National Perspective on Changes
Impacting the Public Health System
2014 North Carolina State Health Director’s Conference
Raleigh, NC
January 23, 2014
Judith A. Monroe, MD
Director, Office for State, Tribal, Local and Territorial Support
Deputy Director, Centers for Disease Control and Prevention
1964
2014
CDC Strategic Directions
Improve
health
security at
home and
around the
world
Better prevent
the leading
causes of
illness, injury,
disability, and
death
Strengthen public health/
health care collaboration
Key Features of Affordable Care Act
“Simply put, in the absence of a radical shift towards
prevention and public health, we will not be successful
in containing medical costs or improving the health of
the American people.” - President Obama
“…health strategies, interventions, and
policies applied at the population level can
advance current approaches to our nation’s
most pressing health concerns more
efficiently and effectively than can isolated,
intensive individual-level actions within the
clinical care sector.”
-Institute of Medicine
IOM Activities with Implications for
Population Health in the ACA
• Primary Care and Public Health: Exploring
Integration to Improve Population Health
• Valuing Community-based, Non-clinical
Prevention Policies and Wellness Strategies
• For the Public’s Health: The Role of
Measurement in Action and Accountability
• The Best Care at Lower Cost: The Path to
Continuous Learning Health Care in America
• Roundtable on Health Literacy
IOM Activities with Implications for
Population Health in the ACA (cont’d)
• Quality Measures for the Healthy People
Leading Health Indicators
• Living Well with Chronic Disease: Public
Health Action to Reduce Disability and
Improve Functioning and Quality of Life
• Roundtable on the Promotion of Health
Equity and the Elimination of Health
Disparities
Resources to Prevent Illness
& Keep People Healthy
• Expanded Insurance Coverage
• Prevention Services
• Innovation Models
• Health Equity
• Health Workforce Incentives
• Health Homes
Resources to Prevent Illness
& Keep People Healthy (cont’d)
• Community benefits accountability
• Community Transformation Grants
• National Prevention Strategy
More Spending, Less Health
Prevention: 3%
Behaviors &
Environment:
70%
Health Care
Services: 97%
Genetics: 20%
Medical Care: 10%
Factors Influencing
Health
National Health
Expenditures
References: Bipartisan Policy Center. “Lots to Lose: How America’s Health and Obesity Crisis
Threatens our Economic Future.” June 2012
Overview of Heath System
Transformation
Health Delivery System Transformation Critical Path
Community Integrated Healthcare
System 3.0
Coordinated Seamless Healthcare
System 2.0
Community Integrated
Healthcare
Acute Care System 1.0
Outcome Accountable
Care

Episodic Non-Integrated Care








Episodic health care
Lack integrated care networks
Lack quality and cost performance
transparency
Poorly coordinate chronic care
management
Source: Neal Halfon, UCLA Center for Healthier Children, Families & Communities




Patient/person centered
Transparent cost and quality
performance
Accountable provider networks
designed around the patient
Shared financial risk
HIT integrated
Focus on care management and
preventive care




Healthy population centered
Population health focused strategies
Integrated networks linked to
community resources capable of
addressing psycho social/ economic
needs
Population-based reimbursement
Learning organization capable of
rapid deployment of best practices
Community health integrated
E-health and telehealth capable
Opportunities to Improve Population Health
Through ACA Implementation
• Integrate population health into the
healthcare system
• Elevate the priority for primary
prevention and health equity
• Empower consumers & communities to
improve health outcomes
• Improve quality and access via language and
cultural competence
Opportunities to Improve Population Health
Through ACA Implementation (cont’d)
• Bridge clinical care and community
health in health homes
• Strengthen the safety net to also serve the
remaining uncovered
• Increase capacity and fix mal-distribution
of workforce
• Incentivize workplace wellness
Opportunities to Improve Population Health
Through ACA Implementation (cont’d)
• Replicate Community Transformation
Grants and Innovation Models
• Community benefits for population
health programs
The Center for Medicare & Medicaid Innovation (the
Innovation Center) with CMS supports the development and
testing of innovative health care payment and service
delivery models.
2013
A Practical Playbook:
Public Health and Primary Care Together
National Public Health
Improvement Initiative
The National Public Health Improvement Initiative
(NPHII) provides support to health departments or
their bona fide agents for
•Accelerating public health accreditation readiness activities
• Implementing performance and improvement management
practices and systems
• Implementing and sharing practice-based evidence
“Health Departments in a Brave New World”
-Christopher Maylahn , David Fleming, Guthrie Birkhead (Prev Chronic Dis 2013)
Centers for Disease Control and Prevention
1600 Clifton Road NE, Atlanta, GA 30333
Phone: 1-800-CDC-INFO (232-4636)/TTY: 1-888-232-6348
E-mail: cdcinfo@cdc.gov
Web: www.cdc.gov