Larry Cohen Executive Director Prevention Institute

Community Centered Health Systems: Transforming Community Health and

Care Delivery Through Upstream Innovations

@preventioninst

http://www.facebook.com/PreventionInstitute.org

UC Berkeley School of Public Health Leadership Conference Transforming Community Health and Care Delivery

May 30, 2013

www.preventioninstitute.org

“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

u Prevention and Public Health Fund u Community Transformation Grants

u National Prevention Strategy u National Prevention, Health Promotion, and

Public Health Council

u Center for Medicare and Medicaid Innovation

u Funding for Community Clinic Expansion

Opportunities for Prevention in Health Reform

It is unreasonable to expect

that people will change their

behavior easily when so many

forces in the social, cultural,

and physical environment

conspire against such change.

“

” Institute of Medicine

Source: Institute of Medicine. (2000). Promoting health: Intervention strategies from social and behavioral research (B. D. Smedley & L. S. Syme, Eds.). Washington, DC: National Academies Press.

What’s Health Got To Do With It?

Photo courtesy of Latino Health Access

Photo courtesy of Latino Health Access

Photo courtesy of Latino Health Access

Photo courtesy of http://spacedust.atspace.com/soccer_archery.html

HEALTH & SAFETY

BEHAVIOR BEHAVIOR

ENVIRONMENT

355 Diseases15 Diseases

44% 56%

Citation: Kenneth Thorpe et al.. “Which Medical Conditions Account For The Rise In Health Care Spending?” Health Affairs, 10.1377, web exclusive.

A Majority of Costly Conditions are Preventable

u  Medical spending increased by $199 billion (1987-2000)

u  15 diseases account for 56% of this increase

Current Health Care Spending

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

70%

10%

20%

$2.2 Trillion

Behaviors & Environment

Genetics

Medical Care

Behaviors & Environment

70%

Medical Care, 10%

Genetics 20%

$2.2 Trillion

Current Health Care Spending

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

Behaviors & Environment

70%

Medical Care, 10%

Genetics 20%

Prevention, 3%

Health Care Services

97%

$2.2 Trillion

Current Health Care Spending

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

$1 Investment

$5.60

Return on Investment

Savings at 5 years

$16 Billion Annual Savings

In 5 Years

Return on Investment with Prevention

Reference: Prevention for A Healthy America: Investments in Disease Prevention Yield Significant Savings, Stronger Communities, Trust for America’s Health, July 2008

Prevention for a Healthier America

u $5.6:$1 ROI

u $16 billion savings in 5 years

http://preventioninstitute.org/component/jlibrary/article/id-75/127.html

Health Services

Prevention

Integrated Approach

Community-Centered Health Homes

Patient-Centered Health Homes

Medical Homes

Community-Centered Health Homes

A Different Way to Think about Health Care

Photo Credit: Daniel Bernstein

“The last time we looked in the book, the specific therapy for malnutrition was food.” Jack Geiger, MD

Medical Equipment

Oakland Chinatown

INQUIRY! ASSESSMENT! ACTION!

ENVIRONMENTAL & POLICY CHANGE!

COORDINATED CLINICAL & COMMUNITY PREVENTION

ACTIVITY!

IDENTIFY PRIORITY

HEALTH ISSUES!

COMPREHENSIVE STRATEGY

DEVELOPMENT!

PARTNERSHIP FORMATION!

• Health Care!• Public Health!• Community

Organizations!

DATA COLLECTION!

CLINICAL/COMMUNITY POPULATION HEALTH INTERVENTION MODEL

OUTCOMES!

IMPROVED HEALTH!!

COST SAVINGS!!

EVIDENCE-BASE FOR EFFECTIVE

PRACTICE!

Existing Clinician Skills PATIENT INTAKE DIAGNOSIS TREATMENT

Emerging Opportunities Ø  Payment mechanisms & incentives

n  maximize healthcare quality, minimize costs, incentivize prevention and an integrated health system

Ø  Population health data innovation n  track population health trends n  reveal the links between determinants and health outcomes n  uncover the best interventions for improving health

Ø  Metrics to promote health in the first place n  incentivize prevention and move away from individual-based assessment n  capture the leading indicators of successful community prevention n  assess the impact of community-level change

Ø  Workforce innovations n  advance the roles of community health workers, promotoras, integrators,

navigators

Ø  Intersectoral community partnerships and advocacy n  support true engagement and partnerships for sustainable community change

How Can We Pay for a Healthy Population?

♦  Wellness Trusts

♦  Social Impact Bonds and Health Impact Bonds

♦  Community Benefits from Non-Profit Hospitals

♦  Accountable Care Organizations

Connecting Clinical & Population Perspectives Through Data

u Collecting community driven data

u Creating interoperable data sets

u Tracking population health trends

Engage Stakeholders: Effective Collaboration

Healthcare Institutions /

Systems

Prevention Advocates

Education Planners / Transportation

Public Health

Service Providers

Elected Officials

Community Members

“We are bringing together the health and human rights voices in south LA and beyond to discuss the healthcare crisis and how we build a movement for the right to health.” -Jim Mangia, CEO St. John’s

National: Health System that Integrates

Prevention/Public Health/ Healthcare

Statewide: Community-Centered

Health System

Accountable Care Community

Local: Community Centered

Health Home

Accountable Care Community

Local: Community Centered

Health Home

NORMS sanction behavior

attitudes, beliefs, ways of being

based in culture & tradition

taken for granted

more than a habit

behavior shapers

communicate regularity

in behavior

Child Restraint & Safety Belt Use

Oh, Britney…

Pharmacy Tobacco Ban

Folsom-Cordova School District

Building a Movement

Photo  courtesy  of:  Jonathan  Moreau  

“You can do more than bail out these medical disasters after they have occurred, and go upstream from medical care to forge instruments of social change that will prevent such disasters from occurring in the first place.” —Jack Geiger, MD

Photo Credit: Daniel Bernstein

“Prevention is better than cure”

-Hippocrates

www.preventioninstitute.org Photo credit: Emily Barney

TOOLS

Community-Centered Health Homes

www.youtube.com/preventioninstitute

Influencing Policy & Legislation

Changing Organizational Practices

Fostering Coalitions & Networks

Educating Providers Promoting Community Education

The Spectrum of Prevention

Strengthening Individual Knowledge & Skills

Take 2 Steps to Prevention

Health Care Services

Exposures & Behaviors

Environment

Collaborator 4

Expertise:

Desired Outcomes:

Key Strategies:

Collaborator 3

Expertise:

Desired Outcomes:

Key Strategies:

Collaborator 1

Expertise:

Desired Outcomes:

Key Strategies:

Collaborator 2

Expertise:

Desired Outcomes:

Key Strategies:

Shared Outcomes

Partner Strengths

Joint Strategies

Collaboration Multiplier

Developing Effective Coalitions: The 8-Step Process

1. Analyze program objectives, determine whether to form a coalition

2. Recruit the right people

3. Devise preliminary objectives and activities

4. Convene the coalition

5. Anticipate necessary resources

6. Develop a successful structure

7. Maintain coalition vitality

8. Improve through evaluation

Communities Taking Action

221 Oak Street Oakland, CA 94607 Tel: (510) 444-7738

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