The Opportunity for Whole Person Health Elizabeth Cuervo Tilson, - PowerPoint PPT Presentation

NC Department of Health and Human Services The Opportunity for Whole Person Health Elizabeth Cuervo Tilson, MD, MPH State Health Director Chief Medical Officer NCDHHS 1

All North Carolinians should have the opportunity for health The opportunity for health begins in our families and communities The opportunity for health begins where we live, learn, work, pray, and play NCDHHS 2 2

Health then gives the opportunity for learning, work, well being, and contributing back to a community Health is an economic driver NCDHHS 3 3

The O Oppor pportunit ity f for or Healt alth • Access to high-quality integrated care is critical to a person’s health, but…. • Up to 80% of a person’s health is determined through social and environmental factors and the behaviors that are influenced by them • The opportunity for health (and health care cost savings and economic growth) lies in how we define, deliver, partner, and invest in health innovatively and across sectors NCDHHS 4

Holistic Approach to Health Horizontal View • Ecologic Perspective • Multi-Sector approach • Addressing underlying drivers of health Early brain development Vertical View Adverse Childhood Experiences/Trauma • Life span perspective Emerging cost/risk • 2-generational approaches • Prevention/early intervention Medically complex/high cost adult NCDHHS 5

Broader Lens of Health Hunger Interpersonal Housing Transportation Violence Stability Early Brain Employment Development NCDHHS 6

Hunger • NC -5th highest for overall food insecurity rate in the United States (1 in 5) - 2 nd highest among children under 5 years old (1 in 4). • Decreased overall health and increased hospitalizations • Iron deficient, lower bone density, obesity • Developmental delays, cognitive impairment, impaired school function, reduced academic achievement, dysregulated behavior, emotional distress, suicidal ideation. • Effects persist beyond early life into adulthood – increased adult diabetes, hyperlipidemia, cardiovascular disease, depression, anxiety. NCDHHS 7

Healthcare Costs Associated w/ Food Insecurity Annualized Estimated Expenditures 7000 6071 6000 2015 US Dollars 5000 4208 4000 3000 Difference: $1800 2000 1000 0 Food Secure Food Insecure NHIS/MEPS data adjusted for: age, age squared, gender, race/ethnicity, education, income, rural residence, and insurance. Berkowitz, Basu, and Seligman. Health Services Research: 2017. 8 NCDHHS 8

SNAP Participation Associated w/ Lower Heath Care Costs Estimated Connecting Seniors with SNAP: Savings Reduces the odds of nursing • associated w/ home admission by 23% SNAP: Reduces the odds of hospital • $1,400 per admission by 14% person per year Estimated healthcare savings of • $2,120 per senior SNAP enrollee per year $6,300 over 3-year • recertification period Berkowitz, Seligman, Rigdon, Meigs, and Basu. JAMA Internal Medicine 2017 . 9 NCDHHS 9

Housing Instability Burden in NC • More than 1.2 million North Carolinians cannot find affordable housing • 1 in 28 of NC children under age 6 is homeless • Housing instability liked to other health factors (e.g. family violence, hunger, transportation instability) Health Outcomes & Cost • Poor physical health, emotional, behavioral, learning outcomes • Children who experience homelessness more likely to have been hospitalized, costing $238m annually • Housing interventions increase health outcomes & decrease emergency department visits, hospitalizations, and costs with good ROI NCDHHS 10

Housing is health care: Housing high cost/high risk people • New Y York M Medicai aid 4 40% in i inpati atient d t days, 2 26% in E ED visits ts and a a 15% in o overal all c cost. • Massac sachuse sett tts’ Pay for S Success ss H Housing Initi tiati ative averag age o of $14,365 per tenant d t during t the first st 6 6 months. hs. • Ho Housing F First S Seattle M Median mo mont nthly co costs from $4066 p $4066 per p person t to $1 $1492 492 a and nd $958 a $958 after 6 6 and nd 1 12 2 mo mos. • Bud C d Clark Commons Housing I Initiative i in Portland O Ore regon I In f first y year, 5 55% in average c costs pe per mo mont nth ($2, $2,006 t 6 to $899) $899) a and nd s significant i imp mprovement in n he health. • Pathways ys t to a a Healthy Bernalil lillo C lo County, N New Mexic ico P o Progra rogram - Comple letion ion of the hous usin ing g pathway is estimat ated t to h have heal althcar are c cost s savings b by betwee een $555,500 a and $ $925,833. th Decile Project • The 10 10 th t in L Los A Angeles s –ROI 2 2:1 i in first y st year, 6 6:1 i in subse sequent y t years. s. • Ch Chez ez S Soi oi/At H Hom ome S e Stud tudy-Can anada a – ROI 1 10: 0:1 1 • SF Dept. o of Public lic H Healt lth & & Mercy H y Housin ing) g) - annu nnual co cost $19, $19,00 000 t to $29, $29,00 000 p per p person • Ra Randomized T Tri rial of Supp pportive H Housing i in San F Francisco - After 1 1 year, treatm atment g t group m medical al costs co >50% >50%, co cont ntrol g group co costs r rose. NCDHHS 11

