SIMCITY SIMCOUNTRY BUILDING THE MINNESOTA ACCOUNTABLE HEALTH MODEL TO TRANSFORM RURAL HEALTH CARE

Transcription

1 SIMCITY SIMCOUNTRY BUILDING THE MINNESOTA ACCOUNTABLE HEALTH MODEL TO TRANSFORM RURAL HEALTH CARE Edward P. Ehlinger, MD, MSPH Commissioner Minnesota Department of Health June 25, 2012 x

2 George Orwell, [Eric A Blair] Born June 25, 1903 Wrote 1984 He who controls the past controls the future.

3 What kind of health system have we built in the past?

4 Current U.S. expenditure for healthcare is $8,666/person

5 Years of life lost males and females

6 UC Atlas of Global Inequality

7 WHO: quality measures of national health systems Health level life expectancy Responsiveness speed of health services, privacy protections, choice of doctors, and quality of amenities Financial fairness progressive or regressive financing Health distribution how equally a nation's health care resources are allocated among the population Responsiveness distribution how equally a nation's health care responsiveness is spread through society.

8 Canada Japan Falling Behind 37 th Health Care System England Germany

9 Sweden Sweden Sweden Japan Singapore Hong Kong 2 Netherlands Netherlands Japan Finland Hong Kong Sweden 3 Norway Norway Finland Sweden Japan Singapore 4 Czech Rep. Japan Norway Hong Kong Sweden Japan 5 Australia Finland Denmark Singapore Finland Finland 6 Finland Denmark Netherlands Switzerland Norway Spain 7 Switzerland Switzerland Switzerland Canada Spain Norway 8 Denmark New Zealand France Norway Czech Rep. France 9 Eng. & Wales Australia Canada Germany Germany Austria 10 New Zealand France Australia Netherlands Italy Czech Republic 11 United States Engl. & Wales Ireland France France Germany 12 Scotland Canada Hong Kong Denmark Austria Denmark 13 N. Ireland Israel Singapore N. Ireland Belgium Switzerland 14 Canada Hong Kong Engl. & Wales Spain Switzerland Italy 15 France Ireland Scotland Scotland Netherlands N. Ireland 16 Infant Mortality Rankings (Ascending) ; Selected Countries (Health United States 2005) 17 Slovakia Scotland Belgium Austria N. Ireland Belgium Ireland United States Spain Engl. & Wales Australia Netherlands 18 Japan Czech Rep. Germany Belgium Canada Australia 19 Israel Belgium United States Australia Denmark Portugal 20 Belgium Singapore New Zealand Ireland Israel Ireland 21 Singapore Germany N. Ireland Italy Portugal Engl. & Wales 22 Germany N. Ireland Austria New Zealand Engl. & Wales Scotland 23 Cuba Slovakia Italy United States Scotland Canada 24 Austria Austria Israel Greece Greece Israel 25 Greece Bulgaria Czech Rep. Israel Ireland Greece 26 Hong Kong Puerto Rico Greece Cuba New Zealand New Zealand 27 Puerto Rico Spain Puerto Rico Czech Republic United States Cuba 28 Spain Greece Cuba Portugal Cuba United States 29 Italy Italy Bulgaria Slovakia Poland Hungary 30 Bulgaria Hungary Costa Rica Puerto Rico Slovakia Poland 31 Hungary Poland Slovakia Bulgaria Hungary Slovakia 32 Poland Cuba Russian Fed. Hungary Puerto Rico Chile 33 Costa Rica Romania Hungary Costa Rica Costa Rica Puerto Rico 34 Romania Portugal Portugal Chile Chile Costa Rica

10 2013

11 United States Health Comparisons The highest rate of death by violence The highest rate of death by car accident The highest chance that a child will die before age 5 The highest teen pregnancy rate The highest rate of women dying due to complications of pregnancy and childbirth The second-highest rate of death by coronary heart disease The second-highest rate of death by lung disease

