Marketing Prevention,
Health & Wellness for
the New Healthcare
Environment
Presented by
Patrick Gauthier, Director
Objectives
• Review the current state:
o A bifurcated prevention system
• Explore the future state
Discussion: Current State
SAPTBG
Future State
Chronic Care Model
Well-Being
Population Health Management
ACA: Reforming Prevention
New Markets
Key Concepts
• Fear, anxiety and uncertainty are normal reactions to
abnormal events
• These are abnormal times and abnormal events are
unfolding around us with increasing frequency
• The Information Age, the Great Recession, Health
Care Reform, elections, wars, and globalization
represent a lot co-occurring abnormal conditions
• Complexity, volatility and paradigm-shifting ensue
Key Concepts
• This is your field. You worked hard to get here.
• This field was carved from the stone of ignorance
and fear and discrimination
• We’ve won important Civil Rights battles in the
form of the ADA, COBRA, HIPAA, EMTALA,
MHPAEA and now the PPACA
• Our work is not done yet. Far from it!
• More to come for those who can perceive the
opportunities and mobilize their resources despite
the fear and uncertainty.
Key Concepts
• Discontinuity and Disruption (P. Druker)
• Instability (A. Toffler)
• Decay and Irrelevance (G. Hammel)
• Tipping Point (M. Gladwell)
• Strategic Inflection Point (A. Grove)
• Value Migration (A. Slywotzky)
• Disruptive Innovation (C. Christensen)
Open Space
What keeps you up at night?
What’s the worst that can happen?
What do you want to do?
What would you rather do?
What’s stopping you?
What do you need?
What does it mean to be Partners?
Rational Reform
• Public health concerns and patient needs have been
on a collision course with economic reality and burden
of healthcare
10
8
• Conditions are Ripe for Innovation
2010
2008
2004
2002
0
2000
$0
1998
2
1996
$1,000
1994
4
1980
1982
1984
1986
1988
1990
1992
1994
1996
1998
2000
2002
2004
2006
2008
2010
$2,000
1992
6
2006
US
NETH
FR
GER
CAN
SWIZ
UK
JPN
1990
$3,000
12
1988
$4,000
14
1986
$5,000
Total health expenditures as
percent of GDP
16
1984
$6,000
18
1982
$7,000
Average spending on health
per capita ($US PPP)
US
SWIZ
NETH
CAN
GER
FR
AUS
UK
JPN
1980
$8,000
Problem: Causes of Premature Death
in the General Population
Proportional Contribution to Premature
Death
Genetic
disposition
30%
40%
10% 5%
15%
Social
circumstances
Environmental
exposure
Health care
Behavioral
patterns
N Engl J Med. 2007 Sep 20;357(12):1221-8.
Health Care Costs Concentrated in Sick Few—
Sickest 10 Percent Account for 65 Percent of Expenses
Distribution of health expenditures for the U.S. population,
by magnitude of expenditure, 2009
Annual mean
expenditure
1%
5%
10%
22%
50%
50%
$90,061
$40,682
65%
$26,767
97%
$7,978
Source: Agency for Healthcare Research and Quality analysis of 2009 Medical Expenditure Panel Survey.
Solution: Applying the
Chronic Care Model
•
•
•
•
Developing an Informed, Activated Patient
Using Information Technology
Developing a Prepared, Proactive Practice Team
Reorganizing Healthcare System to Include
Prevention, Health and Wellness
Health & Wellness
Health
Disease
• Prevent or minimize
disease, disability, injury
Most public health activities
• Build resources, reserves, function, &
competencies to promote & protect
physical and mental assets for health
• Promote conditions that foster
healthy development; satisfying and
productive lives
• Implies greater attention to “positive
health/mental health”
More public health + other stakeholder activities
Breslow, 2006; Antonovsky, 1979; Keyes, 2007
Health & Wellness
Disease
Prevention
“…avoid or minimize
pathological conditions.”
Population Health
Fosters individual
competencies, resources,
and psychological strengths,
and strengthens community
assets to prevent mental
disorder and enhance wellbeing and QOL (Herrmann et
al. 2005; Barry & Jenkins 2007;
Friedli, 2009)
Health & Wellness
Assets for full, productive,
satisfying life
• Positive emotions
• Meaning/fulfillment
• Satisfying relationships
• Autonomy, mastery,
• Achievement
• Physical vitality
• Community supports
(e.g., employment; access
to care; housing; parks)
“PERMA”
(Seligman 2011)
“FLOURISHING”
(Keyes, 2007)
“Positive Mental
Health” (WHO, 2005,
2009; Barry & Jenkins
2007)
Health is the ability to adapt and self-manage
in the face of social, physical, and emotional
challenges (Huber et al., 2011)
Well-Being:
the Public Health Approach
• Well-being integrates mental health (mind) and
physical health (body) resulting in more holistic
approaches to disease prevention and health
promotion.
