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Public Health and PCMH. Karyl Rattay, MD, MS Director Delaware Division of Public Health. Important Points. Health is More than Health Care Population Health Integration of Primary care and Public Health Community Engagement We are learning from interviewing you
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Public Health and PCMH Karyl Rattay, MD, MS Director Delaware Division of Public Health
Important Points Health is More than Health Care Population Health Integration of Primary care and Public Health Community Engagement We are learning from interviewing you Some PCMH-related activities under way
How Can You Explain This? Health Care Spending vs Health Outcomes 4 Source: United Nations Development Programme Report 2007-2008. Retrieved from www.unnatuaralcauses.org
DETERMINANTS OF HEALTH 5-10% 5
Health Care Pyramid Tertiary Medical Care 95%+ Health Care $$ Spent on Acute and Chronic Care Secondary Medical Care PrimaryMedical Care Population-Based Services 10% of Improvement in Health Status Attributed to Medical Care 90% Attributed to Population-Based Approaches Adapted from J. Michael McGinnis, M.D.
Population Health • An approach to health that aims to improve the health of an entire population • Addresses a broad range of factors that impact health on a population-level • A perspective recognizing the importance of social determinants of health and the relatively minor impact that medicine and healthcare have on improving health overall.
Individual Vs Population Health • Best outcome for individual • Treat a patient for gastroenteritis • Vaccinating patients • Counseling against smoking • Treating the consequences of obesity • Treating STD • Diagnosing an illness • Community’s health • Investigating outbreaks, restaurant inspections, safe water • Safety net for vaccinating medically indigent • Advocating for smoke-free environments • Promoting built environments conducive to physical activity • Finding and treating exposed partners • Conducting community health assessments
Health Reform’s Opportunity to Improve Public Health Population Approach + Clinical Care = Better Health
What Do We Mean by Integration Source: Institute of Medicine. Primary Care and Public Health Exploring Integration to Improve Population Health, March 28 2012. • The linkage of programs and activities to promote overall efficiency and effectiveness and achieve gains in population health. • Can take many forms
Why Integrate? Source: Institute of Medicine. Primary Care and Public Health Exploring Integration to Improve Population Health, March 28 2012. Health has many contributors Substantial and lasting improvements will require a common goal Enhance the capacity of both sectors to carry out their missions
Why Integrate Now? Source: Institute of Medicine. Primary Care and Public Health Exploring Integration to Improve Population Health, March 28 2012. Dramatic rise in health care costs Importance of social and environmental determinants of health New opportunities to understand and address community-level health concerns ACA presents opportunities
Principles for Successful Integration Source: Institute of Medicine. Primary Care and Public Health Exploring Integration to Improve Population Health, March 28 2012. Shared goal of population health improvement Community engagement Aligned leadership Sustainability The sharing and collaborative use of data and analysis
Health in all Policies Looks at all public- and private-sector policy making through a health lens Objective is to promote and protect the health of the population Addresses the social and physical environment influences on health
What is a Healthy Community? Source: Prevention Institute. Community-Centered Health Homes: Bridging the gap between health services and community prevention. Feb. 2011.
A work in progress More than 15 interviews Government Healthcare Business Community DPH Stakeholder Interviews
Interview Themes So Far Population Health Integration of Primary Care and Public Health Community Engagement Convening Role Data, research and evaluation Policy Input (as opposed to policy development) Implementation of policy
A partnership between DPH, hospitals and large Delaware Health Centers. Assistance with access to care, cancer screening, cancer care coordination, diabetes education and chronic disease management. Cancer Screening Nurse Navigators in five acute care hospital systems Cancer Care Coordinators in six hospital systems Community healthcare access coordinators in three hospitals and large health centers. Certified Diabetes Educators in large health centers (FQHCs and Claymont) Chronic Disease Nurses in the DPH Chronic Disease Bureau Care Coordination Integration
Help Me Grow Integration
Objectives Organize and manage a Healthy Weight Learning Collaborative utilizing quality improvement methods. Establish innovative partnerships between public health, primary care, and community organizations. Support sustainable change and foster collaboration through technology. Healthy Weight Collaborative Integration
CommunityEngagement Community Health Workers Bridging cultural mediation between communities and the health care system Providing culturally appropriate and accessible health education and information, often by using popular education methods Assuring that people get the services they need Providing informal counseling and social support Advocating for individuals and communities within the health and social service systems Build individual and community capacity
Summary Public health wants to be involved in reforming our delivery system because health is more than health care As we think about PCMH, integration of primary care and public health, population health, and community engagement are among the essential ways in which public health can contribute. While DPH has some efforts under way in all of these areas, we are actively learning about how we can evolve as a value added partner.
