Multi-Sector Approaches to Improving Population Health. CDC s 6 18 Initiative and Lessons Learned for Sustainable State-Based Spread and Scale

Transcription

1 Multi-Sector Approaches to Improving Population Health CDC s 6 18 Initiative and Lessons Learned for Sustainable State-Based Spread and Scale

2 Centers for Disease Control and Prevention Multisector Approaches to Improving Population Health: CDC s 6 18 Initiative and Lessons Learned for Sustainable State-Based Spread and Scale ASTHO Winter Leadership Meeting Thursday, December 7, 2017 Laura C. Seeff MD Director, Office of Health Systems Collaboration CDC Office of the Director

3 Changing Healthcare Landscape Increased access to health insurance Health care payment and delivery reform: volume value, more patient-centered Opportunities to deliver prevention Demographic changes Over 91% of All Americans are Insured as of % 20% 14% 9% 9% Employer Medicaid Medicare Other Uninsured Other Insurance Coverage: Other Private 7% Other Public 2% SOURCE: 1-Robin A. Cohen, Ph.D., Emily P. Zammitti, M.P.H., and Michael E. Martinez, M.P.H., M.H.S.A Division of Health Interview Statistics, National Center for Health StatisticsHealth Insurance Coverage: Early Release of Estimates From the National Health Interview Survey, 2016

4 Another Major Trend: Public Health Evolution Economic forces continue to affect state and local health departments Local health departments have eliminated 51,700 jobs since 2008 Budget cuts affect almost one in four LHDs Local health departments continue to adapt the type and scope of services to their communities The Changing Public Health Landscape: Findings from the 2015 Forces of Change Survey, June

5 Partners in Population Health Health Care Public Health

6 Prevention and Population Health Framework: The 3 Buckets Traditional Clinical Prevention Innovative Clinical Prevention Community-wide Prevention Increase the use of clinical preventive services Provide services that extend care outside the clinical setting Implement interventions that reach whole populations Health Care Public Health SOURCE: Auerbach J. The 3 Buckets of Prevention. J Public Health Management Practice 201http://journals.lww.com/jphmp/Citation/publishahead/The_3_Buckets_of_Prevention_ aspx

7 1 2 High- burden Costly Preventable Scalable Purchasers & payers

8 6 18 Initiative Goals Improve health and control costs using specific evidence-based interventions Establish sustainable cross-sector partnerships between public health and health care to address shared health priorities

9 Evidence-based Interventions REDUCE TOBACCO USE PREVENT HEALTHCARE ASSOCIATED INFECTIONS PREVENT UNINTENED PREGNANCY Increase access to evidence-based tobacco cessation treatments, including individual, group, and telephone counseling and Food and Drug Administration (FDA)- approved cessation medications (in accordance with the 2008 Public Health Service Clinical Practice Guideline and the 2015 U.S. Preventive Services Task Force tobacco cessation recommendation statement). Remove barriers that impede access to covered cessation treatments, such as cost-sharing and prior authorization. Promote increased use of covered treatment benefits by tobacco users. CONTROL HIGH BLOOD PRESSSURE Implement strategies that improve adherence to blood pressure medications, including lipid-lowering medications. Strategies may include: low-cost medication fills and fixed dose medication combinations; calendar blister packs or other medication packaging; and care coordination by primary care teams. Provide patients with known or suspected high blood pressure validated home blood pressure monitors and reimburse for the clinical support services required for self-measured blood pressure monitoring (SMBP) also knowing as home blood pressure monitoring (HBPM). Require antibiotic stewardship programs in all hospitals and skilled nursing facilities, in accordance with CDC s Core Elements of Hospital Antibiotic Stewardship and The Core Elements of Antibiotic Stewardship for Nursing Homes. Reduce inappropriate antibiotic prescribing by incentivizing providers to encourage them to follow CDC s Core Elements of Outpatient Antibiotic Stewardship. CONTROL ASTHMA Use the 2007 National Asthma Education and Prevention Program (NAEPP Guidelines) as part of evidence-based clinical practice and medical management guidelines. Promote strategies that improve access and adherence to asthma medications and devices. Expand access to intensive self-management education by licensed professionals or qualified lay health workers for patients whose asthma is not wellcontrolled with the medical management approach outlined in the 2007 NAEPP Guidelines. Expand access to home visits by licensed professionals or qualified lay health workers to provide targeted, intensive self-management education and reduce home asthma triggers for patients whose asthma is not well controlled by 2007 NAEPP Guidelines medical management and asthma self-management education. Reimburse providers for the full range of contraceptive services (e.g., screening for pregnancy intention; client-centered counseling; insertion, removal, replacement, or reinsertion of long-acting reversible contraceptives [LARCs, such as intrauterine devices and implants] or other contraceptive devices, and follow-up) for women of childbearing age. Reimburse providers or provider systems for the actual cost of FDA-approved contraception, including LARC or other contraceptive devices, to provide the full range of contraceptive methods. Reimburse for immediate postpartum insertion of long-acting reversible contraceptives (LARC) by unbundling payment for LARC from other postpartum services. Remove administrative and logistical barriers to LARC (e.g., remove pre-approval requirement or step therapy restriction and manage high acquisition and stocking costs). PREVENT DIABETES Expand access to the National Diabetes Prevention Program (the National DPP), a lifestyle change program for preventing type 2 diabetes.

