keith j. mueller, ph.d. director, rupri center for rural health policy analysis professor and head...
TRANSCRIPT
Health Systems and Population Health
Keith J. Mueller, Ph.D.Director, RUPRI Center for Rural Health Policy Analysis
Professor and HeadDepartment of Health Management and Policy
University of Iowa College of Public Health
Presentation to the UI College of Public Health’s
Business Leadership Network Community Forum
Charles City, IowaNovember 6, 2014
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Forces Motivating Change
“Form follows finance”
Commercial insurance changing, and employer plans changing
Medicare changes are dramatic and could be more so
Medicaid changes spreading
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Convincing Evidence
Change is underway (not just “coming”)
Driven largely by needs to refinance But also involving reorganizing to
meet quality objectives Respond to change or lead change
but CHANGE
All About Value
Value will determine payment, initially partial eventually all
Responding to those changes Value will take on a new
meaning beyond the hospital/clinic walls
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Change That Creates New Collaborations
Value is value to the people served,
the community Value is creating and
maintaining health Requires collaborations across
all activities and programs that influence health, including social determinants of health
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What are the Determinants of Health?
County Health Rankings & Roadmaps program a collaboration between
the Robert Wood Johnson Foundation
the University of Wisconsin Population Health Institute.
Much of what influences our health happens outside of the provider’s office
http://www.countyhealthrankings.org/about-project/rankings-background
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Another way to look at it
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Measurement as Basis and Motivation for Action
Knowing what is impacting adverse health outcomes in the community
The challenge of how a community compares to others
The challenge of how a community compares to a gold standard
Forms the basis for action strategies tied to measurable goals for achievement
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What to Measure and How
From Community Health Needs Assessment Snapshot, Floyd County Public Health/Home Health Care
Healthy Behaviors, Problems/Needs: Obesity Cancer Diabetes Parenting skills
Prevent Injuries Problems/Needs Texting while driving Mental health access Underage drinking
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What to Measure and How
Protect Against Environment Hazards: Safe Drinking Water
Prevent Epidemics and Spread of Disease: immunization rate
Prepare for, Respond to, and Recover from Public Health Emergencies
Strengthen the Public Health Infrastructure: access to dental services
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What to Measure and How
From Mercy Medical Center – North Iowa CHNA Report of priorities among categories of need
1 Care coordination: between providers, between providers and patients
2 Community wellness: motivation for preventive activities, communication wellness opportunities
3 Substance abuse/mental health: propensity of chronic disease, “siloed” care between providers
4 Access to care: access to medical appointments, emergent dental care for adults
5 Parenting/self-responsibility: adequate self-value to prevent destructive behaviors, accountability for one’s own health
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What to Measure and How
6 Chronic disease management: motivate for self-management/compliance, continue to collaboratively address heart disease and diabetes
7 Transportation: to medial appointments, especially for those living out of town, communicate availability of resources
8 Homeless/temporary shelter: safe place on short term basis for men, women and accompanying children; coordinate with other housing resources
9 Safety: unintentional injuries; suicide
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What to Measure and How
Robert Wood Johnson Foundation County Health Rankings
Health Outcomes: premature death, self-report health status
Health Behaviors: tobacco use, diet and exercise, alcohol and drug use, sexual activity
Clinical care: access to care, quality of care Social and Economic Environment: education,
employment, income, family and social support, community safety
Physical Environment: air and water quality, housing and transit
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Floyd County Rankings
Health Outcomes: 59 of 99 (3rd quartile) Health Factors (combines four domains):
58 of 99 (3rd quartile) More detail available from the web site:
www.countyhealthrankings.org
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Other Sources of Data
Descriptions available from Rural Health Value (a U of IA project in partnership with Stratis Health): http://www.raconline.org/topics/statistics-and-data/data-sources-and-tools
Examples: American Community Survey, Economic Research Service Fact Sheets, American Fact Finder
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Data to Action: a County Health Improvement Plan
From the County Public Health Department
Goal: Decrease Percent of County Residents who are overweight /obese to 65% from baseline of 67%
Quarterly newsletter available to residents with information regarding healthy lifestyle choices
Team with hospital staff to promote healthy eating choices
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New Partners and New Approaches
Nemours Children’s Health System in Delaware and beyond uses prevention and population health measures in their Balanced Scorecard and Executive Compensation Initiatives
MN initiative to effectively address social determinants of health, led by state health department: uses community health needs assessment, a Healthy Minnesota 2020 framework, creation of Accountable Communities for Health
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New Partners and New Approaches
Western Mass: Communities that Care Coalition in a rural region: uses a community action plan based on data from annual teen health survey to generate goals for reduction in youth substance use – coalition of schools, human service providers, local law enforcement, local business, government, faith-based organizations, health care and mental health providers, hospital: 12 year reduction in abuse
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New Partners and New Approaches
Western North Carolina Healthy Impact: partnership of hospitals, health departments, and key regional partners in multicounty (16) region to standardize data collection, create reporting and communication templates and tools, encourage collaboration, provide technical assistance, address regional priorities, and share evidence based practices
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Other Resources
The Rural Health Value project website for further examples of innovation in rural places:
www.ruralhealthvalue.org
Other organizations focused on assistance to rural healthcare organizations and their communities (next slide)
Collaborations to Share and Spread Innovation
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The National Rural Health Resource Center
The Rural Assistance Center
The National Rural Health Association
The National Organization of State Offices of Rural Health
The American Hospital Association
For Further Information
Rural Health Valuehttp://ruralhealthvalue.org
Center for Rural Health Policy Analysishttp://cph.uiowa.edu/rupri
The RUPRI Health Panelhttp://www.rupri.org
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Dr. Keith J. Mueller
Department of Health Management and PolicyCollege of Public Health, N232A145 Riverside DriveIowa City, IA [email protected]
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