How Building Healthy Communities Will...How Building Healthy Communities Will Improve Delaware’s Overall Health Kara Odom Walker, MD, MPH, MSHS Cabinet Secretary Join us on Twitter:

How Building Healthy Communities Will

Improve Delaware’s Overall Health

Kara Odom Walker, MD, MPH, MSHSCabinet Secretary

Join us on Twitter: @Delaware_DHSS @DrKaraWalker2

Healthy Communities DelawareChase Center on the Riverfront

Delaware’s Road to Value

Support patient-centered, coordinated care.

Prepare the health provider workforce and infrastructure.

Improve health for special populations.

Engage communities.

Ensure data-drivenperformance.

Pay for Value

Improved Quality and Cost

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Delaware Spends More on Health Care Than Most Other States

PER CAPITA PERSONAL HEALTH CARE EXPENDITURES, 2014

NOTE: District of Columbia is not included.SOURCE: Centers for Medicare & Medicaid Services, Health Expenditures by State of Residence, CMS, 2017.

State

NATIONAL AVERAGE

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DE is #3

Delaware’s Total Health Spending Will Doublefrom 2015-2025

SOURCE: Centers for Medicare & Medicaid Services, Health Expenditures by State of Residence, CMS, 2017;

Year

Growth Target

5%

3%

2%

DELAWARE’S ACTUAL AND PROJECTED PERSONAL HEALTH CARE EXPENDITURES, 2007—2025(BILLIONS OF DOLLARS)

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• Our population is older and aging faster.

• We are sicker than the average state.

• Our investments have not led to better outcomes — we are ranked 31st

in America’s Health Rankings.

31RANKED

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ST

Delaware’s Overall Health Is Poor

Delaware’s Overall Health Is Poor

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• We rank in the bottom half of states for:

➢ Overdose deaths

➢ Infant mortality

➢ Cancer deaths

➢ Diabetes

➢ Physical inactivity

➢ Smoking

➢ Cardiovascular deaths

Our Objectives:Improved Choice and Better Delivery

• Give Delawareans choices and information to help them make better health care decisions.

• Reinforce healthy choices via institution and neighborhood design.

• Support primary care infrastructure that allows for improvements.

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Define Individual Health in Contextof Community Health

Source: A Public Health Framework for Reducing Health Inequities [Chart]. (2015). In BARHII. Retrieved August, 2016, from http://barhii.org/framework/

Consider What Creates Health

World Health Organization. Ottawa charter for health promotion. International Conference on Health Promotion: The Move Towards a New Public Health, November 17-21, 1986

Ottawa, Ontario, Canada, 1986. Accessed July 12, 2002 at <http://www.who.int/hpr/archive/docs/ottawa.html>.

Determinants of Health Model based on frameworks developed by: Tarlov AR. Ann N Y Acad Sci

1999; 896: 281-93; and Kindig D, Asada Y, Booske B. JAMA 2008; 299(17): 2081-2083.

Spending Mismatch: Health Care and Other Key Determinants of Health

Source: NEHI, 2012

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Advancing Health Equity: Achieving Optimal Health for All

• Expand the understanding about what creates positive health.

• Strengthen community capacity to create their own healthy future.

• Promote a combined health and social determinants approach with health equity as the goal.

Where We’ve Been

Under SIM: Priorities of Healthy Neighborhoods Councils

• Wilmington/Claymont Council: Maternal and child health and behavioral health

• Kent/Smyrna Council: Behavioral health and lifestyles/chronic disease

• Sussex County Health Coalition: Behavioral health and lifestyles/chronic disease

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Healthy Neighborhoods Wilmington/Claymont: Play Streets

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Healthy Neighborhoods Kent/Smyrna: Homeless Engagement Initiative and Open Streets

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• Homeless Engagement: Lockers, on an outdoor pad at Dover Interfaith Mission, available 24/7. In exchange for a locker, clients must meet with a community health worker once a week and begin to create individual action plans

• Open Streets Dover: NCALL coordinated a series of health-related outdoor events in downtown Dover. Activities that drew hundreds include group fitness, healthy eating, a rope course and moon bounce, and health screenings. It also helped people reimagine public spaces.

Healthy Neighborhoods: Sussex County Health Coalition

• Botvin LifeSkills Training: As a way to prevent substance use among young people, SIM funded training for at-risk middle school students in Sussex County.

• Seaford Goes Purple: The Seaford Drug Free Communities Task Force is using this awareness campaign as part of a plan to prevent and reduce substance use and to provide treatment and support to families.

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Where We’re Going

Governor Carney Signed Executive Order Establishing Health Care Benchmarks

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Quality Benchmark: Emergency DepartmentUtilization Rate

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*Adapted from NCQA Quality Compass**Delaware’s baseline was derived from the weighted average performance of Aetna, Cigna,

Highmark, and UnitedHealthcare. Weights were HEDIS 2018 enrollment by plan.

Quality Benchmark: Opioid-Related Overdose Deaths

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308overdose deaths in 2016 overdose deaths in 2017

(double the deaths recorded 5 years earlier)

291preliminary total of suspected overdose deaths in 2018; final total expected to surpass 400

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Quality Benchmark: Opioid-Related Overdose Deaths

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*WONDER, DCD

Quality Benchmark: Concurrent Use of Opioids and Benzodiazepines

• Benchmark Values: After insurer data are obtained by the State during 2019, the figure for residents per 1,000 with overlapping prescriptions will be determined for 2020 and 2021 and for the aspirational benchmark

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Health Care Quality Benchmarks: Adult Obesity

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*Behavioral Risk Factor Surveillance System, CDC

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Quality Benchmark: High School Students Who Were Physically Active

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*Youth Risk Behavior Survey, CDC**There is no benchmark for 2020 because there will be no data available to measure performance. The survey serving as the data source is administered by the federal government every other year.

Quality Benchmark: Tobacco Use

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*Behavioral Risk Factor Surveillance System, CDC

Quality Benchmark: Persistence of Beta-Blocker Treatment After a Heart Attack - Commercial Insurance

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*NCQA Quality Compass**Delaware’s baseline is Highmark’s baseline rate, as Highmark was the only plan with commercial data available in NCQA’s Quality Compass for HEDIS 2018.

Quality Benchmark: Persistence of Beta-Blocker Treatment After a Heart Attack - Medicaid

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*NCQA Quality Compass**Delaware’s baseline is Highmark’s baseline rate, as Highmark was the only plan with Medicaid data available in NCQA’s Quality Compass for HEDIS 2018.

Quality Benchmark: Statin Therapy for Patients with Cardiovascular Disease - Commercial Insurance

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*NCQA Quality Compass**Delaware’s baseline was derived from the weighted average performance of Aetna, Cigna, Highmark, and UnitedHealthcare. Weights were HEDIS 2018 enrollment by plan.

Quality Benchmark: Statin Therapy for Patientswith Cardiovascular Disease - Medicaid

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*NCQA Quality Compass**Delaware’s baseline is Highmark’s baseline rate, as Highmark was the only plan with Medicaid data available in NCQA’s Quality Compass for HEDIS 2018.

Become Engaged

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“The power of community to create health is far

greater than any physician, clinic, or hospital.”

-Dr. Mark Hyman

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THANK YOU

#ourhealthde

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Join us on Twitter: @Delaware_DHSS @DrKaraWalker