Implementing the new HEDIS hypertension performance measure

There is a problem with blood pressure control in the United States--a problem with significant implications for the health and welfare of the populace. This problem is bigger than managed care, but managed care organizations have both unique opportunities and unique obligations to address it. NCQA has responded to this problem, and to the opportunity for better care implicit in it, by introducing into HEDIS a measure that focuses on hypertension control. This measure will add pressure to health plans to address the problem of hypertension control, but it also will create the opportunity for positive recognition for those plans that succeed. The HEDIS hypertension measure is well grounded in both the science of medicine and the science of measurement. But HEDIS measurement alone will not create change. To effect change will require analysis of the problems that limit the delivery of effective care to patients with hypertension. It will require measurement of the success of the key processes of care upon which effective care depends. And it will require response--rational, focused, and operationally effective. These, in turn, will challenge key managers in health plans. Medical directors will have to influence provider behavior. Pharmacy directors will have to leverage pharmacy resources to support efforts to change provider and enrollee behaviors. And QA directors will have to manage a challenging set of measurement activities, from which plans' efforts to improve will be launched. The next few years will not be easy--demands for improvement increase annually, and resources are every year more scarce. Yet the goal is worth the struggle--to transform an industry that the public perceives to be interested in limiting care into one that the public turns to for assurance that care represents high value. Responding effectively to the HEDIS hypertension measure creates a unique opportunity for managed care--to demonstrate to the public that managed care is leading national efforts to improve quality for 50 million Americans needlessly at risk for heart disease and stroke, and in doing so, to demonstrate its commitment to health maintenance--the very foundation of managed care.