Managed Healthcare Executive - February 2009 - (Page 23) { HEALTH MANAGEMENT } Race, comorbidity factors in controlling hypertension Best practices could result in savings above $5 billion, but identifying patients remains the challenge BY STEPHANIE SKERNIVITZ Stephanie Skernivitz is a freelance writer based in Cleveland. YPERTENSION, THE UNITED STATES’ leading medical condition, has gripped the lives of at least 58 million Americans—one in ve—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. While health plans o er similar hypertension management programs, the fact remains, according to the Commonwealth Fund, that as many as one-third of patients identi ed as having hypertension were not previously aware they had high blood H pressure. The gap in treatment and control, research suggests, might be linked to physicians’ hesitation to treat patients with mildly raised blood pressure as aggressively as the literature recommends. The gaps in treatment, as they pertain to speci c populations, struck a chord with Aetna o cials, 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. “It’s been found that high blood pressure is a signi cant issue in the AfricanAmerican community,” explains Wayne Rawlins, MD, national medical director and co-lead for racial and ethnic initiatives at Aetna. “There’s higher prevalence, higher incidence and higher risk of complications.” The Aetna initiative built a specialized disease management program that focused on African Americans with hypertension more speci cally 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 FEBRUARY 2009 Chris Ryan/Getty Images 23
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