all final presentations 5-30-13

The First Northern Virginia Health SummitWhere Are We, and Where Could We Go?

Friday, May 31, 2013

Where Are We? Review of Northern Virginia Health Indicators

Patricia N. Mathews, President & CEO, Northern Virginia Health Foundation

May 31, 2013

Northern Virginia Health Summit

County Health Rankings for Northern Virginia

Indicator Alexandria City of

Arlington County

Fairfax City of

Fairfax County

Estimated Population (2012)

144,055 214,681 22,899 1,108,149

Health Outcomes Rank

8 3 55 1

(Ranking figures indicate rank among 133 Virginia cities and counties, where 1 = best)

May 31, 2013

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Source: Population estimates: Community Health Solutions analysis of data from Alterzx, Inc. Rankings: Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute. www.countyhealthrankings.org.

Northern Virginia Health Summit

County Health Rankings for Northern Virginia (cont.)

IndicatorFalls

Church City of

Loudoun County

Manassas City of

Manassas Park

City of

Prince William County

Estimated Population(2012)

13,028 331,662 39,372 15,210 424,232

Health Outcomes Rank

16 2 7 9 10

(Ranking figures indicate rank among 133 Virginia cities and counties, where 1 = best)

May 31, 2013

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Source: Population estimates: Community Health Solutions analysis of data from Alterzx, Inc. Rankings: Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute. www.countyhealthrankings.org.

Northern Virginia Health Summit

Prenatal Care

May 31, 2013

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Counts (2011) Total Live Births Births w/o Early Prenatal CareRegion Total 33,921 5,189

Alexandria (City of) 2,632 502

Arlington County 3,049 637

Fairfax (City of) 496 72

Fairfax County 15,148 2,110

Falls Church (City of) 148 17

Loudoun County 4,970 443

Manassas (City of) 721 188

Manassas Park (City of) 66 18

Prince William County 6,691 1,202

Virginia 102,525 13,500

Source: Community Health Solutions analysis of Virginia Dept. of Health birth record data (2011).

Northern Virginia Health Summit

Adult Risk FactorsRate Estimates (2012) Overweight or Obese At Risk for Binge Drinking

Region Total 58% 20%

Alexandria (City of) 60% 18%

Arlington County 59% 20%

Fairfax (City of) 58% 21%

Fairfax County 59% 19%

Falls Church (City of) 61% 15%

Loudoun County 57% 21%

Manassas (City of) 60% 21%

Manassas Park (City of) 58% 20%

Prince William County 57% 23%

Virginia 62% 18%

May 31, 2013

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Source: Community Health Solutions analysis of data from Va. Behavioral Risk Factor Surveillance System (2006-2010).

Northern Virginia Health Summit

Youth Risk FactorsRate Estimates (2012) Felt Sad or Hopeless for Two or More Weeks in a Row

Region Total 25%

Alexandria (City of) 26%

Arlington County 26%

Fairfax (City of) 25%

Fairfax County 25%

Falls Church (City of) 25%

Loudoun County 25%

Manassas (City of) 26%

Manassas Park (City of) 26%

Prince William County 26%

Virginia 25%

May 31, 2013

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Source: Community Health Solutions analysis of data from CDC (2011).

Northern Virginia Health Summit

Oral HealthRate Estimates (2012)

Children Age 0-17 with No Dental Visit in Past Year

Adults Age 18+ with No Dental Visit in Last

Two Years

Region Total 22% 24%

Alexandria (City of) 22% 21%

Arlington County 22% 24%

Fairfax (City of) 22% 24%

Fairfax County 22% 23%

Falls Church (City of) 21% 21%

Loudoun County 21% 25%

Manassas (City of) 24% 22%

Manassas Park (City of) 24% 17%

Prince William County 22% 25%

Virginia 21% 22%

May 31, 2013

8Source: Community Health Solutions analysis of CDC data.

Northern Virginia Health Summit

Health Opportunity Index (HOI) for Northern Virginia

May 31, 2013

9Virginia Atlas of Community Health (Forthcoming Summer 2013), Geo Health Innovations and Community Health Solutions, Inc.

Where Innovation Is Tradition

Health Reform: Where is the Commonwealth

NOW?