12 0 Minnesota s State Health Ranking KidsCount Minnesota s ranking is based on determinants and outcomes.. State rank for binge drinking (2012): 42 th State rank per capita public health funding (FY ) : 48 th State rank for diets that include fruits and vegetables (2010): 34 th Adult Obesity Rate: Increased 38% since Over 1 million Minnesota adults are obese (2010) Uninsurance disparity between whites (7.6%) and non-whites (18.8%) is growing (2011). Source: United Health Foundation KidsCount 2012

13 Infant Mortality Rates by Year of Birth Minnesota and U. S. 3-year Averages Rate per 1,000 births U. S. Minnesota

14 Black-White Disparity Deaths per 1, All Other OH MI IN IL WI MN* Total Regions Region V Rate Ratio Population Attributable Fraction 16% 18% 22% 13% 20% 14% 11% 18% *US-born Black mothers

15 Why Are Americans So Unhealthy? Health systems. large uninsured population limited access to primary care inaccessible or unaffordable health care lapses in the quality and safety of care outside of hospitals. Health behaviors. Americans are currently less likely to smoke and may drink alcohol less heavily than people in peer countries, Americans consume the most calories per person, higher rates of drug abuse less likely to use seat belts involved in more traffic accidents that involve alcohol more likely to use firearms in acts of violence U.S. Health in International Perspective: Shorter Lives, Poorer Health Institute of Medicine January 2013

16 Why Are Americans So Unhealthy? Social and economic conditions. the income of Americans is higher on average than in other countries United States has higher levels of poverty (especially child poverty) and income inequality and lower rates of social mobility Other countries are outpacing the United States in the education of young people Americans benefit less from safety net programs that can buffer the negative health effects of poverty and other social disadvantages Physical environments. U.S. communities and the built environment are more likely than those in peer countries to be designed around automobiles U.S. Health in International Perspective: Shorter Lives, Poorer Health Institute of Medicine January 2013

17 SIMCITY SIMCOUNTRY: Building the Minnesota Accountable Health Model to Transform Rural Health Care

18 George Orwell, [Eric A Blair] Born June 25, 1903 He who controls the past controls the future. He who controls the present controls the past.

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20 Rural Health Conference 2013 Build on: The Minnesota Accountable Health Model Lessons Learned with EHR Upgrades Planning and Collaboration with Community Health Needs Assessments State Implications of the Affordable Care Act Southern Prairie Community Care: The Development of a Rural Care Model Telehealth: A Key Solution Engaging Patients as Partners to Design a Patient-Centered Primary Care Model Physician Assistants: Meeting Rural Health Care Workforce Needs Is Health Care Ready for the Age Wave?

21 SIMCITY Planning

22 SIMCOUNTRY Planning

23 Build on the platform of the Statewide and Community Health Needs Assessment People and Place Opportunity Healthy Living

24 Build on What Creates Health

25 Get out of our silos to create health I m looking for help in creating a healthy Minnesota Non health sectors Public Health Medical Care Why ask me? We don t do health.. Please, can we be part of the team? Look no further. it is our job.

26 Rebalance our investments in health Determinants of Health Health Care Environment Social Conditions Genetics Behaviors % 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Distribution of Resources Medical Care Public Health

27 Average social-service expenditures versus average health-services expenditures as percentages of gross domestic product (GDP) from 1995 to 2005 by country. SOURCE: Bradley et al., 2011:3

28 Build a healthy healthcare system that balances treatment and prevention

29 Build on a Community-oriented primary care (COPC) model Community-Oriented Primary Care (COPC) is an approach to health care delivery that undertakes responsibility for the health of a defined population. COPC is practiced by combining epidemiologic study and social interventions with clinical care of individual patients, so that the primary care practice itself becomes a community medicine program. Both the individual patient and the community or population are the foci of diagnosis, treatment and ongoing surveillance.

