The Public Health National Center for Innovations: Advancing Improvements in Practice Jessica Solomon Fisher, MCP September 27, 2016 Public Health National Center for Innovations
Overview Context Overview and future of PHNCI Discussion
Alignment
Community Chief Health Strategist Conditions leading to the need for this evolution Health care needs are changing Demographics are changing Access to clinical care due to ACA Information/data revolution Non-health sector role in optimizing health
Key Practices of the Chief Health Strategist 1. Adopt and adapt strategies to combat the evolving leading causes of illness, injury and premature death 2. Develop strategies for promoting health and well-being that work most effectively for today and tomorrow 3. Identify, analyze and distribute information from new, big and real time data sources 4. Build a more integrated, effective health system through 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 Replace outdated organizational practices with state-of-the-art business, accountability, and financing systems 7. Work with corresponding partners ( federal Chief Health Strategist) to effectively meet the needs of their communities
Key Practices of the Chief Health Strategists Combat evolving leading causes of illness, injury and premature death Innovative strategies for promoting health for communities Use new and big data in real time Integrate with health care Broaden partnerships Improve organizational business practices Work with federal partners
Culture of Health Robert Wood Johnson Foundation In response to the need to catalyze change in health, well-being and equity Spur dialogue and collective action Calls for collaboration between public/private sectors and communities
Culture of Health is broadly defined as one in which good health and well-being flourish across geographic, demographic, and social sectors; fostering healthy equitable communities guides public and private decision making; and everyone has the opportunity to make choices that lead to healthy lifestyles.
Culture of Health Action Framework
Public Health 3.0 It is time to boldly expand the scope and reach of public health to address all factors that promote health and wellbeing, including those related to economic development, education, transportation, food, environment, and housing. -DeSalvo et al
Public Health 1.0
Public Health 2.0
Public Health 3.0 Enhanced leadership and workforce Accreditation Technology, tools and data that matter New metrics of success Funding
Foundational Public Health Services
Investment in Public Health (IOM) A minimum package of foundational and programmatic public health services that: protect and promote the health of populations are available and visible in all communities serve as a framework for program and financial management
Foundational Public Health Services built on the well-known and long-established concepts of the Three Core Public Health Functions and the Ten Essential Public Health Services, it is intended to make more specific the services that every community should receive from its state and local health departments and to inform public health funding decisions. a framework for program and financial management, including the development of charts of accounts. enhance people s understanding of the critical nature of population-based approaches (what communities get for their investment), and their understanding of the package as an instrument to ensure a standard level of health protection for all communities. (IOM For the Public s Health, April 2012)
Definitions Foundational public health services are the suite of skills, programs, and activities that must be available in state and local health departments system-wide, and includes the foundational capabilities and areas. Foundational capabilities are cross-cutting skills and capacities needed to support the foundational areas, and other programs and activities, key to protecting the community s health and achieving equitable health outcomes. Foundational areas are those substantive areas of expertise or programspecific activities in all state and local health departments also essential to protect the community s health. Programs and activities specific to a health department or a community s needs are those determined to be of additional critical significance to a specific community s health and also are supported by the foundational capabilities and areas.
FPHS Capacities Skills and capacities Minimum Created to make the case for sustainable funding and describe what is needed for public health to function anywhere/everywhere Pilot testing underway today Accreditation Standards Implementation of skills and capabilities Stretch/QI Created to improve quality Validated through implementation and evaluation Prescribe mandatory services Prescribe mandatory processes (i.e. CHA/CHIP) Developed by the field For health departments, as the backbone to the public health system Alignment document now available!