Len M. Nichols, Ph.D.

Center for Health Policy Research and Ethics

The First Northern Virginia Health Summit

Springfield, VA

May 31, 2013

Review reform climate • Virginia voted for Obama, twice

(and Sens. Webb and Kaine, respectively)

• McDonnell elected Governor in 2009, Rs gained Senate split 20-20 after 2011 elections

• AG Cuccinelli first to file suit against ACA• 26 person VHRI appointed by Gov, led by Sec.

Hazel, recommended, in December 2010:State-run exchangePrepare for Medicaid expansion, delivery reform

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Where Innovation Is Tradition

Post-Supreme Court decision on ACA• Created opportunity to oppose Obamacare in

the name of fiscal prudence for state• Argument undercut by 3 facts:

Feds would pay 100% of expansion population costs for 3 years, 90% thereafter

State would save money for 5-6 years, low cost thereafter compared to economic benefit to state

Chamber of Commerce of VA came to support Medicaid expansion

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Where Innovation Is Tradition

De Facto Partnership on Exchange

• McDonnell decided, after SCOTUS, to NOT apply for establishment grant for exchange

• Governor also did not want to use the word “partnership” in deal with Feds

• Feds have signaled willingness to let Virginia BOI do “plan management,” one key function of partnership exchanges

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Where Innovation Is Tradition

Medicaid possibilities• Created by Senate split and Gov.’s desire for

transportation signature achievement• Budget created Medicaid Innovation and

Reform Commission (MIRC)• MIRC has 12 members, 3/5 from each house

must vote YES to judgment that:ADEQUATE Medicaid reform progress is being

made to justify expansion in July of 2014

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Where Innovation Is Tradition

Delegate Appointees to MIRC• Steve Landes-R (Albemarle, Augusta,

Rockingham)• Jimmie Massie-R (Henrico)• John O’Bannon-R (Henrico, city of Richmond)• Beverly Sherwood-R (Frederick, Warren, city of

Winchester)• Johnny Joannou-D (cities of Chesepeake,

Norfolk, Portsmouth, Suffolk)

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Where Innovation Is Tradition

Senate Appointees to MIRC

• Walter Stosch-R (Henrico, city of Richmond• Emmet Hanger-R (Augusta, Greene, Madison,

Rockingham, cities of Staunton and Waynesboro)• John Watkins-R (Powhatan, Chesterfield, city of

Richmond)• Janet Howell-D (Fairfax, Arlington)• Louise Lucas-D (Portsmouth).

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Where Innovation Is Tradition

Medicaid Reforms DMAS is pursuing

• Statewide managed care, including for ABD and foster children

• PACE expansion• Enhanced program integrity• Assessment requirements for CBHS• Dual eligibles financial alignment demonstration

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Where Innovation Is Tradition

Medicaid reforms DMAS is planning

• Comprehensive 1115 waiver to allow more coordination, streamline with private insurance features emerging in state employee, FAMIS, exchange, etc.

• Use payment reform to leverage tight, high quality networks

• Coordinate purchasing/delivery reforms in public-private partnership

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Virginia Health Innovation Center• Created in 2012 on 2010 recommendation of

Virginia Health Reform Initiative Advisory Council

• 501c3, housed at state Chamber of Commerce• Seed money from stakeholder associations• Surveyed providers, found 400 “examples,” now

has 6 task forces creating proposals for CMMIPCMH, integrating behavioral and acute, medication

management, care transitions, consumer engagement, bundles for babies

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Where Innovation Is Tradition

Summary

• Medicaid expansion depends on 2013 elections

• Delivery reforms and some coverage expansion through federal exchange will proceed

• Can collaboration replace individualism in time?

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Beyond Health Care

Northern Virginia Health SummitFairfax, VirginiaMay 31, 2013

Steven H. Woolf, MD, MPHVCU Center on Human Needs

Department of Family Medicine and Population HealthVirginia Commonwealth University

Higher Mortality Rates and Lower Life Expectancy

Mortality Rates by Cause of Death Life Expectancy

Beyond the Clinical Setting

WHO Conceptual Model

From: A Conceptual Model for Taking Action on the Social Determinants of Health. Geneva: World Health Organization, 2010

Role of Personal Health Behaviors

Cause Estimated deathsTobacco 400,000Diet/activity patterns 300,000Alcohol 100,000Microbial agents 90,000Toxic agents 60,000Firearms 35,000Sexual behavior 30,000Motor vehicles 25,000Illicit use of drugs 20,000

Source: McGinnis and Foege. JAMA 1993;270:2207-12.

