be available in Spanish and English. As of right now, those are the only two languages available. We certainly take any feedback that you have and we can work nationally to see if we can have it happen. Does anyone else have any questions? Thank you all for a great discussion. I have a few last-minute announcements before we end today s call. A reminder that we are now on Social Media! Visit us on Facebook, LinkedIn and YouTube. When you close out of this webinar, the evaluation will automatically pop up on your computer. If you could please fill that out, we would greatly appreciate it. If you don t have time to fill out the evaluation right now or you re currently sharing a computer with someone else, you ll receive an email tomorrow with the link to the evaluation, as well as the link to the event page on our website. The slides are available on the event webpage. Within the next few business days, a recording and transcript of this webinar will also be added. I have put that link in chat again for you. Thanks again for attending. Have a great day!