Improving Health Outcomes in the Medical Home Paul Jarris MD, MBA - - PowerPoint PPT Presentation
2014 PRIMARY CARE CONFERENCE Improving Health Outcomes in the Medical Home Paul Jarris MD, MBA Executive Director Association of State and Territorial Health Officials May 13, 2014 ASTHO: From Micronesia to Alaska and Across the U.S. to the
Paul Jarris MD, MBA Executive Director Association of State and Territorial Health Officials May 13, 2014
2014 PRIMARY CARE CONFERENCE Improving Health Outcomes in the Medical Home
ASTHO: From Micronesia to Alaska and Across the U.S. to the Virgin Islands
Your State Health Officials
Harry Chen, MD Vermont Commissioner
Jose T. Montero, MD, MPH, MHCDS New Hampshire Director, Division of Public Health Services
Objectives
Highlight current evidence-based policies and practices that align with a health-
in-all-policies approach and the National Prevention Strategy and provide practitioners with specific examples of how they can lead and implement interventions in these areas.
Discuss the complexities of measuring population health and possible ways to
measure healthy behaviors and the effectiveness of policy in creating healthy communities.
Examine innovative approaches for facilitating the integration of public health
and clinical care to transform the health system from an illness-oriented system to a wellness-oriented system.
“A state of complete physical, mental and
social well-being and not merely the absence of disease or infirmity.“
Population Health — Kindig
“The health outcomes of a group of individuals, including the distribution
“The field of population health includes health outcomes, patterns of health determinants, and policies and interventions that link these two.”
http://ajph.aphapublications.org/doi/abs/10.2105/AJPH.93.3.380
Life expectancy and health spending
AUS AUT BEL BRA CAN CHL CHN CZE DNK EST FIN FRA DEU GRC HUN ISL IND IDN IRL ISR ITA JPN KOR LUX MEX NLD NZL NOR POL PRT RUS SVK SVN ESP SUE SWZ TUR GBR USA 64 68 72 76 80 84 $0 $2,000 $4,000 $6,000 $8,000Life expectancy in years Healthcare spending/person OECD
Comparison group
Average 81.8
US, 78.2
Australia Canada Finland France Hong Kong Iceland Israel Italy Japan Macao Norway Spain Sweden Switzerland
16 years
Source: BMJ Quality & Safety. Health and social services expenditures: associations with health outcomes. EH Bradley, BR Elkins, J Herrin, B Elbel, March 2011
Ratio of social to health services spending by country
Life expectancy, by county, compared to the world’s 10 best countries
Murray, C JL and Ezzati, M. “Falling behind: life expectancy in US counties from 2000 to 2007 in an international context,” Population Health Metrics, June 2011
America’s Health Rankings
New Hampshire & Vermont Health Rankings Overview
America’s Health Rankings: High School Graduation Rate
VT: 1st, 91.4% NH: 7th, 86.3%
America’s Health Rankings: Measures Related to High School Graduation Rate
America’s Health Rankings: 25 Years and Older Who Report Their Health as Very Good or Excellent
38 30.9 60.9 61.7 NH VT
Perceptions of those that did not Complete High School Perceptions of those with High School Diploma
County Health Rankings
Healthiest Counties Least Healthy Counties
http://www.countyhealthrankings.org/
Determinants of Health
Determinants of Health and their Contribution to Premature Death, Adapted from McGinnis, et al., 2002
The Real Threats to Our Health
Where Does Health Occur?
The big circle represents the 99.9% of time spent engaging in daily behaviors and environments that can be helpful or harmful to health. This circle represents the 0.1%
healthcare setting.
Health In all Policies
"Health in All Policies is an approach to public policies across sectors that systematically takes into account the health implications of decisions, seeks synergies, and avoids harmful health impacts, in order to improve population health and health equity.
National Prevention Council
Chaired by the US Surgeon
General
20 Federal Agencies,
Departments, and Offices
Council Members
Bureau of Indian Affairs Department of Labor Corporation for National and Community Service Department of Transportation Department of Agriculture Department of Veterans Affairs Department of Defense Environmental Protection Agency Department of Education Federal Trade Commission Department of Health and Human Services Office of Management and Budget Department of Homeland Security Office of National Drug Control Policy Department of Housing and Urban Development White House Domestic Policy Council Department of Justice
National Prevention Strategy
National Quality Strategy
Population Health- Kindig
“The health outcomes of a group of individuals, including the distribution of such outcomes within the group” “The field of population health includes health outcomes, patterns
these two.”
http://ajph.aphapublications.org/doi/abs/10.2105/AJPH.93.3.380
Priorities for the National Quality Strategy
From the Population/Community Health Subcommittee:
Promote healthy living and well-being through community interventions
that result in improvement of social, economic, and environmental factors.
Promote healthy living and well-being through interventions that result in
adoption of the most important healthy lifestyle behaviors across the lifespan.
