Project Summary:
Cardiovascular disease (CVD) remains Wisconsin’s leading cause of death, with hypertension as its primary risk factor. Despite decades of conventional office-based care, 79% of the state’s 2.2 million residents with hypertension are not meeting blood pressure goals, and 40% remain undiagnosed. These gaps drive preventable heart attacks, strokes, and hospitalizations, disproportionately affecting racial, ethnic, and disadvantaged populations. A new approach is urgently needed to close these inequities and improve outcomes.
The Team-based, Asynchronous, Guideline-directed (TAG) care model offers a scalable solution. Built on 2025 national hypertension guidelines, TAG integrates pharmacists, physicians, and community health workers to deliver care beyond the traditional office visit. Patients receive home blood pressure devices, medication management, and lifestyle counseling through collaborative practice agreements, while high-risk individuals are identified for specialty referral. This model leverages self-monitoring, proven to better predict cardiovascular events, and ensures equitable access through reimbursement for devices and services.
By implementing TAG across four health systems and community partners, Wisconsin can achieve measurable improvements in blood pressure control, reduce emergency visits and hospitalizations, and prevent thousands of CVD events. This innovative, team-based approach not only strengthens engagement with the healthcare system but also creates a sustainable framework for statewide—and ultimately national—impact.