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 Virgin Islands
Your State Health Officials Harry Chen, MD Jose T. Montero, MD, MPH, MHCDS Vermont Commissioner New Hampshire Director, of Health 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.“ -World Health Organization definition of health
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 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 84 JPN SWZ ESP AUS SUE ITA ISR FRA CAN ISL LUX NOR NZL GBR KOR AUT NLD 80 FIN DEU PRT IRL BEL GRC DNK CHL USA SVN CZE 76 POL MEX EST SVK Life CHN HUN TUR expectancy BRA 72 in years IDN RUS 68 IND 64 $0 $2,000 $4,000 $6,000 $8,000 Healthcare spending/person OECD
Average 81.8 Comparison group Australia US, 78.2 Canada Finland 16 years France Hong Kong Iceland Israel Italy Japan Macao Norway Spain Sweden Switzerland
Ratio of social to health services spending by country Source: BMJ Quality & Safety. Health and social services expenditures: associations with health outcomes. EH Bradley, BR Elkins, J Herrin, B Elbel, March 2011
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: 1 st , 91.4% NH: 7 th , 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 61.7 60.9 Perceptions of those 38 that did not Complete 30.9 High School Perceptions of those with High School Diploma NH VT
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% of his/her time in a 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 Department of Transportation Service 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 White House Domestic Policy Council Development 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 of health determinants, and policies and interventions that link 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 Population Community Health Health Public Health
Unique to Public health Health Promotion • Public policy/laws • Environmental change • Social norms Health Protection (Govt. Public Health) • Accountability • Authorities • Public health orders • HIPPA exemptions • Convening power
Systems focus: Socio-Ecological Model , behaviors
The Clinical and Community Guides Individual level Clinical Guide: Clinical settings US Preventive Services Delivered by Task Force healthcare providers Screening, Counseling &Treatment Recommendations Community Guide: Community, population-based Task Force on Health system changes Access to/provision of services Community Preventive Informational Services (Group Education, Media) Recommendations Behavioral, Social Environmental & Policy Change
Complementary approaches Clinical Medicine Population Community Health Health Public 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 definition: 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 P 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 Y N 1. During the tax year or either of the two immediately preceding tax years, did the hospital facility conduct a community health needs assessment (CHNA)? A definition of the community served by the hospital facility. A. Demographics of the community. B. Existing health care facilities and resources within community… C. How data was obtained. D. The health needs of the community. E. Primary and chronic disease needs including low income persons and F. minorities The process for identifying and prioritizing health needs… G. The process for consulting with persons representing community interests. H. Information gaps that limit hospital’s ability to assess needs. I. 3. Did the facility take into account input from persons who represent broad interests of the community, including those with special expertise in public health?
Community Health Needs Assessments
Population Health Measures Accountable Care Organizations Patient Centered Medical Homes Community Health Assessments Community Health Improvement Plans IRS 990 Requirements for Tax Exempt Hospitals PHAB Requirements for Health Agencies Public Health Agencies/Governments
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