Public Health 3.0 & Chief Health Strategist: Actions to Improve Population Health

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1 Public Health 3.0 & Chief Health Strategist: Actions to Improve Population Health Sonja Armbruster Director, Center for Public Health Initiatives Governor s Public Health Conference April 25, 2017

2 Overview: The Plan Step 1 Provide historical context Step 2 Deeper dive with CHS and 3.0 Step 3 Focus on Partnerships Step 4 Partnership in Action Now Step Action Planning Step 6 TAKE ACTION

3 What are your favorite quotations or axioms about change?

4 Defining the Role of Governmental Public Health IOM IOM PHAB IOM The Future The Future Public Health For the Public of Public of the Accreditation Public s Health Health Public s Board Health: 3.0: Time Health officially Investing in for an launched. a Healthier Upgrade Future HHS CDC 10 Essential Public Health Services NACCHO Operational Definition of a Functional Local Health Department PHAB Officially launched opportunity to apply for SHD, LHD & THD accreditation. RESOLVE Community Chief Health Strategist

5 Reported: U.S. public health system in state of disarray Defined three core functions of public health Assessment Policy development Assurance Identified roles for levels of government: federal, state, and local

7 34 Recommendations #4. Leadership training, support, and development should be a high priority for governmental public health agencies Area of Action: Build a new generation of intersectoral partnerships (then referenced 10 times) #12. The Secretary of DHHS should appoint a national commission to consider if an accreditation system would be useful for improving and building state and local public health agency capacities. #22a. Developing innovative ways for governmental public health communities to gather, interpret, and exchange mutually meaningful data and information. #10. DHHS should develop a comprehensive investment plan for a strong national governmental public health infrastructure with a timetable, clear performance measures, and regular progress reports to the public. Funding: #s 3, 7, 8, 9, 10, 13, 29, 32

8 10 Recommendations Minimum package of public health services Clinical services shift from PH responsibility to clinical care system

9 Converging Public Health Frameworks

improving and protecting the health of the public by advancing and ultimately transforming the quality and performance of state, local, tribal, and territorial public health departments.

10 improving and protecting the health of the public by advancing and ultimately transforming the quality and performance of state, local, tribal, and territorial public health departments. 12 Domains built on 10 Essential Services The focus of the PHAB Standards and Measures is population-based disease prevention, health protection, and health promotion. 141 Locals 20 States 1 Tribe 1 Centralized Integrated System

11 the case for foundational public health services essential to communities everywhere for the health system to work anywhere. Clarity and consistency of an overall conceptual framework, including definitions and methodologies for estimating costs is critically important to support a case for sustained funding

12 Source:

14 1. combat the evolving leading causes of illness, injury and premature death. 2. promote health and well-being that works most effectively for communities of today & tomorrow. 3. identify, analyze and distribute information from new, big, and real time data sources. 4. collaboration between clinical care and public health. 5. Collaborate with a broad array of allies to build healthier and more vital communities. 6. Replace outdated organizational practices with state-of-the-art business, accountability, and financing systems.

15 1. Public health leaders should embrace the role of Chief Health Strategist for their communities Structured, crosssector partnerships 3. Accreditation 4. Actionable data 5. Funding for public health should be enhanced and substantially modified

embrace Chief Health Strategist role C HS Focus

Accessible, actionable data & clear metrics

Partner with a broad range of allies Integrate

16 Public Health 3.0 Chief Health Strategist Public health leaders embrace Chief Health Strategist role C HS Focus on chronic disease Respond to demographic change Accessible, actionable data & clear metrics Harness the power of data Health Departments partner with community stakeholders Accreditation to assure quality improvement Partner with a broad range of allies Integrate public & clinical health Sustainable, flexible funding State-of-the-art business, accountability, and financing

