AAMC/CDC/Fullerton Sponsored Population Health Improvement Leadership

1. AAMC/CDC/Fullerton Sponsored Population Health Improvement Leadership Tuesday, September 16, 2014 3:00-4:00 pm

2. Agenda • Practical Playbook Use Cases Lara Snyder • Health Care System Transformation in Oregon Katrina Hedberg • Helping Training Programs Learn About Population Health Activities in Their Communities Lloyd Michener

3. A Practical Playbook:Public Health & Primary Care Together 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

4. Practical Playbook Phase II • Build a central point of coordination for national integration efforts • Facilitate an annual national meeting and learning labs • Conduct curriculum gap analysis and develop and implement a strategic response • Facilitate roadshows to support the national health transformation • Enhance the practical playbook website • Provide virtual and in-person technical assistance • Identify paths to achievable, evidence-based outcomes • Oversee and support 10 community demonstration site projects • Success Story Thematic Evaluation

5. Use Case Development • To engage learners (and specifically residents) engaged in population health projects. • Forums for use • Webinars, workshops, classroom activities, etc. • Might be best for group activities. • Interest from collaborative? • Draft completed but needs review/editing/validation from the field. • Contact Lara Snyder at lara.snyder@duke.edu

6. Oregon’s Health Systems Transformation: Role for Public Health Katrina Hedberg, MD, MPH Oregon Public Health Officer September 16, 2014

7. Outline • Describe Oregon’s health care reform • Role of public health/ epidemiology in health system’s transformation • State Innovation Model funds for Public Health • Analyses of indicators • Analytic tool • Prevention grants

8. Health Care Reform in Oregon

9. Oregon’s Coordinated Care Governor’s vision Robust public process Medicaid clients Federal CMS waiver approved - $1.9B 16 CCOs cover state

11. Health SystemTransformation Public Health Division

12. Health SystemTransformation Public Health Division

13. Oregon’s Medicaid Program Commitments to CMS • Lower per capita costs by 2% points • Ensure quality of care improves • Ensure population health improves • Establish a 1% withhold for timely and accurate data reporting • Establish a quality pool

14. Public Health/ Health Care Integration

15. Public Health / CCO Collaboration • Population health indicators as CCO incentive • Health outcomes in CCO members & community • Evidence-based interventions to improve population health • Community Health Assessments • Population in CCO region • Health status of CCO patients Public Health Division

16. Population Health Definitions • Health Care Delivery (Clinical View) • Panel of patients: eligible, enrolled • Patients with specific conditions / utilization • Public Health View • Defined by time, place, person • Indicators are community indicators

17. CCO Measurement Strategy • Multiple measure sets, with overlap • 33 State Performance Measures • 17 CCO Incentive Measures • 16 Core Performance Measures

18. CCO Incentive Measures • Pre- / post-natal care • Developmental screening • Adolescent well-care visit • Colorectal cancer screening • Hypertension control • Diabetes control (HbA1C) • Alcohol/ Substance misuse (SBIRT) • Screening for depression

19. Core Performance MeasuresPopulation Health-focused • Tobacco use in Medicaid members • Tobacco cessation • Obesity in Medicaid members • Effective contraceptive use • Childhood immunization • Chlamydia screening • Need to define measures and identify data sources

20. Possible PH Incentive Metrics • Tobacco prevalence • Obesity prevalence • Vaccine receipt: influenza • Vaccine receipt: HPV • HIV screening • Teen pregnancy rates

21. Cigarette Use by InsuranceOregon, 2012 36% Range: 23%-42% percent

22. Rationale • Medicaid patients >2.5 times more likely to smoke • Smoking costs Oregon: • $1.3 Billion overall in medical costs • $374 Million for Medicaid medical costs • Cessation is evidence-based according to US Preventive Services Task Force

23. Operationalization Assess smoking status Advise to quit Evidence-based smoking cessation Rx Tobacco-free campuses Partner with LHD tobacco control

24. Obesity in Oregon New BRFSS weighting method began in 2010. Source: Oregon BRFSS and Oregon Healthy Teens Survey

25. Oregon Diabetes Prevalence New BRFSS weighting method began in 2010.

26. Obesity by InsuranceOregon, 2012 40% percent

27. Rationale • Medicaid patients >1.5 times more likely to be obese • Medical costs: • $1.6 Billion for medical care overall • $333 Million for Medicaid medical care • Premature deaths: 1,400 Oregonians/ yr

28. Operationalization: MPOWER Monitor: obesity, chronic dz, exercise, diet Promote: healthy eating/ active living Offer: evidence-based support (e.g. weight watchers) Warn: dangers of fats, sugar-sweet drinks Enforce: laws (e.g. breast-feeding space) Raise: price of unhealthful foods

29. Possible PH Incentive Metrics • Tobacco prevalence • Obesity prevalence • Vaccine receipt: influenza • Vaccine receipt: HPV • HIV screening • Teen pregnancy rates

30. State Innovation Model Funds for Public Health:

31. CHIP/ CHA • CCO required to work with public health: • community health assessment • community health improvement plan (CHA/CHIP) • Collaboration to meet CHA/CHIP requirements: • CCOs • Mental health • Public health • Nonprofit hospitals

32. SIM Funds for Epidemiology • State Innovation Model grant • Analysis of state health profile by • CCO region • Race/ ethnicity • Medicaid BRFSS

33. Oregon Population Health indicators • 50 indicators, updated annually • Analyzed by CCO region/ race-ethnicity • Data sources: • BRFSS • Oregon Health Teens • Vital Statistics (birth, death) • Reportable conditions (infectious, cancer, vaccines)

34. Medicaid BRFSS • Survey of Medicaid participants by CCO • Telephone-based survey • 400 per CCO • Assess those enrolled under regular and expansion criteria • Field this summer

35. Medicaid BRFSS topics • General physical, mental & oral health • Social determinants • Housing; ACES; Hunger • Chronic conditions • Physical activity and nutrition • Substance use (including tobacco) • Preventive services and screening • Violence

36. SIM: Community Prevention Grants • $1.8M for three years • Partnership between CCO & local health dept • Population health interventions in CCO & community settings • Evidence-based practices that align: • Leading causes of death / disability • CCO incentive measures

37. Focus: Maternal Child Health • Partners include: • Eastern Oregon CCO; 12 local health depts • Objectives include: • Increasing the number of children who receive developmental screening • Expanding evidence-based home visiting programs

38. Focus: Pre-conception Health • Partners include: • 3 southern Oregon CCO’s, 2 local health depts; 3 Federally Qualified Health Clinic systems; regional health equity coalition • Objectives include: • Routinely screen for pregnancy intent • Implement a preconception health campaign in community and schools • Interventions tailored to Latino community

39. Focus: Tobacco • Partners include: • 3 counties health depts; 1 CCO; health equity coalition • Objectives include: • Expanding support for tobacco cessation (Medicaid benefit design; 5-A’s training for providers) • Implementing tobacco retail license requirements

40. Focus: Opioid Overdose • Partners include: • 3 local health depts; 1 CCO; 1 health equity coalition; one non-profit clinic • Objectives include: • Training syringe exchange clients and social service agency staff on naloxone use for heroin overdose • Implementing opioid prescribing guidelines for CCO provider network

41. Summary Addressing triple aim of: improved care; lowered costs; improved health requires transforming health care system AND community in which people live Medical care providers play a critical role in providing direct patient care, and supporting policy/ environmental/ systems changes

42. Questions? Public Health Division

43. Current CMMI Projects in the U.S.