Resource Guide. Montana. Chronic Disease Improvement. Sharing resources to build healthier lives.

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1 Montana Chronic Disease Improvement Resource Guide As part of a statewide effort to prevent and improve management of chronic disease, the Montana Department of Public Health & Human Services (MT DPHHS) has developed this provider guide for accessing resources for diabetes, cardiovascular health, tobacco cessation, cancer control, asthma control, and falls prevention. In this Guide, Montana providers will find a summary of quality improvement resources for: 1) Asthma Control 2) Cancer Control 3) Cardiovascular Health 4) Diabetes Prevention and Control 5) Tobacco Cessation 6) Injury Prevention In addition to these MT DPHHS resources, the Centers for Medicare and Medicaid Services (CMS) has developed several quality initiatives, including the Physician Quality Reporting System (PQRS) program, that provide information on the quality of care across different healthcare settings. The aim of these initiatives is to empower providers and consumers with information that would support the overall delivery and coordination of care, and ultimately support new payment systems that provide more financial resources to provide improved quality care, rather than simply paying based on the volume of services. As part of the PQRS program, CMS has developed numerous quality measures. These measures are part of an incentive payment for eligible professionals who satisfactorily report data on PQRS measures for covered professional services furnished to Medicare beneficiaries. Many of the measures are related to chronic disease prevention and management improvement with a portion of these being highlighted in this guide. A comprehensive list of PQRS measures, descriptions, and implementation resources is available at Sharing resources to build healthier lives.

2 Asthma Control Program Mission: The Montana Asthma Control Program s Quality Improvement Program collaborates with primary care practices to improve the quality of care given to patients who have asthma. Overview: The program assists primary care practices in meeting the requirements of the PQRS by: a) offering software to monitor asthma measures at the patient and practice level b) developing and implementing quality improvement projects Software: The Asthma Care Monitoring System (ACMS) is a free registry to assist primary care providers in tracking care and clinical outcomes for their patients with asthma. This registry tracks PQRS measures. Quality Improvement Projects: Tailored interventions target asthma control assessment, selfmanagement education, triggers, co-morbidities, medication use, tobacco cessation, influenza and pneumococcal vaccination, and other asthma measures. These efforts raise awareness of evidence-based asthma care among Montana clinicians and improve the quality of care provided to patients. Asthma PQRS Measures: The five measures related to asthma include: Appropriate medication use (#53, 311) Patients with asthma evaluation and spirometry screening in past year (#64) Patients who may require tobacco cessation or reduced exposure (#231, 232) For Asthma Control Program resources and additional information, contact: Katie Loveland, Asthma Program Manager Asthma affects 9% of the adults and 7% of children in Montana, which is an estimated 85,000 people. Phone: , kloveland@mt.gov Website: Montana BRFSS, 2011 Providing in-depth asthma education to patients in Montana can be a challenge for health care providers. The wide-spread geography of Montana and shortage of specialists puts additional burdens on many of our busy generalist providers who are trying to meet the expectations of their large and varied patient population. - Dewey Hahlbohm, Physicians Assistant, Certified Asthma Educator

3 Cancer Control Program Screenings: The Montana Cancer Control Program (MCCP) provides low or no cost quality screening services to eligible men and women to include mammograms, clinical breast exams, pap tests and pelvic exams for the early detection of breast and cervical cancers and colonoscopies and fecal occult blood tests for the early detection of colorectal cancer. Partners: The MCCP is a partner within the Montana Cancer Control Coalition (MTCCC). The MTCCC is a statewide coalition working to reduce the burden of cancer in Montana through cancer prevention and early detection, treatment, research and quality of life and survivorship. The MTCCC is a collaborative partnership of private and public individuals and organizations. Surveillance: Included within the MCCP is the Cancer Surveillance and Epidemiology Program which uses data from the Montana Central Tumor Registry, the Montana Office of Vital Statistics, and other sources to monitor trends in cancer incidence and mortality. The Montana Central Tumor Registry is the primary source of cancer statistics (incidence, trends, and survival) in Montana and has been continuously collecting cancer information statewide since The Registry s goal is to collect, analyze, and disseminate quality cancerrelated data to help reduce the burden of cancer in Montana. Cancer PQRS Measures: There are numerous measures related to cancer. Those most relevant to our cancer control program include: Mammography screening (#112) Colorectal Cancer Screening (#113) Cervical Cancer Screening (#309) For cancer control resources and additional information, contact: Lisa Troyer, Cancer Program Manager Cancer is the second leading cause of death among Montana residents, after diseases of the circulatory system such as heart disease and stroke. Phone: , ltroyer@mt.gov Website: Four sites prostate, lung and bronchus, female breast, and colon and rectum accounted for 57% of all reported cancers in Montana in the interval One third of all cancer deaths in Montana are caused by tobacco use. Screening for breast, cervical, and colorectal cancer saves lives, either by finding cancer at an early stage when it is most treatable, or by finding and treating precancerous lesions so they do not progress to cancer.

