Cardiovascular disease remains a leading driver of morbidity and cost, especially in the southeastern US, home of the “Stroke Belt.” This session spotlights how one Stroke Belt state harnessed its statewide health information exchange (HIE) to quantify population and patient-level cardiovascular-kidney-metabolic (CKM) risk while uncovering geographic and treatment patterns. Participants will hear findings from a statewide baseline study of heart health that gained  traction across multiple provider organizations and  earned recognition from payers and large employers—an essential ingredient for a whole ecosystem approach. 

Attendees will see practical innovations and tactics that help health systems more efficiently identify, prioritize, and manage CKM-related risk, with a clear line of sight to NCQA quality standards—including blood pressure control—ultimately improving care and patient outcomes.  Content will be tailored for health system quality leaders, primary care networks, payers and employer groups. Leave with practical playbooks, implementation tips and collaboration strategies to replicate and scale CKM risk stratification and quality improvement in your market.

Learning Objectives:

• Describe how one state leveraged data from its health information exchange (HIE) to reduce cardiovascular-kidney-metabolic (CKM) risk, while uncovering geographic, clinical and treatment differences to guide targeted population health initiatives. 
• Understand how data-enabled tools and workflows are designed to identify, prioritize, and engage high-risk patients across diverse care settings—including community health centers and health systems—to meet quality standards for chronic disease management, with a focus on cardiovascular health and hypertension control.
• Evaluate multi-stakeholder collaboration models—including health systems, community health centers, payers, large employers, data aggregators and the pharmaceutical industry—that align on common goals to address data-sharing challenges and accelerate adoption of a replicable playbook for cardiovascular disease risk stratification and improvement.