The First Northern Virginia Health Summit Where Are We, and Where Could We Go? Friday, May 31, 2013
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The First Northern Virginia Health SummitWhere Are We, and Where Could We Go?
Friday, May 31, 2013
Where Are We? Review of Northern Virginia Health Indicators
Patricia N. Mathews, President & CEO, Northern Virginia Health Foundation
May 31, 2013
Northern Virginia Health Summit
County Health Rankings for Northern Virginia
Indicator Alexandria City of
Arlington County
Fairfax City of
Fairfax County
Estimated Population (2012)
144,055 214,681 22,899 1,108,149
Health Outcomes Rank
8 3 55 1
(Ranking figures indicate rank among 133 Virginia cities and counties, where 1 = best)
May 31, 2013
3
Source: Population estimates: Community Health Solutions analysis of data from Alterzx, Inc. Rankings: Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute. www.countyhealthrankings.org.
Northern Virginia Health Summit
County Health Rankings for Northern Virginia (cont.)
IndicatorFalls
Church City of
Loudoun County
Manassas City of
Manassas Park
City of
Prince William County
Estimated Population(2012)
13,028 331,662 39,372 15,210 424,232
Health Outcomes Rank
16 2 7 9 10
(Ranking figures indicate rank among 133 Virginia cities and counties, where 1 = best)
May 31, 2013
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Source: Population estimates: Community Health Solutions analysis of data from Alterzx, Inc. Rankings: Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute. www.countyhealthrankings.org.
Northern Virginia Health Summit
Prenatal Care
May 31, 2013
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Counts (2011) Total Live Births Births w/o Early Prenatal CareRegion Total 33,921 5,189
Alexandria (City of) 2,632 502
Arlington County 3,049 637
Fairfax (City of) 496 72
Fairfax County 15,148 2,110
Falls Church (City of) 148 17
Loudoun County 4,970 443
Manassas (City of) 721 188
Manassas Park (City of) 66 18
Prince William County 6,691 1,202
Virginia 102,525 13,500
Source: Community Health Solutions analysis of Virginia Dept. of Health birth record data (2011).
Northern Virginia Health Summit
Adult Risk FactorsRate Estimates (2012) Overweight or Obese At Risk for Binge Drinking
Region Total 58% 20%
Alexandria (City of) 60% 18%
Arlington County 59% 20%
Fairfax (City of) 58% 21%
Fairfax County 59% 19%
Falls Church (City of) 61% 15%
Loudoun County 57% 21%
Manassas (City of) 60% 21%
Manassas Park (City of) 58% 20%
Prince William County 57% 23%
Virginia 62% 18%
May 31, 2013
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Source: Community Health Solutions analysis of data from Va. Behavioral Risk Factor Surveillance System (2006-2010).
Northern Virginia Health Summit
Youth Risk FactorsRate Estimates (2012) Felt Sad or Hopeless for Two or More Weeks in a Row
Region Total 25%
Alexandria (City of) 26%
Arlington County 26%
Fairfax (City of) 25%
Fairfax County 25%
Falls Church (City of) 25%
Loudoun County 25%
Manassas (City of) 26%
Manassas Park (City of) 26%
Prince William County 26%
Virginia 25%
May 31, 2013
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Source: Community Health Solutions analysis of data from CDC (2011).
Northern Virginia Health Summit
Oral HealthRate Estimates (2012)
Children Age 0-17 with No Dental Visit in Past Year
Adults Age 18+ with No Dental Visit in Last
Two Years
Region Total 22% 24%
Alexandria (City of) 22% 21%
Arlington County 22% 24%
Fairfax (City of) 22% 24%
Fairfax County 22% 23%
Falls Church (City of) 21% 21%
Loudoun County 21% 25%
Manassas (City of) 24% 22%
Manassas Park (City of) 24% 17%
Prince William County 22% 25%
Virginia 21% 22%
May 31, 2013
8Source: Community Health Solutions analysis of CDC data.
Northern Virginia Health Summit
Health Opportunity Index (HOI) for Northern Virginia
May 31, 2013
9Virginia Atlas of Community Health (Forthcoming Summer 2013), Geo Health Innovations and Community Health Solutions, Inc.
