Building Healthy Communities:Understanding Outcomes One, Two and

Three

Joel Diringer, JD, MPHMichael Cousineau, DrPH

Dana Hughes, DrPH

Long Beach, December 3, 2009

Building Healthy Communities: Guiding principles

Shift in thinking toward addressing root causes of poor health and policies that prioritize prevention. This will involve changes in the way things are currently done – “systems change”

Through advocacy and strategic communications, local experiences will influence and shape policy at the regional, state and national level.

Building Healthy Communities: Goals

10-year strategic plan designed to improve health systems and the physical, social, economic and service structures that support healthy living and healthy behaviors in California.

Four goals guide The Endowment’s work:• Health systems prioritize prevention;• Schools promote healthy behaviors and are a gateway for resources

and services;• Human services systems prioritize prevention and promote

opportunities for children and their families;• Physical, social and economic environments in local communities

support health.

Building Healthy Communities: “Big Results”

The Four Big Results

• Big Result #1: Provide a health home for all children

• Big Result #2: Reverse the childhood obesity epidemic

• Big Result #3: Increase school attendance• Big Result #4: Reduce youth violence

Building Healthy Communities: Outcomes

The 10 Outcomes of Success

1. All children have health coverage.2. Families have improved access to a “health home” that supports healthy

behaviors.3. Health and family-focused human services shift resources toward prevention.4. Residents live in communities with health-promoting land use, transportation and

community development.5. Children and their families are safe from violence in their homes and

neighborhoods.6. Communities support healthy youth development.7. Neighborhood and school environments support improved health and healthy

behaviors.8. Community health improvements are linked to economic development.9. Health gaps for young men and boys of color are narrowed.10. California has a shared vision of community health.

Outcome 1 – All Kids Have Coverage

Outcome 1 – All Children Have Health Coverage

Roadmap to coverage1. Expand health coverage to all children in

California2. Improve systems and policies to ensure that

children get enrolled and stay enrolled 3. Increase points of access for children by using

coverage to provide preventive health care and health promotion services (inclusive of physical, dental, mental, and vision)

4. Reduce the burden of chronic health conditions through coverage of prevention strategies

Examples of systems change approachesCurrent systems Systems change

Pay providers for direct services using local funds

Develop resources to get kids on federal-state funded coverage programs; develop coverage for uninsured for short term and advocate for children’s coverage

Pay for dental care for those who have medical coverage

Advocate for state adoption of CHIPRA option for “dental wrap-around benefits in Healthy Families

Have families enroll for different programs at different places

• Work in community coalitions of providers, enrollers, schools, advocates, social services, health plans, etc.

• Develop “no wrong door” approach to accepting applications

• One-e-App enrollment software• Express Lane Enrollment

Outcome 1 – All Kids Have Coverage

Outcome 2 – “Health Home”A “Health Home” is a primary care provider who:

• Coordinates and integrates care across the health care system (e.g., subspecialty care, hospitals, home health agencies) and the patient’s community (e.g., family, public, and private community-based services).

• Considers a patient’s cultural traditions, personal preferences and values, family situations, and lifestyles.

• Puts responsibility for self-care and monitoring in patients’ hands—but provides the tools and support needed to carry out that responsibility.

• Focuses on promoting good health through ensuring that transitions among providers, departments, and healthcare settings are respectful, coordinated, and efficient.

• Emphasizes preventing disease and poor health by using health care providers other than physicians.

Outcome 2 – Health Home

Promising Strategies and Practices1.Integrated, Coordinated, and Comprehensive

Care 2.Patient- and Family-Centered Care3.Culturally Competent Care4.High-quality Care

Outcome 2 – Health HomeCurrent System Health home

After several days of waiting, eight-year-old Sam and his mother get in to see his pediatrician. Sam has been missing school lately because of a combination of colds and an ongoing asthmatic condition. When they arrive at the busy doctor’s office, they spend time updating their information in a crowded waiting room. After meeting with the physician for ten minutes, they receive an adjustment to Sam’s medication with verbal instructions on how to monitor his asthma. While Sam’s cold resolves, his asthma symptoms worsen to the point that Sam's mother thinks she needs to take him to the emergency room one night.

Pediatrician responds to an e-mail from Sam’s mother regarding his school absences, and sets up appointment. When they arrive for the appointment, they verify that all the information from Sam’s electronic medical record (EMR) is correct and his immunizations are current. Following the meeting with the pediatrician to discuss Sam’s symptoms, they meet with the practice's nurse, who performs an asthma assessment and discusses family issues that have been aggravating his condition. Together, they draw up a written plan to help Sam manage his asthma. Nurse refers Sam to a local group of children with similar asthmatic conditions at the recreation department. The Pediatrician’s office provides Sam’s information to the health center at his school. Nurse follows up a week later to check on Sam’s progress.

Outcome 3 – Services shift to prevention

• Support systems for families include– Social supports– Financial resources– Human services

• Resource poor families living in isolated neighborhoods are more reliant on public health and human services systems than those in more affluent communities

• Current focus is more on intervention of those with problems• Need to shift focus to prevention when it comes to health,

family security, and social services• Links to other outcomes on youth, economic and community

development

Outcome 3 – Prevention

• Strategies to create seamless, coordinated, culturally competent and accessible “quilt” of health and human services that:

1. Support health and human services systems to become more preventive in their approaches

2. Coordinate services to strengthen families and promote children’s health development

3. Strengthen family’s economic security

Outcome 3– PreventionCurrent System Prevention oriented systems

• Reactive – you need to “fail” to receive services

• Fragmented and uncoordinated

• Not effective at engaging consumers

• Focus on strengthening health of individual, family and community

• Coordinated, culturally competent and accessible

• Engages clients and consumers in improving service delivery

Concluding remarks

• The outcomes are inter-related and should be viewed as a package

• Focus on changing the current systems to be more responsive to and inclusive of families and community

• Try to get ahead of the curve by emphasizing prevention at the policy, community, family and individual level

Questions?

Thank you!