Primary Care – Public Health Integration and the Role of Data and Epidemiology

1. Primary Care – Public Health Integration and the Role of Data and Epidemiology J. Lloyd Michener, MD Professor and Chair Department of Community and Family Medicine Director, Duke Center for Community Research Duke University Health System Council of State and Territorial Epidemiologists Annual Conference Nashville, Tennessee June 23, 2014

2. www.iom.edu/primarycarepublichealth Released: March 28, 2012

3. What Do We Mean By Integration? “The linkage of programs and activities to promote overall efficiency and effectiveness and achieve gains in population health.” • Degrees of Integration:

4. Why integrate now? Changes in Health Care Rise in Health Care Costs Disturbing Health Trends Increase in Health Research and Data Impact of Social Determinants of Health Drive to PCMHs and ACOs Availability of Electronic Health Records Call to Action • IOM Report • Affordable Care Act • New Funding Opportunities

5. Principles for Successful Integration • Shared goal of population health improvement • Community engagement in defining and addressing population health needs • Aligned leadership • Sustainability • Shared data and analysis

7. System Overview

9. CalPERS Excess Medical Spendingattributable to selected preventable conditionsby county (2008) THE URBAN INSTITUTE

10. CalPERS Excess Medical Spending per person per year (2008) THE URBAN INSTITUTE

12. Neighborhoods Matter Emergency Department Utilization for Primary Care in Charlotte, NC

13. Neighborhoods Matter People with Hypertension in Durham Note: density plots depict ACTUAL patients and respective blood pressures in Durham County Source: DSR data from 1/1/06-5/1/09; patients seen at DUHS

14. DM patients seen at Duke 2007-2009 14,345 unique patients 8.7% of all patients >20 yo 14.3% of all patients >40 yo Durham County Stats (per CDC): 2008 ~ 10% of adults diagnosed with diabetes North Carolina (CDC): 2008 ~ 9% of adults diagnosed with diabetes By Race: 8.4% White 15.6% AA 12.4% NA 4.5% Hispanic 4.3% Other

15. HbA1C >9 HbA1C >9, AA HbA1C >9, AA 40-60, 60+

16. Integrated Intervention – Durham, NC Just For Us

17. Just For Us

18. Building Neighborhood Capacityin Durham, NC • DHI teams are connecting community partners and working with neighborhood residents to ensure: • Healthy schools and neighborhoods • Safe places to exercise • Access to healthy foods • Access to health information

19. Percent Difference Between Medicaid Recipients Enrolled in CCNC and Those Not Enrolled in CCNC, for Rates of Asthma-Related Emergency Department Visits and Inpatient Admissions, 2008–2012 Note. CCNC, Community Care of North Carolina. NCMJ September/October 2013, Volume 74, Number 5

21. The Practical Playbook A cornerstone of the next transformation of health, in which primary care and public health groups work collaboratively to achieve population health improvement. www.practicalplaybook.org

22. Target Audience • Public Health Professionals • Primary Care Teams • Additional Stakeholders • Hospitals • Health Care Investors • Academic Institutions • Community Organizations

23. Steering Committee Duke Community and Family Medicine • Lloyd Michener de Beaumont Foundation • Brian Castrucci • Jim Sprague Centers for Disease Control and Prevention • Denise Koo

24. National Advisory Committee

25. Practical Playbook Overviewwww.practicalplaybook.org

26. Maryland Prevents One Million Heart Attacks and Strokes The Maryland Million Hearts Initiative is part of a national campaign to prevent one million heart attacks and strokes by 2017. The statewide initiative is a partnership between the Department of Health and Mental Hygiene and local communities, health systems, nonprofit organizations, federal agencies and private-sector businesses. The program has seen a 27 percent increase in blood pressure control at participating centers.

27. MASSACHUSETTS IMPROVES QUALITY OF LIFE FOR CHILDREN WITH ASTHMA Massachusetts Improves Quality of Life for Children with Asthma The Community Asthma Initiative works to improve the health and quality of life for children with asthma. Boston Children’s Hospital designed the program to focus on medical interventions rather than environmental influences. Since its establishment, the program has worked in tandem with partners at every level, including the individual, family, and larger community. CAI helped reduce the number of asthma-related hospitalizations by 80 percent.

28. Playbook Google analytics • Visitors: 14,131 • - Returning visitors: 31.7% • - New visitors: 68.3% • Page views: 59,348 • March 5 - June 18, 2014 (3 ½ months) 6

29. KEY ELEMENTS: • Aggregated data from healthcare and public health • Hot spotting for avoidable illness • Coordinated community interventions • IT as key infrastructure

30. Introducing PCORnet:The National Patient-Centered Clinical Research Network

31. PCORnet embodies a “community of research” by uniting systems, patients & clinicians

32. 29 CDRN and PPRN awards were approved on December 17th by PCORI’s Board of Governors This map depicts the number of PCORI-funded Patient-Powered or Clinical Data Research Networks that have coverage in each state.

33. PCORnet organizational structure

34. Other related activities Improving Population Health by working with communities Draft report available at www.qualityforum.org Community Health Improvement Technical Package

35. June 2014 Report to the Congress: Measuring population-based outcomes -Roundtable on Population Health Improvement -Building Capacity for Population Intervention Research in Primary Care -Opportunity Knocks: Population Health in State Innovation Models -Paying for Population Health: A View of the Opportunity and Challenges in Health Care

36. What this means to Epidemiologists: • More activity with and across health systems • 16 Epidemiologists in Duke • Department of Community of Family Medicine • (8 with PhD in Epidemiology) • Collaboration and Competition