Where Innovation Is Tradition
Health Reform: Where is the Commonwealth
NOW?
Len M. Nichols, Ph.D.
Center for Health Policy Research and Ethics
The First Northern Virginia Health Summit
Springfield, VA
May 31, 2013
Review reform climate • Virginia voted for Obama, twice
(and Sens. Webb and Kaine, respectively)
• McDonnell elected Governor in 2009, Rs gained Senate split 20-20 after 2011 elections
• AG Cuccinelli first to file suit against ACA• 26 person VHRI appointed by Gov, led by Sec.
Hazel, recommended, in December 2010:State-run exchangePrepare for Medicaid expansion, delivery reform
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Where Innovation Is Tradition
Post-Supreme Court decision on ACA• Created opportunity to oppose Obamacare in
the name of fiscal prudence for state• Argument undercut by 3 facts:
Feds would pay 100% of expansion population costs for 3 years, 90% thereafter
State would save money for 5-6 years, low cost thereafter compared to economic benefit to state
Chamber of Commerce of VA came to support Medicaid expansion
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Where Innovation Is Tradition
De Facto Partnership on Exchange
• McDonnell decided, after SCOTUS, to NOT apply for establishment grant for exchange
• Governor also did not want to use the word “partnership” in deal with Feds
• Feds have signaled willingness to let Virginia BOI do “plan management,” one key function of partnership exchanges
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Where Innovation Is Tradition
Medicaid possibilities• Created by Senate split and Gov.’s desire for
transportation signature achievement• Budget created Medicaid Innovation and
Reform Commission (MIRC)• MIRC has 12 members, 3/5 from each house
must vote YES to judgment that:ADEQUATE Medicaid reform progress is being
made to justify expansion in July of 2014
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Where Innovation Is Tradition
Delegate Appointees to MIRC• Steve Landes-R (Albemarle, Augusta,
Rockingham)• Jimmie Massie-R (Henrico)• John O’Bannon-R (Henrico, city of Richmond)• Beverly Sherwood-R (Frederick, Warren, city of
Winchester)• Johnny Joannou-D (cities of Chesepeake,
Norfolk, Portsmouth, Suffolk)
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Where Innovation Is Tradition
Senate Appointees to MIRC
• Walter Stosch-R (Henrico, city of Richmond• Emmet Hanger-R (Augusta, Greene, Madison,
Rockingham, cities of Staunton and Waynesboro)• John Watkins-R (Powhatan, Chesterfield, city of
Richmond)• Janet Howell-D (Fairfax, Arlington)• Louise Lucas-D (Portsmouth).
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Where Innovation Is Tradition
Medicaid Reforms DMAS is pursuing
• Statewide managed care, including for ABD and foster children
• PACE expansion• Enhanced program integrity• Assessment requirements for CBHS• Dual eligibles financial alignment demonstration
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Where Innovation Is Tradition
Medicaid reforms DMAS is planning
• Comprehensive 1115 waiver to allow more coordination, streamline with private insurance features emerging in state employee, FAMIS, exchange, etc.
• Use payment reform to leverage tight, high quality networks
• Coordinate purchasing/delivery reforms in public-private partnership
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Virginia Health Innovation Center• Created in 2012 on 2010 recommendation of
Virginia Health Reform Initiative Advisory Council
• 501c3, housed at state Chamber of Commerce• Seed money from stakeholder associations• Surveyed providers, found 400 “examples,” now
has 6 task forces creating proposals for CMMIPCMH, integrating behavioral and acute, medication
management, care transitions, consumer engagement, bundles for babies
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Where Innovation Is Tradition
Summary
• Medicaid expansion depends on 2013 elections
• Delivery reforms and some coverage expansion through federal exchange will proceed
• Can collaboration replace individualism in time?
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Beyond Health Care
Northern Virginia Health SummitFairfax, VirginiaMay 31, 2013
Steven H. Woolf, MD, MPHVCU Center on Human Needs
Department of Family Medicine and Population HealthVirginia Commonwealth University
Higher Mortality Rates and Lower Life Expectancy
Mortality Rates by Cause of Death Life Expectancy
Beyond the Clinical Setting
WHO Conceptual Model
From: A Conceptual Model for Taking Action on the Social Determinants of Health. Geneva: World Health Organization, 2010
Role of Personal Health Behaviors
Cause Estimated deathsTobacco 400,000Diet/activity patterns 300,000Alcohol 100,000Microbial agents 90,000Toxic agents 60,000Firearms 35,000Sexual behavior 30,000Motor vehicles 25,000Illicit use of drugs 20,000
Source: McGinnis and Foege. JAMA 1993;270:2207-12.