17 PH 3.0 and CHS in Action! Kansas Health Foundation, Healthy Communities Initiative Jeff Usher WorkWell Kansas Dr. Elizabeth Ablah State and Local Public Health Actions to Prevent Obesity, Diabetes, and Heart Disease and Stroke (DP PPHF14) Ryan Lester Blue Cross Blue Shield Pathways Initiative Virginia Barnes

18 Healthy Communities Initiative Governors Public Health Conference April 25, 2017

19 Health Communities Initiative (HCI) Overview 12 communities selected to participate, beginning with a planning year in Dec additional communities awarded planning grants in April 2013 Total investment $6 million This initiative ends 2017

Healthy Communities Initiative Round 1 HCI Round 2 Cheyenne Rawlins Decatur Norton Phillips Smith Jewell Republic Washington Marshall Nemaha Brown Doniphan Sherman Thomas Sheridan Graham Rooks

20 Healthy Communities Initiative Round 1 HCI Round 2 Cheyenne Rawlins Decatur Norton Phillips Smith Jewell Republic Washington Marshall Nemaha Brown Doniphan Sherman Thomas Sheridan Graham Rooks Osborne Mitchell Cloud Clay Riley Pottawatomie Jackson Atchison Leavenworth Jefferson Wallace Logan Gove Trego Ellis Russell Lincoln Ottawa Saline Dickinson Geary Wabaunsee Shawnee Douglas Wyandotte Johnson Greeley Hamilton Stanton Wichita Kearny Grant Scott Finney Haskell Lane Gray Ness Hodgeman Ford Rush Pawnee Edwards Kiowa Barton Stafford Pratt Ellsworth Rice Reno Kingman McPherson Harvey Sedgwick Marion Butler Morris Chase Lyon Greenwood Elk Osage Coffey Woodso n Wilso n Franklin Neosho Miam i Anderson Linn Allen Bourbon Crawford Morton Stevens Seward Meade Clark Comanche Barber Harper Sumner Cowley Montgomery Labette Cherokee Chautauqua

21 HCI Team HCI Leadership Teams Build support for policy, systems and environmental changes that promote healthy eating and active living Kansas Health Foundation Support leadership teams to implement the community change framework (an advocacy framework) Technical Assistance Providers Community Engagement Institute - Facilitation/Coaching Public Health Law Center Policy Development Innovation Network Evaluation

22 HCI Policy Priorities Healthy Eating Food Policy Councils Healthy foods in public service venues Healthy Concessions Land Banking for Community Agriculture Active Living Safe Routes to School Complete Streets Active Transportation

23 KHF Strategic Focus Areas The Kansas Health Foundation envisions a culture in which every Kansan can make healthy choices where they live, work, and play. Reduce health disparities related to social and economic factors (health equity) Social Determinants of Health Engage Kansans to improve the health of our state (civic health) Actionable Data Prevention Media and Journalism Access to Care Leadership and Capacity Building We accomplish our vision through grantmaking, policy advocacy, and strategic communication.

24 HCI: Health Equity Purpose Support leadership teams in Kansas cities, towns, counties or regions to engage in advocacy efforts that will improve the health of Kansans experiencing poor health outcomes. Create a network of community health advocates willing to learn and discover how to effectively impact the health of Kansans using a health equity lens.

25 Goals for Communities Convene cross-sectorial community leadership teams to facilitate planning and implement strategies to address community health inequities. Intentionally and authentically engage populations experiencing health inequities to develop a plan to improve the health of the population impacted and increase the capacity and influence of the targeted populations to improve their health outcomes. Engage in a broad range of advocacy strategies intended to address health equity issues.

26 HCI: Health Equity Structure Grantees will spend Year One (July 1, 2017 May 1, 2018) identifying the health inequity in their community they would like to address and work in partnership with the population directly affected by that issue in developing solutions. As a result of this planning, participating HCI leadership teams will submit an Action Plan by May 1, 2018 that will include: Increased understanding of local health inequities leading to the identification of the issue chosen; Strategies on how the leadership team will continue to authentically engage the affected communities post-planning year; and Strategies on how the leadership team will support the affected communities to engage civically and to identify policy, systems and environmental interventions to address health inequity.

