Healthy Public Health 2016: A Four-Year View

1. Healthy Public Health 2016: A Four-Year View Jeffrey Levi, PhD Open Forum Meeting for Quality Improvement National Network of Public Health Institutes Charlotte, NC December 7, 2012

2. Context • Affordable Care Act implementation • Prevention and Public Health Fund • Fiscal cliff or fiscal slope • New funding hard to come by • “Improve many things when focus on a few things” • Short-term investment to modernize for long-term savings • It’s all about partnerships

3. Four years, four goals • Creating health equity by building the culture of “health in all policies” • Prioritizing prevention – especially community change/prevention – as part of the redesign of the US health care system and how it is financed • Restructuring health programs and agencies to break down silos and reflect new health infrastructure • Providing a stable base of funding for state and local public health

4. Create health equity through HIAP • Addressing social determinants of health requires new partnerships • National Prevention Council/National Prevention Strategy as a federal base • Building new constituencies for HIAP—and accessing new resources • Building social capital through engagement and policy/programmatic change

5. National Prevention Council=New Partnerships

6. Coming together • Education • Community Development • Climate Change/Environment • Transportation • In various constellations • Across government and private sector • Building social capital builds resilience and health

7. National Prevention Strategy

8. National Prevention Council Commitments • Consider prevention and health within departments and encourage partners to do so voluntarily as appropriate. • Increase tobacco free environments within its departments and encourage partners to do so voluntarily as appropriate. • Increase access to healthy, affordable food within its departments and encourage partners to do so voluntarily as appropriate.

9. New partnerships with health • Structural integration of prevention and public health—from Accountable Care Organizations to Accountable Care Communities • Making the ROI case for prevention – within the health system and more broadly • Inclusion of prevention/public health funding as part of any global budget initiatives • Defining the need and what it would look like • Expand use of new tools such as community benefit

10. Improving Population Health Outcomes Depends on Transforming the Health System to Coordinate and Integrate Primary Care, Public Health and Community Prevention Efforts Health Care System/Primary Care • Incentives for providers to achieve pop. health out-comes and improve quality • Incentives for plans/ACOs to address population health outcomes • Funding mechanisms that enable braiding of financing streams • Primary care & team based care • Patient assessments include personal data and SDOH regarding patients’ homes and communities • Quality improvement • Leveraging, linkages and referrals to community resources • Data collection & EHRs contribute to community health data base • Coordination with community health outreach workers • Chronic disease mgmt Community Prevention/Social Determinants of Health (SDOH) Payers, Insurers, and ACOs • Interventions at the intersectionof primary care, public health and the social • determinants of health • require: • Common agendas and goals • Shared responsibility • A compelling story • Partnerships and collaboration • Leadership and Integrators • Data • Financing systems • Accountability mechanisms Interventions At The Intersection Public Health • Social and support services • Disease prevention and management programs • Outreach and referral to clinicians • Education, including health education • Coalitions and advocacy to address SDOH • Community engagement Public policy is a critical lever to support all of these activities • Policy leadership on programs and policies that improve community health • Community health assessments • Educating policymakers, agencies, and stakeholders regarding pop. health • Population health data tracking and analytic tools Improved Population Health, Health Outcomes, and Lower Costs (Triple Aim)

11. Decentralization of ACA decision making • New partnerships with health insurance exchanges, Medicaid programs, hospital system, ACOs, etc. • New language, new ways of making our case, new expertise • PATIENCE

12. Partners, Accountable Care Community

13. ACC Coalition Collaborative partnerships leverage multi-sector resources to improve community health. Benefits of partnership: Addresses broad range of issues with greater breadth and depth Coordinates services and prevents redundant efforts Increases public support Allows individual organizations to influence community on a larger scale Includes diverse perspectives Strengthens connections between existing resources Provides shared frame of inquiry for community health concerns

14. Public Health and Health Care Cost Containment: Making ROI Case

15. How does public health change? (1) • Foundational capabilities first • Information systems and resources; • Health planning; • Partnership development and community mobilization; • Policy development analysis and decision support; • Communication; and • Public health research, evaluation and quality improvement. • Every American served by these capabilities

16. How does public health change? (2) • True modernization of core systems • Surveillance and epidemiology as case study • Streamlined categorical programs • Break down silos • Emphasize approaches that have cross cutting impact – within health • Focus investment in partnerships • CTGs model for leadership and sharing resources

17. How does public health change? (3) • Payer of last resort • Doing what public health must do, not necessarily what it has always done • Restructuring of federal public health agencies to reflect the new reality

18. Create stable funding for public health • Federal mandate to demonstrate foundational capabilities • Develop federal-state relationship similar to Medicaid • Federal government provides very high match (90-100%) for foundational capabilities • States determine how they assure achieved for every resident • Federal government provides diminishing match for lower priorities • Incentives to merge similar categorical efforts; if core addressed, less funding needed for categorical

19. Can we do it? • Four years ago we considered the following to be dreams or too much of a stretch • Accreditation • Health reform • National Prevention Council, Strategy • Mandatory funding for public health • Major new prevention programming • Status quo is not an option

20. Healthy Public Health 2016 • Accreditation tied to assured funding for foundational capabilities • Population health integrated into new systems of health care delivery and financing • Health inequities reduced by partnership across sectors • Healthier and more resilient nation