10 6 18 Evidence Review Process Step 1 Step 2 Step 3 Step 4 Identified health conditions that: Affect large numbers of people Are associated with high health care costs Have CDC evidence-based interventions that may improve health and reduce health care costs Prioritized interventions: With a high potential health impact With evidence of effectiveness among certain population/payer groups That address gaps in coverage or low utilization That payers or providers could deliver Consulted individual experts from public health and the health care delivery system and the following sources for candidate interventions: Health and medical databases The Guide to Community Preventive Services United States Preventive Services Task Force Agency for Healthcare Research and Quality Used two CDC frameworks* to define level and types of evidence: Included moderate or higher level of evidence Prioritized interventions that are feasible, have public health impact, and have available economic and budgetary impact information Result: Evidence-based summaries of the 18 interventions associated with each of the 6 health conditions. * Spencer LM, Schooley MW, Anderson LA, Kochtitzky CS, DeGroff AS, Devlin HM, et al. Seeking Best Practices: A Conceptual Framework for Planning and Improving Evidence- Based Practices. Prev Chronic Dis 2013;10:130186, and Centers for Disease Control and Prevention. CDC s Policy Analytical Framework. Atlanta, GA: Centers for Disease Control and Prevention, US Department of Health and Human Services; 2013.

11 State Medicaid State and Local Public Health Department Implementation in NV MN MI UT MD District of Columbia CO NY MA RI NC Los Angeles County Health Department AK TX LA GA SC KEY Year 1 States GA Year 2 States, cities, and counties

12 Evaluation and Theory of Change State readiness to change payment Payment change for 18 services Increased provider delivery and patient utilization of services Improved health outcomes Decreased costs

13 RWJF Assisting States in Providing Prevention Services Critical foundational support to CHCS Knowledge and technical expertise for state Medicaid and public health leaders Peer-to-peer learning CHCS-developed Resource Library

14 Approaches and mechanisms to improve payment for and utilization of 6 18 Interventions* STATE ACTIVITIES TO APPROACH PAYMENT AND UTILIZATION CHANGE Conducted systematic assessment of services already provided by Medicaid managed care organizations (MCOs). Delivered targeted promotion of covered benefits to beneficiaries. Promoted covered benefits to providers, with guidance on billing procedures to facilitate payment for covered services. Expanded scope of practice for licensed providers. STATE MECHANISMS TO MAKE PAYMENT CHANGES Implemented managed care plan coverage changes in pilot settings. Amended MCO contractual language. Amended Medicaid State Plans. Received Medicaid waivers. Passed new legislation. *Embargoed from pre-release of JPHMP article; not ready for distribution

15 SOUTH CAROLINA SOURCE: Tobacco Cessation Coverage. July 1, 2017: South Carolina Department of Health and Human Services. ; to be included in embargoed JPHMP article As of July 1, 2017, SC Medicaid has removed barriers to access to cessation treatment (eg, no co-pays and no prior authorizations) SC now provides consistent medication and cessation counseling coverage across all Medicaid Managed Care Organizations The SC 6 18 team is educating providers and consumers about cessation services SC received a 50% CMS administrative match for quitline services Quitline and claims data are being aligned to monitor impact of above efforts

16 RHODE ISLAND RI Health Department working closely with its two managed care organizations on the HARP (Home Asthma Response Program) program Uses community health worker and asthma educator to 1) deliver asthma self-management education, 2) assess home for triggers, 3) offer cost effective remediation HARP program has demonstrated strong health and cost returns RI Medicaid intends to make HARP a covered benefit for high utilizers (2+ asthma ER visits or an inpatient asthma hospitalization) SOURCE: The Home Asthma Response Program (HARP). 2016: Rhode Island Department of Health; ; to be included in embargoed JPHMP article

17 Public Health and Health System Complementary Roles PUBLIC HEALTH Contributed conditionspecific subject expertise Translated epidemiologic evidence into benefits for coverage Developed awareness campaigns targeting providers and patients Promoted linkages with community services MEDICAID AGENCY Developed a business case for chosen interventions Utilized available policy levers to improve coverage and promote increased uptake of services Engaged with Medicaid managed care plans to enhance benefits Engaged providers and members via targeted educational efforts Tightened connections between Health Department and State Medicaid Agency

18 Expanding 6 18 to Commercial Health Plans Payer-specific/multi-payer initiatives Shared learning platform Added issues: behavioral economics, provider engagement, targeted member engagement

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20 Considerations for Spread and Scale

21 Thank you! Laura Seeff For more information, contact CDC CDC-INFO ( ) TTY: The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

22 Rhode Island Dr. Nicole Alexander Scott Director Rhode Island Department of Health John Bonin Chief of Staff to Patrick Tigue, Rhode Island Medicaid Director

23 South Carolina Dr. Lillian Peake Director of Public Health South Carolina Department of Health and Environmental Control Deidra Singleton Acting Director South Carolina Department of Health and Human Services

24 Multi-Sector Approaches to Improving Population Health CDC s 6 18 Initiative and Lessons Learned for Sustainable State-Based Spread and Scale