27 Technical Assistance Providers Wichita State University Community Engagement Institute (CEI) will provide facilitation, coaching, leadership development and project management for the initiative Public Health Law Center (PHLC) will provide policy expertise to communities on new and emerging public health priorities Innovation Network (IN) will evaluate the initiative

Technical Assistance Will Provide: Facilitation, leadership development training, coalition development assistance, cross-community learning environment and project management Policy analysis and

28 Technical Assistance Will Provide: Facilitation, leadership development training, coalition development assistance, cross-community learning environment and project management Policy analysis and development Comprehensive evaluation to learn how to best invest in improving the health of those experiencing health inequities Community/economic development, philanthropic and public health sector input from an advisory council

29 Improving Population Health through WorkWellKS Elizabeth Ablah, PhD, MPH University of Kansas School of Medicine-Wichita

30 The Working Parts of WorkWell KS KLC Kansas Leadership Blue Cross Blue Center Shield of Blue Cross Blue Kansas Shield of Kansas Kansas Department of Health and Environment Wichita Business Coalition on Health Care Kansas Health Foundation

31 WorkWell KS Advisory Group From across the country Cross-sectional Insurance Carriers Local Worksites Chamber of Commerce Health Departments Hospitals Economic Development Universities American Heart Association

32 WorkWell KS Champions Represent different disciplines Identified through grant proposals, chambers of commerce, or contacted us Able to recruit teams of at least 7 worksites from their community to participate Partner with other regional champions

34 WorkWell KS Goal To create healthier worksites in Kansas through worksite implementation of policies, systems, and environmental best practices to sustainably promote: 1) integration of worksite wellness into the worksite's infrastructure 2) physical activity 3) access to and consumption of healthy foods and beverages 4) tobacco prevention and cessation 5) well-being

35 Intent of Initiative So the healthy behavior is easy

36 The Problem?

37 Manifestations vs. Causes of Disease We need to know the causes of disease. (Katz, 2011) Top 3 1. Tobacco 2. Poor nutrition 3. Physical inactivity (Bauer, Briss, Goodman, & Bowman, 2014; Mokdad, Marks, Stroup, Gerberding, 2004; McGinnis, Foege, 1993)

38 3 Risk Factors 3 Four 80 (tobacco use, poor diet, physical inactivity) Contribute to Four chronic diseases (heart disease, type 2 diabetes, lung disease, some cancers) Which, in turn, contribute to approximately 80% of all deaths in the United States (KDHE, 2012; KFF, 2016)

39 WorkWell KS Philosophy Change the culture of worksites. Begin with the employer, not the employee. Not good and bad. Not right and wrong. What are our goals, what does the literature suggest is effective?

40 Healthcare, Costs, and the Worksite WorkWellKS

41 Why Worksite Wellness? WorkWellKS

42 Traditional Approach to Worksite Wellness WorkWellKS

43 The WorkWellKS Framework WorkWellKS

45 Creating Worksite Wellness Plans WorkWellKS

46 What is Success WorkWellKS

47 Exercising Leadership to Improve Health at Worksites Example of Tobacco Workshop Success It takes time, but worksite cultures are changing! Increased team engagement at worksites Policies implemented across the state

48 Questions? WorkWellKS

49 Innovative Approaches to Addressing Health Disparities Ryan Lester, MPH Director, Bureau of Health Promotion (First Role: Environmental Health Specialist; Johnson County) Our Mission: To protect and improve the health and environment of all Kansans.

50 What is the Kansas Department of Health and Environment? Our Mission: To protect and improve the health and environment of all Kansans.

51 Our Mission: To protect and improve the health and environment of all Kansans.

Equality vs. Equity vs. Disparity Inequities are created when barriers prevent individuals and communities from accessing these conditions and reaching their full potential.

