Region 2: Texas 1115 Medicaid Waiver fighting hypertension

The Texas Healthcare Transformation and Improvement Program, referred to as the 1115 Medicaid Waiver, provides incentives to health care providers for improving patient care for all with a special emphasis on Medicaid and uninsured patients.

University of Texas Medical Branch at Galveston is the anchor institution for Region 2 of the Medicaid Waiver, a 16-county region spanning from Brazoria County to as far as Shelby County. As the anchor institution, UTMB helps to guide other health care providers through the rules and regulations of the waiver.

UTMB also hosts learning collaboratives that allow health care providers to come together and share ideas, experiences and their knowledge on improving patient care.“I received help with writing a grant for mental health services by attending a learning collaborative,” said Pamela Jahnke, chief nursing officer for Galveston County’s Health District’s Coastal Health and Wellness Clinics.

The mental health services will not be a waiver project, but Coastal Health and Wellness has recently started a waiver initiative to lower hypertension in Galveston County.

Ask anyone the No. 1 cause of death and you will probably hear heart attack or heart disease. But seldom will you hear hypertension, better known as high blood pressure, although it is often the root cause of heart disease.
 

Any good landscaper will tell you you’ve got to kill weeds at the root for a healthy lawn. The same premise holds true for your body. Fix the root of your health problem — poor diet, lack of exercise, tobacco use — and you can lead a healthier life.

CHW clinics are doing just that with their 1115 Medicaid Waiver project, aimed at lowering hypertension.

“We so often put a Band-Aid on health problems as they occur,” said Dr. Mark Guidry, chief executive officer and health authority of Galveston County Health District. “This waiver is allowing us to prevent disease from a public health standpoint, by addressing the root cause of many chronic illnesses.”

Hypertension is often the underlying cause of stroke and cardiovascular disease, two of the leading causes of death.

According to Guidry, the majority of CHW patients have hypertension, with 40 percent having uncontrolled hypertension. “Our goal is to decrease our number of patients with uncontrolled hypertension by 5 percent,” said Guidry.

To reduce uncontrolled hypertension, CHW is instituting a comprehensive strategy. They will begin identifying their patients with uncontrolled hypertension, schedule them to see a physician and provide an all-inclusive plan for improvement.

The all-inclusive plan includes an investigation into the root cause of the patient’s hypertension. Once the contributing factors are identified, they educate the patient on how to change poor habits to improve their blood pressure, beyond the use of prescription medication.

“Hypertension control is a lifestyle change that may include a change of diet, increase in exercise, smoking cessation or better stress control,” said Guidry.

After the treatment plan is recommended to the patient, CHW staff calls the patients at home to monitor their at-home blood pressure readings, how they are following the plan and to schedule follow-up doctor’s appointments.

To facilitate the increased appointments, CHW has added two providers and support staff — all made possible by the waiver.

“We’re also holding monthly staff meetings with training and discussions on different methods to control hypertension,” said Pamela Jahnke, chief nursing officer for CHW.
 

“With 1 out of every 3 adults suffering from hypertension in America, Coastal Health and Wellness’s initiatives are imperative to improving health in our community,” said Craig Kovacevich, associate vice president of Waiver Operations for UTMB.