• Well-being is a valid population outcome measure
beyond morbidity, mortality, and economic status
that tells us how people perceive their life is going
from their own perspective.
• Well-being is an outcome that is meaningful to the
public.
Well-Being
• Advances in psychology, neuroscience, and
measurement theory suggest that well-being can
be measured with some degree of accuracy.
• Results from cross-sectional, longitudinal and
experimental studies find that well-being is
associated with:
o
o
o
o
o
o
o
Self-perceived health
Longevity
Healthy behaviors
Mental and physical illness
Social connectedness
Productivity
Factors in the physical and social environment
Well-Being
• Well-being can provide a common metric that can
help policy makers shape and compare the effects
of different policies (e.g., loss of green space might
impact well-being more so than commercial
development of an area).
• Measuring, tracking and promoting well-being can
be useful for multiple stakeholders involved in
disease prevention and health promotion.
Well-Being
• In this sense, health enables social, economic and
personal development fundamental to well-being.
• Health promotion is the process of enabling people to
increase control over, and to improve their health.
• Environmental and social resources for health can
include: peace, economic security, a stable ecosystem,
and safe housing.
• Individual resources for health can include: physical
activity, healthful diet, social ties, resiliency, positive
emotions, and autonomy. Health promotion activities
aimed at strengthening such individual, environmental
and social resources may ultimately improve well-being.
Well-Being
“Well-Being is a dynamic state where one maximizes his or
her physical, mental, and social functioning in supportive
environments to live a full, satisfying and productive life.”
(CDC Well-being Work group 2010)
• Integrates psychological notions of well-being with
positive physical health for greater health impact
• Links health with the places where people live,
learn, work and play
• Points to the roles and opportunities for multiple
social sectors to affect well-being
• Grounded in health equity & social justice:
disadvantaged individuals may face more unfair
obstacles in maximizing well-being
CDC Measures of
Well-Being
Survey
Questionnaires/questions
National Health and Nutrition
Examination Survey (NHANES)
General Well-Being Schedule (1971–1975)
•
National Health Interview Survey •
•
(NHIS)
•
Quality of Well-being Scale
Global life satisfaction
Satisfaction with emotional and social support
Feeling happy in the past 30 days
Behavioral Risk Factor
Surveillance System (BRFSS)
Global life satisfaction
Satisfaction with emotional and social support
•
•
•
•
Porter Novelli Healthstyles Survey •
•
•
•
Satisfaction with Life Scale
Meaning in life
Autonomy, competence, and relatedness
Overall and domain specific life satisfaction
Overall happiness
Positive and Negative Affect Scale
Population Behavioral
Health Promotion
• Employment opportunities
• Safe, affordable housing
• Social inclusion & anti-discriminatory
policies
• Positive parenting/early childhood
development interventions
• Active living
• Public transportation
• Parks to encourage social
connectedness, access to nature
and physical activity
• Taxation of addictive substances
• Healthy school environments
The ACA Promotes Prevention and Wellness
for All Americans
•
The new law ensures all Americans receive critical clinical and
community preventive services and makes public health and prevention
a permanent part of the health care system by:
o Eliminating cost sharing on recommended preventive services delivered by
Medicare and all new insurance plans;
o Providing coverage under Medicare—with no co-payment or deductible—for
an annual wellness visit that includes a comprehensive health risk assessment
and 5-10 year personalized prevention plan;
o Providing enhanced federal Medicaid matching funds to states who offer
evidence-based prevention services and requiring coverage of tobacco
cessation services for pregnant women in Medicaid; and,
o Delivering community preventive services by investing in state, territorial, and
local public health infrastructure and by providing grants to implement
recommended services.
Reform Highlights
1.
2.
3.
4.
5.
6.
7.
8.
Insurance Market Reform
Coverage Requirements
Health Insurance Exchange
Payment Reform and Care Coordination
National Quality Strategy
Prevention & Public Health
Long Term Care
Workforce Development
ACA Prevention Benefits
Covered Preventive Services for Adults
• Abdominal Aortic Aneurysm one-time screening for men of specified ages
who have ever smoked
• Alcohol Misuse screening and counseling
• Aspirin use for men and women of certain ages
• Blood Pressure screening for all adults
• Cholesterol screening for adults of certain ages or at higher risk
• Colorectal Cancer screening for adults over 50
• Depression screening
• Type 2 Diabetes screening for adults with high blood pressure
• Diet counseling for adults at higher risk for chronic disease
• HIV screening for all adults at higher risk
• Immunization vaccines for adults--doses, recommended ages, and
recommended populations
A New Commitment to Prevention
• The Affordable Care Act signed into law by
President Obama creates a National Prevention,
Health Promotion, and Public Health Council.