4 Cardiovascular Health Program The Cardiovascular Health (CVH) Program impacts Montana s leading cause of death, cardiovascular disease. The program strives to improve the health of Montanans by reducing cardiovascular risk factors and mortality from heart disease and stroke. Priority areas are improving blood pressure and cholesterol control, smoking cessation, promoting appropriate aspirin usage for secondary prevention, and coordinating telestroke systems of care. Emphasis is on policy, systems, and environmental change in healthcare, worksite and community settings. The CVH Program offers multiple resources which include: Hypertension Tackle Box: Educational materials which promote national blood pressure guideline adherence, enhance office staff s blood pressure measurement technique and encourage home blood pressure monitoring. Materials are available electronically on the CVH web page at publichealth/cardiovascular/links.shtml. Hypertension Workshops: These day long workshops sponsored by the Cardiovascular Health Program provide education for health care professionals on managing blood pressure medications, nutrition, a blood pressure monitoring practicum, and improving hypertension outcomes in the practice setting. Hypertension Coalition: The CVH Program coordinates the Hypertension Coalition, a statewide group of health professionals focused on improving blood pressure control of Montanans. The State of Montana Pharmacist Blood Pressure Management Program: This program provides blood pressure education to eligible state of Montana employees, spouses, and retirees who are health plan members living in the Helena, Billings or Missoula area. Participants screened at Stage 1 or 2 hypertension levels may receive educational materials and/or consultations with a program pharmacist. CVH PQRS Measures: There are numerous measures related to CVD; some of these measures may also relate to diabetes control. Those most relevant to our CVH program resources include: Proper Hypertension management (#3, 236, 244, 317) Proper Cholesterol management (#2, 316) Proper medication use (#118) For Cardiovascular Health resources and additional information, contact: Target the ABCS: aspirin, blood pressure, cholesterol, and smoking cessation. Crystelle Fogle, CVH Program Manager Phone: , cfogle@mt.gov Montana Stroke Initiative Website: Cardiac Initiative Website: Thanks to the in-home BP cuffs/pedometers provided by the Cardiovascular Health Program, our Medicaid Health Improvement Program clients were able to track their BPs/steps and be proactive with their numbers at health care provider visits. With these tools, clients worked diligently to improve their health. - Kay Silk, RN CCP - Medicaid HIP Health Coach

5 Diabetes Prevention and Control Program Mission: The Montana Diabetes Project s Quality Improvement Program collaborates with primary care practices to improve the quality of care given to patients with diabetes. The Montana Cardiovascular Disease and Diabetes Prevention Program (DPP) provides an evidence-based 10-month intensive lifestyle intervention to adults at high risk for type 2 diabetes. Overview: The program assists primary care practices in meeting the requirements of PQRS by: 1) offering software to monitor diabetes measures at the patient and practice level, 2) implementing quality improvement projects, 3) training lifestyle coaches to deliver the DPP, and 4) providing program evaluation software for diabetes prevention. Software: The Diabetes Quality Care Monitoring System (DQCMS) is a free registry to assist primary care providers in tracking preventive care and clinical outcomes to include pertinent PQRS measures for their patients with diabetes. For information on DQCMS, please refer to: The Primary Prevention Software (PPS) is a free program evaluation tool to assist DPP sites in tracking participant progress. Quality Improvement Projects: Tailored interventions target A1C, blood pressure, and cholesterol testing and levels, tobacco cessation, influenza and pneumococcal immunizations, foot care, chronic kidney disease care, and other health measures among persons with diabetes. These efforts improve the quality of preventive and clinical care for patients with diabetes. The DPP continues to show successful results in weight loss, increased physical activity, and reduced cardiometablic risk factors. Diabetes PQRS Measures: Several diabetes measures overlap with other areas such as cardiovascular health and tobacco use. Selected diabetes-related measures are: Hemoglobin A1C control (#1) High blood pressure control in diabetes mellitus (#3) LDL Cholesterol control in diabetes mellitus (#2) Dilated eye exam (#117) Urine Screening for microalbumin or medical attention for nephropathy (#119) Foot exam (#163) Diabetes is the seventh leading cause of death in Montana. Montana Vital Statistics, 2010 For diabetes program resources and additional information, contact: Sarah Brokaw, Diabetes Program Manager Phone: , sbrokaw@mt.gov Diabetes Website: Diabetes Prevention Website: I have used the DQCMS registry for all of my patients with diabetes for several years. This valuable tool has not only helped me manage my patients with diabetes better, but has been priceless for quality improvement projects for board recertification and transforming into a patient centered medical home. - Dr. Jay L. Larsen, MD South Hills Internal Medicine Associates

