National Perspective on Changes Impacting the Public Health System

Judith A. Monroe, MDDirector, Office for State, Tribal, Local and Territorial SupportDeputy Director, Centers for Disease Control and Prevention

2014 North Carolina State Health Director’s Conference

Raleigh, NC

January 23, 2014

1964

2014

CDC Strategic Directions

Improve health security at home and around the world

Better prevent

the leading causes of illness, injury, disability, and death

Strengthen public health/health care collaboration

Key Features of Affordable Care Act

“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

“…health strategies, interventions, and policies applied at the population level can advance current approaches to our nation’s most pressing health concerns more efficiently and effectively than can isolated, intensive individual-level actions within the clinical care sector.”

-Institute of Medicine

IOM Activities with Implications for Population Health in the ACA

• Primary Care and Public Health: Exploring Integration to Improve Population Health

• Valuing Community-based, Non-clinicalPrevention Policies and Wellness Strategies

• For the Public’s Health: The Role of Measurement in Action and Accountability

• The Best Care at Lower Cost: The Path to Continuous Learning Health Care in America

• Roundtable on Health Literacy

IOM Activities with Implications for Population Health in the ACA

(cont’d)• Quality Measures for the Healthy People

Leading Health Indicators

• Living Well with Chronic Disease: Public Health Action to Reduce Disability and Improve Functioning and Quality of Life

• Roundtable on the Promotion of Health Equity and the Elimination of Health Disparities

• Expanded Insurance Coverage• Prevention Services• Innovation Models• Health Equity• Health Workforce Incentives• Health Homes

Resources to Prevent Illness & Keep People Healthy

Resources to Prevent Illness & Keep People Healthy (cont’d)

• Community benefits accountability• Community Transformation Grants• National Prevention Strategy

More Spending, Less Health

Genetics: 20%

Medical Care: 10%

Behaviors & Environment: 70%

Prevention: 3%

Health CareServices: 97%

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

Overview of Heath System Transformation

Health Delivery System Transformation Critical Path

Episodic Non-Integrated Care

Acute Care System 1.0

Episodic health care Lack integrated care networks Lack quality and cost performance

transparency Poorly coordinate chronic care

management

Outcome Accountable Care

Coordinated Seamless Healthcare System 2.0

Patient/person centered Transparent cost and quality

performance Accountable provider networks

designed around the patient Shared financial risk HIT integrated Focus on care management and

preventive care

Community Integrated Healthcare

Community Integrated Healthcare System 3.0

Healthy population centered Population health focused strategies Integrated networks linked to

community resources capable of addressing psycho social/ economic needs

Population-based reimbursement Learning organization capable of

rapid deployment of best practices Community health integrated E-health and telehealth capable

Source: Neal Halfon, UCLA Center for Healthier Children, Families & Communities

• Integrate population health into the healthcare system

• Elevate the priority for primary prevention and health equity

• Empower consumers & communities to improve health outcomes

• Improve quality and access via language and cultural competence

Opportunities to Improve Population Health Through ACA Implementation

• Bridge clinical care and community health in health homes

• Strengthen the safety net to also serve the remaining uncovered

• Increase capacity and fix mal-distributionof workforce

• Incentivize workplace wellness

Opportunities to Improve Population Health Through ACA Implementation (cont’d)

• Replicate Community Transformation Grants and Innovation Models

• Community benefits for population health programs

Opportunities to Improve Population Health Through ACA Implementation (cont’d)

The Center for Medicare & Medicaid Innovation (the Innovation Center) with CMS supports the development and

testing of innovative health care payment and service delivery models.

2013

A Practical Playbook: Public Health and Primary Care Together

National Public Health Improvement Initiative

The National Public Health Improvement Initiative (NPHII) provides support to health departments or their bona fide agents for

•Accelerating public health accreditation readiness activities• Implementing performance and improvement management practices and systems• Implementing and sharing practice-based evidence

“Health Departments in a Brave New World”-Christopher Maylahn , David Fleming, Guthrie Birkhead (Prev Chronic Dis 2013)

Centers for Disease Control and Prevention 1600 Clifton Road NE, Atlanta, GA 30333

Phone: 1-800-CDC-INFO (232-4636)/TTY: 1-888-232-6348E-mail: cdcinfo@cdc.gov Web: www.cdc.gov