Integrating Public Health & Primary Care. Bruce Gray, CEO

Transcription

1 Integrating Public Health & Primary Care Bruce Gray, CEO

2 Northwest Regional Primary Care Association Began in 1983: support and advocate for Community & Migrant Health Centers Long-term partnership: Region X SPCAs and Region VIII association CHAMPS ~20 staff 79 CHC members

3 Health is A state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity. World Health Organization, 1948 Health Care 10% Environmental Exposure 5% Social Circumstances 15% Behavioral Patterns 40% Genetics 30% Schroeder, Steven A., We Can Do Better -- Improving the Health of the American People, N Engl J Med :

4 The Health Impact Pyramid smallest Impact largest Counseling & education Clinical interventions Long-lasting protective interventions Changing the context to make default decisions healthy Socioeconomic factors Adapted from: Frieden, Thomas R. Am J Public Health April; 100(4):

5 Institute of Medicine Report, March, 2012 Jointly commissioned by CDC and HRSA

6 Principles for Successful Integration Shared goal of population health improvement Community engagement in defining and addressing population health needs Aligned leadership that Bridges disciplines, programs, and jurisdictions Clarifies roles and ensures accountability Develops and supports appropriate incentives Has the capacity to manage change Sustainability (shared infrastructure and building for enduring value and impact) Sharing and collaborative use of data and analysis

7 Degrees of Integration Isolation Mutual awareness Cooperation Collaboration Partnership Merger

8 Highlights From the Recommendations Link staff, funds, and data at all levels. Create common research and learning networks. Develop the workforce needed for integration. Improve integration through existing HHS programs and newly legislated initiatives. Develop a national strategy and investment plan for creation of PC and PH infrastructure.

9 ACA Provides Opportunity Prevention and Public Health Fund Health Center Trust Fund

10 Select ACA Opportunities Community Health Center ($11 billion) Patient-Centered Medical Homes (PCMH) Accountable Care Organizations (ACO) Primary Care Extension Program National Health Service Corps Teaching Health Centers Community Transformation Grants Community Health Needs Assessments Medicaid Preventive Services National Prevention, Health Promotion and Public Health Council and the National Prevention Strategy CMS Innovation Center

11 NWRPCA Response: Let s Move Forward Together What are the implications for how community health centers and local health departments function today? How they will function in the future? Who are the other players in the community? How can we best operationalize the connection between public health and primary care? Excerpted from public health-primary care stakeholder discussion, NWRPCA Primary Care Conference, May, 2012

12 Examples: Northwest Region Global to Local Project HealthPoint/Seattle-King County Public Health/Swedish (King County, WA) Transforming Health Care in Whatcom County SeaMar & Interfaith Community Health Centers (WA) Trauma-Informed Care (TIC) initiative and CDC-funded REACH Su Comunidad project NWRPCA

13 Examples: National Sixteenth Street Community Health Center Milwaukee, WI Beaufort-Jasper-Hampton Comprehensive Health Services Ridgeland, SC Hidalgo Medical Services & The Community- Campus Partnership to Improve New Mexico s Health

14 Select National Efforts Institute for Alternative Futures: Primary Care 2025; Community Health Centers Leveraging the Social Determinants of Health; and Public Health 2030 (coming spring 2014) ASTHO s Primary Care and Public Health Integration Strategic Map: Prevention Institute s Community-Centered Health Homes model

15 ACOs, CCOs, and Public Health: Oh My! Patrick F. Luedtke, MD, MPH Medical Director, Community & Behavioral Health clinics Lane County Department of Health & Human Services

16 How Did We Get Here? Source: Centers for Medicare & Medicaid Services, Office of the Actuary NOTE: United States Nominal Gross Domestic Product in 2010 = $14.7 trillion

17 We are here, we are here, we are here! USA: 51 th in infant mortality, 40 th in life expectancy (CIA World Factbook 2012 & United Nations 2010 revision)

18 Where Are We Going?

19 In this difficult time, we have two choices: transform or die! John Kitzhaber, MD Governor of Oregon

20 Transforming not Dying in Oregon Reduce projected state and federal Medicaid spending by $11 billion over 10 years. Oregon will bend the cost curve two percentage points in the next two years. $1.9 billion from the U.S. Department of Health and Human Services over five years to support coordinated care model.

21 $1.9 Billion CMS Supplement Over Five Years Millions of Dollars Shortfall Paid $620M $620M $291M $183M $183M

22 Oregon: Fiscal Epidemiology 20% of state budget is healthcare $16.2B Total Oregon Health Authority budget $10.2B Total Oregon Medicaid ($1.1 billion general fund) $30M Transformation (50% public health & 50% BH)

23 Transformation & the Triple Aim Better care for individuals Better health for populations Lower cost growth through improvements in care Donald M. Berwick: N Engl J Med 2011; 365:

24 CMS Requirements Patient Experience Integrate physical/behavioral health (medical homes) Quality Patient satisfaction Health Improve population health outcomes Cost Reduce cost growth 2% per member per year

25 Public Health Authority & Transformation Epidemiology & control of preventable diseases Parent and child health services, including family planning clinics (as described in ORS ) Collection & reporting of health statistics Health information and referral services Environmental health services (ORS )

26 Public Health and Primary Care Integration What happens when health transformation, public health, and primary care intersect?

27 Lane County Public Health: Primary Care Integration Public health officer/fqhc medical director position Public health nurses in FQHC STD program integration with FQHC Medical home implementation

28 High Impact Population Health Projects Smoking in pregnancy Vaccination rates Community Health Assessment/Improvement

29 Smoking in Pregnancy 25 Prenatal Smoking By Trimester, Oregon vs. Lane County, 2009 Prenatal Smoking (%) Lane County Oregon 0 1st Trimester 2nd Trimester 3rd Trimester Data Sources: Oregon Health Authority and Lane County Public Health

30 Lane County: Smoking in Pregnancy Age Smoking Rate Patient Number <20 27% % % 1, % % 348 >/= 40 11% 81 Data Source: Lane County Vital Statistics: 2009

31 Vaccine Hesitancy 7 Oregon Religious Exemption Rates, % Religious Exempt Children's Facility Kindergarten and 1st Grade* 7th Grade

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33 Vaccine Preventable Diseases Total reported cases Lane Co = 2,245 No. of hospitalized Cost/case Total cost cases Influenza 222 $6,900 $1,531,800 Pertussis 118 $9,586 $226,230 NOTE: Nationally, roughly 20% of reported pertussis cases are hospitalized. AHRQ: Healthcare Cost & Utilization Project (Influenza) Lancet Infect Dis Jul;3(7):413-8 and BMC Infectious Diseases 2005, 5:57 (Pertussis)

34 Community Health Assessment/Improvement Community Needs Assessment Transformation Plan Business Plan Implementation: now!

35 Public Health: Transformation Roles Fulfill requirements of Public Health and Mental Health Authorities Identify, prioritize, and direct resourcing of population health goals Collect and analyze population level surveillance data Perform Community Health Assessments Develop Community Health Improvement plan

36 There s no place like a medical home!