Million Hearts® Workshop & Initiative

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Submission Date: September 2014

Entry Type: Case Study

State/Territory Submitted on the Behalf of: Colorado

States/Territories Involved: Colorado

Domain Addressed:

Health Systems Strategies

Public Health Issue:

Colorado spends over one billion dollars on heart disease, stroke and hypertension each year. More than 21% of Coloradans have high blood pressure, a major risk factor for heart disease and stroke. Only about half the people with high blood pressure in the U.S. have their blood pressure under control.

Project Objectives:

To convene public health and health system partners and coordinate work through a leadership team to achieve better blood pressure control for the Colorado residents they serve.

Program Action:

Initial partner outreach activities by the Colorado Department of Public Health and Environment (the Department) introduced the MH initiative to partners and elicited feedback and interest in coordinating and expanding their work to reach mutual goals.  A 2012 MH Workshop, facilitated by NACDD, brought together department staff and about 50 individuals representing 31 organizations to focus on blood pressure. The purpose of the 1-day workshop was to identify assets and opportunities, to improve competency of state partners to improve blood pressure control and to build collaboration and consensus among Colorado partners on strategies and priorities that address goals of the Million Hearts® Initiative. Staff from the Department identified the types of partners to invite and worked with facilitators to finalize the agenda for the workshop. The morning sessions established the framework for the day, including providing an overview of both Million Hearts® and the Department’s work in the context of the four CDC Domains. Three partners gave presentations on the blood pressure-related work they were doing, representing two of the four CDC domains the Department focused on—health systems and clinical-community linkages. Attendees then identified additional current activities addressing hypertension as well as gaps. They set goals for a Million Hearts® initiative in Colorado (which coordinate with State Public Health Actions (1305) goals) and identified & prioritized potential strategies for reaching these goals. Work groups continue to refine and implement these strategies.  Priority action areas are: health systems, clinical quality improvement, team-based care with a pharmacist focus, community-clinical linkages, team-based care with a patient navigator/CHW focus and health care delivery reform.

The Million Hearts leadership team developed an action plan to reduce heart attacks and strokes in Colorado with six strategies focused on the goals of increasing awareness of hypertension and improving care and management of cardiovascular disease. The Team includes partners such as the American Heart Association, Kaiser Permanente Colorado, Colorado Prevention Center, Walgreens, local public health agencies, Colorado Regional Health Information Organization (CORHIO), Telligen, University of Colorado Skaggs School of Pharmacy, Regis University School of Pharmacy, the American College of Cardiologists and other stakeholders.

Several department programs including 1305, WISEWOMAN, and the state tobacco tax-funded Cancer, Cardiovascular and Pulmonary Disease program (CCPD) provide the primary vehicle for advancing work on priority areas. The Department now makes key MH strategies a component of the funding to communities, counties & organizations receiving CCPD grants and WISEWOMAN programs are providing health coaching/motivational interviewing and referrals for individuals in 4 health systems across the state.

Additional work includes development of health information systems and processes through which providers can dashboard their practice’s medication adherence and hypertension and diabetes rates. Quality improvement work will follow this development to ensure providers can use the data to increase control rates.

Data/Other Information Collected:

  • MH partners will provide data on hypertension rates to enable the Department to estimate an average for MH participants.
  • The Department has direct access to clinic data in targeted counties, as well as state-level discharge and prevalence data & are monitoring both
  • A Leadership Team value survey will help quantify improvements in collaboration & linkages and enable a better understanding of team participation factors such as why team members participate and how their ability to make new connections may have changed as a result.


  • Developed an action plan with broad buy-in from partners and including six key strategies for reducing heart attacks and strokes in Colorado.
  • Assessed screening activities in 4 systems with WISEWOMAN programs and developed a baseline screening assessment to determine current blood pressure, diabetes and obesity screening & follow-up rates and plan for improvement.
  • Strategically aligned cancer, cardiovascular and pulmonary disease grants to provide funding support for standardized clinical quality improvement and community-based blood pressure and diabetes prevention programs.
  • Are building on the plans of 2 university schools of pharmacy to create a new training model & another plan by a Colorado ACO to integrate pharmacy into team-based care. The ACO project will pilot sharing of Medicaid claims data with pharmacists to help them identify people with diabetes and cardiovascular disease who have medication adherence issues (specifically DM & CVD) and offer them consultation & medication therapy management to improve adherence.
  • Developing tools, processes, and products to fill a partner need related to quality improvement work.
  • Evolving CHW work in Colorado continues to identify lay patient navigator qualifications. The work is continuing with the development of training modules available to assure that these workers get standardized education.
  • Another pharmacy school project will place 4th year pharmacy students in certain ACOs to provide medication therapy management at no charge as a way to start building a better system.
  • The University of Colorado Department of Family Medicine, Nursing School, and School of Pharmacy are joining forces to develop learning modules on the role of ancillary clinic staff to facilitate use of team-based care.
  • New projects funded through “State Public Health Actions (1305)” funding are promoting home BP monitoring, Diabetes Prevention Program referrals, and CHW & patient navigation.

Challenges/Lessons Learned:

  • Providing Million Hearts Leadership Team members with opportunities to engage in specific projects was helpful and supplemental one-on-one partner chats gave time to delve deeper into projects and answer questions.
  • Leadership Team meetings needed to allow time for networking & informal chats so team members could connect one-on-one.
  • Meeting structure naturally evolved from partner activities.
  • Leadership Team needed a work plan and a structure to be successful.

Next Steps:

Maintain momentum

Program Areas:

Heart Disease and Stroke

State Contact Information:

Tara Trujillo, MNM, Clinical and Community Linkages Coordinator
Colorado Department of Public Health and Environment

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