Population Health Collaborative
Constellation Consulting, LLC is working in collaboration with the New Mexico Department of Health, Heart Disease & Stroke Prevention Program to launch the Population Health Collaborative (PHC). The PHC will meet three times this fiscal year, and together will address the six strategies developed by the CDC to reduce the burden of cardiovascular disease:
STRATEGY 1: Utilizing Electronic Health Records (EHR) to identify patients with undiagnosed or uncontrolled high blood pressure.
STRATEGY 2: Utilizing team-based care (non-physicians, such as pharmacists, nutritionists, nurse practitioners) to help patients manage high blood pressure and high cholesterol.
STRATEGY 3: Utilizing Community Health Workers (CHWs) to help control high blood pressure and high cholesterol.
STRATEGY 4: Facilitate use of self-measured blood pressure monitoring (SMBP) with clinical support.
STRATEGY 5: Systematic referral of patients with hypertension and high cholesterol to community programs/resources.
STRATEGY 6: Promote the adoption of Medication Therapy Management (MTM) between pharmacists and physicians for the purpose of managing high blood pressure, high blood cholesterol, and lifestyle modification.