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The Initiative

Million Hearts® Hypertension Control Challenge 2015: Rules, Eligibility, etc.

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About the Challenge

The Million Hearts® Hypertension Control Challenge is a competition to identify clinicians, practices, and health systems that have demonstrated exceptional achievements in working with their patients to control hypertension. The Challenge is open to public and private clinicians, medical practices, and health systems. Strategies used by Champions that support hypertension control may be written into a success story and posted on the Million Hearts® website.

In 2014, CDC recognized 30 Hypertension Control Champions.

AUTHORITY for the Private Sector (15 U.S.C. § 3719) COMPETES Act

AGENCY: Centers for Disease Control and Prevention (CDC), US Department of Health and Human Services (HHS)

AWARD APPROVING OFFICIAL: Thomas R. Frieden, MD, MPH, director, Centers for Disease Control and Prevention

WHO IS ELIGIBLE? The 2015 Million Hearts® Hypertension Control Challenge is intended to recognize public and private clinicians, practices and systems that are successful in working with their patients to achieve exemplary hypertension control rates, improve understanding of successful implementation strategies at the health system level, and motivate national improvement in hypertension control.

DEADLINE? The deadline to submit a nomination is Saturday, October 31, 2015, at 11:59 pm EST. The 2015 Champions will be posted on the Million Hearts® Web site in May 2016.

WHAT IS MILLION HEARTS®? Million Hearts® is a national initiative to prevent 1 million heart attacks and strokes by 2017. Achieving this goal means that 10 million more Americans will have their high blood pressure under control. Million Hearts® is working to control high blood pressure through clinical approaches, such as using health information technology to its fullest potential and integrating team-based approaches to health care, and community approaches, such as strengthening tobacco control and lowering sodium consumption. For more information about the initiative, visit http://millionhearts.hhs.gov.

Questions about the Challenge should be directed to millionhearts@cdc.gov with the word "Challenge" in the subject line.


Eligibility

The Million Hearts® Hypertension Control Challenge is open topublic and private individual clinicians, practices, and health systems providing health care services to patients in a US state or territory. To be eligible to win the Challenge, the nominee must

  1. Be a US licensed clinician, practicing in any US setting, who provides continuing care for adult patients with hypertension. In the case of an individual, whether participating singly or in a group, the individual must be a citizen or permanent resident of the United States.
  2. Or be a US incorporated clinical practice, defined as any practice with two or more U.S. licensed clinicians who by formal arrangement share responsibility for a common panel of patients, practice at the same physical location or street address, and provide continuing medical care for adult patients with hypertension.

    In the case of a private entity, the private entity shall be incorporated in and maintain a primary place of business in the US.
  3. Or be a health system that provides continuing medical care for adult patients with hypertension.

    In the case of a private entity, the private entity shall be incorporated in and maintain a primary place of business in the US.
    • A health system provides a wide range of medical services and coordination of care for patients and their dependents.
    • We encourage large health systems (those that comprise of a large number of geographically dispersed clinics or have multiple hospital locations, or both) to consider having one or a few of the highest performing clinics or regional affiliates apply individually instead of the health system applying as a whole.
    • For purposes of this Challenge, an Accountable Care Organization (ACO) may apply as an ACO or one or more of its practices can apply independently.

In addition, the clinician, practice, or health system:

  1. Must treat all adult patients with hypertension in the practice seeking care, not a select subgroup of patients.
  2. Must treat a minimum of 500 adult patients annually.
  3. Must have completed the nomination in its entirety.
  4. Must have a hypertension control rate of at least 70% during the 12 month reporting period among the practice's hypertensive patient population. Must have a data management system (electronic or paper) that allows for verification of data submitted.
  5. Must agree to:
    1. Participate in a data validation process to be conducted by a reputable independent contractor. To the extent applicable law allows, data will be kept confidential by the contractor and will be shared with the CDC in aggregate form only (i.e., the hypertension control rate for the practice not individual hypertension values).
    2. Accept the award if selected and participate in award activities as described more fully below.
    3. Provide information through a 60 minute, or other similar, interview about their clinical strategies and protocol implementation for the development of a success story document.
  6. Individual nominees and individuals in a group practice must be free from convictions or pending investigations of criminal and health care fraud offenses such as felony health care fraud, patient abuse or neglect; felony convictions for other health care-related fraud, theft, or other financial misconduct; and felony convictions relating to unlawful manufacture, distribution, prescription, or dispensing of controlled substances as verified through the Office of the Inspector General List of Excluded Individuals and Entities. Individual nominees must be free from serious sanctions, such as those for misuse or mis-prescribing of prescription medications. Such serious sanctions will be determined at the discretion of the agency consistent with CDC’s public health mission. CDC’s contractor may perform background checks on individual clinicians or medical practices.
  7. Health systems must have a policy in place that conducts periodic background checks on all providers and takes appropriate action accordingly. The background check should ensure that staff are free from convictions or pending investigations of criminal and health care fraud offenses such as felony health care fraud, patient abuse or neglect; felony convictions for other health care-related fraud, theft, or other financial misconduct; and felony convictions relating to unlawful manufacture, distribution, prescription, or dispensing of controlled substances as verified through the Office of the Inspector General List of Excluded Individuals and Entities. The policy must ensure that staff are free from serious sanctions, such as those for misuse or mis-prescribing of prescription medications. Such serious sanctions will be determined at the discretion of the agency consistent with CDC’s public health mission. In addition, a health system background check will include a search for JCAHO sanctions and current investigations for serious institutional misconduct (e.g., attorney general investigation). CDC’s contractor may request the policy and any supporting information deemed necessary.
  8. Centers for Disease Control and Prevention (CDC) employees are not eligible to apply.  Contractors working on a CDC campus are not eligible. Neither the judges nor any individuals or entities participating in the development or implementation of the Challenge are eligible.
  9. A federal entity or federal employee acting within the scope of their employment are not eligibile to apply.
  10. Champions previously recognized through the 2013 and 2014 Million Hearts® Hypertension Control Challenge retain their designation as a "Champion" and are not eligible to be named a Champion in the 2015 Challenge.

