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Eight Key Strategies

* 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.

In 2008, a RAND heart and diabetes work group of medical directors (representing Aetna, Blue Cross, Blue Shield, Health Net and LA Care), quality improvement organizations, experts and key stakeholders met under the under the direction of Dr. Paul Shekelle—practicing physician and director of RAND’s Southern California Evidence-Based Practice Center—and UCLA Professor Gerald Kominski. They identified eight strategies for meeting national 90th percentile HEDIS targets.

View a printable version of the Eight Key Strategies report. PDF Help

Summary of Eight Key Strategies to Improve Heart and Diabetes Clinical Health Outcomes

  1. Of the ten HEDIS measures in heart and diabetes, the greatest emphasis should be first on control of:
    1. Lipids
    2. Blood pressure
    3. Glucose levels

    because of their importance in preventing mortality and morbidity due to strokes and heart attacks, the greatest killers for both heart disease and diabetes.

    From the perspectives of Dr. Shekelle; the heads of the California Department of Public Health’s Diabetes and Heart programs, Dr. Dean Schillinger and Dr. Lilly Chaput; as well as the medical director of the Pacific Business Group on Health, Dr. Arnold Milstein; the quality improvement medical director for Sharp Rees- Stealy, Dr. Jerry Penso; and Dr. Ken Kizer, improvements of HEDIS measures in these three areas are important for preventing mortality and morbidity due to strokes and heart attacks, the greatest killers for both heart disease and diabetes. HEDIS measures act as proxies for the clinical control of heart attack and stroke key factors.

  2. Aligning and improving payments and incentives to support strategy one among all stakeholders (patients, plans, medical groups, employers) is essential.


  3. Proactive outreach and coaching of patients is critical.


  4. A broad team approach to patient care for chronically ill patients is proven to be effective, and efforts that are underway to spread this model require additional support.
    1. Grow capacity of existing team training efforts
    2. Amplify community centers as resources for patient education and support

  5. Practice redesign, including preset protocols and flow charts, should be broadly deployed to improve outcomes and ensure up-to-date scientific research is incorporated into care management.


  6. Clinician and public health/education campaigns are an essential component of an overall outcomes improvement campaign.


  7. HIT- Clinicians need accurate and timely information about patients as individuals, as well as from a macro-analysis panel perspective.


  8. Over the longer term, support a broader payer/purchaser/clinician quality collaborative modeled after Minnesota’s Institute for Clinical Systems Improvement.