Public Health / Healthcare Collaboration

Public Health /

Healthcare

Collaboration a multi-lingual endeavor

Missouri Department of Health and Senior Services and LPHA Public Health Conference

March 21, 2017

Don Bradley, MD, MHS-CL Executive Director, The Practical Playbook

Associate Consulting Professor, Duke School of Medicine

Objectives

• Recognize gaps in population health

definitions

• Identify collaboration opportunities

between public health and healthcare

• Identify at least one tangible action you will

undertake to collaborate to improve your

community’s health and well being

Midwest and rural roots

My [Primary Care] Public Health Story

• July 1976 First Legionaire’s Disease cases

• 1977 Public Health certificate- University of Minnesota

• 1978 Teaching- Penn State Hershey

• March 1979 Three Mile Island

• June 1979 Polio outbreak- Amish

Top Strategic issues: Missouri Public Health System Partners Group, 2017

1. Access to healthcare a) Access, cost, uninsured

b) Economy

2. Modifiable risk factors a) Obesity

b) Smoking

c) Mental health/substance abuse

3. Infrastructure issues a) Mobilizing partnerships

b) Performance management/Quality improvement

c) Workforce development

http://health.mo.gov/data/pdf/mohealthimproveplan.pdf

Disclosures [and alignments]:

The

Practical

Playbook

www.practicalplaybook.org

PPB Strategic Priorities

• Promoting/providing practical tools and resources that facilitate effective cross-sector collaboration, and evaluating their use and impact

• Connecting like-minded state, national, and local organizations to generate collaboration, creativity, and interventions at scale and document results of those collaborations

• Supporting the training and development of health professionals that improve the health of the U.S. population.

Four opportunities for public health

• #1 Language and listening

• #2 Integration [collaboration]

• #3 Information and stories

• #4 Disruption: New rules,

Same goals, New opportunities

Opportunity #1:

Language and listening

Raise your hand if you :

• Work in public health

• Work in population health

• Are a health professional

• Are multi-lingual

Speak the 5 Ps:

• Provider [health care]

• Policy [legislative

and/or regulatory]

• Public health

• Payer

• Person

Health: World Health Organization

Health is a state of complete physical, mental and social well-being

and not merely the absence of disease or infirmity. The correct bibliographic citation for the definition is:

Preamble to the Constitution of the World Health Organization as adopted by the International Health

Conference, New York, 19-22 June, 1946; signed on 22 July 1946 by the representatives of 61 States (Official

Records of the World Health Organization, no. 2, p. 100) and entered into force on 7 April 1948.

The Definition has not been amended since 1948.

Population: 3 a : a body of persons or individuals having a

quality or characteristic in common http://www.merriam-webster.com/dictionary/population

Professional: c (1) : characterized by or conforming to

the technical or ethical standards of a profession (2) : exhibiting a

courteous, conscientious, and generally businesslike manner in

the workplace http://www.merriam-webster.com/dictionary/professional

Definition of Population Health

The health outcomes of a group of

individuals, including the distribution of

such outcomes within the group. It is an

approach to health that aims to improve

the health of an entire human

population. Kindig D, Stoddard G, Models for Population Health, AJPH 2003, 90(3):380-383

“Population Health” differentiated

Population Health

Management

• Current paradigm

• Attribution retroactive,

algorithm-driven

• Passive engagement

• Clinical focus

• Mostly clinical health

professionals

• Funding value-based +/-

per capita

Population Health

Improvement

• Future paradigm

• Attribution geographic

and/or population

characteristic

• Proactive engagement

• Community, public health,

and clinical health

professionals

• Funding flexible [vague]

Definition of Public Health:

