AAMC/CDC/Fullerton Sponsored
Population Health Improvement Leadership
Tuesday, September 16, 2014
3:00-4:00 pm
Agenda

Practical Playbook Use Cases

Health Care System Transformation in Oregon

Helping Training Programs Learn About Population Health
Activities in Their Communities
Lara Snyder
Katrina Hedberg
Lloyd Michener
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
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
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
Oregon’s Health Systems
Transformation:
Role for Public Health
Katrina Hedberg, MD, MPH
Oregon Public Health Officer
September 16, 2014
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
Public Health Division
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Health Care Reform in Oregon
Public Health Division
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Oregon’s Coordinated Care
• Governor’s vision
• Robust public process
• Medicaid clients
• Federal CMS waiver
approved - $1.9B
• 16 CCOs cover state
Public Health Division
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PUBLIC HEALTH DIVISION
Office of the State Public Health Director
Health SystemTransformation
Benefits and
services are
integrated and
coordinated
One global budget
that grows at a
fixed rate
Local
accountability for
health and budget
Metrics: standards
for safe and
effective care
Local flexibility
Public Health Division
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Health SystemTransformation
Benefits and
services are
integrated and
coordinated
One global budget
that grows at a
fixed rate
Local
accountability for
health and budget
Metrics: standards
for safe and
effective care
Local flexibility
Public Health Division
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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
Public Health Division
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Public Health/ Health Care
Integration
Public Health Division
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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
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
Public Health Division
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CCO Measurement Strategy
Multiple measure sets, with overlap
• 33 State Performance Measures
• 17 CCO Incentive Measures
• 16 Core Performance Measures
Public Health Division
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CCO Incentive Measures
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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
Public Health Division
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Core Performance Measures
Population Health-focused
•
•
•
•
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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
Public Health Division
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Possible PH Incentive Metrics
• Tobacco prevalence
• Obesity prevalence
• Vaccine receipt: influenza
• Vaccine receipt: HPV
• HIV screening
• Teen pregnancy rates
Public Health Division
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20
percent
Cigarette Use by Insurance
Oregon, 2012
Public Health Division
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36% Range: 23%-42%
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
Public Health Division
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Operationalization
• Assess smoking status
• Advise to quit
• Evidence-based smoking
cessation Rx
• Tobacco-free campuses
• Partner with LHD tobacco
control
Public Health Division
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Obesity in Oregon
New BRFSS weighting
method began in 2010.
Public Health Division
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Source: Oregon BRFSS and Oregon Healthy Teens Survey
Oregon Diabetes Prevalence
New BRFSS weighting
method began in 2010.
Public Health Division
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percent
Obesity by Insurance
Oregon, 2012
Public Health Division
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40%
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
Public Health Division
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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
Public Health Division
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Possible PH Incentive Metrics
• Tobacco prevalence
• Obesity prevalence
• Vaccine receipt: influenza
• Vaccine receipt: HPV
• HIV screening
• Teen pregnancy rates
Public Health Division
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State Innovation Model Funds
for Public Health:
Public Health Division
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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
Public Health Division
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SIM Funds for Epidemiology
• State Innovation Model grant
• Analysis of state health profile by
– CCO region
– Race/ ethnicity
• Medicaid BRFSS
Public Health Division
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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)
Public Health Division
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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
Public Health Division
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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
Public Health Division
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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
Public Health Division
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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
Public Health Division
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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
Public Health Division
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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
Public Health Division
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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
Public Health Division
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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
Public Health Division
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Questions?
Public Health Division
Current CMMI Projects in the U.S.