• The Council will elevate and coordinate prevention
activities and design a focused National Prevention
and Health Promotion Strategy in conjunction with
communities across the country to promote the
nation’s health.
• The Strategy will take a community health approach
to prevention and well-being – identifying and
prioritizing actions across government and between
sectors.
Prevention in Reform
• There is a very strong emphasis on prevention in the ACA
including enhanced access to care by requiring insurance
companies to cover evidence-based preventive services
and eliminating co-payments for many of those services.
• The ACA also provides increased provider access and
choice, as well as federal funding for programs with
extraordinary track records of reducing problems for
children later in life.
• The focus on primary and preventive care in the ACA will
help improve health outcomes for consumers
Investing in Prevention: The New National
Prevention, Health Promotion
and Public Health Council
•
Chronic diseases – such as heart disease, cancer, stroke, and
diabetes – are responsible for 7 of 10 deaths among
Americans each year and account for 75% of the nation’s
health spending. Often due to economic, social, and
physical factors, too many Americans engage in behaviors –
such as tobacco use, poor diet, physical inactivity, and
alcohol abuse – that lead to poor health.
•
A focus on prevention will offer our nation the opportunity to
not only improve the health of Americans but also help
reduce health care costs and improve quality of care. By
concentrating on the underlying drivers of chronic disease,
the Affordable Care Act helps us move from today’s sickcare system to a true “health care” system that encourages
health and well-being.
The Council will:
• Provide coordination and leadership to ensure the
government is focused on improving prevention, wellness,
and health promotion practices.
• With continual public input, make recommendations to the
President and the Congress concerning the most pressing
health issues confronting the nation and changes in federal
policy to achieve national health promotion, and public
health goals, including the reduction of tobacco use,
sedentary behavior, and poor nutrition.
The Advisory Group
on Prevention, Health Promotion,
and Integrative and Public Health
• As required by the Act, the President will establish an
Advisory Group on Prevention, Health Promotion,
and Integrative and Public Health to help develop
the new Strategy.
• The Advisory Group will reside within the
Department of Health and Human Services (HHS)
and report to the Surgeon General.
• It will have up to 25 non-federal members
appointed by the President who will develop policy
and program recommendations and advise the
Council on lifestyle-based chronic disease
prevention and management, integrative health
care practices, and health promotion.
Developing the
National Prevention and
Health Promotion Strategy
• After obtaining ideas from relevant stakeholders
and working closely with the Advisory Group, the
Council will devise a National Prevention and
Health Promotion Strategy that will:
o Set specific goals, measurable actions and timelines to
carry out the strategy to reduce the incidence of
preventable illness and disability in the U.S. and promote
health and well-being, and;
o Make recommendations to improve federal efforts
relating to prevention, health promotion, public health,
and integrative health-care practices to ensure that
federal efforts are consistent with available standards
and evidence.
Guiding Principals for Establishing the
Prevention Strategy
1. Prioritize Prevention & Wellness
2. Establish a Cohesive Federal Response
3. Focus on Leading Causes and Factors of
Preventable Death
4. Prioritize High-Impact Interventions
5. Promote High-Value Practices
6. Promote Health Equity
7. Promote Alignment Between Public and Private
Systems
8. Ensure Accountability
Focus on Five
Leading Causes of Death
•
•
•
•
•
Heart Disease
Cancers
Stroke
Chronic Lower Respiratory Disease
Unintentional Injuries
How is each impacted by SUD?
What can you do to make the case for the prevention
services you provide?
Prevention Measures that Address the
Underlying Causes of Death
•
•
•
•
Reduce Tobacco Use
Improve Nutrition
Increase Physical Activity
Reduce Underage Drinking and SUD
Public Health Investment Fund
(the “Fund”)
• This new initiative has new resources – $12.5
billion over ten years (FY2013-FY2022) in
mandatory spending – to expand and sustain
the necessary infrastructure to prevent
disease, detect it early, and manage
conditions before they become severe.
• Fund is dedicated to improving community
and clinical prevention efforts, strengthening
public health infrastructure, improving
research and data collection and bolstering
the training of public health and primary care
professionals.
The Fund
•
The legislation finances proven community-based
prevention programs targeting public health problems
such as tobacco use and obesity. Americans spend more
than $2 trillion a year to treat disease and manage
illnesses, and almost three quarters of that money is spent
on caring for people whose illnesses we know how to
prevent.
• Fiscal Year Allocation:
o
o
o
o
o
o
•
FY10: $500 million
FY11: $750 million
FY2012-FY2017: $1 billion
FY2018-FY2019: $1.25 billion
FY2020-FY2021: $1.5 billion
FY2022 and each fiscal year after: $2 billion
Effective prevention will mean fewer premature deaths,
less disease and more cost-effective health care
spending.
