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ncslhealth

Strong States, Strong Nation

HEALTH SEMINAR FOR

NEWER LEGISLATORS

Meeting Overview | Friday, April 13, 2018

Bipartisan membership organization

All 50 states and the territories

7,383 state legislators

All state legislative staff (30,000+)

Goals:

To improve the quality & effectiveness of state legislatures

To promote policy innovation and communication among state legislatures

To ensure states a strong, cohesive voice in the federal system

Research, education, technical assistance

National Conference of State Legislatures

Publications

Webpages and Databases

Meetings & Seminars

6

http://www.ncsl.org/meetings-training/legislative-summit-18.aspx

Meeting Sponsorship

Increase knowledge about state health issues &

opportunities to improve efficiencies & effectiveness

Network with and learn from each other

Learn more about NCSL

Have fun! ☺

Meeting Objectives

Health Issues by the Dozens

“Going through all this information

we have here is kind of like trying

to drink from a fire hydrant.” Former CO Rep. Mark Paschall

“My seatmate told me this was a

bad bill. I was going to vote no on

it until I realized it was my own

bill.” Former CO Sen. Ray Powers

50+ Unique State Legislatures

State Legislatures: Every state legislature is made

up of varying number of legislators

New Hampshire – 400 representatives 24 senators

Alaska- 40 representatives 20 senators

Nebraska- Unicameral 49 total

Friday April 13th

State Roles in Health Policy and Public Health Tour and Reception at Novartis

Please wear closed toe shoes! Saturday April 14th

Medicaid Health Insurance Issues Federal Update Access to Healthcare Services

Sunday April 15th

Prescription Drugs Behavioral Health

Meeting Sessions

Other content

Other topics NCSL has resources on:

Teen Pregnancy

Immunizations

Nutrition and Physical Activity

Health Impact Assessments

Children with special healthcare needs

Reducing injury and violence

And more!

Walk the Talk! A (mostly) Healthy Meeting!

Exercise Opportunities Fitness Center

2 optional group walks tomorrow

Trails around the hotel

Healthy Food Options

Yes, we also have bacon

Feel free to stand or stretch!

Breaks

Name

State

Position

One interesting fact 15 seconds

Participant & Staff Introductions

Test Your Awareness!

8-10 Questions

Less than 10 minutes!

Strong States, Strong Nation

HEALTH SEMINAR FOR

NEWER LEGISLATORS

State Roles in Health| Friday, April 13, 2018

State Roles in Health Policy

Purchaser

Access Broker

Regulator

Guardian of the Public’s Health

Safety Net Provider

Educator

State as Purchaser

Medicaid

State Employees

Community services (e.g., alcohol & drug abuse treatment,

mental health , etc.)

Medical care for prisoners

Other …

Is your state getting the best bang for the buck?

State as Access Broker

Insurance access

Insurance exchanges

Consumer protections

A competitive market

Other …

State as Regulator

Health professionals

Scope of practice

Licensure, certifications, etc.

Health facilities

Health insurance

Restaurants

Other …

State as Guardian of the Public’s Health

Infectious diseases, hazards

Immunizations

Injury prevention

Safe food and water, clean air

Other …

State as Safety Net Provider

Community health centers

Public hospitals

Addressing health disparities

Pharmaceutical assistance

Other …

State as Educator

Medical education

Consumer education

School health education

Other …

State Health Goals

What are your goals?

Healthy residents?

Health coverage for all?

Increased individual responsibility?

Other?

Major cost drivers …

Technological advances & increased use of

expensive care

Preventable Illness (e.g., smoking, obesity,

excessive alcohol/substance abuse, accidents,

lack of preventive care, etc.)

Unmanaged care, system inefficiencies

Consumer demands & consumer non-compliance

Over-utilization & under-utilization

Stewards of the Public Purse

Some ideas:

Invest in cost-effective programs & services: use evidence-based practices

Promote personal responsibility

Oversee health insurance premiums and insurer practices

Strengthen the private sector marketplace & options

Emphasize prevention & primary care

Increase competition and price transparency

Explore provider payment reforms & efficient delivery system models

Address end-of-life issues

Governance: State and Local Public Health Agencies

State Public Health Agency Classification: Understanding the Relationship Between State and Local Public Health, Association of State and Territorial Health Officials and NORC, at the University of Chicago

State Health Improvement Plans (SHIP)

State Departments of Health responded with the

following priority areas:

Chronic Disease Prevention

Behavioral Health/Substance Abuse

Maternal and Child Health

Access to Care

What Influences Health?