Public health is the science of protecting and improving

the health of families and communities through

promotion of healthy lifestyles, research for disease and

injury prevention and detection and control of infectious

diseases. http://www.cdcfoundation.org/content/what-public-health

Public health promotes and protects the health of

people and the communities where they live, learn,

work and play. https://www.apha.org/what-is-public-health

Essential

Public Health

Services

http://www.cdc.gov/nphpsp/es

sentialservices.html

Opportunity #2: Integration/collaboration

https://www.cdc.gov/nchs/data/databriefs/db267.pdf

Missouri overall health ranking, 2016

http://www.americashealthrankings.org/learn/reports/2016-

annual-report/findings

Missouri

#37

And health outcomes are variable [2016]

http://www.countyhealthrankings.org/app/missouri/2016/overview

Missouri core measures impact-

positive, 2015

http://www.americashealthrankings.org/explore/2015-annual-

report/measure/Overall/state/MO

Mo. core measures impact, 2015

http://www.americashealthrankings.org/explore/2015-annual-

report/measure/Overall/state/MO

ACOs are struggling to meet targets

http://www.commonwealthfund.org/publications/issue-

briefs/2015/may/aca-payment-and-delivery-system-reforms-at-5-years

Despite some significant improvements

http://www.commonwealthfund.org/publications/issue-briefs/2015/may/aca-

payment-and-delivery-system-reforms-at-5-years

The pace of reform is accelerating

http://www.commonwealthfund.org/publications/issue-

briefs/2015/jun/medicare-payment-reform-aligning-incentives

Health 3.0 evolution

www.healthypeople.gov/ph3

“Integration” defined

Institute of Medicine:

‘the linkage of programs and activities to promote overall efficiency

and effectiveness and to achieve gains in population health.’

Principles of Integration:

Shared goal of population health

Aligned leadership

Community engagement

Sustainability

Collaborative use of data

If you want to go fast, go alone.

If you want to go far, go together.

Public Health System

http://www.cdc.gov/nphpsp/essentialservices.html

National Academy of Medicine (IOM) Roundtable

on Obesity Solutions, 2017

https://nam.edu/a-model-framework-that-integrates-community-

and-clinical-systems-for-the-prevention-and-management-of-

obesity-and-other-chronic-diseases/

A deeper look at the population health framework:

Opportunity # 3: Information and Stories

San Diego collaboration

How does Healthy Homes Des Moines work?

Through Healthy Homes Des Moines, households with children

suffering from asthma will receive home repairs to address

asthma triggers, and families will receive tailored health

education to self-manage asthma and maintain a healthy

home.

http://www.healthyhomesdesmoines.org/ http://buildhealthchallenge.org/our-communities/

Opportunity # 4: new rules, same goals, New Opportunities

Health[care] and the Federal Budget:

Where our money

goes: And what it gets us:

Largest

Impact

Smallest

Impact/ highest individual effort

Examples

Condoms, eat

healthy, be

physically active

Rx for high blood

pressure, high

cholesterol

Poverty, education, housing, inequality

Immunizations, brief

intervention, cessation

treatment, colonoscopy

Fluoridation, 0g trans

fat, iodization, smoke-

free laws, tobacco tax

Socioeconomic Factors

Changing the Context

to Make Individuals’ Default

Decisions Healthy

Long-lasting

Protective Interventions

Clinical

Interventions

Counseling

& Education

Factors That Affect Health

Frieden TR. A framework for public health action. Am J Public Health. 2010;100(4):590–595.

Healthcare Transformation-

• Block grants to states

• Value-based payment/ MACRA

• Accountable care organizations (ACOs)/

Accountable Health Communities

• Patient-centered medical homes/medical

neighborhood

• On-line and digital care, telehealth

• Alternative providers/sites of care

• Limited and/or tiered networks [and formularies]

• Transparency, consumerism and self-management

If you’re not at the table, you’re on the menu!

www.PracticalPlaybook.org/NationalMeeting

For more information, connect with us on social media.

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https://practicalplaybook.org/

Take home opportunities

• Become multi-lingual and listen

• Look for opportunities to collaborate/align

• Use information [data] to tell compelling

stories

• View disruption as a positive lever rather

than an inconvenience

Thank you!