Early Experiences Shape Brain Architecture NCDHHS 12

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Adverse Childhood Experiences/ Toxic Stress Alters Normal Cortisol Response NCDHHS 14

Center on the Developing Child, Harvard University NCDHHS 15

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e.g. Triple P, Parents as Teachers, Nurse Family Partnership, CC4C, Family Connects, Child First, Incredible Years, Parent Child Psychotherapy, Trauma Focused Therapy, Circle of Security Centers for Disease Control and Prevention. Adverse childhood experiences NCDHHS 18

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NC DHHS Priorities – through that lens Opioid Crisis Early Childhood Opportunities for Health Medicaid Transformation NCDHHS 20

Opioid Crisis FOCUS AREAS • Create a coordinated infrastructure • Reduce oversupply of prescription opioids • Reduce diversion of prescription drugs and flow of illicit drugs • Increase community awareness and prevention • Make naloxone widely available and link overdose survivors to care • Expand access to treatment and recovery oriented systems of care • Measure our impact and revise strategies based on results NCDHHS 21

30 ACEs and Injection Drug Use ACEs and Illicit Drug Use Percent illicit drug use 25 20 15 10 5 0 none 1 2 3 4+ Number of Adverse NCDHHS 22

Estimates of the Population Attributable Risk* of ACEs for Drug Use Problems PAR Drug Use Problem Implications Drug misuse 56% for our Addiction 64% Opioid Epidemic IV drug use 67% *The portion of a condition attributable to specific risk factors Source: Dube S, Felitti V, Dong M, Chapman D, Giles W, Anda R. Childhood abuse, neglect, and household dysfunction and the risk of illicit drug use: the adverse childhood experiences study. Pediatrics. 2003 Mar;111(3):564-72. NCDHHS 23

Early Childhood Action Plan Stable, healthy housing Access to Healthy Food Trauma Informed Schools and Job training and availability Communities Family Forward Work places Parenting Programs with Closing the coverage gap transportation and child care for parents support Income support for lower Home visiting programs for young income families families Pregnancy intendedness Intensive Family Support and Behavioral Health and Therapy (e.g. Sobriety Treatment Substance Use Prevention and and Recovery Teams) Treatment High Quality early child Intimate Partner Violence care and pre-school Prevention and Intervention Early Literacy Programs NCDHHS 24

Statewide Framework for Healthy Opportunities NCCARE360 - Statewide Standardized screening Resource and Referral Platform Work force Multi-faceted Approach for Promoting the e.g. Community Opportunity for Health Health Workers “Hot Spot” map for Social Determinants Medicaid Managed Care – Aligning enrollment and connecting Core program elements existing resources Regional Pilots https://www.ncdhhs.gov/about/department-initiatives/healthy-opportunities NCDHHS 25

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What is NCCARE360? NCCARE360 is the first statewide coordinated network that includes a robust data repository of shared resources and connects healthcare and human services providers together to collectively provide the opportunity for health to North Carolinians. NCCARE360 Partners: 27 PROPRIETARY & CONFIDENTIAL NCDHHS 27

Three Partners Three Deliverables • Intake and Referral • Outcomes Platform • Text and Chat • System Integration • Local agency engagement • Dedicated navigators • Data Repository • Outcomes Reporting • Data team verifying resources • Accepts and shares resources • Web Search and Site 28 PROPRIETARY & CONFIDENTIAL PROPRIETARY & CONFIDENTIAL NCDHHS 28

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