Frequently Asked Questions About the 6-18 Initiative

THE

SIX WAYS TO SPEND SMARTER
PEOPLE

FOR HEALTHIER

6|18 INITIATIVE

Frequently Asked Questions

REDUCE
TOBACCO USE

CONTROL ASTHMA

1

What is CDC’s 6|18 Initiative?

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CONTROL
BLOOD PRESSURE

PREVENT HEALTHCAREASSOCIATED INFECTIONS (HAI)

PREVENT UNINTENDED
PREGNANCY

CONTROL AND
PREVENT DIABETES

How will the 6|18 Initiative be implemented?

The Centers for Disease Control and Prevention (CDC) is

CDC is forming collaborative partnerships with state Medicaid

partnering with health care purchasers, payers, and providers

programs and commercial insurers to help inform decisions

to improve health and control health care costs. CDC provides

on coverage and delivery. Key actions of this initiative

these partners with rigorous evidence about high-burden

include bringing together health care purchasers, payers, and

health conditions and associated interventions to inform their

providers with select CDC researchers, economists, and policy

decisions to have the greatest health and cost impact. This

analysts to offer opportunities to improve health and control

initiative offers proven interventions that prevent chronic

costs with the 6|18 interventions. These partners will focus

and infectious diseases by increasing their coverage, access,

on implementing one or more of the 6|18 interventions to

utilization and quality. Additionally, it aligns evidence-based

expand access, quality, and utilization. CDC will work directly

preventive practices with emerging value-based payment and

with these partners to understand challenges and successes

delivery models.

associated with this effort.

2

Why is it called the “6|18?”

The name “6|18” comes from the initial focus on 6 high-burden
health conditions and 18 evidence-based interventions that can
improve health and control costs.

5

What are the six high-burden conditions
in the 6|18, and how were they selected?
Will other high-burden health conditions
be added?

The six initial conditions CDC has focused on are: tobacco use,
high blood pressure, healthcare-associated infections, asthma,
unintended pregnancies, and diabetes. CDC selected these

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conditions and the associated interventions because:

What is the goal of the 6|18 Initiative?
ü They affect large numbers of people

In this critical time of active health system transformation,

ü They are associated with high health care costs

CDC is helping to accelerate evidence into action to improve

ü There are evidence-based interventions to prevent or

the health of all Americans. CDC will provide key evidence
and analysis to purchasers, payers, and providers to
inform their decisions when considering risk and benefits,

control these conditions
ü The interventions are most likely to improve health and
control costs

determining coverage, and deciding where to invest to have
the greatest impact on both population health outcomes

As more evidence accumulates on high-cost, high-burden

and controlling costs.

conditions with associated interventions, they will be
incorporated into the 6|18 Initiative.
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THE

6|18 INITIATIVE

6

F REQU ENTLY ASKED QUEST ION S

What are the 18 interventions promoted in
the 6|18? How were they selected?

8

Who at CDC is involved in the
6|18 Initiative?

Initially, 18 interventions were identified that can help prevent

The 6|18 Initiative is led by CDC’s Office of the Associate

or control the 6 conditions. CDC used a rigorous process

Director for Policy, in collaboration with CDC Centers,

to select the interventions most likely to improve health

Institutes, and Offices (CIOs). CDC leaders and staff are

and control costs. See About the Evidence Summaries for

working with purchasers, payers, and providers to match health

a current list of interventions (www.cdc.gov/sixeighteen/

care goals with the one or more of the 6|18 interventions. CDC

aboutsummaries).

experts, scientists, and economists are providing the evidence
base and additional support on implementation and evaluation.
The 6 conditions and their associated CDC CIOs are as follows:

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Why is the 6|18 Initiative a CDC priority?

One of CDC’s three strategic directions is to strengthen public
health and health care collaboration. The 6|18 Initiative is a
key component of this strategic direction of strengthening
collaboration between CDC and its traditional public health
partners and the rapidly changing health care system.
The U.S. health care system is undergoing unprecedented

ü Tobacco: Office on Smoking & Health
ü High Blood Pressure: Million Hearts Program, Division of
Heart Disease & Stroke Prevention
ü Healthcare-Associated Infections: Division of Healthcare
Quality Promotion
ü Asthma: Air Pollution & Respiratory Health Branch,
Division of Environmental Hazards & Health Effects
ü Unintended Pregnancy: Division of Reproductive Health
ü Diabetes: Division of Diabetes Translation

change, driving toward a system that is “better, smarter,
healthier” (Secretary Burwell, Medicare Reimbursement
Announcement, http://www.hhs.gov/news/press/2015pres/
01/20150126a.html). Major trends in health care, including
more people with health insurance, widespread payment

