Centers for Disease Control and Prevention Evidence-Based Interventions: Improving Health and Reducing Cost in Clinical and Community Settings Von Nguyen, MD, MPH Acting Associate Director for Policy BetterHealth Learning Collaborative September 15, 2017
National Trends in Health System Transformation Increased access to health insurance Value-based payment model Innovative care models Demographic changes Evolving role of public health, healthcare delivery systems, and communities SOURCE: JAMA. 2014;314(4):328. doi:10.1001/jama.2015.8129; http://kff.org/other/state-indicator/total-population/; Behavioral Risk Factor Surveillance System, 2013 & Preliminary 2014; National Health Interview Survey
Key Practices of the Chief Health Strategists of the Future Build a more integrated, effective health system through collaboration between clinical care and public health
Key Practices of the Chief Health Strategists of the Future Collaborate with a broad array of allies including those at the neighborhood-level and the non-health sectors to build healthier and more vital communities
Newly insured At MD for first physical in 5 years 55 years old, married, smokes, overweight, little exercise Asthmatic, high blood pressure Stopped taking medications in past due to cost Let s meet Fran Edwards
Insurance and Quality Care Help But the Following Contribute to Her Health Income Low-income family of 5 Barriers to fitness Rising crime rate, few parks, no nearby supermarket Under stress Child with behavioral health concerns, worried about money Sub-par housing Mold and ventilation problems
Questions We Have Heard I work for a governor who only wants health initiatives that will lead to positive results before she runs for re-election? Got any of those? How do I make the business case for my community benefits health proposals to a hospital board? I lead a small health department. How do I address the social determinants of health?
The 3 Buckets of Prevention Traditional Clinical Prevention Innovative Clinical Prevention Community-wide Prevention 1 2 3 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_.99695.aspx
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Improve Asthma Control: 6 18 Interventions Promote evidence-based medical management following the 2007 National Asthma Education and Prevention Program guidelines (NAEPP) Promote strategies that improve access and adherence to asthma medications and devices. Expand access to intensive self-management education for individuals Expand access to home visits by licensed professionals or qualified lay health workers to improve self-management education and reduce home asthma triggers
State Public Health Medicaid Teams 9State Medicaid Agency & Public Health Programs Teams 6 Additional states 2 Cities MN MI NY MA RI MI CO GA SC LA GA 2016 2017 GA
Improve Asthma Control: HI-5 Intervention Home Improvement Loans and Grants Description Home improvement loans and grants provide funding for low-income families to repair their homes, make improvements, and remove health and safety hazards. Economic Impact Overall benefits can be 1.5 to 2 times the magnitude of the costs of installing insulation in the homes Health Impact Improvement in general health status Improvement in respiratory health Improvement in mental health Reduction in visits to general practitioners
Traditional Clinical Prevention Asthma in All Three Buckets Innovative Clinical Prevention Community-wide Prevention 1 2 3 Promote evidence-based medical management Asthma self-management education by clinical staff Home visits by Community Health Workers to Provide additional education Assess risk factors in the home Assist in removing risk factors Home Improvement Loans and Grants to Improve insulation and air quality Remove safety hazards from homes Health Care Public Health
Community-wide Health Improvement Initiatives www.cdc.gov/socialdeterminants www.cdc.gov/chinav
CDC s Social Determinants of Health Website www.cdc.gov/socialdeterminants
www.cdc.gov/chinav Community Health Improvement Navigator
Accountable Health Communities Bridges clinical care and community services 32 funded communities Works across buckets 2 and 3 1 2 3
How Does All This Fit Together? Traditional Clinical Prevention Innovative Clinical Prevention Community-wide Prevention 1 2 3 Platform Content Accountable Health Communities CHI nav SDOH Website Cross-sector collaboration
How Can a Three Buckets Approach Help Ms. Edwards? Bucket 1: Promote medication adherence Tobacco cessation meds & counseling Screening for abnormal blood glucose Bucket 2: Home visits to reduce asthma Team-based approach to HTN control Diabetes Prevention Program if pre-diabetic Bucket 3: Statewide tobacco approaches Workplace obesity program Home improvement loans & grants
How Can Providers and Public Health Agencies Promote Community-wide Health? Build connections between the buckets Train/support community-based leaders Use evidence to inform and educate policy decision-making Support implementation of 6 18 and Hi-5 Initiatives