52 Equality vs. Equity vs. Disparity Inequities are created when barriers prevent individuals and communities from accessing these conditions and reaching their full potential. Inequities differ from health disparities, which are differences in health status between people related to social or demographic factors such as race, gender, income or geographic region. Health disparities are one way we can measure our progress toward achieving health equity. -American Public Health Association Our Mission: To protect and improve the health and environment of all Kansans.

53 Health Equity Health Connections Addresses: Prediabetes diagnosis and lifestyle change Hypertension diagnosis and lifestyle change Community Health Worker integration Our Mission: To protect and improve the health and environment of all Kansans.

54 CDAK Our Mission: To protect and improve the health and environment of all Kansans.

55 1422 Grantee Acknowledgements Our Mission: To protect and improve the health and environment of all Kansans.

56 Self-Management Interventions CDSMP=Chronic Disease Self-Management Program DSMP=Diabetes Self-Management Program CDSMP-S=Tomando Control de su Salud DSMP-S=Programa de Manejo Personal de la Diabetes

57 Location of Workshops and Program Leaders-2016 County with a grant to expand CDSME

60 Our Mission: To protect and improve the health and environment of all Kansans.

61 29 million with Diabetes 86 million with Prediabetes

62 What is Prediabetes? A medical condition, impaired glucose tolerance, in which blood glucose (sugar) is higher than normal but not yet at the level of diabetes (Fasting Blood Glucose = mg/dl / A1c = 5.7% 6.4%) Primary causes of prediabetes are obesity and inactivity No symptoms for prediabetes; 90% of individuals with prediabetes do not know they have it If healthy lifestyle changes are made, prediabetes can be reversible Annually, 10% of individuals with prediabetes will convert to diabetes

65 Diabetes Health Equity North Central Kansas Targeting rural and lowincome populations Developed a bidirectional referral system with Mitchell County Hospital Health System to refer patients to the DPP program in their area Johnson County Targeting low-income and Hispanic populations La Mega radio station is using Spanish radio to advertise Our Mission: To protect and improve the health and environment of all Kansans.

67 PREVENTDIABETESKC.COM

68 Hypertension Health Equity Crawford County Targeting rural and lowincome individuals Mathis Drug, in Girard, providing free blood pressure checks Referrals given to providers Working to refer to Check. Change. Control. Sedgwick County Priority populations are African-American, Hispanic and low income Assisted providers to create workflows that address hypertension management Our Mission: To protect and improve the health and environment of all Kansans.

69 Hypertension Health Equity

Individual or client Healthc are CH W Work Preventi on Educatio n 211 EH R CHW Community

70 Crawford County - Model of Target Population Low Economic Status Nutritio usfoods CH W Medical Goals Diabetes Prevention Control High Blood Pressure Home Physical Activity Individual or client Healthc are CH W Work Preventi on Educatio n 211 EH R CHW Community Health Worker EHR Electronic Health Record 211 United Way data base and National referral resource.

71 Health ICT Sedgwick County Blood Pressure Workflows

72 Community Health Workers American Public Health Association definition: A frontline public health worker who is a trusted member of and/or has an unusually close understanding of the community served. This trusting relationship enables the worker to serve as a liaison/link/intermediary between health/social services and the community to facilitate access to services and improve the quality and cultural competence of service delivery. Our Mission: To protect and improve the health and environment of all Kansans.

73 Community Health Workers Key component of Health Connections Provide referrals for DPP Provide guidance for Check. Change. Control. Link patients to providers and community resources Ensure that individual health needs are addressed Kansas CHW Symposium June 8, 2017 Wichita, KS Our Mission: To protect and improve the health and environment of all Kansans.