6 Tobacco Cessation The Montana Tobacco Use Prevention Program (MTUPP) focuses on eliminating tobacco use, especially among young people, through statewide programs, policies, and resources. A quick and easy tobacco cessation reference guide for providers, to include FREE Nicotine Replacement Therapy (NRT), is available at: MTUPP offers numerous tobacco cessation resources to include: A FREE telephone Quit Line service for all Montanans (1-800-QUIT-NOW) A FREE personalized & FREE cessation coaching personalized quit plans 5 FREE pro-active cessation coaching sessions 4 FREE weeks of NRT (gum, patches or lozenges), if appropriate Chantix at a reduced cost ($50.00 co-pay per month for three months) Bupropion at reduced cost ($5.00 co-pay per month for three months) FREE educational materials for providers and friends/families of tobacco users A fax referral system for health care providers who have patients that want to quit Tobacco use is the leading cause of preventable disease in America. From: Preventing Tobacco Use Among Youth and Young Adults: A Report of the U.S. Surgeon General Montana Medicaid has recently expanded: The types of licensed health service providers/ organizations who can now deliver tobacco cessation counseling to Montana Medicaid clients are listed in the Table below. These providers/organizations can now be reimbursed for tobacco cessation counseling, under certain program limitations. Anyone interested should contact Montana Medicaid ( ; MTPRHelpdesk@ACS-inc.com) or visit the web site ( Physician Mid Level Practitioner dentist dental Hygienist Psychologist licensed Clinical Social Worker Rural Health Clinic Federally Qualified Health Center Public Health Clinic hospital Outpatient licensed Professional Counselor chemical Dependency Provider Tobacco Use PQRS Measures: Several of the tobacco measures overlap with asthma and cardiovascular health. The most relevant tobacco cessation measures include: Tobacco use preventive care and screening (#226) Tobacco use cessation (#308) Patients with chronic conditions who require tobacco cessation or reduced exposure (#231, 232, 315) For tobacco cessation resources and additional information, contact: Simon Habegger, Tobacco Cessation Specialist Phone: , SHabegger@mt.gov Tobacco use imposes enormous public health and financial costs on this nation costs that are completely avoidable. Until we end tobacco use, more young people will become addicted, more people will become sick, and more families will be devastated by the loss of loved ones. From: Preventing Tobacco Use Among Youth and Young Adults: A Report of the U.S. Surgeon General

7 Injury Prevention Program Preventing Falls among Older Adults: The Montana DPHHS Injury Prevention Program has identified falls among older adults to be a priority injury prevention focus area. In Montana, falls are the leading cause of fatal and non-fatal injury for individuals ages 65. Often individuals injured from a fall develop a fear of falling, which can result in the individual limiting their activity level and ultimately increasing the risk for continued falls. Falls are not an inevitable part of aging and can be prevented. Healthcare providers can impact fall reduction among older patients as defined by several PQRS measures to include: Routinely assessing fall risk & developing a plan of care (#154, 155) Reviewing medications for potential fall risks (#46, 130) Reducing Unhealthy Alcohol Use: Binge drinking may lead to injury, violence, poor health and alcohol dependence. In Montana, 17% of adults report binge drinking behavior (consuming five or more drinks in one setting) in the last 30 days. Healthcare providers play an important role in addressing binge drinking to include: Recognizing that most binge drinkers are not alcohol dependent or alcoholics Screening patients for unhealthy alcohol use and advising those who misuse alcohol to reduce their use (PQRS #173) For injury prevention resources and additional information, contact: Bobbi Perkins, Injury Prevention Program Manager We were checked often to make sure exercises were done properly. I appreciated this part of the course Phone: , bperkins@mt.gov Preventing Falls Website: Unhealthy Alcohol Website: It has made me more aware of my surroundings I liked learning exercises that can help my mobility Comments from Stepping On Fall Prevention Course participants This Guide was Created by: Chronic Disease Prevention & Health Promotion Bureau Montana Department of Public Health & Human Services P.O. Box Helena, MT Fax: copies of this public document were published at an estimated cost of $0 per copy, for a total cost of $0, which includes $0 for printing and $0 for distribution. The Montana Department of Public Health and Human Services attempts to provide reasonable accommodations for any known disability that may interfere with a person participating in any service, program or activity of the Department. Alternative accessible formats of this document will be provided upon request. For more information, call (406) or TDD: 1 (800) This publication was supported by Cooperative Agreement Number 3U58DPP W2 from the Centers for Disease Control and Prevention (CDC). Its contents are solely the responsibility of the authors and do not necessarily represent the official views of CDC.