Marketing Prevention , Health & Wellness for the New Healthcare Environment

1. Marketing Prevention, Health & Wellness for the New Healthcare Environment Presented by Patrick Gauthier, Director

2. Objectives • Review the current state: • A bifurcated prevention system • Explore the future state

3. Discussion: Current State SAPTBG

4. Future State Chronic Care Model Well-Being Population Health Management ACA: Reforming Prevention New Markets

5. Key Concepts • Fear, anxiety and uncertainty are normal reactions to abnormal events • These are abnormal times and abnormal events are unfolding around us with increasing frequency • The Information Age, the Great Recession, Health Care Reform, elections, wars, and globalization represent a lot co-occurring abnormal conditions • Complexity, volatility and paradigm-shifting ensue

6. Key Concepts • This is your field. You worked hard to get here. • This field was carved from the stone of ignorance and fear and discrimination • We’ve won important Civil Rights battles in the form of the ADA, COBRA, HIPAA, EMTALA, MHPAEA and now the PPACA • Our work is not done yet. Far from it! • More to come for those who can perceive the opportunities and mobilize their resources despite the fear and uncertainty.

7. Key Concepts • Discontinuity and Disruption (P. Druker) • Instability (A. Toffler) • Decay and Irrelevance (G. Hammel) • Tipping Point (M. Gladwell) • Strategic Inflection Point (A. Grove) • Value Migration (A. Slywotzky) • Disruptive Innovation (C. Christensen)

8. Open SpaceWhat keeps you up at night?What’s the worst that can happen?What do you want to do?What would you rather do?What’s stopping you?What do you need?What does it mean to be Partners?

9. Rational Reform • Public health concerns and patient needs have been on a collision course with economic reality and burden of healthcare • Conditions are Ripe for Innovation Average spending on healthper capita ($US PPP) Total health expenditures aspercent of GDP

10. Problem: Causes of Premature Death in the General Population N Engl J Med. 2007 Sep 20;357(12):1221-8.

11. Health Care Costs Concentrated in Sick Few—Sickest 10 Percent Account for 65 Percent of Expenses 1% 5% 22% $90,061 10% 50% $40,682 65% 50% $26,767 97% $7,978 Distribution of health expenditures for the U.S. population, by magnitude of expenditure, 2009 Annual mean expenditure Source: Agency for Healthcare Research and Quality analysis of 2009 Medical Expenditure Panel Survey.

12. Solution: Applying the Chronic Care Model • Developing an Informed, Activated Patient • Using Information Technology • Developing a Prepared, Proactive Practice Team • Reorganizing HealthcareSystem to Include Prevention, Health and Wellness

13. Health & Wellness Health Disease • Build resources, reserves, function, & competencies to promote & protect physical and mental assets for health • Promote conditions that foster healthy development; satisfying and productive lives • Implies greater attention to “positive health/mental health” • Prevent or minimize disease, disability, injury Most public health activities More public health + other stakeholder activities Breslow, 2006; Antonovsky, 1979; Keyes, 2007

14. Health & Wellness Disease Health & Wellness Assets for full, productive, satisfying life Prevention “…avoid or minimize pathological conditions.” “PERMA” (Seligman 2011) “FLOURISHING” (Keyes, 2007) “Positive Mental Health” (WHO, 2005, 2009; Barry & Jenkins 2007) • Positive emotions • Meaning/fulfillment • Satisfying relationships • Autonomy, mastery, • Achievement • Physical vitality • Community supports • (e.g., employment; access • to care; housing; parks) Population Health Fosters individual competencies, resources, and psychological strengths, and strengthens community assets to prevent mental disorder and enhance well-being and QOL (Herrmann et al. 2005; Barry & Jenkins 2007; Friedli, 2009) Health is the ability to adapt and self-manage in the face of social, physical, and emotional challenges (Huber et al., 2011)

15. Well-Being: the Public Health Approach • Well-being integrates mental health (mind) and physical health (body) resulting in more holistic approaches to disease prevention and health promotion. • Well-being is a valid population outcome measure beyond morbidity, mortality, and economic status that tells us how people perceive their life is going from their own perspective. • Well-being is an outcome that is meaningful to the public.