Determinants of Health Model based on frameworks developed by: TarlovAR. Ann NY AcadSci 1999; 896: 281-93; and KindigD, Asada Y, BooskeB. JAMA2008; 299(17): 2081-2083.

Contact Information

Tahra Johnson, MPH

Program Manager

Tahra.Johnson@ncsl.org

Office: 303-856-1389

Cell: 720-447-3775

La Jolla, CA| April 13-15, 2018

HEALTH SEMINAR FOR

NEWER LEGISLATORS

Shifting the Health of our

Communities through

State and Local Collaboration

April 13, 2018

Health is a state of complete physical, mental and social well-

being and not merely the absence of disease or infirmity.

World Health Organization

What is Public Health?Original Focus Areas – Public Health 2.0

• Prevents epidemics and the spread of communicable disease.

• Promotes and encourages healthy behaviors.

• Prevents injuries.

• Promotes accessible and quality health services.

• Plans disaster response and preparedness.

• Protects against environmental hazards.

• Disease surveillance and monitoring.

Long Beach Public HealthCommunity Health

• Chronic Disease & Injury Prevention

• Women, Infants and Children (WIC)

• Public Health Nursing

• Health Insurance Enrollment (Medicaid, Open Enrollment)

• Tobacco and Cannabis Education

Environmental Health

• Food Facility and Water Inspections

• Vector Control

• Hazardous Materials Program

• Lead Hazard Abatement & Healthy Homes Program

• Tobacco Control/Enforcement

• Community Asthma & Air Quality Resource Education (CAARE) Program

Long Beach Public HealthPhysician Services

• Public Health Laboratory

• Clinical Services (Immunization, HIV/STD, Family Planning, TB)

• Birth and Death Records

Public Health Emergency Management

• Plans Disaster Response and Preparedness.

• Disease Surveillance and Monitoring (epidemiology, disease investigation)

Human Services and Housing Programs

• Violence Prevention and Trauma

• Strengthening Families and Fatherhood Initiatives

• Housing Authority

• Homeless Services

Evolution of Health Practices

Public Health Framework for Reducing Health Inequities

SOCIALFACTORS

What is Public Health?Role is Expanding – Public Health 3.0

Public health is what we do as a society to ensure the conditions in which everyone can be healthy.

• Strives to reduce health disparities across the City through policy, planning, community, and services.

• Serves as Chief Health Strategist and backbone for health.

• Structured, cross-sector partnerships

• Health in All Policies

• Blended and braided funding strategies

Public Health: Going Upstream

Physical

environment

10%

Genetics

10%

Clinical Care

10%

Social &

Economic

Factors

40%Health

Behaviors

30%

Determinants of Health Model based on frameworks developed by: TarlovAR. Ann NY AcadSci 1999; 896: 281-93; and KindigD, Asada Y, BooskeB. JAMA2008; 299(17): 2081-2083.

Social Determinants of Health

The complex social andeconomic circumstances, inwhich people are born, growup, live, and work. Thesecircumstances are shaped by awider set of forces includingeconomics, social policies, andpolitics. Examples of socialdeterminants of well‐beinginclude…

Social Determinants of Health

• Social Support

• Healthcare Services

• Transportation

• School Systems

• Education Quality

• Public Safety

• Violence

• Poverty

• Housing

• Physical Environment

• Food Security

• Child Development

• Culture

• Trauma

• Working Conditions

Going Upstream: Prevention

Physical

environment

10%

Genetics

10%

Clinical Care

10%

Social &

Economic

Factors

40%Health

Behaviors

30%

Based on emerging evidence that addressing health-related social needs through enhanced clinical-community linkages can improve health outcomes and reduce costs.

Accountable Health Communities-An Opportunity

• Screening to identify certain unmet health-related social needs

• Referral to increase awareness of community services

• Providing navigation services to assist high-risk with accessing community services

• Encouraging alignment between clinical and community services to ensure that community services are available and responsive to the needs of individuals and families.

