Utah BeWise Program - In 2008, Utah received funding from the Centers for Disease Control and Prevention (CDC) to implement the CDC’s Well Integrated Screening and Education for Women across the Nation (WISEWOMAN). In Utah, WISEWOMAN is known as BeWise. BeWise is passionate about improving the health of Utah’s women. Many of the Utah women aged 35-64 served by Utah’s National Breast and Cervical Cancer Early Detection Program (NBCCEDP) were unable to access cardiovascular (CV) screening and health behavior support services before WISEWOMAN funding was awarded to Utah. Beginning January 2024, BeWise will offer (CV) screening, health Behavior Support Services (HBSS), behavioral support, and social services referrals to 2,380 eligible Utah women at no cost and then link clients to resources with low out-of-pocket costs and work improve existing processes designed to engage women in becoming informed and motivated to manage their chronic conditions using program and community-based support services. These are effective evidence-based strategies designed to foster participants’ self-management by providing tools and resources to enable participants to monitor their blood pressure, adopt a healthy diet, increase their physical activity, stop smoking, and utilize social services that they need. To ensure that the services are implemented as intended, BeWise has established the following project period short, intermediate, and long-term outcomes which will ultimately support clinical systems of care to improve access and delivery of CVD preventive health services with an emphasis on prevention and control of HTN, outcomes described below. Program Period of Performance-Short Term Outcomes: 1. Increased number of under and uninsured Utah women ages 35-64 who receive CVD risk assessments. 2. Increased use of EHR and HIT (Utah’s self-developed data collection system BBHW (Breast and BeWise Health and Wellness application)) to query, monitor, and track clinical and social services and support needs data for improved identification, management, and treatment of participants at risk of CVD, particularly hypertension. 3. Increased use utilization of social services relevant to the participant’s need. Utah will partner with Unite Us, a platform that connects and refers people to social services based on their need to achieve this. 4. Increased use of data and metrics from program data to guide continuous quality improvement within the BeWise program as they relate to program enrollment, retention, referrals, engagement, and completion of various HBSS. 5. Increased use of EHR, HIT, and program data to identify health care disparities and address health outcomes within the BeWise population. 6. Increased use of multidisciplinary care teams adhering to evidence-based guidelines to address participant needs. 7. Increased multidisciplinary partnerships with a network of state, regional, and local social services and support. For BeWise partnering with Unite Us will allow the program to increase referrals and utilization of social services. 8. Increased data sharing and utilization through bidirectional feedback mechanisms. BeWise will work with clinical and social service partners to create automatic bidirectional feedback loops to increase data sharing. Program Period of Performance Intermediate-Term Outcomes: 1. Improved blood pressure control and reduce disparities among BeWise participants. 2. Increased utilization of social services and support among BeWise participants, based on the need of each woman. Program Period of Performance-Long Term Outcomes: 1. Improved cardiovascular health among BeWise participants. 2. Reduced disparities in cardiovascular health among BeWise participants. 3. Improve quality of life for BeWise participants by addressing their needs for social services and support across the state. BeWise has been successful implementing and evaluating the CDC’s WISEWOMAN Program in Utah since July 2008 by consistently meeting program performance measur