30 Invest in primary care $8,000 $7,000 $6,000 $5,000 $4,000 $3,000 $2,000 $1,000 $0 $7,590 $6,913 $420 $260 Health Care Spending Per Person Primary Care Spending Per Person Access to primary care services produces better health outcomes, higher patient satisfaction, and lower health care spending. Chang, et, al JAMA, 305(20): MDH, Health Economics Program. (June, 2011). Minnesota Health Care Spending and Projections,

31 Primary Care is a Public Good US adults who have a primary care physician have 33 percent lower health care costs and 19 percent lower odds of dying than those who see only a specialist. As a nation, we would save $67 billion each year if everybody used a primary care provider as their usual source of care. You/Primary-Care-Our-First-Line-of-Defense.aspx?page=all

32 Build on the Health Care Home As ACO Foundation Shared Risk/ Benefit Accountable Care Organizations defined by population management and financial risk/benefit sharing with payers Performance Reporting Coordinati on of Care Quality improvem ent EMR Communi cation and Access Health Care Home Components - An organization that cannot do these things is unlikely to succeed as an ACO Integration with Community Services Care Plans Patient Registries, Tracking

33 Improve the Quality, Safety, and Efficiency of the Health Care System We spend $750 billion on unnecessary health care. Sources of health-care overspending IOM report 9/5/12

34 Build on IT infrastructure and enhance use

35 Build on the work of our Rural health hero award winner: Al Vogt, CEO of Cook Hospital His work on HIT/telehealth small hospitals getting to scale and doing so through collaboration. A collaborator extraordinaire e.g., helped develop an after-hours pharmacy program through the MN Wilderness Health Care Coalition. Dedication to keeping long-term care services available, despite financial challenges. Active in a variety of state and national policy orgs, in addition to his local work.

36 Build on the work of our Rural health team award winner Open Door Health Center s mobile health team Community Health Centers are great example of community-oriented primary care, and mobile teams perhaps even more so. ODHC s mobile teams bring two 40-foot motor coaches one equipped to meet medical and behavioral health needs and the other for dental to regular stops in three counties with more planned in four additional counties. In one year on the road, have already served patients from 26 counties. The Sibley public health director calls them a critical resource for rural counties in southern MN.

37 Build around the specific needs of communities Health Factors Health Outcomes

38 Build to embrace our increasing diversity Percent of Color 20%+ Hennepin, Ramsey, Mahnomen, Beltrami, Watonwan, Nobles 15-19% Scott, Dakota, Mower, Olmsted 5-14% 54 additional counties Source: mncompass.org

39 Recognize health is an economic development tool and vice versa

40 Build on what individuals define as health Personal Indicators for Health and Quality of Life Low crime rate Good access to healthcare Good place to raise children Affordable healthcare High quality healthcare Personal Health And Wellness Low level of child abuse Not afraid to walk late at night High environmental quality Good schools Strong family life

41 Build on what communities define as health Community Indicators for Health and Quality of Life

42 Healthy Communities Advocate for health in all policies

43 Build on and aligning existing community resources/expertise Statewide Health Improvement Program (SHIP) Community Transformation Grants Health Care Delivery Systems (HCDS) model Community Benefit Activities Collaboration Plans AHEC Other community activities

44 Build on our values A healthy population is ultimate goal Community ownership and leadership Integration of clinical care, public health, social services, behavioral health, long-term care, oral health, etc. Integration not consolidation of services Prevention Fungibility of funding to effectively create health Health Equity Health in All Policies

45 Build our capacity to act Health Capacity to Act Living Conditions Presented by: Jeanne F. Ayers, Minnesota Department of Health - Milstein B. Hygeia's constellation: navigating health futures in a dynamic and democratic world. Atlanta, GA: Syndemics Prevention Network, Centers for Disease Control and Prevention; April 15, Available at:

46 Build the Minnesota Accountable Health Model With a focus on creating health and not just treating disease, the Minnesota Accountable Health Model has the potential to transform and improve health and health care in communities throughout the state.

47 Massachusetts Governor John Winthrop Introduced the use of the Fork to American dining on June 25, For we must consider that we shall be as a City upon a Hill, the eyes of all people are upon us.

48 Public health is what we, as a society, do collectively to assure the conditions in which people can be healthy. -Institute of Medicine (1988), Future of Public Health Edward P. Ehlinger, MD, MSPH Commissioner, MDH P.O. Box St. Paul, MN Ed.ehlinger@state.mn.us