HEALTH in VIRGINIA: VIRGINIA as the HEALTHIEST STATE IN THE NATION - - PowerPoint PPT Presentation

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HEALTH in VIRGINIA: VIRGINIA as the HEALTHIEST STATE IN THE NATION - - PowerPoint PPT Presentation

Apr 14, 2023 294 likes •733 views

HEALTH in VIRGINIA: VIRGINIA as the HEALTHIEST STATE IN THE NATION Marissa J. Levine, MD MPH State Health Commissioner 1 Life Expectancy 1900, 2013 1900 2013 50.6 years 78.8 years old old 0 20 40 60 80 100 Age (Years) 3 Year -

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HEALTH in VIRGINIA: VIRGINIA as the HEALTHIEST STATE IN THE NATION

Marissa J. Levine, MD MPH State Health Commissioner

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20 40 60 80 100

Life Expectancy 1900, 2013

Age (Years)

1900 50.6 years

  • ld

2013 78.8 years

  • ld
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Source: http://ucatlas.ucsc.edu/health.php

Year - 2000

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Source: http://www.forbes.com/sites/danmunro/2012/12/30/2012-the-year-in-healthcare-charts/

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Source: Wikimedia Commons

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Virginians spend $49,427,000,000 per year

  • n healthcare

Hospital Care Physician and Other Professional Services Prescription Drugs and Other Medical Nondurables Nursing Home Care Dental Services Home Health Care Medical Durables Other Health, Residential, and Personal Care

37% 27% 15% 6% 6% 2% 2% 6%

United States Virginia

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8 20,000 40,000 60,000 80,000 100,000 120,000

Leading Causes of Hospitalization in Virginia - 2013

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3,838,092

  • verweight
  • r obese

1,159,396

tobacco users

VIRGINIANS

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County Health Rankings from Robert Wood Johnson

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VIRGINIA’S PLAN FOR WELL BEING:

AN APPROACH

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Source: http://www.masslocalinstitute.org/onlinecourses/publichealthhistory/ PublicHealthHistory_print.htmlHistory of Public Health, Wayne LaMorte, Boston University School of Public Health

WW I & II TB Antibiotics

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Well Being Components: Data Driven

Statewide focus on agreed upon well-being metrics for Virginia – metric alignment Specific focus on metrics that quantify Virginian’s investment in children’s well being = Strong Start Other metrics focused on:

  • Health/Disease Burden (Mortality, Morbidity metrics)
  • Cost Burden
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Well Being Components: Process/System Design

Standardized Local/Regional Community Health Assessment Design a process of coordinated action resulting from assessments/metrics and informed by evidence Continual evaluation and reevaluation to ensure improvement in health and well being

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Framework for Well-Being in Virginia

Strong Start for Children

Healthy Heart Emotional Wellness Aging Well Preventive Actions Quality Healthcare

Healthy, Connected Community

Well-Being

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Public Health Reporting Systems

American Health Rankings Commonwealth Fund County Health Rankings VDH Metrics DMAS Quality Buying Value Tool CMS Recommended Metrics

Analyzed 500+

  • f the most

commonly utilized metrics to define population health

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Sample Analysis: American Health Rankings – Virginia Ranking By Metric

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Criteria

  • 1. Can it be compared easily to other national

benchmarks?

  • 2. Does it impact a significant number of Virginians?
  • 3. ROI Analyses Possible?
  • 4. Is it timely?
  • 5. Can a majority of the community help impact the
  • utcome?
  • 6. Does it fit in the CMS SIM Parameters?
  • 7. Can we improve performance in this area and have a

positive impact?

National Numbers Cost Timely Health Team CMS Impact

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Aligning Metrics With SIM and DMAS Quality Metrics

Primary Categories HEDIS Measures of Priority In Virginia Medcaid Medallion 3.0 Contract CMS SIM Suggested Population Level Measures

  • Access To Healthcare

Cervical Cancer Screening, Breast Cancer Screening , Adult Access to Preventive/ Ambulatory Health Services Access to Healthcare, Percentage of respondents aged 50-75 who reported colorectal test

  • Diabetes

Comprehensive Diabetes Care (all indicators) Percentage of Adults (aged 18 yeasr or older) with Diabetes Having Two or More A1c Tests in the Last Year

  • Heart Health

Controlling High Blood Pressure Taking medicine for high blood perssure among adults > 18

  • Hospitalizations
  • Immunizations

Childhood Immunization Status (Combo 3) Adults aged 65+ who have had a flu shot within the past year; Youth: Estimated vaccinaton coverage with individual vaccines and slected vaccination series

  • Infant & Child Health

Timeliness of Prenatal Care, Postpartum Visit, Well Child Visits in First 15 Months, 3rd, 4th, 5th & 6th Years, Adolescent Well Care Visits Percent of Live Births < 2500g

  • Mortality Metrics
  • Obesity

Adult Weight Classification by BMI, Youth: Students who were > 95th Percentile for BMI,

