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

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 - 2000 Source: http://ucatlas.ucsc.edu/health.php

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

Source: Wikimedia Commons

United States Virginia Virginians spend $49,427,000,000 per year 37% on healthcare 27% 15% 6% 6% 6% 2% 2% Hospital Care Physician and Prescription Nursing Dental Home Health Medical Other Other Drugs and Home Care Services Care Durables Professional Health, Other Services Residential, Medical and Personal Nondurables Care 7

Leading Causes of Hospitalization in Virginia - 2013 120,000 100,000 80,000 60,000 40,000 20,000 0 8

1,159,396 3,838,092 tobacco overweight users or obese VIRGINIANS 11

County Health Rankings from Robert Wood Johnson 12

VIRGINIA’S PLAN FOR WELL BEING: AN APPROACH 13

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WW I & II TB Antibiotics Source: http://www.masslocalinstitute.org/onlinecourses/publichealthhistory/ PublicHealthHistory_print.html History of Public Health , Wayne LaMorte, Boston University School of Public Health

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 19

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 20

Framework for Well-Being in Virginia Well-Being Healthy Heart Emotional Wellness Aging Well Preventive Quality Actions Healthcare Strong Start for Children Healthy, Connected Community

American Health Rankings Analyzed 500+ CMS Commonwealth Recommended Fund of the most Metrics commonly Public utilized Health Reporting metrics to Systems Buying Value County Health Tool Rankings define population health DMAS Quality VDH Metrics 23

Sample Analysis: American Health Rankings – Virginia Ranking By Metric

Criteria 1. Can it be compared easily to other national National benchmarks? 2. Does it impact a significant number of Virginians? Numbers 3. ROI Analyses Possible? Cost 4. Is it timely? Timely 5. Can a majority of the community help impact the Health outcome? Team 6. Does it fit in the CMS SIM Parameters? CMS 7. Can we improve performance in this area and have a positive impact? Impact 26

Aligning Metrics With SIM and DMAS Quality Metrics HEDIS Measures of Priority In Virginia Medcaid Medallion 3.0 Primary Categories Contract CMS SIM Suggested Population Level Measures Cervical Cancer Screening, Breast Cancer Screening , Adult Access to Access to Healthcare, Percentage of respondents • Access To Healthcare Preventive/ Ambulatory Health Services aged 50-75 who reported colorectal test Percentage of Adults (aged 18 yeasr or older) • Diabetes Comprehensive Diabetes Care (all indicators) with Diabetes Having Two or More A1c Tests in the Last Year Controlling High Blood Pressure Taking medicine for high blood • Heart Health perssure among adults > 18 • Hospitalizations Adults aged 65+ who have had a flu shot within Childhood Immunization Status (Combo 3) the past year; Youth: Estimated vaccinaton • Immunizations coverage with individual vaccines and slected vaccination series Timeliness of Prenatal Care, Postpartum Visit, Well Child Visits in First 15 Months, 3rd, 4th, 5th & 6th Years, Adolescent Well Care Visits • Infant & Child Health Percent of Live Births < 2500g • Mortality Metrics Adult Weight Classification by BMI, Youth: • Obesity Students who were > 95th Percentile for BMI, 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 • Quality Health & Mental Days Illness Health Related Quality of Life-Physically and Mentally Unhealthy Days In the Past Months Stage 3 (AIDS) at the the time of diagnosis of HIV infection among persons aged 13 years and • Sexually Transmitted Infections older, HIV Viral supression at most recent viral load test among persons 13 years and older Four Level Smoking Status, Percent of Smokers Who Have Made a Quit Attempt In The Past Medical Assistance With Smoking and Tobacco Use Cessation • Tobacco Use Year, Legislation - Smoke free Indoor Air, Youth: Smoked cigarettes on at least one day in the last 30 days

Creating a Set of Integrated Metrics Well-Being Healthy Heart Emotional Wellness Aging Well Preventive Quality Actions Healthcare Strong Start Healthy, Connected Community

Primary Public Health Metrics: Healthy Connected Community

Primary Public Health Metrics: Preventive Actions Percentage of Children Immunized by Series Type Percentage of Population Percentage of Getting Population Colorectal 65+ Receiving Cancer a Flu Shot Screening Preventive Actions Percentage of Population Percentage of Getting Population Cervical Living Smoke Cancer Free Screening Percentage of Population Getting Breast Cancer Screening 30

Primary Public Health Metrics: Quality Healthcare Percentage of Population With Access to Healthcare Quality Percentage of Percentage of Population With Population With Appropriate Healthcare A Medical Home Diabetes Testing & Management Smoking Status & Cessation Advice or Treatment 31

Primary Public Health Metrics: Well-Being Percentage of Population with Controlled Blood Pressure Percentage of Population Free of Percentage of Cardiovascular Population within Disease Recommended Follow Up Range for BMI Care for Children Newly Prescribed ADHD Follow Up Medication Care After Hospitalizatio Percentage of Percentage n For Population With of Population Depression Advanced Reporting Directives Good Mental No Hospital Re- Percentage of Health Population Admission Within Reporting 30 Days of Good Physical Discharge For Sustained Health Patients 65+ Treatment For Depression 32

Primary Public Health Metrics: Strong Start Percentage Rate of Percentage of Newborns Infants of Well Child Free of Birth Thriving In Visits Defects Their First Completed Year In Life Public School Percentage Children That High School of Newborns Kindergarten Don’t Need A With a Graduation Readiness Free Lunch Healthy Birth-weight 33

Make the Greatest Impact in Triple Aim by Starting Upstream with Children Health Opportunity Prevention & Health Medical Care Promotion Behavioral Health Socioeconomic Factors & Function Factors Disease Burden & Well Injury Genetic Being Physiological Endowment Factors Physical Mortality Environment Spirituality Resilience Upstream Individual Intermediate Health Quality of Factors Factors Outcomes Outcomes Life Adapted from: A Guide To Measure Triple Aim, Institute for Healthcare Improvement 2012

Levels of Prevention Secondary Primary Tertiary Public Health: Primary Care 38

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

For Virginia to match current lowest state in the nation: Decrease prevalence by 8 percentage points. Current Goal Reduction Number of Virginians with 2,103,405 1,539078 564,328 Hypertension Total Cost per Year $3,551,000,000 $3,019,000,000 $532,000,000 Health Care Related Costs per $3,375,000,000 $2,885,000,000 $490,000,000 Year Absenteeism Related Costs per $176,000,000 $134,000,000 $42,000,000 Year Total Workdays missed per 713,000 521,000 192,000 Year Data Source: CDC Chronic Disease Burden Calculator, estimate based on 2013 U.S. Census estimate. 40

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 41