Integration of Primary Care and Public Health

AAFP 2016 State Legislative ConferenceJ. Lloyd Michener, MDProfessor and ChairDepartment of Community & Family MedicineDuke University Medical CenterOctober 29, 2016

ww.iom.edu/primarycarepublichealth

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

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SAN DIEGO SCHOOL SYSTEM AND LOCAL MEDICAL RESIDENTS JUMPSTART HEALTHY HABITS IN STUDENTS:

How Maps Helped Engage A Community and Target Interventions to Reduce Obesity

The Situation Target Health Outcome ResultsThe Chula Vista Elementary School Districts BMI data indicated that Rice Elementary School had one of the highest obesity rates in the district. Meanwhile, physicians at a nearby clinic were frustrated by their lack of influence of the social and behavioral factors affecting their patients, many of whom were in the Rice school district.

Promote healthy eating and physical activity to reduce obesity in the community, as measured by body mass index (BMI).

The obese or overweight range decreased 3.2% for all students in the target population, and there was a 3.2 percent gain in the normal range.

PHONE CALL-BACK PROGRAM REDUCES ASTHMA-RELATED ER VISITS:

Indiana partnership relies on nurses to educate patients

The Situation Target Health Outcome Results

A community health survey showed that asthma was causing significant school and work absenteeism. This also was resulting in unnecessary, high-cost use of the emergency department (ED).

A reduction in the number of unnecessary asthma-related emergency room visits – as well as the related costs – in the communities served.

Since their involvement in the Asthma Call Back Initiative, 59% of participants said they didn’t miss any days of work or school, and never had trouble carrying out normal activities because of their asthma.

The cost savings to the hospital was substantial: after moderate decreases in costs the first two years. Parkview Hospital avoided nearly $1.9 million in ED costs in the third year.

Bold Innovative solutions that bring forth new ideas and approaches for addressing complex problems

Upstream Focus on social, environmental, and economic factors that have the greatest influence on health across a community, rather than on the provision of direct services, health education, or individual behavior change

Integrated Strong commitment and partnership between a hospital or health system, a nonprofit organization, and a local public health department, including the option to involve other industry, educational, philanthropic, or governmental

organizations

Local Focus on solutions that are deeply rooted in and led by the urban community (city of metro area of 150,000 or more) for which the proposal is written

Data-Driven Focus on innovative uses of data and information sharing to identify key needs and opportunities, as well as to measure outcomes

A National Challenge Program to engage communities, public health organizations and health systems in improving health outcomes. The Program awarded $8.5M in monetary awards and low-interest loans over two years to support 18 community-driven projects, beginning January 1, 2015

Technical Support:

Technical Assistance:

Cleveland, Ohio

Engaging the Community in New Approaches to Health Housing in Cleveland, Ohio is:• Creating a Healthy Homes Zone• Enacting prevention-based housing maintenance• Determining feasibility of HMO reimbursements for

asthma home visits

Key Partners• Environmental Health Watch• The MetroHealth System• Cleveland Department of Public Health

In partnership with:• Stockyards Clark-Fulton Brooklyn Center• The Cleveland Building and Housing Department• The Hispanic Alliance and Spanish American

Community• Cuyahoga Place Matters Team• HIP-C (a consortium of 50 partners)

Action Plan:ECNAHH seeks to improve asthma and lead poisoning outcomes related to unhealthy housing, as well as COPD and injury prevention.

Look out for an announcement of a 2nd call for applications soon!

National Meeting:

“we see CMS as playing a catalytic role. By embedding population-based strategies in our programs and policies, CMS can help drive transformation that aligns health care systems with public healthand social service systems and thereby accelerate progress to- ward improved health for our whole country.”

Payors are paying attention – especially CMS:

U.S. Health Care Payments in APMs

Source: Primary Care Payment Models Draft White Paper. Written by: The Primary Care Payment Model (PCPM) Workgroup. Draft for Public Release-Version Date: 10/19/2016

Structural Components of PCPMs in Relation to the APM Framework

Source: Primary Care Payment Models Draft White Paper. Written by: The Primary Care Payment Model (PCPM) Workgroup. Draft for Public Release-Version Date: 10/19/2016

Source: Primary Care Payment Models Draft White Paper. Written by: The Primary Care Payment Model (PCPM) Workgroup. Draft for Public Release-Version Date: 10/19/2016

Supporting AAFP State Chapter Efforts to Collaborate and Integrate for Population Health

Partnerships and consulting:

Schools of Public Health: Population Health and Workforce Development

Mid-level practitioners using the PPB