FLO HTN STANDARD PROTOCOL

Standardized Hypertension Management Framework

Generated Health | Version 3.0 | March 2025

Evidence Base: AHA/ACC 2025 Multisociety Hypertension Guideline

Purpose: This protocol establishes the Flo texting framework for hypertension management for CCHA. Customer-specific configuration fields are modular and do not alter the core clinical logic or blood pressure escalation thresholds.

1. Purpose & Clinical Goals

Goal	Detail
Primary Goal	Reduce uncontrolled HTN to controlled; improve HEDIS HTN control measure (CBP); facilitate CM connect requirements; increase attribution.
Secondary Goals	Facilitate PCP engagement and care coordinator touchpoints; improve medication adherence; address SDOH barriers.
Success Metrics	% non-attributed patients attributed; BP at goal (<130/80 per AHA/ACC 2025; <140/90 minimum); CC touchpoints/member/month (goal: 2); medication adherence rate.
Protocol Duration	6 months
Message Frequency	Standard: 2x/week (daily in Week 1 for onboarding)

Important: Hypertensive Emergency = BP ≥180/120 mmHg with symptoms such as chest pain, shortness of breath, severe headache, visual changes, or neurologic symptoms, and requires immediate ED evaluation.

2. Patient Eligibility & Cohort

Inclusion Criteria	Exclusion Criteria
Enrolled in CCHA Confirmed HTN diagnosis Age ≥18 Not yet engaged in chronic disease management (Attributed or Unattributed) Active cell phone (can receive SMS)	Actively engaged in high-touch CC program (flag for coordination; do not duplicate) No cell phone or persistent inability to receive SMS Pregnancy or post-partum Active hospice or palliative care

3. Protocol Cadence & Messaging Framework

Period	Frequency	Core Focus	Message Types
Week 1	Daily	Onboarding & device activation	Welcome; expectation setting; PCP check; SDOH check; CC connect info; education 2x/week
Weeks 2–4	2x/week	Habit building & adherence	BP monitor check; BP reading; PCP follow-up; SDOH follow-up; education 2x/week
Months 2–3	2x/week	Trend monitoring & SDOH	BP reading; trend feedback; SDOH screen (1x/month); PCP connection support; appointment encouragement; CC prompt (2x/month then 1x/month); medication adherence; education 2x/week
Months 4–6	2x/week	Maintenance & engagement	BP reading; medication adherence reinforcement; CC prompt 1x/month; PCP connection support; education 2x/week; NPS

4. Protocol Modules & CCHA Configuration

4a. Core Modules (Default ON — Cannot Be Disabled)

Module	Description	Default
Enrollment Confirmation	Welcome message and program explanation	ON
Reading Collection (BP)	BP prompts 2x/week; positive/concern feedback based on threshold	ON
Health Education (Drip)	HTN-specific education 2x/week: low-sodium diet, exercise, medication purpose, stress management	ON
Escalation Notifications	Detects readings outside clinical thresholds; triggers escalation pathway	ON

4b. Optional Clinical Modules

Module	Description	GH Recommended for CCHA
Device Check	Verifies patient has access to a BP monitor	Yes
Symptom Check-In	Structured prompts for symptom tracking between readings	Yes
Medication Adherence	Refill reminders, adherence check-ins, barrier screening	Yes
SDOH Screening	Validated screeners for food, housing, transport, and social needs	Yes
Appointment Prompts	Visit reminders (scheduling-linked or static cadence)	Yes
Self-Management Pathway	Self-care guidance without staff escalation below threshold	Yes
Medication Coaching	Guidance around specific HTN medications	No
Post-Visit Follow-Up	Structured check-in following clinical encounter	No

4c. Operating Model Modules

Module	Description	GH Recommended for CCHA
Care Manager Escalation	Prompts patients to connect with a care coordinator	Yes
PCP Engagement	Assesses whether patient has PCP and encourages connection	Yes
EHR Task / Alert Creation	Escalation creates a task or alert in EHR workflow	No
Nurse Triage Line Handoff	Out-of-range trigger or unprompted patient comment generates nurse triage referral	Yes

5. Evidence-Based Blood Pressure Parameters

All thresholds are derived from the 2025 AHA/ACC Multisociety Hypertension Guideline. This guideline supersedes the 2017 ACC/AHA Guideline and replaces the term "hypertensive urgency" with "Severe Hypertension" for readings ≥180 without emergency symptoms.

Classification	Systolic (mmHg)	Diastolic (mmHg)	Flo Response
Hypotension	< 90	< 60	Patient notified; advised to call PCP or nurse triage if symptomatic. 911 for emergencies.
Normal	90–119	60–79	Positive reinforcement message.
Pre-Hypertension / Elevated	120–129	< 80	Encouragement and education; no escalation.
Stage 1 HTN	130–139	80–89	Concern message; medication adherence check; PCP follow-up encouraged.
Stage 2 HTN	140–159	≥ 90	Elevated concern message; prompt to contact PCP.
Severe Hypertension	≥ 160	< 120	Confirm reading (recheck in 15 min). Based on second reading: instruct patient to call PCP or nurse triage same day; 911 for emergencies.
Hypertensive Emergency	≥ 180	≥ 120	Emergency: confirm reading (recheck in 15 min). Direct patient to call nurse triage, call 911, or go to ED immediately.