SAMHSA’s Position on
ACA Prevention
1. It will provide preventive care with no cost to Medicare
beneficiaries.
2. Eliminating cost-sharing on recommended preventive
services delivered by Medicaid, Medicare and Health
Insurance Exchange plans.
3. Allowing Medicare payments for annual wellness visits
including assessment and recommendations to address
mental health conditions or risks.
4. Establishing a community based prevention and
wellness grant program for individuals aged 55 to 64
years of age. Targeted actions may include improving
mental health or reducing tobacco and substance
use. Program also includes screening activities for
mental health and substance use disorders.
5. Establishes a national public-private outreach and
education campaign regarding prevention benefits.
Example: Postpartum Depression
Research and Services
• The Affordable Care Act recognizes the distress
experienced by families resulting from postpartum
depression and psychosis, and offers provisions aimed at
providing support, education and research activities to
address these conditions. The law authorizes grants to
states for the establishment, operation and coordination of
effective and cost-efficient systems for the delivery of
essential services to individuals with or at risk for postpartum
conditions and their families.
Example: Early Childhood
Home Visitation Program
•
•
•
One of the most promising areas of mental health
prevention and early intervention is early childhood home
visits by health care workers.
A considerable body of research has shown that this
improves the social and emotional development of very
young children and enables identification of mental
health problems in infants and toddlers.
The Affordable Care Act promotes the expansion of these
programs through a new section added to the Maternal
and Child Health block grant program (Title V of the
Social Security Act) that requires states to conduct needs
assessments to determine which communities are most at
risk for poor maternal and child health and have few
quality home visitation programs. The assessment would
also evaluate the state’s capacity to provide necessary
and appropriate services to communities at risk.
Healthy Lifestyles
•
The law includes incentives for states to fund initiatives to
prevent chronic diseases among Medicaid beneficiaries.
In 2011, States were awarded five- year grants to provide
incentives to Medicaid beneficiaries who participate in
comprehensive, evidence-based, widely available and
easily accessible programs aimed at encouraging healthy
lifestyles.
•
These programs address all co-morbid conditions, and
depression is specifically mentioned as an included
condition. HHS will develop criteria for programs, based
on recent evidence, and programs will be required to
show improved outcomes, including cessation of
tobacco use, decreased blood pressure and cholesterol,
and prevention of diabetes.
New Prevention Benefits
• Depression Screening
• Alcohol and Other Drug Use/Abuse and
Dependence Screening – Adult and Adolescent
Plans must provide first-dollar coverage
Prevention in Commercial Health
Insurance
Hospital and Provider Quality Comparisons online
Personal Health Records (PHR)
Coverage Advisors
Treatment Advisors
Nurse Line
Health Risk Assessments and Health Risk Management
Programs with Incentives ($)
• Disease Management Programs
• Patient-Centered Medical Homes
•
•
•
•
•
•
Prevention in Commercial Health
Insurance
Be Smart. Be Well. Health and Wellness : Health Care Service
Corporation
Be Smart Be Well is an innovative, interactive, health, and wellness website. The website is
dedicated to raising awareness of health issues that are largely preventable or best
addressed through early intervention.
Caring Place: A Center for Grieving Children, Adolescents, and Their
Families: Highmark, Inc.
The Highmark Caring Place, A Center for Grieving Children, Adolescents, and Their Families is
a safe place where grieving children and families can come together and be with others
who understand what they're going through.
Fitness for Kids: Independent Health
Fitness for Kids is an innovative program designed to foster the development of healthy habits
among Western New York's youth to improve their health and plant the seeds for a lifetime
commitment to good health.
Prevention in Commercial Health
Insurance
• Blue KC: Independence School District, Missouri, Becomes First
School District in Nation to Tackle Student Weight Issues with
MEND 7-13, a Healthy Lifestyle Program
• Youth Are Invited to “Step into Service” as UnitedHealth
HEROES to Fight Childhood Obesity
• PureWellness Enables Continuity of Care Document (CCD)
Integration for Wellness and Prevention Records
Prevention in Commercial Health
Insurance
Prevention in Commercial Health
Insurance
Prevention in Commercial Health
Insurance
Opportunities
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•
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•
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•
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Obesity
Smoking Cessation
Asthma
Childhood Trauma
Mental Health Disorders
Heart Disease
Cancers
Stroke
Respiratory Disease
Unintentional Injuries and Accidents
http://www.cdc.gov/hr
qol
Thank You!
Patrick Gauthier
Director
888-898-3280 ext. 802
pgauthier@ahpnet.com