PHNCI Overview Division of the Public Health Accreditation Board (PHAB) Launched November 2015 Three-year initiative funded by the Robert Wood Johnson Foundation Governed by PHAB board of directors, advised by an Advisory Committee Charged with aligning national initiatives and fostering innovations in practice
Advisory Committee
PHNCI Advisory Committee TERRY ALLAN, Cuyahoga County Board of Health (OH) LESLIE BEITSCH, Center for Medicine/Public Health at the Florida State University College of Medicine LIZA CORSO, Centers for Disease Control and Prevention PAUL HALVERSON, Fairbanks School of Public Health at the University of Indiana HEATHER HOWARD, Princeton University Woodrow Wilson School of Public and International Affairs PATRICK LIBBEY, Center for Sharing Public Health Services JOHN AUERBACH, Centers for Disease Control and Prevention BETTY BEKEMEIER, Northwest Center for Public Health Practice at the University of Washington CHARLIE FAUTIN, Oregon Conference of Local Health Officials LAMAR HASBROUCK, National Association of County and City Health Officials PAUL KUEHNERT, Robert Wood Johnson Foundation GENE MATTHEWS, Network for Public Health Law GLEN MAYS, University of Kentucky CAROL MOEHRLE, Idaho North Central District Public Health PAMELA RUSSO, Robert Wood Johnson Foundation JOSHUA SHARFSTEIN, Johns Hopkins Bloomberg School of Public Health CRAIG THOMAS, Centers for Disease Control and Prevention PAMELA SCHWARTZ, Kaiser Permanente Community Benefit Program JENNIFER TEBALDI, Washington State Department of Health LISA WADDELL, Association of State and Territorial Health Officials
Major Activities National coordinating hub Link with PHAB s body of work for small health departments Foster innovations and support a learning community Capture and disseminate best practices Foundational public health services (FPHS)
A Few of Our Partners Uniform Chart of Accounts: University of Washington Cross-jurisdictional sharing: Center for Sharing Public Health Services Comprehensive Public Health System Assessment: University of Kentucky And more
Cross-jurisdictional Sharing of Services Systems redesign One strategy in achieving the foundational public health services or accreditation Alignment with Center for Public Health Sharing
Uniform Chart of Accounts IOM recommendation To analyze, track, compare and assess financial data Would allow for: Standardization and comparison across agencies Demonstration of accountability of resources Data for research on impacts to long-term outcomes
Public health and healthcare transformation and cross-sector partnerships Addressing population health and the triple aim Public health as chief strategist, as integrator Strategies: Health in all policies (HiAP) State Innovation Models (SIM) Community Health Needs Assessment (CHNA, Community Benefit) Payment Reform ACOs, CCOs, PCMHs, EHRs Direct service delivery or not
Education and Technical Assistance Instructional design based on adult learning techniques Aligned with PHAB s existing educational services: elearning, adult learning principles, CEs Developed, and refined, based on Learning Community needs
Learning Community Supporting partnerships in Ohio, Oregon and Washington through provision of RWJF funding, technical assistance and peer learning opportunities These 3 sites are charged with: Engaging multi-stakeholder coalitions to implement innovations Implementing FPHS Alignment with healthcare to improve population health Demonstrating improvement in a priority health status or reduction of a major risk factor (e.g. reduced disparities in teen pregnancies)
Washington Overview Goal of sustainable funding for public health Timeline 2011-2017 Technical definitions, cost model, primary estimates for current spending, cost, gap Refinement Legislative ask: comprehensive FPHS framework (including $$) by 2017 Organized by Steering Committee and subgroups Service delivery Statutes and regulations Revenue Funding allocation Communication and stakeholder engagement Desire: state government to pay for FPHS not covered by S/L fees
Washington Challenges Aggressive timeline FPHS definitions Legislative ask: policy and level of fiscal request Maintaining momentum Keeping everyone updated Expertise for communication and advocacy work for external stakeholders
Washington Opportunities Local and state PH leadership has prioritized Modernizing the system, imagining new service delivery models Learning from others Integration with Health WA (SIM) Complementary Tribal process
Oregon Overview HB 2348 (2013): created Task Force on the Future of Public Health Services Modernizing OR report submitted to legislature 2014 Recommendations: Adopt a framework re: FPHS ID adequate and sustainable funding Implement statewide in waves Allow for flexible LHD structures and include options for single county, single county with shared services or multi-county jurisdictions Structure changes around metrics established and evaluated by an Advisory Board
Oregon Overview HB 3100 (2015): operationalized Task Force recommendations Adopts modernization framework Changes composition and role of Advisory Board Requires S/L health departments to assess ability re: FPHS Submission of findings to Legislative Fiscal Office June 2016 Submission of local implementation plans by December 2023
Oregon Deliverables Modernization manual (6 mos): S/L roles, tools needed, developed collaboratively and including comment period Final manual adopted by administrative rule following assessment FPHS model Adoption of statewide modernization assessment and plan Total cost of, and ROI for, FPHS Use of incentives to encourage effective and equitable provision of services Develop plans for distribution of funds to LHDs Provide support and monitor implementation of plans Alignment with healthcare
Challenges Engaging all LHDs Developing consistent measures across variable county structures Short timelines for assessment and implementation (concurrent with local budget development) Receiving support for modernization in 2017 legislative session Opportunities Modernization manual complete Capacity assessment Cost estimations (current and future) Engagement of policymakers
Ohio Overview 2012 Public Health Futures Report 19 recommendations on capacity, quality, financing, CJS, etc Collaboration between 5 organizations Organized by Steering Committee, Advisory Committee and subcommittees (costing, shared services, small LHD accreditation, SIM/population health) Accreditation mandate in administrative code: apply 2018, accredited 2020
Ohio Overview Costing FPHS, using UKY/national costing model Import existing financial data into PHUND$ Shared services exploration Interest in PHAB small LHD product Connection to SIM, alignment of CHAs/CHNAs
Commonalities Policy driven strategy Interest in systems/structural change and sustainable funding Strategic thinking and timelines Learning from others S/L collaboration Provision of tools and resources
PHNCI s Future Defining innovation in public health: think tank How to get there Educational opportunities Website with library of resources and examples Fostering innovative practice, dissemination FPHS model revision
Public Health National Center for Innovations 1600 Duke Street, Suite 200 Alexandria, VA 22314 703-778-4549 www.phnci.org