Terminology note: The 2025 AHA/ACC Guideline replaced "hypertensive urgency" with "Severe Hypertension."

6. Notification Triggers

Notification	Default	Trigger	Flo Message to Patient	CC Alert Text
Medication Issue	ON	Patient reports missed dose, confusion, or access barrier	Prompts patient to contact PCP, care coordinator, or member services (pharmacy)	Patient reports medication issue
BP Monitor Access	OFF	No monitor confirmed after Week 1	Prompts patient to connect with care coordinator and/or pharmacy for assistance	Patient does not have confirmed BP monitor access
Low BP Reading	ON after 3 readings	BP reading below 90/60 mmHg	Notifies patient their BP is low and advises calling nurse triage or PCP if symptomatic; 911 for emergencies	Patient BP below 90/60 — low BP flagged for clinical review
High BP Reading	ON	≥160/<120 for 2 readings	Confirm reading (recheck in 15 min). Based on second reading: instruct patient to call PCP or nurse advice line same day; 911 for emergencies	Patient BP ≥160/<120 — elevated reading, clinical review required
Very High BP Reading	ON after 3 readings	BP ≥180/120 for 2 readings	Emergency: confirm reading (recheck in 15 min). Based on second reading: direct patient to call nurse triage, call 911, or go to ED immediately	Emergency: Patient BP ≥180/120 — immediate follow-up required
Symptom Escalation	ON	Patient reports dizziness, chest pain, shortness of breath, severe headache, blurred vision, weakness, nosebleed, or fainting	Flo acknowledges symptom and advises patient to call nurse triage or 911 if emergency	Patient reports concerning symptom — clinical review required
Contact Requested	ON	Patient replies CALL or requests to speak with CC	Acknowledges request and advises patient that care coordinator will follow up	Patient requests to speak with care coordinator
SDOH Need	ON	Patient reports food insecurity, housing, medication access, or transportation barrier	Prompts patient to contact care coordinator or visit member services	SDOH need flagged — follow-up required
Safety — Unsafe at Home	ON	Patient reports feeling unsafe at home	CCHA can support you. Medical emergency? Call 911. Mental health crisis? Call or text 988.	Safety alert: Patient reports feeling unsafe
Safety — Suicidal Ideation	ON	Patient reports suicidal thoughts	CCHA can support you. Medical emergency? Call 911. Mental health crisis? Call or text 988.	Crisis alert: Patient reports suicidal ideation — immediate follow-up required

7. Language & Accessibility

Standard Languages	English and Spanish
Additional Languages	N/A
Preferred Terminology	"Care Coordinator," "Doctor," "Medication," "Office"

8. Resources, Websites & Hotlines

Member Support	Phone: 303-256-1717 Contact Us page: https://www.cchacares.com/for-members/member-assistance
Urgent / Emergent Guidance	Medical emergency: 911 Mental health crisis: 988 Nurse Advice Line: 800-283-3221

9. Data, Reporting & Outcome Measures

30-Day Review

Patient engagement (reply rates, interactions)
Notification volume by type and priority
% of notifications acted upon
CC workflow fit feedback
Early SDOH patterns
Licenses used

Quarterly Business Review (QBR)

All 30-day review items
Enrollment and completion volumes
Stop rates by friction point
Patient satisfaction / NPS
% members with PCP assigned: baseline vs. during protocol
Readmissions and hospitalizations (as available)
Medication adherence (member self-report)

Primary Outcome Measures

Measure	Definition
BP at Goal Rate (Primary)	% members with most recent BP <130/80 (AHA/ACC 2025 target) or <140/90 (minimum threshold). Measured at most recent reading and average of last 3 readings.
CC Touchpoint Completion	% members with 2 completed touchpoints/month
Medication Adherence Rate	% weekly adherence checks answered YES
HEDIS HTN Control Rate	Controlling High Blood Pressure (CBP) measure compliance

Value-Based Care Alignment

Measure / Program	Specification
HEDIS CBP	BP <140/90 in members age 18–85 with diagnosed HTN
CMS MA Star Ratings	Controlling Blood Pressure (weighted measure)
VBC Reporting	Configurable extract for care management documentation
Baseline Data Required	6–12 months pre-Flo BP control rate required from CCHA data analytics contact before go-live (if applicable)

10. Document Control

This protocol is aligned with the 2025 AHA/ACC Multisociety Hypertension Guideline (published August 2025), which supersedes the 2017 ACC/AHA Guideline.

Reviewed annually or upon release of updated guidelines.

All BP parameters are evidence-based and non-negotiable, but configured to alert at levels intended to avoid unnecessary alert fatigue.

Configuration changes must be reviewed by GH Medical Director.

References

Jones DW et al. 2025 AHA/ACC Multisociety Hypertension Guideline. JACC. Aug 2025.
ADA Standards of Care 2024.
KDIGO 2021 CKD Blood Pressure Guideline.
AHA PREVENT Risk Calculator (2023).

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