Economic & SocialOpportunities and Resources
Living & Working Conditionsin Homes and Communities
PersonalBehavior
Medical Care
HEALTH
The importance of behavioral and social factors
Policies to promote
healthier homes, neighborhoods,
schools and workplaces
Policies to promote child and youth
development and education,
infancy through college
Policies to promote economic development and reduce
poverty
Robert Wood Johnson Foundation Commission to Build a Healthier America www.commissiononhealth.org
“Downstream” determinants
• Access to healthy foods• Physical activity
• Tobacco and alcohol• Healthy housing• Safe neighborhoods• Clean air and water• Safe working conditions
“Upstream determinants”
• Inadequate education• Unemployment• Declining income and net worth
19961997
19981999
20002001
2002
-50,000
0
50,000
100,000
150,000
200,000
250,000
Dea
ths
(per
yea
r) p
ote
nti
ally
av
erte
d i
n t
he
Un
ited
Sta
tes
Year
Deaths potentially averted by medical advances (see footnotes)
Deaths potentially averted by eliminating education-associated excess mortality (see footnotes)
Am J Public Health. 2007;97:679–683
Proportion of Deaths in Virginia Associated With Reduced Household Income
0
5
10
15
20
25
30
Proportion of deaths that would be
averted (%)
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
Am J Public Health. 2010;100:750-5
“Health in All” Policies
• Transportation• Land use• Built environment• Taxes• Housing• Agriculture• Environmental justice• Etc.
Health and illness
Annual Costs (Health Care And Program Spending), Three Layered Intervention Scenarios, Year 0 To Year 25.
Milstein B et al. Health Aff 2011;30:823-832
©2011 by Project HOPE - The People-to-People Health Foundation, Inc.
The House Bill would “save” approximately $1.516 billion per year between 2013 - 2017 and $1.78 billion per year between 2018 - 2022.
Increase in U.S. Poverty Rate
0.25% increase
0.50% increase
1.00% increase
Costs for diabetes care
$0.723 billion $1.473 billion $2.946 billion
Page County, Virginia
Contact Information
• Steven H. Woolf, MD, MPHCenter on Human NeedsDepartment of Family MedicineVirginia Commonwealth University804-828-9625
MOBILIZING COMMUNITY PARTNERSHIPS TO IMPROVE PUBLIC
HEALTH
The First Northern Virginia Health Summit
Gloria Addo-Ayensu, MD, MPHDirector of Health, Fairfax County
May 31, 2013
41
Human Services Agencies
Parks
Economic Developme
nt
Mass Transit
Employers
Nursing Homes
Mental Health
Drug Treatment
Civic GroupsCHCs
Laboratory
Facilities
Hospitals
EMS
Health Care
Providers
Health Departmen
t
Churches
Philanthropist
Elected Officials
Media
Schools
Police
Fire
Corrections
Environmental Health
Community Centers MCOs
Local Public Health System
Factors That Affect Health
Social Determinants of Health and other root causes of poor health
Changing the Contextto make individuals’ default
decisions healthy
Long-lasting Protective Interventions
ClinicalInterventions
Counseling & Education
Examples
Poverty, education, housing, inequality
Immunizations, brief intervention, cessation treatment, colonoscopySmoke-free laws, water fluoridation, restrictions on trans fats and sodium
Rx for high blood pressure, high cholesterol, diabetes
Eat healthy, be physically active
Adapted from Frieden TR, Am J Public Health. 2010;100:590-595.