74 Community Health Workers Addressing Health Equity Allen County Targeting rural and lowincome groups CHW referrals to DPP, Care Coordinator Wyandotte County CHWs serving refugee and immigrant communities Community Health Worker Forum for MCC graduates Finney County Targeting rural, low-income, Hispanic, and refugee populations Over 50 CHWs and Promotoras de Salud provide services CHWs completed DPP Lifestyle Coach training Our Mission: To protect and improve the health and environment of all Kansans.

75 Our Mission: To protect and improve the health and environment of all Kansans.

76 Blue Health Initiatives: Investing in Kansas Communities Tuesday, April 24, 2017 An independent licensee of the Blue Cross Blue Shield Association

77 My First Job in Public Health KS-EDSS Coordinator for the Bureau of Epidemiology and Surveillance at the Kansas Department of Health and Environment Kansas Electronic Disease Surveillance System: webbased database for reporting infectious disease data. The data is used to monitor and track diseases in Kansas. Through disease surveillance, the overall health of Kansas can be described, providing an accurate and timely picture of infectious disease trends, as well as the overall burden of disease in Kansas.

78 Blue Cross and Blue Shield of Kansas In Kansas, the Blue tradition of security and dependability has thrived for nearly 75 years under the guidance of Blue Cross and Blue Shield of Kansas (BCBSKS). From its earliest days in 1942, when the company first opened its doors with just three employees and eight members, it has grown into a company that today serves approximately 950,000 Kansans Each day, the company s 1,600 employees strive to maintain the long-standing tradition of trust the company has developed with its customers.

79 Why We Care at Blue Cross Mission: Being the insurer Kansans trust with their health Core Purpose: To provide peace of mind and access to a better quality of life Kansans serving Kansans

80 Blue Health Initiatives Invest in community health in Kansas Be present and engaged in health activities and discussion across the state Provide financial backing directly or through collaboration to improve health in Kansas

81 Where to Invest for Impact?

82 Invest in communities to create sustainable, healthy places where Kansans live, work, and play in ways that improve the quality of their lives.

83 What We Aim to Achieve Increase awareness and community engagement in leading healthy lifestyles Make the healthy choice the default choice across sectors of the community through both policy and practice Increase consumption of and access to healthy foods Increase access to and use of safe environments for physical activity Support tobacco-free living Improve quality of life in participating communities starting now and continuing for generations to come

84 Cross-sector Collaboration

85 Funding Details Eight communities selected for each round of funding. Each receives a $100,000 coordination grant, along with technical assistance and support from other resources. In addition, each community will have the opportunity to receive implementation and achievement grants of up to $400,000 per community. In all, each Pathways community may receive up to $500,000 in grants during the next three years.

86 Design Team and technical assistance

87 Pathways to a Healthy Kansas Communities

88 Community Eligibility Criteria Be within the 103-county service area of Blue Cross and Blue Shield of Kansas (all Kansas counties except Johnson and Wyandotte). Be located in a semi-urban, densely-settled rural, rural or frontier county. Represent the community through an active coalition.

89 Questions?

90 Thank you! Virginia Barnes, MPH Director, Blue Health Initiatives Blue Cross and Blue Shield of Kansas Toll-free: , ext In Topeka:

91 Discussion & Action Planning What are you (your department) already doing now that demonstrates 3.0/CHS action? What are some barriers to 3.0/CHS action? What s needed to support progress? What one thing can you commit to trying to move toward PH 3.0?

Strategists for their communities, mobilizing community action to strengthen infrastructure

92 PH 3.0 Call to Action For Public Health 3.0 to succeed, local and state public health leaders must step up to serve as Chief Health Strategists for their communities, mobilizing community action to strengthen infrastructure and form strategic partnerships across sectors and jurisdictions. ult/files/public-health-3.0-white-paper.pdf

Leadership and Mentoring Survey Final Report

Leadership and Mentoring Survey Final Report July, 2014 Prepared by: Jill Peltzer, PhD, RN, APRN-CNS Assistant Professor, University of Kansas School of Nursing Project Staff, Promoting Nursing Education