Economic & SocialOpportunities and Resources

Living & Working Conditionsin Homes and Communities

PersonalBehavior

Medical Care

HEALTH

The importance of behavioral and social factors

Policies to promote

healthier homes, neighborhoods,

schools and workplaces

Policies to promote child and youth

development and education,

infancy through college

Policies to promote economic development and reduce

poverty

Robert Wood Johnson Foundation Commission to Build a Healthier America www.commissiononhealth.org

“Downstream” determinants

• Access to healthy foods• Physical activity

• Tobacco and alcohol• Healthy housing• Safe neighborhoods• Clean air and water• Safe working conditions

“Upstream determinants”

• Inadequate education• Unemployment• Declining income and net worth

19961997

19981999

20002001

2002

-50,000

0

50,000

100,000

150,000

200,000

250,000

Dea

ths

(per

yea

r) p

ote

nti

ally

av

erte

d i

n t

he

Un

ited

Sta

tes

Year

Deaths potentially averted by medical advances (see footnotes)

Deaths potentially averted by eliminating education-associated excess mortality (see footnotes)

Am J Public Health. 2007;97:679–683

Proportion of Deaths in Virginia Associated With Reduced Household Income

0

5

10

15

20

25

30

Proportion of deaths that would be

averted (%)

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

Am J Public Health. 2010;100:750-5

“Health in All” Policies

• Transportation• Land use• Built environment• Taxes• Housing• Agriculture• Environmental justice• Etc.

Health and illness

Annual Costs (Health Care And Program Spending), Three Layered Intervention Scenarios, Year 0 To Year 25.

Milstein B et al. Health Aff 2011;30:823-832

©2011 by Project HOPE - The People-to-People Health Foundation, Inc.

The House Bill would “save” approximately $1.516 billion per year between 2013 - 2017 and $1.78 billion per year between 2018 - 2022.

Increase in U.S. Poverty Rate

0.25% increase

0.50% increase

1.00% increase

Costs for diabetes care

$0.723 billion $1.473 billion $2.946 billion

Page County, Virginia

www.countyhealthcalculator.org

Contact Information

• Steven H. Woolf, MD, MPHCenter on Human NeedsDepartment of Family MedicineVirginia Commonwealth University804-828-9625

• swoolf@vcu.edu

MOBILIZING COMMUNITY PARTNERSHIPS TO IMPROVE PUBLIC

HEALTH

The First Northern Virginia Health Summit

Gloria Addo-Ayensu, MD, MPHDirector of Health, Fairfax County

May 31, 2013

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Human Services Agencies

Parks

Economic Developme

nt

Mass Transit

Employers

Nursing Homes

Mental Health

Drug Treatment

Civic GroupsCHCs

Laboratory

Facilities

Hospitals

EMS

Health Care

Providers

Health Departmen

t

Churches

Philanthropist

Elected Officials

Media

Schools

Police

Fire

Corrections

Environmental Health

Community Centers MCOs

Local Public Health System

Factors That Affect Health

Social Determinants of Health and other root causes of poor health

Changing the Contextto make individuals’ default

decisions healthy

Long-lasting Protective Interventions

ClinicalInterventions

Counseling & Education

Examples

Poverty, education, housing, inequality

Immunizations, brief intervention, cessation treatment, colonoscopySmoke-free laws, water fluoridation, restrictions on trans fats and sodium

Rx for high blood pressure, high cholesterol, diabetes

Eat healthy, be physically active

Adapted from Frieden TR, Am J Public Health. 2010;100:590-595.