16. Well-Being • Advances in psychology, neuroscience, and measurement theory suggest that well-being can be measured with some degree of accuracy. • Results from cross-sectional, longitudinal and experimental studies find that well-being is associated with: • Self-perceived health • Longevity • Healthy behaviors • Mental and physical illness • Social connectedness • Productivity • Factors in the physical and social environment

17. Well-Being • Well-being can provide a common metric that can help policy makers shape and compare the effects of different policies (e.g., loss of green space might impact well-being more so than commercial development of an area). • Measuring, tracking and promoting well-being can be useful for multiple stakeholders involved in disease prevention and health promotion.

18. Well-Being • In this sense, health enables social, economic and personal development fundamental to well-being. • Health promotion is the process of enabling people to increase control over, and to improve their health. • Environmental and social resources for health can include: peace, economic security, a stable ecosystem, and safe housing. • Individual resources for health can include: physical activity, healthful diet, social ties, resiliency, positive emotions, and autonomy. Health promotion activities aimed at strengthening such individual, environmental and social resources may ultimately improve well-being.

19. Well-Being “Well-Being is a dynamic state where one maximizes his or her physical, mental, and social functioning in supportive environments to live a full, satisfying and productive life.” (CDC Well-being Work group 2010) • Integrates psychological notions of well-being with positive physical health for greater health impact • Links health with the places where people live, learn, work and play • Points to the roles and opportunities for multiple social sectors to affect well-being • Grounded in health equity & social justice: disadvantaged individuals may face more unfair obstacles in maximizing well-being

20. CDC Measures of Well-Being

21. Population Behavioral Health Promotion • Employment opportunities • Safe, affordable housing • Social inclusion & anti-discriminatory policies • Positive parenting/early childhood development interventions • Active living • Public transportation • Parks to encourage social connectedness, access to nature and physical activity • Taxation of addictive substances • Healthy school environments

22. The ACA Promotes Prevention and Wellness for All Americans • The new law ensures all Americans receive critical clinical and community preventive services and makes public health and prevention a permanent part of the health care system by: • Eliminating cost sharing on recommended preventive services delivered by Medicare and all new insurance plans; • Providing coverage under Medicare—with no co-payment or deductible—for an annual wellness visit that includes a comprehensive health risk assessment and 5-10 year personalized prevention plan; • Providing enhanced federal Medicaid matching funds to states who offer evidence-based prevention services and requiring coverage of tobacco cessation services for pregnant women in Medicaid; and, • Delivering community preventive services by investing in state, territorial, and local public health infrastructure and by providing grants to implement recommended services.

23. Reform Highlights • Insurance Market Reform • Coverage Requirements • Health Insurance Exchange • Payment Reform and Care Coordination • National Quality Strategy • Prevention & Public Health • Long Term Care • Workforce Development

24. ACA Prevention Benefits Covered Preventive Services for Adults • Abdominal Aortic Aneurysm one-time screening for men of specified ages who have ever smoked • Alcohol Misuse screening and counseling • Aspirin use for men and women of certain ages • Blood Pressure screening for all adults • Cholesterol screening for adults of certain ages or at higher risk • Colorectal Cancer screening for adults over 50 • Depressionscreening • Type 2 Diabetes screening for adults with high blood pressure • Diet counseling for adults at higher risk for chronic disease • HIV screening for all adults at higher risk • Immunization vaccines for adults--doses, recommended ages, and recommended populations

25. A New Commitment to Prevention • The Affordable Care Act signed into law by President Obama creates a National Prevention, Health Promotion, and Public Health Council. • The Council will elevate and coordinate prevention activities and design a focused National Prevention and Health Promotion Strategy in conjunction with communities across the country to promote the nation’s health. • The Strategy will take a community health approach to prevention and well-being – identifying and prioritizing actions across government and between sectors.

