Chronic condition management (diabetes and hypertension)
- This year, PCC and Montgomery Cares clinics participated in the American Heart Association's Target: BP Program. All clinics received awards and two received the highest level (Gold) award for achieving >70% blood pressure control among hypertensive patients seen in calendar year 2017.
- Montgomery Cares clinics continue to improve cancer screening rates
- Clinics are approaching HEDIS benchmarks in breast and cervical cancer screening.
- Although no HEDIS Medicaid benchmarks are published for colorectal cancer screening, the Montgomery Cares program continues to demonstrate significant improvement in colorectal cancer screening.
- Montgomery Cares clinics routinely screen for depression.
- In FY 2018, 95% of active patients received depression screening within the previous twelve months.
- Annual depression screening among Montgomery Cares participants continues to improve as a result of robust collaborative care models that integrate behavioral health and primary care, and focused attention on quality improvement in the Montgomery Cares Behavioral Health Program.
Racial disparities are apparent in blood pressure control, diabetes testing, and cancer screening.
- White patients have the highest rates of blood pressure control and diabetes testing.
- Black patients have the highest rates of colorectal cancer screening.
- Asian patients have the lowest rates of breast cancer screening and diabetes A1c, testing (but not control).
- There are no racial differences noted in diabetes control.