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Improving Health Outcomes

The American Medical Association is galvanizing a new, bold professional movement in pursuit of healthier people, better health care and lower health care costs.

The AMA is committing its resources, expertise and reach to prevent heart disease and type 2 diabetes and to improve outcomes for those suffering from these diseases. The toll of these two diseases—both in dollars and human suffering—is staggering.

To improve health outcomes, we believe a new approach is required: by focusing on health as well as medical care, and by strengthening links between the clinic and community through novel strategies and collaborations, we can achieve a healthier nation.

  • Our Approach
  • Prediabetes
  • Hypertension
  • Collaboration
  • Our Approach

    Why the American Medical Association?

    The AMA is in a unique position to reach physicians in all practice settings and specialties. Our work to improve the health of the nation positions us to bring physicians together with communities and public and private sector organizations to prevent—and to achieve measurable improvements in health outcomes for—cardiovascular disease and diabetes.

    Why cardiovascular disease and diabetes?



    The AMA chose to focus on cardiovascular disease and type 2 diabetes because these conditions impact millions of patients and nearly all physicians, cause enormous suffering and death, and add significant costs to our economy.

    In addition, the direct and indirect costs of cardiovascular disease and diabetes are more than $535 billion a year. With proper intervention, the effects of these conditions can be dramatically reduced, leading to a healthier nation and reducing health care spending.

    How is the AMA tackling high blood pressure and prediabetes?

    To address these risk factors, the AMA is collaborating with other organizations to develop new approaches to achieve better control of blood pressure and prevent progression of prediabetes to diabetes.

    The AMA is teaming up with the YMCA of the USA to help prevent the onset of diabetes among Medicare participants who have prediabetes. The AMA will begin its work by collaborating with the YMCA to help attain a joint target of 10,000 additional Medicare participants in the YMCA's Diabetes Prevention Program, with the longer-term goal of increasing referral of all adults who have prediabetes.

    Learn more
    To prevent heart disease, the AMA is working with the Johns Hopkins Medicine Armstrong Institute for Patient Safety and Quality and the Center to Eliminate Cardiovascular Health Disparities to create a nationwide professional movement by supporting practices in their efforts to improve hypertension control. Our efforts will work in concert with the U.S. Department of Health and Human Services' "Million Hearts®" initiative, for which a primary objective is to bring the high blood pressure of 10 million more American under control by 2017.

    Learn more
    Find out more about other important AMA Improving Health Outcomes alliances

    Resources:

    Improving health outcomes strategic focus
    About Type 2 diabetes and prediabetes
    About Hypertension (high blood pressure)

  • Prediabetes

    To address type 2 diabetes, the AMA is focusing its attention and resources on prediabetes, a serious health condition that increases the risk of developing type 2 diabetes, heart disease and stroke.

    The annual total costs of diagnosed diabetes rose from $174 billion to $245 billion (approximately 41 percent) between 2007 and 2012 (source: American Diabetes Association).

    The problem

    Approximately 79 million Americans have prediabetes—that's about one in three people—and in U.S. adults aged 65 years or older, the percentage is even higher, at roughly 50 percent.

    The annual total costs of diagnosed diabetes rose from $174 billion to $245 billion (approximately 41 percent) between 2007 and 2012 (source: American Diabetes Association).

    How is the AMA improving health outcomes?

    The AMA is creating innovative clinical-community linkages that leverage the existing, substantial body of evidence on diabetes prevention in order to make best practices easier to implement.

    To help prevent diabetes and its associated health complications, and in support of the Center for Disease Control and Prevention's National Diabetes Prevention Program (DPP), the AMA will work with the YMCA of the USA.

    In 17 communities, qualifying seniors may be able to participate in the YMCA's DPP at no cost.

    Program eligibility

    People who are eligible to participate in the YMCA's DPP at no cost must have Medicare part A&B and meet the following criteria:

    • BMI of 25 or greater (22+ for Asian individuals) AND
    • Blood values of:
      • A1c: 5.7%–6.4% OR
      • Fasting plasma glucose: 100–125 mg/dL OR
      • Two-hour (75 gm glucola) plasma glucose: 140–199 mg/dL

    People with Medicare Part C (Advantage Plans) will have to self-pay.

    What's happening right now?

    The AMA is focusing on increasing physician referrals of people with prediabetes to local YMCA's Diabetes Prevention Program sites and enhancing communication between clinical practices and the YMCA program sites.

    Our first step is working with physician practices and YMCAs in pilot sites in Delaware, Indianapolis and Minneapolis. In these communities, qualifying seniors who have prediabetes may be able to participate in the YMCA's Diabetes Prevention Program at no cost.

    As we learn from these pilot sites, we will expand our efforts to engage more physicians, patients and Diabetes Prevention Program providers.



    Why the YMCA's Diabetes Prevention Program?



    The YMCA's Diabetes Prevention Program is based on the Centers for Disease Control and Prevention's evidence-based National Diabetes Prevention Program, and is focused on delaying or preventing the progression of prediabetes to diabetes through lifestyle interventions that target improving diet, physical activity and achieving moderate weight loss.

    The National Diabetes Prevention Program has been shown to reduce the number of new cases of type 2 diabetes by 58 percent among adults, and 71 percent in adults over the age of 60.

    A recent article in American Medical News provides a valuable overview of the impact the YMCA's Diabetes Prevention Program has on patients, providers and communities.

    What can physician practices do right now?



    All practices can start screening for prediabetes right now, and stop type 2 diabetes before it starts. Use the chart shown on this page, and the CDC Prediabetes screening test-patient handout.

    Find out more about our pilot efforts and how you can participate.

    What can patients do right now?

