Healthy Public Health 2016: A Four-Year View Jeffrey Levi, PhD Open Forum Meeting for Quality Improvement National Network of Public Health Institutes.

Healthy Public Health 2016: A Four-Year View

Jeffrey Levi, PhDOpen Forum Meeting for Quality Improvement

National Network of Public Health Institutes

Charlotte, NC

December 7, 2012

Context Affordable Care Act implementation

Prevention and Public Health Fund Fiscal cliff or fiscal slope

New funding hard to come by “Improve many things when focus on a few things” Short-term investment to modernize for long-term

savings

It’s all about partnerships

Four years, four goals Creating health equity by building the culture of

“health in all policies” Prioritizing prevention – especially community

change/prevention – as part of the redesign of the US health care system and how it is financed

Restructuring health programs and agencies to break down silos and reflect new health infrastructure

Providing a stable base of funding for state and local public health

Create health equity through HIAP Addressing social determinants of health

requires new partnerships National Prevention Council/National

Prevention Strategy as a federal base Building new constituencies for HIAP—and

accessing new resources Building social capital through engagement

and policy/programmatic change

National Prevention Council=New PartnershipsBureau of Indian Affairs Department of Labor

Corporation for National and Community Service

Department of Transportation

Department of Agriculture Department of Veterans Affairs

Department of Defense Environmental Protection Agency

Department of Education Federal Trade Commission

Department of Health and Human Services

Office of Management and Budget

Department of Homeland Security Office of National Drug Control Policy

Department of Housing and Urban Development

White House Domestic Policy Council

Department of Justice

Coming together Education Community Development Climate Change/Environment Transportation

In various constellations Across government and private sector

Building social capital builds resilience and health

National Prevention Strategy

National Prevention Council Commitments Consider prevention and health within departments

and encourage partners to do so voluntarily as appropriate.

Increase tobacco free environments within its departments and encourage partners to do so voluntarily as appropriate.

Increase access to healthy, affordable food within its departments and encourage partners to do so voluntarily as appropriate.

New partnerships with health Structural integration of prevention and public health

—from Accountable Care Organizations to Accountable Care Communities

Making the ROI case for prevention – within the health system and more broadly

Inclusion of prevention/public health funding as part of any global budget initiatives Defining the need and what it would look like

Expand use of new tools such as community benefit

Health Care System/Primary Care

Payers, Insurers, and

ACOs

Community Prevention/

Social Determinants

of Health (SDOH)

Public Health

Improved Population Health, Health Outcomes, and Lower Costs (Triple Aim)

Improving Population Health Outcomes Depends on Transforming the Health System to Coordinate and Integrate Primary Care, Public

Health and Community Prevention Efforts

Interventions At The Intersection

• Primary care & team based care

• Patient assessments include personal data and SDOH regarding patients’ homes and communities

• Quality improvement• Leveraging, linkages and

referrals to community resources

• Data collection & EHRs contribute to community health data base

• Coordination with community health outreach workers

• Chronic disease mgmt

• Social and support services• Disease prevention and

management programs• Outreach and referral to

clinicians• Education, including health

education• Coalitions and advocacy to

address SDOH• Community engagement

Interventions at the intersection of primary care, public health and the social determinants of health require:• Common agendas and

goals• Shared responsibility• A compelling story• Partnerships and

collaboration• Leadership and Integrators• Data• Financing systems• Accountability mechanisms

• Incentives for providers to achieve pop. health out-comes and improve quality

• Incentives for plans/ACOs to address population health outcomes

• Funding mechanisms that enable braiding of financing streams

• Policy leadership on programs and policies that improve community health

• Community health assessments• Educating policymakers,

agencies, and stakeholders regarding pop. health

• Population health data tracking and analytic tools

Public policy is a critical lever to support all of these activities

Decentralization of ACA decision making New partnerships with health insurance

exchanges, Medicaid programs, hospital system, ACOs, etc.

New language, new ways of making our case, new expertise

PATIENCE

Partners, Accountable Care Community

Collaborative partnerships leverage multi-sector resources to improve community health. Benefits of partnership:

– Addresses broad range of issues with greater breadth and depth

– Coordinates services and prevents redundant efforts

– Increases public support– Allows individual organizations to

influence community on a larger scale– Includes diverse perspectives– Strengthens connections between

existing resources– Provides shared frame of inquiry for

community health concerns

Community Members

Medicine

Public Health

Government & Philanthropy

Higher education

Secondary education

Safety-net health services

NationalHealth Coalitions

Academic researchers

Health Systems & Healthcare providers

Alcohol/drug services

Mental health services

Faith community

Community programs

ACC Coalition

Public Health and Health Care Cost Containment: Making ROI Case

How does public health change? (1) Foundational capabilities first

Information systems and resources; Health planning; Partnership development and community mobilization; Policy development analysis and decision support; Communication; and Public health research, evaluation and quality

improvement. Every American served by these capabilities

How does public health change? (2) True modernization of core systems

Surveillance and epidemiology as case study Streamlined categorical programs

Break down silos Emphasize approaches that have cross cutting

impact – within health Focus investment in partnerships

CTGs model for leadership and sharing resources

How does public health change? (3) Payer of last resort Doing what public health must do, not

necessarily what it has always done Restructuring of federal public health

agencies to reflect the new reality

Create stable funding for public health Federal mandate to demonstrate foundational

capabilities Develop federal-state relationship similar to

Medicaid Federal government provides very high match (90-100%)

for foundational capabilities States determine how they assure achieved for every resident

Federal government provides diminishing match for lower priorities

Incentives to merge similar categorical efforts; if core addressed, less funding needed for categorical

Can we do it? Four years ago we considered the following

to be dreams or too much of a stretch Accreditation Health reform National Prevention Council, Strategy Mandatory funding for public health Major new prevention programming

Status quo is not an option

Healthy Public Health 2016 Accreditation tied to assured funding for

foundational capabilities Population health integrated into new systems

of health care delivery and financing Health inequities reduced by partnership

across sectors Healthier and more resilient nation