  • Quality Health & Mental Days

Use of Appropriate Medications for People with Asthma, Follow Up care for Children Prescribed ADHD Medication, Antidepressant Medication Management, Follow- Up After Hospitalization for Mental Illness Health Related Quality of Life-Physically and Mentally Unhealthy Days In the Past Months

  • Sexually Transmitted Infections

Stage 3 (AIDS) at the the time of diagnosis of HIV infection among persons aged 13 years and

  • lder, HIV Viral supression at most recent viral

load test among persons 13 years and older

  • Tobacco Use

Medical Assistance With Smoking and Tobacco Use Cessation Four Level Smoking Status, Percent of Smokers Who Have Made a Quit Attempt In The Past Year, Legislation - Smoke free Indoor Air, Youth: Smoked cigarettes on at least one day in the last 30 days

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Creating a Set of Integrated Metrics

Strong Start

Well-Being

Healthy Heart Emotional Wellness Aging Well Preventive Actions Quality Healthcare

Healthy, Connected Community

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Primary Public Health Metrics: Healthy Connected Community

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Primary Public Health Metrics: Preventive Actions

Preventive Actions

Percentage

  • f Children

Immunized by Series Type Percentage of Population 65+ Receiving a Flu Shot Percentage of Population Living Smoke Free Percentage of Population Getting Breast Cancer Screening Percentage of Population Getting Cervical Cancer Screening Percentage of Population Getting Colorectal Cancer Screening

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Primary Public Health Metrics: Quality Healthcare

Quality Healthcare

Percentage of Population With Access to Healthcare Percentage of Population With Appropriate Diabetes Testing & Management Smoking Status & Cessation Advice or Treatment Percentage of Population With A Medical Home

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Primary Public Health Metrics: Well-Being

Percentage

  • f Population

Reporting Good Mental Health

Percentage of Population Reporting Good Physical Health

Percentage of Population Free of Cardiovascular Disease

Percentage of Population with Controlled Blood Pressure

Percentage of Population within Recommended Range for BMI

Follow Up Care for Children Newly Prescribed ADHD Medication Sustained Treatment For Depression Follow Up Care After Hospitalizatio n For Depression

No Hospital Re- Admission Within 30 Days of Discharge For Patients 65+ Percentage of Population With Advanced Directives

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Primary Public Health Metrics: Strong Start

Rate of Infants Thriving In Their First Year In Life Percentage

  • f Well Child

Visits Completed Percentage

  • f Newborns

With a Healthy Birth-weight Kindergarten Readiness High School Graduation

Public School Children That Don’t Need A Free Lunch

Percentage

  • f Newborns

Free of Birth Defects

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Adapted from: A Guide To Measure Triple Aim, Institute for Healthcare Improvement 2012 Health Opportunity

Prevention & Health Promotion Medical Care Health & Function Well Being Mortality Disease Burden & Injury Behavioral Factors

Physiological Factors

Socioeconomic Factors Physical Environment Genetic Endowment Spirituality Resilience

Upstream Factors Individual Factors Intermediate Outcomes Health Outcomes Quality of Life

Make the Greatest Impact in Triple Aim by Starting Upstream with Children

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Primary Secondary Tertiary

Levels of Prevention Public Health: Primary Care

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Estimated Prevalence of Hypertension United States and Virginia (1999 – 2006) Hypertension Category Prevalence in U.S. Number of Virginians

Diagnosed Hypertension 32.8% 2,103,405 Undiagnosed Hypertension 17.1% 1,096,592 Pre-Hypertension 20.9% 1,340,280 Normal Blood Pressure 29.2% 1,872,544

Data Sources: Crews et. Al. using NHANES 1999-2006, DMAS.

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Current Goal Reduction Number of Virginians with Hypertension 2,103,405 1,539078 564,328 Total Cost per Year $3,551,000,000 $3,019,000,000 $532,000,000 Health Care Related Costs per Year $3,375,000,000 $2,885,000,000 $490,000,000 Absenteeism Related Costs per Year $176,000,000 $134,000,000 $42,000,000 Total Workdays missed per Year 713,000 521,000 192,000

For Virginia to match current lowest state in the nation: Decrease prevalence by 8 percentage points.

Data Source: CDC Chronic Disease Burden Calculator, estimate based on 2013 U.S. Census estimate.

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Examples

Patients With Undiagnosed Hypertension Hiding in Plain Sight

  • JAMA November 19, 2014 Volume 312, No 19

Million Hearts initiative

  • http://millionhearts.hhs.gov/index.html
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Summary: Designing a System For Well Being in Virginia

1 –Establish a Vision: Virginia as the healthiest state in the nation 2- Integrate metrics that cross all spectrums

  • f the health system

3 - Living Community Health Assessment

  • Real-time/Visualized data
  • Statewide to local level data

4 - Incorporate cost drivers 5 - Create a process of accountability that is transparent & actionable at the district level. 6- Continuous evaluation

Metrics

Well Being Metrics Preventive Actions Metrics Strong Start Metrics Healthy Connected Community Metrics Quality Healthcare Metrics