Aetna Hypertension Program
Agostini stated that high blood pressure affects about two-thirds of people who reach Medicare age, and 50 percent of people are inadequately or suboptimally treated for the condition. The Aetna Hypertension Program offers an automated blood pressure monitor at no cost to people who volunteer for the program. Once a month, in response to an interactive voice response call, participants record their blood pressure and enter their results along with answers to a series of questions over the phone. They also receive supplementary educational mailings about hypertension, conditions associated with hypertension such as hyperlipidemia, and other topics. If participants have an out-of-range blood pressure, they get immediate feedback from a nurse case manager. The goal is to encourage self-management over time. As people gather data and enter information into the phone, they learn about their blood pressure and about things they can do to manage their condition.
A review of the program found that about 18 percent of people who started in the program moved from out-of-control blood pressure to in-control blood pressure by the end of the study (Wade et al., 2010). Low density lipoprotein (LDL) screening rates increased approximately 90 percent, and 87 percent of survey respondents said they knew more about controlling their blood pressure as a result of the program. Economic modeling showed that if just 8 percent of eligible candidates participated in the program, better management of blood pressure could result in 23 fewer strokes, 22 fewer coronary artery disease events, and 16 fewer deaths per 100,000 people annually. In reality, more than 20 percent of eligible candidates chose to participate in the program, which will hopefully lead to even better outcomes in the long term.
Agostini identified a number of opportunities generated by the program. This low-technology intervention relies on phone communications rather than the Internet, which many older people still do not use. By entering and sending information to a central location, people learn more about their blood pressure than they would if the data were monitored and relayed to a central location automatically. Also, having nurses available for management backup allows for more efficient use of higher-cost resources.
Agostini also described several barriers revealed by the program. Adherence rates can wane, which often happens when people are asked to interact with a technology over time. Some participants prefer to interact with a human rather than entering their data into an automated system. Also, nurse case managers are trained in motivational interviewing, can respond in a thoughtful way, and understand what motivates people to make health behavior changes. This personalization cannot be done as well with an interactive voice response system.