26. Prevention in Reform • There is a very strong emphasis on prevention in the ACA including enhanced access to care by requiring insurance companies to cover evidence-based preventive services and eliminating co-payments for many of those services. • The ACA also provides increased provider access and choice, as well as federal funding for programs with extraordinary track records of reducing problems for children later in life. • The focus on primary and preventive care in the ACA will help improve health outcomes for consumers

27. Investing in Prevention: The New National Prevention, Health Promotion and Public Health Council • Chronic diseases – such as heart disease, cancer, stroke, and diabetes – are responsible for 7 of 10 deaths among Americans each year and account for 75% of the nation’s health spending. Often due to economic, social, and physical factors, too many Americans engage in behaviors – such as tobacco use, poor diet, physical inactivity, and alcohol abuse – that lead to poor health.  • A focus on prevention will offer our nation the opportunity to not only improve the health of Americans but also help reduce health care costs and improve quality of care.  By concentrating on the underlying drivers of chronic disease, the Affordable Care Act helps us move from today’s sick-care system to a true “health care” system that encourages health and well-being.

28. The Council will: • Provide coordination and leadership to ensure the government is focused on improving prevention, wellness, and health promotion practices. • With continual public input, make recommendations to the President and the Congress concerning the most pressing health issues confronting the nation and changes in federal policy to achieve national health promotion, and public health goals, including the reduction of tobacco use, sedentary behavior, and poor nutrition.

29. The Advisory Group on Prevention, Health Promotion, and Integrative and Public Health • As required by the Act, the President will establish an Advisory Group on Prevention, Health Promotion, and Integrative and Public Health to help develop the new Strategy. • The Advisory Group will reside within the Department of Health and Human Services (HHS) and report to the Surgeon General. • It will have up to 25 non-federal members appointed by the President who will develop policy and program recommendations and advise the Council on lifestyle-based chronic disease prevention and management, integrative health care practices, and health promotion.

30. Developing the National Prevention and Health Promotion Strategy • After obtaining ideas from relevant stakeholders and working closely with the Advisory Group, the Council will devise a National Prevention and Health Promotion Strategy that will: • Set specific goals, measurable actions and timelines to carry out the strategy to reduce the incidence of preventable illness and disability in the U.S. and promote health and well-being, and; • Make recommendations to improve federal efforts relating to prevention, health promotion, public health, and integrative health-care practices to ensure that federal efforts are consistent with available standards and evidence.

31. Guiding Principals for Establishing the Prevention Strategy • Prioritize Prevention & Wellness • Establish a Cohesive Federal Response • Focus on Leading Causes and Factors of Preventable Death • Prioritize High-Impact Interventions • Promote High-Value Practices • Promote Health Equity • Promote Alignment Between Public and Private Systems • Ensure Accountability

32. Focus on Five Leading Causes of Death • Heart Disease • Cancers • Stroke • Chronic Lower Respiratory Disease • Unintentional Injuries How is each impacted by SUD? What can you do to make the case for the prevention services you provide?

33. Prevention Measures that Address the Underlying Causes of Death • Reduce Tobacco Use • Improve Nutrition • Increase Physical Activity • Reduce Underage Drinking and SUD

34. Public Health Investment Fund (the “Fund”) • This new initiative has new resources – $12.5 billion over ten years (FY2013-FY2022) in mandatory spending – to expand and sustain the necessary infrastructure to prevent disease, detect it early, and manage conditions before they become severe. • Fund is dedicated to improving community and clinical prevention efforts, strengthening public health infrastructure, improving research and data collection and bolstering the training of public health and primary care professionals.

35. The Fund • The legislation finances proven community-based prevention programs targeting public health problems such as tobacco use and obesity. Americans spend more than $2 trillion a year to treat disease and manage illnesses, and almost three quarters of that money is spent on caring for people whose illnesses we know how to prevent. • Fiscal Year Allocation: • FY10: $500 million • FY11: $750 million • FY2012-FY2017: $1 billion • FY2018-FY2019: $1.25 billion • FY2020-FY2021: $1.5 billion • FY2022 and each fiscal year after: $2 billion • Effective prevention will mean fewer premature deaths, less disease and more cost-effective health care spending.