    Stats and resources

    Diabetes statistics

    • Diabetes affects 25.8 million people, 8.3 percent of the U.S. population (all ages, 2010 data; 95 percent is type 2 diabetes)
      • Diagnosed 18.8 million people
      • Undiagnosed 7 million people
    • More than 230,000 American deaths in 2010 included diabetes as a primary or contributing cause Source: National Center for Health Statistics, November 2012
    • The total costs of diagnosed diabetes have risen from $174 billion in 2007 when the cost was last examined to $245 billion in 2012

    Prediabetes statistics

    • $176 billion in direct medical expenses
    • $69 billion in lost productivity
    • This figure represents a 41 percent increase over a five year period
    • About 33 percent of U.S. adults (approximately 79 million) have prediabetes but awareness of this high risk condition is very low; about 50 percent of U.S. adults aged 65 years or older have prediabetes
    • People with prediabetes can prevent or delay the onset of type 2 diabetes by losing 5–7 percent of their body weight and getting at least 150 minutes per week of moderate physical activity


    Links to additional resources:

    About Type 2 diabetes and prediabetes
    Adapting the Diabetes Prevention Program Lifestyle Intervention for Delivery in the Community : The YMCA Model
    Translating the Diabetes Prevention Program into the Community – The Deploy Study
    AM News article about the impact of the DPP
    Prediabetes, am I at risk?
    CDC diabetes prevention fact sheet
    CDC video about the Diabetes Prevention Program

  • High Blood Pressure (Hypertension)

    The AMA seeks to address heart disease and stroke by focusing on high blood pressure, a major contributor to cardiovascular disease, which is the leading cause of death in the United States.

    The problem

    One in every three American adults (67 million or 31 percent) has high blood pressure, which can lead to heart attack, stroke, kidney failure, blindness and heart failure.

    Total annual costs associated with high blood pressure are $51 billion (Medical Expenditure Panel Survey 2009).

    More than 30 million Americans have both hypertension and a usual source of medical care—but their blood pressure is still too high.

    How is the AMA improving health outcomes?

    The AMA is tackling high blood pressure in clinics and communities, leveraging the existing, substantial body of evidence on blood pressure management and making best practices easier to implement for patients and doctors alike.

    The AMA is focusing on improving health outcomes for the 30 million people with hypertension who are receiving medical care but do not have their blood pressure under control.

    The AMA is collaborating with the U.S. Department of Health and Human Services' "Million Hearts®" initiative. We have adopted the initiative's goal of preventing one million heart attacks and strokes, including helping 10 million more Americans get their blood pressure under control.

    The AMA is working with the Johns Hopkins Medicine Armstrong Institute for Patient Safety and Quality and the Center to Eliminate Cardiovascular Health Disparities to improve care for patients by developing and spreading a model for better detection and management of high blood pressure, both in the clinic and in the community.

    What's happening right now?

    Currently, in the early phase of its work to engage practices, people and communities in addressing hypertension control, the AMA is initiating prototyping with physician practices in Chicago and in Baltimore.

    These practices are working together and with experts in hypertension and practice improvement to develop and test a new clinical care improvement package. By incorporating this prototype improvement package into their workflow, these practices will seek to determine its impact on controlling patients' high blood pressure, as well as its sustainability and feasibility in diverse clinical practice settings.

    AMA will take what it learns from these practices to improve workflows in clinical care environments, then use a community-based approach to spread hypertension improvement to more practices regionally and nationwide.

    How many lives could be saved by controlling high blood pressure?

    AMA Improving Health Outcomes (IHO) data analysts offer new estimates of the additional lives that need to be saved between 2015 and 2020 to maintain the 60-year trend decline in U.S. ischemic heart disease and stroke death rates.

    That number is 28,000–41,000.

    AMA IHO will use these data in setting goals for our work in hypertension management, and ultimately cardiovascular disease prevention.

    Read the full issue brief from AMA IHO, which also breaks out death rates from ischemic heart disease and stroke.

    What can physician practices do right now?

    All physicians can visit the "Million Hearts®" website for resources you can use in your practice and with your patients to prevent and control high blood pressure. Many primary care physicians can use hypertension improvement efforts to meet Maintenance of Certification requirements, visit American Board of Internal Medicine or the American Board of Family Medicine to find out more.

    Find out more about our pilot efforts and how you can participate.

    What can patients do right now?

    • Talk with your doctor about your risk for high blood pressure.
    • Get your blood pressure checked and then monitor it regularly.
    • Eat a healthy diet, be physically active, don't smoke, and maintain a healthy weight.
    • Visit the "Million Hearts" website to learn how to prevent or control high blood pressure.

    Stats and resources

    Statistics about hypertension:

  • Collaboration

    Collaboration is essential to our success.

    The AMA is interested in collaborating with organizations whose efforts are aligned with our "Improving Health Outcomes" Initiative and our strategies around controlling high blood pressure and preventing diabetes.

    Our collaborations with the Johns Hopkins Medicine Armstrong Institute for Patient Safety and Quality and the Center to Eliminate Cardiovascular Health Disparities (to support the goal of improving blood pressure control in people with hypertension), and with the YMCA of the USA (to support the goal of reducing the incidence of type 2 diabetes) represent the beginning stages of a long-term effort toward accomplishing our vision.

    Our engagement with the U.S. Department of Health and Human Services' "Million Hearts®" initiative, and with the Centers for Disease Control and Prevention's National Diabetes Prevention Program, are further examples of strategic alignment toward shared goals.

    The AMA improving health outcomes team wants to learn about what is happening in your community or state to improve health outcomes in our two key areas of focus.


    Send a description of your organization's efforts around hypertension and/ or prediabetes to Marsha.Kaufman@ama-assn.org Please include as many details as possible and let us know if you are collaborating with other partners on your efforts.