Smallest
Impact
Largest
Impact
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Human Services Agencies
Parks
Economic Developme
nt
Mass Transit
Employers
Nursing Homes
Mental Health
Drug Treatment
Civic GroupsCHCs
Laboratory
Facilities
Hospitals
EMS
Health Care
Providers
Health Departmen
t
Churches
Philanthropist
Elected Officials
Media
Schools
Police
Fire
Corrections
Environmental Health
Community Centers MCOs
Local Public Health System
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Engaging LPHS Partners – Phase One
Emergency Preparedness
911 and anthrax crisis Smallpox & CRI planning Pandemic preparedness
H1N1
Fairfax County Pandemic Flu Planning
Pandemic Flu Planning Initiative Structure
•Vaccine and anti-viral distribution•Community disease prevention•Surge Capacity•Laboratory and Surveillance•First Responders and mass casualty•Legal Considerations•Communications and Notification•Essential Needs
1 The Emergency Management Coordinating Committee will serve as the Leadership Team for this effort2 Steering Committee: Dr. Gloria Addo-Ayensu, Dr. Raja’a Satouri, Barbara Antley, Holly Clifton, Kimberly Cordero, Zandra Duprey, Marilyn McHugh, Michelle Milgrim, John Niemiec3 Steering Committee: John Burke, Carol Lamborn, Amanda McGill, Becky McKinney, Larry Moser
Updated August, 2006
•Policy Support•Operational Support•Public Safety•County Infrastructure•Private Sector Planning
Executive Team(provides oversight, sets direction and insures appropriate inter nal and external communication)
Co-Chairs: Verdia Haywood, Rob Stalzer
Leadership Team (EMCC)1
(ensures coordination and integration of coordinating committees )Chairperson: Rob Stalzer
Public Health Coordination
(responsible for planning, response and recovery for public health efforts)
Co-Chairs: Dr. Gloria Addo-Ayensu, Dr. Raja’a Satouri
Critical Infrastructure and Resource ManagementCoordination
(responsible for planning, response and recovery for infrastruct ureand resource management efforts and private sector planning)
Co-Chairs: Doug Bass, Merni Fitzgerald
Public Health Work Groups2 Critical Infrastructure and Resource ManagementWork Groups 3
Fairfax CountyPandemic Flu
Plan CoordinatorsJohn Burke
(Deputy Fire Chief)Amanda McGill
(Program Manager)Laura Suzuki, R.N. MPH
(Public Health Nurse)
46
Engaging LPHS Partners – Phase Two
Community health challenges Individual and family
preparedness Cultural competency HIV Vaccine/health
literacy TB Health promotion Workforce
development
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Rationale for Engaging LPHS Partners
Builds capacity for addressing public health challenges
Promotes cultural competency Provides opportunity to address gaps and
root causes of poor health Empowers the community to participate in
improving their own health Strengthens local public health system
Improves community health
Engaging LPHS Partners – Phase Three
Expectation of LHDs Essential Public Health
Services Community assessment
and planning (MAPP) Healthy People 2020 National Prevention
Strategy Accreditation County Health Rankings
Shift in drivers of morbidity and mortality Transition to population-
based service delivery
48
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Principles for Successful Partnerships
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Maintaining Effective Partnerships
Build on what already exists and leverage existing resources to minimize the need for additional costs initially.
Look for opportunities for early successes and set realistic goals.
Listen to partners and be flexible. Find ways to collaborate on priorities that further
each other’s mission. Allow sufficient time for partnership to develop and
scale up gradually. Make capacity building and sustainability a core
strategy of the partnership. Partnership building is work, but rewarding!
Crude Death Rate for Infectious Diseases in the United States
Good Sanitation = Good Hygiene
Transforming Public Health Together
Investing in Effective Partnerships is ROI
2001 Anthrax Health Department response
2009 H1N1 Entire LPHS participation Activation of County EOC ICS & COOP 75,000 vaccinated 287 clinics 1018 MRC volunteers
19,548 Hours $516,000
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Health in All Policies (HiAP) – A Better Way
Thank You54
Event Name
DISCUSSION QUESTIONS
1. Where are there opportunities for collaboration across specific silos that might yield improved health for Northern Virginians?
2. What can I do -- in my work and where I live -- to improve the public’s health?
3. Complete the sheet on your table by listing groups you know that are working on health and health-related solutions in the region.
April 10, 2023
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The First Northern Virginia Health SummitWhere Are We, and Where Could We Go?
Friday, May 31, 2013
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