triggs-2014
TRANSCRIPT
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Designing a Framework for Population Health Management
Susan L. Triggs, PhD, MPH, RN
VRHA Annual Conference
December 11, 2014
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OVERVIEW •Fundamentals of Population Health
•Individual Behavior
•Community Health Outcomes
•Managing the Population’s Health
•Pros and Cons
•Moving the Status Quo Needle
•Sharing Ideas – Marketing
•Engaging People
•State Rural Health Plan
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Fundamentals of Population Health
What is it?
Relevance to Relationships
Engagement Empowerment
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INDIVIDUAL BEHAVIOR
Capacity
Capital
Networking
Ecology
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COMMUNITY HEALTH OUTCOMES
• Determinants of Health
• Sick Care
• Preventive Care
• Resource Availability
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POPULATION HEALTH MANAGEMENT (PHM)
Population health: “The health outcomes of a group of individuals, including the distribution of such outcomes within the group.” (Institute of Health Technology Transformation)
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POPULATION HEALTH MANAGEMENT (PHM)
• Success Factors – Collaboration – Planning – Community Engagement
• Workforce/Culture • Economic Development
– Data Collection, Management, and Analysis • Resources available • External partners with needed resources
– Outcomes and Impact
(Institute of Health Technology Transformation)
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PHM BENEFITS
• Prevention and chronic disease management
• Health outcomes problems resolved by pooling resources
• Sharing the weight of PHM among all stakeholder sectors
• Proactive vs reactive engagement
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MOVING THE NEEDLE
• Self Interest to Shared Agenda
– Community Needs Assessments and Health Needs Assessments
– Strategic Plans
– Community Action Plans
– Coalitions/Tasks Forces/Consortiums, etc.
– Community Advisory Boards
• Community-Based Participatory
Approaches
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SHARING IDEAS - MARKETING
• Speaking stakeholder language – Business Systems Thinking
– Youth relevance: How I am affected now
– Seniors: Relevance to aging
– Mid-Lifers: Juggling multiple priorities
– Community at Large: Easy, popular, and fun
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MARKETING
Decision Point
Product
Place
Price
Promotion
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ENGAGING PEOPLE TO GET THE JOB DONE
COMMUNITY
Experience
Problem
Solution
Resources Health
Outcomes
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Some Community Involvement Communication flows from one to the other, to inform Provides community with information. Entities coexist. Outcomes: Optimally, establishes communication channels and channels for outreach.
Outreach
More Community Involvement Communication flows to the community and then back, answer seeking Gets information or feed- back from the community. Entities share information. Outcomes: Develops connections.
Better Community Involvement Communication flows both ways, participatory form of communication Involves more participa- tion with community on issues. Entities cooperate with each other. Outcomes: Visibility of partnership established with increased coopera- tion.
Community Involvement Communication flow is bidirectional Forms partnerships with community on each aspect of project from development to solution. Entities form bidirectional communication channels. Outcomes: Partnership building, trust building.
Strong Bidirectional Relationship Final decision making is at community level. Entities have formed strong partnership structures. Outcomes: Broader health outcomes affecting broader community. Strong bidirectional trust built.
Consult
Involve Collaborate
Shared Leadership
NIH Publication No. 11-7782 (2011), Principles of Community Engagement
Principles of Community Engagement
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VIRGINIA’S STATE RURAL HEALTH PLAN
Supporting Rural Health through Community Engagement and Action
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Virginia’s State Rural Health Plan
Obesity and associated
behaviors and diseases
Mental and behavioral
health
Oral health Cancer
Perinatal issues
Lung disease
Key Health Issues:
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Virginia’s State Rural Health Plan
Health Outcomes
Healthy Communities
Access to Health Care
Individual Empowerment
Workforce Development
Advocacy
Objectives
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Goals for Rural Population Health Management
1) Bring widespread attention to current and anticipated rural health issues and needs
2) Capture the ideas, commitment, and energy of rural health stakeholders around the Commonwealth
3) Motivate participation in enacting the state rural health plan actions among a wide range of stakeholders
4) Facilitate community engagement
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Critical Access Hospitals as Conveners
Mini-Grants Scope of Work – Services
• Services the Hospital shall perform:
– Function as a core leader of the Virginia State Rural Health Plan community engagement
– Collaborate with the Department (VDH), the local health department, and local EMS providers as the core leadership group in this effort
– Assist with developing population health management work using the systems-based approach outlined in “Improving Population Health: A Guide for Critical Access Hospitals”
– Focus community engagement around key health issues identified in the Hospital’s Community Health Needs Assessment
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Key Health Issue(s) Health Outcomes Strategy(ies) Healthy Communities Strategy(ies)
Access to Health Care Strategy(ies) Individual Empowerment Strategy(ies) Workforce Development Strategy(ies)
Advocacy Strategy(ies) Hospital Mission/Vision Strategic Planning Population Health Approaches
Partners/Stakeholders Activity(ies) Activity Description
Service Area Demographic Data
COMMUNITY ENGAGEMENT PLAN (Template)
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Critical Access Hospitals as Conveners
Mini-Grants Scope of Work – Deliverables:
• Community Engagement Plan: Draft Outline
• Projected Start Date
• Draft Implementation Plan and timeline estimation
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Critical Access Hospitals as Conveners
• Virginia Rural Health Advisory Board (VRHAB)
– Mission:
• To promote and support the health of Virginia’s rural communities by advising in the implementation of Virginia’s State Rural Health Plan.
– Vision:
• Healthy people in healthy rural communities
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Critical Access Hospitals as Conveners
• Community Engagement Plans
-- 5 of 7 CAHs signed a Memorandum of Agreement
-- Going forward
VRHAB will review, evaluate, provide recommendations
CAHs will receive input from VRHAB
Yearly progress reporting
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CONTACT INFORMATION
Susan L. Triggs, PhD, MPH, RN
Rural Health Program Specialist
804-864-7429
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QUESTIONS