36. SAMHSA’s Position on ACA Prevention • It will provide preventive care with no cost to Medicare beneficiaries. • Eliminating cost-sharing on recommended preventive services delivered by Medicaid, Medicare and Health Insurance Exchange plans. • Allowing Medicare payments for annual wellness visits including assessment and recommendations to address mental health conditions or risks. • Establishing a community based prevention and wellness grant program for individuals aged 55 to 64 years of age. Targeted actions may include improving mental health or reducing tobacco and substance use. Program also includes screening activities for mental health and substance use disorders. • Establishes a national public-private outreach and education campaign regarding prevention benefits.

37. Example: Postpartum Depression Research and Services • The Affordable Care Act recognizes the distress experienced by families resulting from postpartum depression and psychosis, and offers provisions aimed at providing support, education and research activities to address these conditions. The law authorizes grants to states for the establishment, operation and coordination of effective and cost-efficient systems for the delivery of essential services to individuals with or at risk for postpartum conditions and their families.

38. Example: Early Childhood Home Visitation Program • One of the most promising areas of mental health prevention and early intervention is early childhood home visits by health care workers. • A considerable body of research has shown that this improves the social and emotional development of very young children and enables identification of mental health problems in infants and toddlers. • The Affordable Care Act promotes the expansion of these programs through a new section added to the Maternal and Child Health block grant program (Title V of the Social Security Act) that requires states to conduct needs assessments to determine which communities are most at risk for poor maternal and child health and have few quality home visitation programs. The assessment would also evaluate the state’s capacity to provide necessary and appropriate services to communities at risk.

39. Healthy Lifestyles • The law includes incentives for states to fund initiatives to prevent chronic diseases among Medicaid beneficiaries. In 2011, States were awarded five- year grants to provide incentives to Medicaid beneficiaries who participate in comprehensive, evidence-based, widely available and easily accessible programs aimed at encouraging healthy lifestyles. • These programs address all co-morbid conditions, and depression is specifically mentioned as an included condition. HHS will develop criteria for programs, based on recent evidence, and programs will be required to show improved outcomes, including cessation of tobacco use, decreased blood pressure and cholesterol, and prevention of diabetes.

40. New Prevention Benefits • Depression Screening • Alcohol and Other Drug Use/Abuse and Dependence Screening – Adult and Adolescent Plans must provide first-dollar coverage

41. Prevention in Commercial Health Insurance Hospital and Provider Quality Comparisons online Personal Health Records (PHR) Coverage Advisors Treatment Advisors Nurse Line Health Risk Assessments and Health Risk Management Programs with Incentives ($) Disease Management Programs Patient-Centered Medical Homes

42. Prevention in Commercial Health Insurance Be Smart. Be Well. Health and Wellness : Health Care Service CorporationBe Smart Be Well is an innovative, interactive, health, and wellness website. The website is dedicated to raising awareness of health issues that are largely preventable or best addressed through early intervention. Caring Place: A Center for Grieving Children, Adolescents, and Their Families: Highmark, Inc.The Highmark Caring Place, A Center for Grieving Children, Adolescents, and Their Families is a safe place where grieving children and families can come together and be with others who understand what they're going through.Fitness for Kids: Independent HealthFitness for Kids is an innovative program designed to foster the development of healthy habits among Western New York's youth to improve their health and plant the seeds for a lifetime commitment to good health.

43. Prevention in Commercial Health Insurance • Blue KC: Independence School District, Missouri, Becomes First School District in Nation to Tackle Student Weight Issues with MEND 7-13, a Healthy Lifestyle Program • Youth Are Invited to “Step into Service” as UnitedHealth HEROES to Fight Childhood Obesity • PureWellnessEnables Continuity of Care Document (CCD) Integration for Wellness and Prevention Records

44. Prevention in Commercial Health Insurance

45. Prevention in Commercial Health Insurance

46. Prevention in Commercial Health Insurance

47. Opportunities • Obesity • Smoking Cessation • Asthma • Childhood Trauma • Mental Health Disorders • Heart Disease • Cancers • Stroke • Respiratory Disease • Unintentional Injuries and Accidents

48. http://www.cdc.gov/hrqol

49. Thank You! Patrick Gauthier Director 888-898-3280 ext. 802 pgauthier@ahpnet.com