To measurably improve clinical outcomes through enhancing the practice of patient-centered, evidence-based medicine.

The Right Care Initiative’s goal is to apply scientific evidence and outcomes improvement strategies to reduce morbidity and mortality among California’s 15 million managed health plan enrollees. Data from NCQA, The Integrated Health Care Association, the Agency for Health Care Quality and Research, the Commonwealth Foundation, and the Centers for Disease Control indicate three trouble spots where evidence-based patient management and clinical quality improvement will significantly enhance and save lives:

  1. Cardiovascular disease, with particular emphasis on hypertension,
  2. Diabetes, with particular emphasis on heart attack and stroke prevention,
  3. Hospital acquired infections.

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Our Demonstration Goals

California Statewide Goals- preventing Strokes, Heart Attacks, and Diabetic Complications

Achieve National Healthcare Effectiveness Data and Information Set (HEDIS)

  • 76% of hypertensive patients with blood pressure controlled: <140/90 mm Hg
  • 73% of patients with cardiovascular conditions with lipids controlled: LDL-C< 100 mg/dL
  • 71% of diabetic patients with blood sugar controlled: HbA1c<8
  • 58% of diabetic patients with lipids controlled; LDL-C<100 mg/d

Reduce Hospital Acquired infections

  • Median of zero central line infections
  • Significantly reduce infections designated by the Right Care Initiative work group
  • Heart attack and stroke prevention focused on heart disease, hypertension and diabetes patients through lipid, blood pressure, and blood sugar management
  • Support for medical, pharmacy and quality improvement directors via “University of Best Practices” colloquia

Right Care Promising Interventions

Project Inspiration

NCQA estimates that improving the cardiovascular disease and diabetes measures among California’s 15 million commercial managed health plan enrollees to the national HEDIS 90th percentile could result in 1,694 to 2,818 Californian lives saved annually. It would also avoid $118 million in yearly hospital costs, 766,401 sick days and $125.56 million in lost productivity. Hospital acquired infections are estimated to kill more than 10,000 Californians per year, and are mostly preventable.

Heart disease, hypertension, diabetes, and prevention of hospital acquired infections are increasingly well understood scientifically. Like the “100,000 Lives” national campaign for reducing medical errors, this project will improve the lives of tens of thousands of California enrollees by catalyzing the work of experts and applying evidence based medicine in the coordinated, managed care model.

Key Partners

  • CA Dept. of Managed Health Care
  • CA medical groups, clinics & health plans
  • University of California
  • California Chronic Care Coalition
  • Stanford Clinical Excellence Research Center
  • RAND
  • University of Southern California
  • Health Services Advisory Group
  • Sierra Health Foundation
  • CA Office of the Patient Advocate
  • CA Medi-Cal Program
  • CA Dept. of Public Health
  • Integrated Healthcare Assoc. (IHA)
  • Pacific Business Group on Health
  • Department of Veterans’s Affairs
  • American College of Cardiology
  • American Heart/Stroke Association
  • CA Medical Association Foundation
  • American Medical Group Association: Measure Up/Pressure-Down Campaign
  • California Health Care Foundation
  • No More Broken Hearts
  • Ralphs Grocery Company
  • Novo Nordisk
  • Genetech
  • Boehringer-Ingelheim

Implementation Action and Goals

The CA Department of Managed Healthcare (DMHC) publicly launched the Right Care Initiative with NCQA and the Deans of UC Berkeley and UCLA Schools of Public Health in March 2008 at the first annual Clinical Quality Improvement Leadership Summit. Since then, eight Right Care summits have been held around the state. Thanks to an NIH GO grant (Nov. 2009-July 2012), the Right Care Initiative was given a special opportunity to launch intensive efforts toward quickly achieving national 90th percentile HEDIS hypertension and cardiovascular disease performance targets in a community-focused effort to reach the Right Care Initiative goals of preventing heart attacks and strokes. Each Right Care gathering is a collaborative effort among medical, pharmacy and quality improvement directors, as well as thought leaders in evidence-based medicine. Through quality improvement support for medical groups, clinics and plans, the Right Care Initiative’s current goal is to reach Grade-A performance (national 90th percentile) in CVD and diabetes HEDIS control measures of blood pressure, lipids, and glucose, thereby reducing disability and death due to strokes, heart attacks and diabetic complications.

Research Questions

  • What are the most promising interventions for quickly bringing patients into safe control?
  • What barriers are preventing improvement, and what are the best strategies for overcoming them?
  • What are the best strategies for California to expedite a focused re-engineering effort to refine the implementation of evidence-based medicine to quickly meet these goals that are estimated to save thousands of lives annually?
  • What strategies are needed to improve clinical outcomes in light of health disparities in California’s diverse population?