Public Health National Center for Innovations: fostering alignment and innovations to advance public health and improve communities Jessica Solomon Fisher and Shirley Orr KALHD Mid-year Meeting June 21, 2016
Overview • Context and PHNCI overview • Foundational public health services • Learning community details • Discussion
Drivers
Culture of Health • Robert Wood Johnson Foundation • In response to the need to catalyze change in health, well-being and equity • Spur dialogue and collective action • Calls for collaboration between public/private sectors and communities
Culture of Health Action Framework
Public Health 3.0 “It is time to boldly expand the scope and reach of public health to address all factors that promote health and well- being, including those related to economic development, education, transportation, food, environment, and housing.” -DeSalvo et al
Public Health 1.0
Public Health 2.0
Public Health 3.0 • Enhanced leadership and workforce • Accreditation • Technology, tools and data that matter • New metrics of success • Funding
PHNCI Overview • Division of the Public Health Accreditation Board (PHAB) • Launched November 2015 • Three-year initiative funded by the Robert Wood Johnson Foundation • Governed by PHAB board of directors, advised by an Advisory Committee • Charged with aligning national initiatives and fostering innovations in practice
Advisory Committee
PHNCI Advisory Committee TERRY ALLAN , Cuyahoga County Board of Health (OH) JOHN AUERBACH , Centers for Disease Control and Prevention LESLIE BEITSCH , Center for Medicine/Public Health at the Florida BETTY BEKEMEIER , Northwest Center for Public Health Practice at State University College of Medicine the University of Washington LIZA CORSO , Centers for Disease Control and Prevention CHARLIE FAUTIN , Oregon Conference of Local Health Officials PAUL HALVERSON , Fairbanks School of Public Health at the LAMAR HASBROUCK , National Association of County and City University of Indiana Health Officials HEATHER HOWARD , Princeton University Woodrow Wilson School PAUL KUEHNERT , Robert Wood Johnson Foundation of Public and International Affairs PATRICK LIBBEY , Center for Sharing Public Health Services GENE MATTHEWS , Network for Public Health Law GLEN MAYS , University of Kentucky CAROL MOEHRLE , Idaho North Central District Public Health PAMELA RUSSO , Robert Wood Johnson Foundation PAMELA SCHWARTZ , Kaiser Permanente Community Benefit Program JOSHUA SHARFSTEIN , Johns Hopkins Bloomberg School of Public JENNIFER TEBALDI , Washington State Department of Health Health CRAIG THOMAS , Centers for Disease Control and Prevention LISA WADDELL , Association of State and Territorial Health Officials
Major Activities • National coordinating hub • Link with PHAB’s body of work for small health departments • Foster innovations and support a learning community • Capture and disseminate best practices • Foundational Public Health Services (FPHS)
A Few of Our Partners • Uniform Chart of Accounts: University of Washington • Cross-jurisdictional sharing: Center for Sharing Public Health Services • Comprehensive Public Health System Assessment: University of Kentucky • Health systems transformation • And more…
Education and Technical Assistance • Instructional design based on adult learning techniques • Aligned with PHAB’s existing educational services • Developed, and refined, based on Learning Community needs
Learning Community • Supporting partnerships in Ohio, Oregon and Washington through provision of RWJF funding, technical assistance and peer learning opportunities • These 3 sites are charged with: – Engaging multi-stakeholder coalitions to implement innovations – Implementing FPHS – Alignment with healthcare to improve population health – Demonstrating improvement in a priority health status or reduction of a major risk factor (e.g. reduced disparities in teen pregnancies)
Investment in Public Health (IOM) A minimum package of “foundational” and “programmatic” public health services that: • protect and promote the health of populations • are available and visible in all communities • serve as a framework for program and • financial management
Foundational Public Health Services “… built on the well-known and long-established concepts of the Three Core Public Health Functions and the Ten Essential Public Health Services, it is intended to make more specific the services that every community should receive from its state and local health departments and to inform public health funding decisions . …a framework for program and financial management, including the development of charts of accounts. …enhance people’s understanding of the critical nature of population-based approaches (what communities get for their investment), and their understanding of the package as an instrument to ensure a standard level of health protection for all communities .” (IOM For the Public’s Health, April 2012)
FPHS Accreditation Capacities Standards Skills and capacities Implementation of skills and capabilities Minimum Stretch/QI Created to make the case for sustainable funding and Created to improve quality describe what is needed for public health to function anywhere/everywhere Pilot testing underway today Validated through implementation and evaluation Prescribe mandatory services Prescribe mandatory processes (i.e. CHA/CHIP) Developed by the field For health departments, as the backbone to the public health system Alignment document coming soon!
Definitions • Foundational public health services are the suite of skills, programs, and activities that must be available in state and local health departments system-wide, and includes the foundational capabilities and areas. • Foundational capabilities are cross-cutting skills and capacities needed to support the foundational areas, and other programs and activities, key to protecting the community’s health and achieving equitable health outcomes. • Foundational areas are those substantive areas of expertise or program-specific activities in all state and local health departments also essential to protect the community’s health. • Programs and activities specific to a health department or a community’s needs are those determined to be of additional critical significance to a specific community’s health and also are supported by the foundational capabilities and areas.
Washington Overview • Seeking sustainable funding for public health • Timeline 2011-2017 – Technical definitions, cost model, primary estimates for current spending, cost, gap – Refinement – Legislative ask: comprehensive FPHS framework (including $$) by 2017 • Organized by Steering Committee and subgroups – Service delivery – Statutes and regulations – Revenue – Funding allocation – Communication and stakeholder engagement • Desire: state government to pay for FPHS not covered by S/L fees
Oregon Overview • HB 2348 (2013): created Task Force on the Future of Public Health Services • Modernizing OR report submitted to legislature 2014 • Recommendations: – Adopt a framework re: FPHS – ID adequate and sustainable funding – Implement statewide in waves – Allow for flexible LHD structures and include options for single county, single county with shared services or multi-county jurisdictions – Structure changes around metrics established and evaluated by an Advisory Board
Oregon Overview • HB 3100 (2015): operationalized Task Force recommendations – Adopts modernization framework – Changes composition and role of Advisory Board – Requires S/L health departments to assess ability re: FPHS – Submission of findings to Legislative Fiscal Office June 2016 – Submission of local implementation plans by December 2023
Ohio Overview • 2012 Public Health Futures Report – 19 recommendations on capacity, quality, financing, CJS, etc • Collaboration between 5 organizations • Organized by Steering Committee, Advisory Committee and subcommittees (costing, shared services, small LHD accreditation, SIM/population health) • Accreditation mandate in administrative code: apply 2018, accredited 2020
Ohio Overview • Costing FPHS, using UKY/national costing model • Import existing financial data into PHUND$ • Shared services exploration • Interest in PHAB small LHD product • Connection to SIM, alignment of CHAs/CHNAs
Commonalities • Policy driven strategy • Interest in systems/structural change and sustainable funding • Strategic thinking and timelines • Learning from others • S/L collaboration • Provision of tools and resources
Foundational Capabilities
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