Healthy Public Health 2016: A Four-Year View
Jeffrey Levi, PhDOpen Forum Meeting for Quality Improvement
National Network of Public Health Institutes
Charlotte, NC
December 7, 2012
Context Affordable Care Act implementation
Prevention and Public Health Fund Fiscal cliff or fiscal slope
New funding hard to come by “Improve many things when focus on a few things” Short-term investment to modernize for long-term
savings
It’s all about partnerships
Four years, four goals Creating health equity by building the culture of
“health in all policies” Prioritizing prevention – especially community
change/prevention – as part of the redesign of the US health care system and how it is financed
Restructuring health programs and agencies to break down silos and reflect new health infrastructure
Providing a stable base of funding for state and local public health
Create health equity through HIAP Addressing social determinants of health
requires new partnerships National Prevention Council/National
Prevention Strategy as a federal base Building new constituencies for HIAP—and
accessing new resources Building social capital through engagement
and policy/programmatic change
National Prevention Council=New PartnershipsBureau of Indian Affairs Department of Labor
Corporation for National and Community Service
Department of Transportation
Department of Agriculture Department of Veterans Affairs
Department of Defense Environmental Protection Agency
Department of Education Federal Trade Commission
Department of Health and Human Services
Office of Management and Budget
Department of Homeland Security Office of National Drug Control Policy
Department of Housing and Urban Development
White House Domestic Policy Council
Department of Justice
Coming together Education Community Development Climate Change/Environment Transportation
In various constellations Across government and private sector
Building social capital builds resilience and health
National Prevention Council Commitments Consider prevention and health within departments
and encourage partners to do so voluntarily as appropriate.
Increase tobacco free environments within its departments and encourage partners to do so voluntarily as appropriate.
Increase access to healthy, affordable food within its departments and encourage partners to do so voluntarily as appropriate.
New partnerships with health Structural integration of prevention and public health
—from Accountable Care Organizations to Accountable Care Communities
Making the ROI case for prevention – within the health system and more broadly
Inclusion of prevention/public health funding as part of any global budget initiatives Defining the need and what it would look like
Expand use of new tools such as community benefit
Health Care System/Primary Care
Payers, Insurers, and
ACOs
Community Prevention/
Social Determinants
of Health (SDOH)
Public Health
Improved Population Health, Health Outcomes, and Lower Costs (Triple Aim)
Improving Population Health Outcomes Depends on Transforming the Health System to Coordinate and Integrate Primary Care, Public
Health and Community Prevention Efforts
Interventions At The Intersection
• Primary care & team based care
• Patient assessments include personal data and SDOH regarding patients’ homes and communities
• Quality improvement• Leveraging, linkages and
referrals to community resources
• Data collection & EHRs contribute to community health data base
• Coordination with community health outreach workers
• Chronic disease mgmt
• Social and support services• Disease prevention and
management programs• Outreach and referral to
clinicians• Education, including health
education• Coalitions and advocacy to
address SDOH• Community engagement
Interventions at the intersection of primary care, public health and the social determinants of health require:• Common agendas and
goals• Shared responsibility• A compelling story• Partnerships and
collaboration• Leadership and Integrators• Data• Financing systems• Accountability mechanisms
• Incentives for providers to achieve pop. health out-comes and improve quality
• Incentives for plans/ACOs to address population health outcomes
• Funding mechanisms that enable braiding of financing streams
• Policy leadership on programs and policies that improve community health
• Community health assessments• Educating policymakers,
agencies, and stakeholders regarding pop. health
• Population health data tracking and analytic tools
Public policy is a critical lever to support all of these activities
Decentralization of ACA decision making New partnerships with health insurance
exchanges, Medicaid programs, hospital system, ACOs, etc.
New language, new ways of making our case, new expertise
PATIENCE
Collaborative partnerships leverage multi-sector resources to improve community health. Benefits of partnership:
– Addresses broad range of issues with greater breadth and depth
– Coordinates services and prevents redundant efforts
– Increases public support– Allows individual organizations to
influence community on a larger scale– Includes diverse perspectives– Strengthens connections between
existing resources– Provides shared frame of inquiry for
community health concerns
Community Members
Medicine
Public Health
Government & Philanthropy
Higher education
Secondary education
Safety-net health services
NationalHealth Coalitions
Academic researchers
Health Systems & Healthcare providers
Alcohol/drug services
Mental health services
Faith community
Community programs
ACC Coalition
How does public health change? (1) Foundational capabilities first
Information systems and resources; Health planning; Partnership development and community mobilization; Policy development analysis and decision support; Communication; and Public health research, evaluation and quality
improvement. Every American served by these capabilities
How does public health change? (2) True modernization of core systems
Surveillance and epidemiology as case study Streamlined categorical programs
Break down silos Emphasize approaches that have cross cutting
impact – within health Focus investment in partnerships
CTGs model for leadership and sharing resources
How does public health change? (3) Payer of last resort Doing what public health must do, not
necessarily what it has always done Restructuring of federal public health
agencies to reflect the new reality
Create stable funding for public health Federal mandate to demonstrate foundational
capabilities Develop federal-state relationship similar to
Medicaid Federal government provides very high match (90-100%)
for foundational capabilities States determine how they assure achieved for every resident
Federal government provides diminishing match for lower priorities
Incentives to merge similar categorical efforts; if core addressed, less funding needed for categorical
Can we do it? Four years ago we considered the following
to be dreams or too much of a stretch Accreditation Health reform National Prevention Council, Strategy Mandatory funding for public health Major new prevention programming
Status quo is not an option