9

Which partners are involved in the
6|18 Initiative?

reform, and the testing and scaling of new health care delivery
models, are providing opportunities to prevent illness, improve

CDC is working with a variety of organizations across the

population health, and forge closer ties between public health

purchaser, payer, and provider landscape to improve health

and the health care sector.

and control health care costs. CDC’s partner list includes
other federal agencies, state Medicaid programs, commercial

We are linking the health care and public health sectors by

insurers, employers, large health systems, provider networks,

providing evidence and science on improving health and

health insurance exchanges, and other key stakeholders with

controlling costs across a spectrum of prevention interventions,

expertise in health care or health care financing.

from clinical to community prevention. CDC’s strength in
identifying and analyzing scientific evidence complements the
purchaser, payer, and provider role of financing and delivering
care. CDC can help by providing key evidence and analysis to
purchasers, payers, and providers to inform their decisions
when considering risk and benefits, determining coverage, and
deciding where to invest to have the greatest impact on both
population health outcomes and controlling costs.

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THE

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1

F REQU ENTLY ASKED QUEST ION S

6|18 INITIATIVE

What are the references from the
www.cdc.gov/sixeighteen landing page?

Secretary Burwell, Medicare Reimbursement Announcement,

http://www.hhs.gov/news/press/2015pres/01/20150126a.html.
2

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How can I get more information about
the 6|18 Initiative?

For more information, email healthpolicynews@cdc.gov or go
to www.cdc.gov/sixeighteen.

ASPE. Health Insurance Coverage and the Affordable

Care Act. September 22, 2015. http://aspe.hhs.gov/sites/
default/files/pdf/111826/ACA%20health%20insurance%20
coverage%20brief%2009212015.pdf

HIGH-BURDEN HEALTH CONDITIONS AND EVIDENCE-BASED INTERVENTIONS
The following is a list of six high-burden health conditions with 18 effective interventions
that CDC is prioritizing to improve health and control health care costs.
REDUCE
TOBACCO USE
• Expand access to evidence-based tobacco
cessation treatments, including individual,
group, and telephone counseling and
FDA-approved cessation medications—in
accordance with the 2008 Public Health
Service Clinical Practice Guideline.
• Remove barriers that impede access to
covered cessation treatments, such as cost
sharing and prior authorization.
• Promote increased utilization of covered
treatment benefits by tobacco users.

CONTROL HIGH
BLOOD PRESSURE
• Promote strategies that improve access
and adherence to anti-hypertensive and
lipid- lowering medications.
• Promote a team-based approach to
hypertension control (e.g., physician,
pharmacist, lay health worker, and
patient teams).
• Provide access to devices for self-measured
blood pressure monitoring for home-use
and create individual, provider, and health
system incentives for compliance and
meeting of goals.

PREVENT HEALTHCAREASSOCIATED INFECTIONS
• Require antibiotic stewardship programs in
all hospitals and skilled nursing facilities.
• Prevent hemodialysis-related infections
through immediate coverage for insertion of
permanent dialysis ports.

CONTROL
ASTHMA
• Promote evidence-based asthma medical
management in accordance with the 2007
National Asthma Education and Prevention
Program guidelines.
• Promote strategies that improve access
and adherence to asthma medications
and devices.
• Expand access to intensive self-management
education for individuals whose asthma is not
well-controlled with guidelines-based medical
management alone.
• Expand access to home visits by licensed
professionals or qualified lay health workers
to improve self-management education and
reduce home asthma triggers for individuals
whose asthma is not well-controlled with
guidelines-based medical management and
intensive self-management education.

PREVENT UNINTENDED
PREGNANCY
• Reimburse providers for the full range of
contraceptive services (e.g., screening for
pregnancy intention; tiered contraception
counseling; insertion, removal, replacement,
or reinsertion of long-acting reversible
contraceptives (LARC) or other contraceptive
devices; and follow-up) for women of childbearing age.
• Reimburse providers or health systems for the
actual cost of LARC or other contraceptive
devices in order to provide the full range of
contraceptive methods.
• Reimburse for immediate postpartum
insertion of LARC by unbundling payment for
LARC from other postpartum services.
• Remove administrative and logistical
barriers to LARC (e.g., remove pre-approval
requirement or step therapy restriction and
manage high acquisition and stocking costs).

CONTROL AND
PREVENT DIABETES
• Expand access to the National Diabetes
Prevention Program, a lifestyle change
program for preventing type 2 diabetes.
• Promote screening for abnormal blood
glucose in those who are overweight or obese
as part of a cardiovascular risk assessment.

Centers for Disease Control and Prevention
Office of the Associate Director for Policy
December 2015