Promote healthy living and well-being through receipt of effective clinical
preventive services across the lifespan in clinical and community settings.
http://www.qualityforum.org/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=68238
Complementary approaches
Clinical Medicine Community Health Public Health Population Health
Unique to Public health
Health Promotion
Health Protection (Govt. Public Health)
Systems focus: Socio-Ecological Model
, behaviors
The Clinical and Community Guides
healthcare providers
(Group Education, Media)
Community Guide: Task Force on Community Preventive Services Recommendations Clinical Guide: US Preventive Services Task Force Recommendations
Complementary approaches
Clinical Medicine Community Health Public Health Population Health
What are social determinants of health?
The social determinants of health are the conditions in which people are born, grow, live, work and age. These circumstances are shaped by the distribution of money, power, and resources at global, national, and local levels.
Health-in-All-Policies Toolkit
Creating shared goals. Engaging partners early/developing
partner relationships
Defining a common language. Activating the community. Leveraging funding/investments.
Health Impact Assessments
A health impact assessment (HIA) is a means for decision makers, such as planners and departments of transportation, to identify the health consequences of their actions and make informed decisions about land use and development.
Transportation: Policy and Legislation
Initiative: Healthy
Transportation Compact
Approach: Statewide
legislation
Partners: MassDOT,
planners,developers, public health department
Hospital Community Health Needs Assessment
CHNAs must take into account input from “persons who represent the broad interests of the community served by the hospital facility, including those with special knowledge of or expertise in public health.”
IRS Schedule H, Form 990, Part V: Facility Information, Sec. B
hospital facility conduct a community health needs assessment (CHNA)?
A.
A definition of the community served by the hospital facility.
B.
Demographics of the community.
C.
Existing health care facilities and resources within community…
D.
How data was obtained.
E.
The health needs of the community.
F.
Primary and chronic disease needs including low income persons and minorities
G.
The process for identifying and prioritizing health needs…
H.
The process for consulting with persons representing community interests.
I.
Information gaps that limit hospital’s ability to assess needs.
interests of the community, including those with special expertise in public health?
Y N
Community Health Needs Assessments
Population Health Measures
Accountable Care Organizations Patient Centered Medical Homes Community Health Assessments Community Health Improvement Plans
Public Health Agencies/Governments
NQF-Endorsed Population-Level Measures
Diabetes
0272: Diabetes Short-Term Complications Admission Rate 0274: Diabetes Long-Term Complications Admission Rate 0638: Uncontrolled Diabetes Admission Rate
Potential
Prevalence of Diabetes in the community Prevalence of Obesity in the community
What is a population
A panel of Patients A group practice panel Patients who walk through our hospital doors A group of patients with a medical condition The enrollees in an insurance plan or accountable care organization Everyone living within a hospital market/service area Everyone living within a geopolitical area (town, county, state) Population vs. Total Population Health
NQF-endorsed Population-level Measures Children
0717: Number of School Days Children Miss Due to Illness 0728 : Asthma Admission Rate (pediatric) 1334 : Children Who Received Preventive Dental Care 1346 : Children Who Are Exposed To Secondhand Smoke
Inside Home
1348 : Children Age 6-17 Years who Engage in Weekly
Physical Activity
Public Health Data Clinical Data Accountability
Measurement
Public Health and Clinical Care How Do We Meet?
Integration
Reference: Institute of Medicine. Primary Care and Public Health: Exploring Integration to Improve Population Health. Washington, DC. The National Academies Press. 2012
Degre rees of Integr grati ation n Principles for Successful Integration of Public Health and Primary Care:
a shared goal of population health improvement; community engagement aligned leadership sustainability the sharing and collaborative use of data and analysis.
Mapping Session (July 2012)
Partners.
integration of public health- primary care infrastructure
Million Hearts – National Initiative Overview
Prevent 1 Million Heart Attacks and Strokes by 2017. Focus on the "ABCS":
50
Prevalence of Hypertension Nationally
Prevalence of hypertension for those over 18 years old — 31% (68 million adults)
51
http://www.cdc.gov/mmwr/preview/mmwrhtml/su6102a4.htm Cheshire Medical Center/ Dartmouth-Hitchcock Keene, NH
Champion recognized by HHS
control rates above 70% by creating:
providers to engage with their patients.
New Hampshire Million Hearts Project
The ultimate goal is to learn from and expand this program throughout New Hampshire, and in the process, improve heart health statewide through successful integration of public health and clinical health.
HTN patient registry to identify patients with HTN and monitor NQF-18. Dashboards for providers to easily track % patients in control. Community-based blood pressure screenings at local health departments, and parish nurse programs. Wallet cards translated into Spanish, Portuguese, and Arabic and distributed to community partners.
Public Health and Primary Care Partnership
Manchester Health Department Manchester Community Health Center
Lamprey Health Care’s Nashua Center City of Nashua Division of Public Health and Community Services.
55
Vermont: Using Insurance Data
Insurance Data: Patients with Medical Claims for Hypertension
49% 29% 44%
Comprehensive Approach to Improved HTN Control
Education Self Management support and tools Algorithms Registry use and active management Transparent feedback Rewards and incentives Team based care
Summary Themes
What we have been doing doesn’t work
The Triple Aim: Population Health Integration of PC and PH Social Determinants of Health and Health in
all Policies