Smallest

Impact

Largest

Impact

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Human Services Agencies

Parks

Economic Developme

nt

Mass Transit

Employers

Nursing Homes

Mental Health

Drug Treatment

Civic GroupsCHCs

Laboratory

Facilities

Hospitals

EMS

Health Care

Providers

Health Departmen

t

Churches

Philanthropist

Elected Officials

Media

Schools

Police

Fire

Corrections

Environmental Health

Community Centers MCOs

Local Public Health System

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Engaging LPHS Partners – Phase One

Emergency Preparedness

911 and anthrax crisis Smallpox & CRI planning Pandemic preparedness

H1N1

Fairfax County Pandemic Flu Planning

Pandemic Flu Planning Initiative Structure

•Vaccine and anti-viral distribution•Community disease prevention•Surge Capacity•Laboratory and Surveillance•First Responders and mass casualty•Legal Considerations•Communications and Notification•Essential Needs

1 The Emergency Management Coordinating Committee will serve as the Leadership Team for this effort2 Steering Committee: Dr. Gloria Addo-Ayensu, Dr. Raja’a Satouri, Barbara Antley, Holly Clifton, Kimberly Cordero, Zandra Duprey, Marilyn McHugh, Michelle Milgrim, John Niemiec3 Steering Committee: John Burke, Carol Lamborn, Amanda McGill, Becky McKinney, Larry Moser

Updated August, 2006

•Policy Support•Operational Support•Public Safety•County Infrastructure•Private Sector Planning

Executive Team(provides oversight, sets direction and insures appropriate inter nal and external communication)

Co-Chairs: Verdia Haywood, Rob Stalzer

Leadership Team (EMCC)1

(ensures coordination and integration of coordinating committees )Chairperson: Rob Stalzer

Public Health Coordination

(responsible for planning, response and recovery for public health efforts)

Co-Chairs: Dr. Gloria Addo-Ayensu, Dr. Raja’a Satouri

Critical Infrastructure and Resource ManagementCoordination

(responsible for planning, response and recovery for infrastruct ureand resource management efforts and private sector planning)

Co-Chairs: Doug Bass, Merni Fitzgerald

Public Health Work Groups2 Critical Infrastructure and Resource ManagementWork Groups 3

Fairfax CountyPandemic Flu

Plan CoordinatorsJohn Burke

(Deputy Fire Chief)Amanda McGill

(Program Manager)Laura Suzuki, R.N. MPH

(Public Health Nurse)

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Engaging LPHS Partners – Phase Two

Community health challenges Individual and family

preparedness Cultural competency HIV Vaccine/health

literacy TB Health promotion Workforce

development

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Rationale for Engaging LPHS Partners

Builds capacity for addressing public health challenges

Promotes cultural competency Provides opportunity to address gaps and

root causes of poor health Empowers the community to participate in

improving their own health Strengthens local public health system

Improves community health

Engaging LPHS Partners – Phase Three

Expectation of LHDs Essential Public Health

Services Community assessment

and planning (MAPP) Healthy People 2020 National Prevention

Strategy Accreditation County Health Rankings

Shift in drivers of morbidity and mortality Transition to population-

based service delivery

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Principles for Successful Partnerships

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Maintaining Effective Partnerships

Build on what already exists and leverage existing resources to minimize the need for additional costs initially.

Look for opportunities for early successes and set realistic goals.

Listen to partners and be flexible. Find ways to collaborate on priorities that further

each other’s mission. Allow sufficient time for partnership to develop and

scale up gradually. Make capacity building and sustainability a core

strategy of the partnership. Partnership building is work, but rewarding!

Crude Death Rate for Infectious Diseases in the United States

Good Sanitation = Good Hygiene

Transforming Public Health Together

Investing in Effective Partnerships is ROI

2001 Anthrax Health Department response

2009 H1N1 Entire LPHS participation Activation of County EOC ICS & COOP 75,000 vaccinated 287 clinics 1018 MRC volunteers

19,548 Hours $516,000

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Health in All Policies (HiAP) – A Better Way

Thank You54

Event Name

DISCUSSION QUESTIONS

1. Where are there opportunities for collaboration across specific silos that might yield improved health for Northern Virginians?

2. What can I do -- in my work and where I live -- to improve the public’s health?

3. Complete the sheet on your table by listing groups you know that are working on health and health-related solutions in the region.

April 10, 2023

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The First Northern Virginia Health SummitWhere Are We, and Where Could We Go?

Friday, May 31, 2013