Beating the Odds in Hypertension Management

By Steven R. Carson, MHA, BSN, RN

Community health care providers are in a unique position to improve blood pressure management for better overall health in underserved populations. In this article, we aim to provide you with an overview of information and resources to help you meet those goals.

Controlling High Blood Pressure HEDIS Measure: TCIN Practice Performance

Controlling High Blood Pressure (CBP) is one of the HEDIS measures that enables TCIN practices to earn an incentive for performance improvement. The practice Medicaid Members must perform 5.0% better than the Health Partners Plan group average in order to earn the incentive payment.

Overall, the attributed TCIN practices performed better in the Blood Pressure Control measure than the HPP group average. The attributed TCIN practices performed at a rate of 52.31% which was the same as the Temple group rate of 52.9%, and HPP group averaged performed at a rate of 48.05% for Contract Year 4, FY21.

The HEDIS data received December 2021 from Health Partners Plan shows that the TCIN Tier 2 Excel Medical Practice, LLC performed well in the measure for Contract Year 4 (FY21). Also, the EXCEL practices are the only TCIN Tier 2 practices that met the threshold for achievement in the Blood Pressure Control measure for Contract Year 4. The data shows that all of the attributed TCIN EXCEL Medical practices with the exception of the recently acquired Parkstone Medical Practice achieved the Blood Pressure Control metric and each EXCEL practice earned an incentive payment.

The Guidelines: Diagnosis and Management

Staying up-to-date with the most recent ACC/AHA guidelines is vital. Here are highlights of guidelines for diagnosing and managing blood pressure:

• BP classification: 120/80 mm Hg or above=elevated blood pressure; 130/80 and above=stage 1 hypertension; 140/90 and above=stage 2 hypertension. Systolic BP over 180 or diastolic BP over 120 qualify as hypertensive urgency (emergency if combined with target organ damage).
• Nonpharmacological interventions such as heart-healthy diet and increased physical activity should be attempted for all patients with blood pressures above normal.
• Antihypertensive medications should be prescribed for those with stage 2 hypertension, or with stage 1 hypertension plus clinical cardiovascular disease (CVD) or CVD risk.
• A lower blood pressure target is better than a higher target. A BP goal of less than 130/80 mm Hg is recommended for adults with confirmed hypertension plus known CVD/high CVD risk.
• Practices should implement self-measured blood pressure monitoring (SMBP) for hypertension patients.

Provider Strategies for BP Management

Patient health and provider compensation both benefit from improving blood pressure management. We recommend making BP goals as achievable as possible with strategies that optimize your own practice and address barriers patients face, including:

• Optimize medications. A combination of hypertensive medications may be necessary for optimal blood pressure control. Work with and monitor patients to find a medication regimen that works best for them and that they can access through their insurance and local pharmacy[KP3] . Use one-dose medications where possible.
• Enroll in the AHA/American Medical Association Target: BP™ program to access data tracking and benchmarking tools, best-practices, continuing education, and opportunities for national recognition.
• Implement self-measured blood pressure monitoring to improve patient involvement in hypertension diagnosis and management as well as patients’ involvement in their own care.
• Address social determinants of health. Adverse financial, social, psychological, and other circumstances can impact patients’ overall health and limit their ability to follow diet, lifestyle, and medication regimens. You can help by working with them to reduce some of those barriers. For example:
  • Implement ongoing screening with a validated social needs assessment that includes food insecurity. Train your staff to connect patients to social services and programs through Temple Health Community Connect to find free or reduced-cost social services and programs.

We want you to succeed and be fully compensated for the critical work you do. Temple Health aims to be your partner in health care, and we are here to support you. For complex cases, you can make a referral to our hypertension program by calling 800-TEMPLE-MED.

• Educational Video Resources from Temple Specialists
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• Setting Up Self-Monitored Blood Pressure (SMBP) for Empowered Care
  Learn best practices for implementing self-measured blood pressure through the AHA Target: BP program.
• Get Support Through Target: BP™
  Find out how to enroll in the AHA/American Medical Association Target BP program.
  Learn More
• Resources for Providers and Patients
  Access resources for providers and patients to improve hypertension management.
• Case Study: Connecting with Patients through Blood Pressure