INSTITUTE FOR POPULATION HEALTH
IMPROVEMENT: An Overview
Kenneth W. Kizer, MD, MPH
California Cancer Registry Directors Meeting
Sacramento, CA
May 22, 2013
Presentation Objectives
 Provide a brief overview of the Institute for Population
Health Improvement and its present portfolio
 Highlight selected cancer-related activities and
opportunities
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WHAT IS THE
INSTITUTE FOR POPULATION HEALTH
IMPROVEMENT?
Population health refers to the overall
health status or net health outcomes for
a defined group of persons resulting from
the combination of health care, public
health, and the social and environmental
determinants of health.
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Population health management refers to
purposeful design of active and ongoing
efforts to integrate and align health care
delivery, public health interventions, and
the social and environmental determinants
of health to achieve a desired health
outcome in a defined group of persons.
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Institute for Population Health Improvement
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Established as an independent operating unit in the UCDHS in mid2011; has since developed a diverse portfolio of funded activities
>$71M and >100 FTE and consultants
New value-based health care payment models require that
population health management be a core competency for health
care systems
Serves as a resource for:
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Health care reform
Clinical quality improvement
Building health leadership capacity
Developing clinical intelligence
Health policy
To date, work has primarily focused on assisting government healthrelated agencies and philanthropies design, implement, administer
and/or evaluate programs
Promotes understanding of the multiple determinants of health and
appreciation of health being a function of the totality of one’s
circumstances
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Selected IPHI Activities
 Provide technical assistance and thought leadership in quality
improvement to the state Department of Health Care Services for
Medi-Cal (California’s $60B/yr Medicaid program)
 Medi-Cal Quality Improvement Program
 Evaluate the Delivery System Reform Incentive Payments (DSRIP) Program
 Design the CA-specific Evaluation of the California Medicare-Medicaid Dual
Eligible Demonstration Program
 Manage operations of the California Cancer Registry
 Manage the California Health eQuality (CHeQ) Program - California’s
Health Information Exchange Development Program
 Provide technical assistance and support for multiple CDPH
statewide chronic disease prevention and surveillance programs
 Conducting a statewide assessment of surgical adverse events
 Conducting population health research projects
 Approaches to prevention of prescription opioid use (with CHPR)
 Use of the Oncotype Dx Assay in Medi-Cal beneficiaries with breast cancer
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Selected IPHI Activities
 Investigating the feasibility of developing Community Paramedicine
in California
 Assist CDPH achieve accreditation
 Develop a basic QI training program for all CDPH employees
 Partnering with California Health & Human Services Agency on a
CMMI-funded Payment Reform Model for the California
 $2.3M 6-month planning grant received in Mar 2013
 Anticipate submitting a $60M 3-year implementation proposal before Dec 2013
 IPHI asked to join the hACT for the new $1B HHS/CMS Health FFRDC
managed by MITRE
 Establishing a Center for Veterans and Military Health
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IPHI’s Strategic Aspirations
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Identify and promote inter- or cross-programmatic
opportunities for collaboration and synergy
Mobilize and leverage data to create actionable clinical
and population health intelligence that can be used for
health improvement
Promote understanding of the multiple determinants of
health and appreciation of health being a function of the
totality of one’s circumstances
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SOME EMERGING
OPPORTUNITIES
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Trusted Exchange
Infrastructure
$1 million
Integrating Clinical Care
with Public Health
Increasing
Public Health
Capacity
$1.8 million
$0.7 million
California
Health eQuality
$16.6 million
Accelerating HIE
Adoption
Federal HIE Funds
Monitoring HIE
Adoption
$4 million
$0.9 million
Communications
and Education
$0.6 million
Personnel
$4.1 million
Operations
$1 million
Indirects
$2.5 million
Project INSPIRE
Integrating Clinical Care with Public Health
Project INSPIRE
INSPIRE – INteroperability to Support Practice
Improvement, Disease REgistries, and Care Coordination
Improve the acquisition and exchange of patient
data for high impact conditions in order to
support care coordination, practice
improvement and longitudinal disease registries
INSPIRE’s Two Initiatives
1. Next Generation Registries
2. The “Health Information Home”
Next Generation Disease Registries:
Transforming Disease Registries With EHRs and HIE
Problem
 Registry reporting utilizes manual abstraction from charts –
expensive and slow
 Registry knowledge of a new cancer takes 24-36 months, which
significantly impacts data usability
 Data needed by registries are also needed to provide good care
Opportunity  Structured data capture from EHRs and transfer through
HIEs can dramatically improve registry case ascertainment
while also improving care coordination for cancer patients
Solution
 Implement EHR-based capture of structured breast cancer case
data at point-of-care from clinicians in the Athena Breast Health
Network
 Demonstrate use of new HL-7/ASCO “clinical oncology data
exchange standards”
 Demonstrate the benefits of making the same case data
available for both registries and clinical care
The “Health Information Home” -
Improving Care with an HIE Document Repository
Problem
 Patients with high impact conditions receive care from multiple
providers across time and space
 No provider has a complete view of the patient record
 This leads to poor care coordination, duplicative testing, errors
of omission, and missed opportunities for health improvement
Opportunity  A “health information home” will facilitate accountable care
by providing a shared common view of the patient for all
providers
 Data going to disease registries has clinical care value
Solution
 Implement a “health information home” using HIE technology
 Make the health information home accessible to providers as an
HIE ‘node’ for population health management
 Work with providers to have registry-bound data sent to the
health information home
 Use standards-based data transfer
NOT WHAT IT USED TO BE!