Rules

  1. The Challenge recognizes clinicians, practices and health systems that achieve notable hypertension control rates across their adult patient population, not just for select patients. Applicants submitting research studies, pilot studies, or entries that limit hypertension control data submitted to a subset of the provider or health system population such as treatment cohorts, patients of a specific age range, or patients enrolled in limited quality improvement projects are not eligible.
  2. Federal grantees and contractors:
    1. Federal grantees may not use federal funds to develop COMPETES Act Challenge applications unless consistent with the purpose of their grant award and specifically requested to do so due to competition design, and as announced in the Federal Register.
    2. Federal contractors may not use federal funds from a contract to develop COMPETES Act Challenge applications or to fund efforts in support of a COMPETES Act Challenge submission. Costs associated with such activities are unallowable and are not allocable to government contracts.
  3. According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection or information unless it displays a valid OMB control number. The valid OMB Control number for this information collection is 0920-0976 which expires July 31, 2016. The time required to complete this information collection is estimated to be 30 minutes, including the time to review the instructions, search existing data resources, gather the data needed and complete and review the information collection. If you have comments concerning the accuracy or the time estimate(s) or suggestions for improving this form, please write to the US Department of Health and Human Services, OS/OCIO/PRA, 200 Independence Ave SW, Suite 336-E. Washington, DC, 20201, Attention: PRA Reports Clearance Officer.
  4. By participating in this Challenge:
    1. An individual or organization agrees to assume any and all risks related to participating in the Challenge. Individuals or organizations also agree to waive claims against the Federal Government and its related entities, except in the case of willful misconduct, when participating in the Challenge, including claims for injury; death; damage; or loss of property, money, or profits, and including those risks caused by negligence or other causes.
    2. An individual or organization agrees to protect the Federal Government against third party claims for damages arising from or related to Challenge activities. Individuals and organizations are not required to hold liability insurance related to participation in this Challenge.

Submission Guidelines

To enter the Challenge, participants must complete the nomination form by clicking the link at the bottom of this page. The nomination form is a combination of short answer responses, checkbox responses, and assurances.

Nomination information includes:

  1. The size of the nominee’s adult patient population defined as the number of adult patients served during the reporting year regardless of diagnosis, a summary of known patient demographics (e.g., age distribution), and any noteworthy patient population characteristics. The reporting year should reflect the most currently available data with an end date no earlier than 3 months prior to the date of submission.
  2. The percent of the nominee’s adult patient population identified above that were seen during the reporting year and had a hypertension diagnosis (i.e., hypertension prevalence).

    There are an estimated 14 million people who are unaware of their hypertension. Most of these people are hiding in plain sight—they are in clinical treatment with elevated blood pressure documented, but hypertension neither diagnosed nor treated. Nominees selected as finalists will have their reported hypertension prevalence (i.e., percentage of their practice or system population with the condition) assessed for alignment with their predicted hypertension prevalence. Initially, a rough estimate of the nominee’s predicted hypertension prevalence will be calculated using the reported age distribution of their patient population and hypertension prevalence findings from national studies, using the Million Hearts® Hypertension Prevalence Estimator Tool. If the nominee’s reported prevalence varies considerably from this rough estimate, the nominee may be asked to describe possible reasons for this disparity during the data validation process. If the reported hypertension prevalence is extreme and there is not a justifiable reason, the nominee may be excluded from further participation in the Challenge.
  3. The nominee’s current hypertension control rate among their hypertensive population identified above during the reporting year. In addition, the hypertension control rate during the previous reporting year is also required For example, if the current reporting year is September 1, 2014, to August 31, 2015, then the previous reporting year should be September 1, 2013, to August 31, 2014.
  4. In determining the hypertension control rate, CDC defines "hypertension control" as a blood pressure reading <140 mmHg systolic and <90 mmHg diastolic among adult hypertensive patients.
  5. A description of clinic systems or processes that support hypertension control. Checkbox responses may be supplemented by a short answer response. Supporting information about clinic systems is encouraged but not required. Sustainable systems may include provider or patient incentives, dashboards, staffing characteristics, electronic record keeping systems, reminder or alert systems, clinician reporting, service modifications, etc.
  6. The nominee must agree to:
    • Participate in a data validation process (described below), accept the award if selected, and participate in award activities.
    • To complete, without revisions, a required Business Associate Agreement form and/or other forms that may be required by applicable law.
    • Participate in a 60-minute interview or similar activity to gather information about their hypertension control strategies, and work with CDC on the review of material to share clinical strategies. Strategies used by Champions that support hypertension control may be written into a success story, placed on the Million Hearts® website, and attributed to Champions.
    • Assume any and all risks and waive claims against the Federal Government and its related entities except in the case of willful misconduct, for any injury, death, damage, or loss of property, revenue or profits, whether direct, indirect or consequences, arising from participation in this prize contest, whether the injury, death, damage or loss arises through negligence or otherwise.
    • Indemnify the Federal Government against third party claims for damages arising from or related to competition activities.