Accountable Health Communities-Promotes Clinical-Community Collaboration

• Increase in access to medication and medication utilization

• Reduction in conditions that lead to asthma

Example: Asthma and the Community Health Worker

Reduced collateral impacts

Missed work days: 180 61

Missed school days: 154 79

Missed caregiver work days: 337 141

Reduced indirect and collateral costs

Missed work days1

$61,380 $20,801

Missed school days2

$26,257 $13,467

Caregiver missed work days1

$114,917 $48,081

Example: Asthma and the Community Health Worker

Reduced Emergency Services Use

Hospitalizations: 317 125

Emergency department visits: 521 226

Unscheduled office/clinic visits: 1,004 474

Asthma wellness visits: 1,706 1,558

Reduced Direct Care Costs

Inpatient Hospitalizations1

$10,698,433 $4,218,625

Emergency & unscheduled visits2

$1,563,000 $678,000

Unscheduled office/clinic visits3

$1,004,000 $474,000

Asthma wellness visits4

$170,600 $155,800

A Local Story:The City of Long Beach

Poverty

28%

46%

31%29%

23%24%

16%

9%

5%7%

5%

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

50%

90802 90813 90804 90806 90810 90805 90814 90807 90808 90815 90803Zip Code

Individuals with a High School Education

84%

55%

77%

69%72%

68%

93% 91%95% 95% 97%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

90802 90813 90804 90806 90810 90805 90814 90807 90808 90815 90803Zip Code

Life Expectancy

76

77 77 77 77 77

81 81

82

83

82

72

74

76

78

80

82

84

90802 90813 90804 90806 90810 90805 90814 90807 90808 90815 90803

Life Expectancy at Age 1

Zip Code

Socio-Economic Index Life Expectancy in Long Beach

Social Determinants of Health Central EastLA

CountyPeople of Color 86% 20% 70%

Living under 2X Poverty Rate 69% 18% 39%

Unemployment Rate 11% 8% 9%

Median Income $31,030 $75,817 $60,566

Adults Without HS Education 45% 2% 26%

Open Space Acres per 1,000 Residents .26 8.8 6.2

Age-Eligible Children Not Enrolled in

Preschool

55% 31% 43%

Health OutcomesLow Birth Weight 5.4% 4.9% 5.2%

Uninsured 28.8% 7.4% 22.6%

Life Expectancy 76.7 81.7 80.3

Diabetes Hospitalizations* 48.5 8.1 19.9

Asthma Hospitalizations* 20.9 4.2 9.7

Hypertension Hospitalizations* 14.1 2.6 4.8*Rate per 10,000

Source: Health Disadvantage Index, http://phasocal.org/ca-hdi/

Focus of Health in the US…

Comparing internationally.

A key difference…

the focus of spending

Shifting the Conversation from a Health Care System

to a

Health System

Collective ImpactMultiple Players Working Together to Solve Complex Issues

• All working toward the same goal and measuring the same things

• Cross-sector alignment with government, nonprofit, philanthropic, faith-based and corporatesectors as partners

• Organizations actively coordinating their action and sharing lessons learned

Healthy Community

Focus Areas in CaliforniaHealth Care

• Increasing access and affordability of health care coverage

• Health care cost containment

• Reducing health care disparities

• Preventing prescription drug price spikes

Social Determinants

• Adverse Childhood Events (ACEs) and Trauma

• Violence Prevention

• Early Childhood supports

• Homelessness

State Level Opportunities• Increasing access and affordability of health care coverage

• Utilizing a social determinant lens in decision making

• Designing policies and funding to support:

• Health Prevention

• Early Childhood Health and Education Programs

• Violence Prevention

• Active Infrastructure

• Social Supports/Trauma Informed Systems

• Mental Health Treatment/Substance Use Prevention & Treatment

• Increased possibilities for blending and braiding funding

Updated document. Original from Dr. Eric Walsh Presentation, April, 2014

Kelly ColopyDirector, Long Beach Health and Human

Serviceskelly.colopy@longbeach.gov

562-570-4016

Thank you!