Nominees not agreeing to each of these items on the nomination form will be excluded from the Challenge.

Paper responses will not be accepted.


Data Validation Process

Nominees will be scored based on their reported hypertension control rate (95% of score); and sustainable systems in the practice that support hypertension control (5% of score).

Nominees with the highest score will be required to participate in a two-phase validation process. Nominees determined to be non-compliant with the validation submission requests or timelines will be removed from further consideration.

Phase 1 of validation includes an initial verification of the hypertension prevalence and blood pressure control rate data submitted in the nomination form. In addition, background checks will be conducted by an independent source for individual or small practice nominees to ensure there are no serious sanctions or other misconduct has occurred (as outlined in the “Eligibility section). For large providers or health systems, the background check policy and implementation will be reviewed for compliance with the individual background check protocol. Some nominees may be eliminated based on these reviews. In addition, a health system background check will include a search for the Joint Commission sanctions and current investigations for serious institutional misconduct (e.g., attorney general investigation).

Phase 2 of validation, for nominees whose Phase 1 data is verified as accurate, consists of hypertension management validation via medical chart review.

Nominees must provide documents showing the criteria used to include patients as “controlled” and a list with each hypertensive patient found to have blood pressure in control. Eight patients will be selected randomly for file review for compliance, along with 32 additional patients whose records may be requested for review if needed (described below). For the eight records selected, electronic copies of all of the pertinent medical records will be submitted through a secure FTP site with a secure login. Criteria for compliance with the measure include having documentation of having at least one outpatient encounter with a diagnosis of hypertension during the first 6 months of the measurement period and evidence that the patient’s most recent blood pressure is adequately controlled (a reading of <140/90 mmHg).

If all eight patients are determined to be in compliance, then the proposed nominee is determined to be in HIGH compliance and the validation process is complete. If one or more of the initial eight patients’ records is out of compliance, then 22 randomly selected patient records, from the 32 patients identified above, will be required for review. For these nominees, 30 total patients’ records will be reviewed to assess compliance. The remaining 10 patients will serve as alternates to replace patients with records that do not meet inclusion criteria.

Performance categories: HIGH (90% - 100% of the records are in compliance with the review criteria); MEDIUM (60% - 89% in compliance); or LOW (less than 60% in compliance).


Prizes

Up to 35 Champions will be recognized.

Champions will be recognized by Centers for Disease Control and Prevention (CDC) Director Dr. Tom Frieden. In addition to recognition on the Million Hearts® and CDC websites, national press releases will be initiated to recognize and congratulate Champions. Documentation of clinical systems and strategies Champions adopted that support hypertension control will be housed on the Million Hearts® website and attributed to Champions.

No cash prize will be awarded this year.


Selecting the Champions

The First Round Finalists will be selected based on a composite score generated from the information on the nomination form. These nominees will participate in a data validation process.

Nominations will be scored and judged separately by size and type of nominee in the three categories listed below. CDC does not guarantee that a specific proportion of Champions will be selected from each category.

Impact: 95% of score. The hypertension control rate for the provider/system�s entire hypertensive population based on recommended measurement and documentation protocols. Two data points are requested: 1) within three months of submission and 2) 9-12 months prior.

Sustainability: 5% of score. The type of systems or processes in place that support hypertension control and are likely to endure, such as electronic reminder systems or team based care.

If scores are tied, the patient population served and geographic location will be considered in breaking the tie. Providers or health systems that serve populations with greater challenges or barriers in controlling hypertension, will receive up to 5 points additional points. If a tie remains, the CDC Judges Panel will break the tie and may consider all of the information provided in the application.

Champion selection: Finalists whose reported hypertension control rate is validated will move on to the final selection round. The CDC Judges Panel has full and sole discretion in selecting the 2015 Champions. Judges will consider all of the information generated from the nomination, the validation process, and the background check. Judges will also consider the hypertension prevalence, patient population served (considering populations less likely to achieve hypertension control), and geographic region served (considering high need or high burden areas).

Judges will confirm that there are no conflicts of interest with any nominees being considered as a Champion.


CDC Judges Panel

Judges will be selected by CDC based on their knowledge of hypertension and hypertension control strategies. Judges may include at least three of the following:



Submit your Entry to the 2015 Hypertension Control Challenge

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