#healthmeanswealth: Indiana Health Data and Trends · Infant Mortality Rates County Level, All...
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#healthmeanswealth: Indiana Health Data and Trends Jerome Adams, MD, MPH State Health Commissioner July 13, 2016 @jeromeadamsMD
Transcript of #healthmeanswealth: Indiana Health Data and Trends · Infant Mortality Rates County Level, All...
#healthmeanswealth:
Indiana Health Data
and Trends
Jerome Adams, MD, MPH State Health Commissioner July 13, 2016 @jeromeadamsMD
Indiana Unwell?
• Wellness in Indiana? – Over million smokers
– Enough overweight or obese to populate all of Iowa
– One third IN adults sedentary/ do not participate in leisure time activities
• Chronic disease – Responsible for 7 out of 10 deaths, nationally
– Accounts for approximately 70% of healthcare costs
– Many are preventable or reversible with lifestyle modifications
What’s the Cost?
• Increase in BMI means an increase on direct healthcare costs, sick days and medical claims • Moderately obese individuals are more than twice as likely
to be prescribed drugs to manage conditions
• Every pack of cigarettes sold equals $15.90 in healthcare costs, lost productivity, and premature death
• Health affects recruitment, productivity, safety/liability, and health care costs
Help us help you!!!!
• Worksites are crucial partners in improving population health – Provide opportunities for adults to eat better,
move more and avoid tobacco
• Employers are crucial in efforts to advocate for community health – As community leaders you can make the business
argument – business means health!
Indiana State Department of Health-Top Priorities
#1. Reduction in Infant Mortality rates #2. Reduction in Adult Obesity rates #3. Reduction in Adult Smoking rates #4. Assuring preparedness for infectious disease #5. Combatting our National Opioid Epidemic #6. Getting people enrolled in HIP!!!
Infant Mortality
Defined as the death of a baby before his/her first birthday
The Infant Mortality Rate (IMR) is an estimate of the
number of infant deaths for every 1,000 live births
Large disparities in infant mortality in Indiana and the
United States exist, especially among race and ethnicity
Infant Mortality is the #1 indicator of health status in the world
International Infant Mortality Rates 2010
Source: Indiana State Department of Health, Maternal & Child Health Epidemiology Division [October 26, 2015] Original Source: CDC/NCHS, linked birth/infant death data set (U.S. data); and OECD 2014 (all other data). Data are available from http://www.oecd.org
Infant Mortality Rates United States, 2013
Source: Indiana State Department of Health, Maternal & Child Health Epidemiology Division [October 26, 2015] Original Source: CDC/NCHS, National Vital Statistics Report “Deaths: Final Data for 2013”, Volume 64, Number 2
Infant Mortality Rates Indiana, U.S. and Healthy People 2020 Goal: 2007 - 2014
Source: Indiana State Department of Health, Maternal & Child Health Epidemiology Division [February 23, 2016]
United States Original: Centers for Disease Control and Prevention National Center for Health Statistics
Indiana Original Source: Indiana State Department of Health, PHPC, ERC, Data Analysis Team
Infant Mortality Rates County Level, All Races
2010 - 2014
HIGHEST Infant Mortality Rates in State
• Daviess = 10.6
• Grant = 10.5
• Bartholomew = 10.0
• Henry = 9.7
• Kosciusko = 9.2
• LaPorte = 9.0
• Adams, Marion = 8.9
• Delaware = 8.6
• Jackson, Vanderburgh = 8.3
• Lake, Wayne = 8.2
• St. Joseph = 8.1
Source: Indiana State Department of Health, Epidemiology Resource Center, Data Analysis Team
Allen
Jay
Lake
Knox
Cass
Vigo
Jasper
Clay
White
Rush
Pike
Parke
Clark
Greene
La Porte
Ripley
Grant
Perry Posey
Gibson
Noble
Wells
Jackson
Porter
Elkhart
Owen
Boone
Henry
Dubois
Pulaski
Shelby
Putnam
Sullivan
Miami
Wayne
Daviess
Fulton
Kosciusko
Clinton
Harrison
Carroll Benton
Orange
Marion
Wabash
Morgan
Madison
Marshall
Monroe
Newton
Warrick
Starke
Martin
Adams
Spencer
St Joseph
Franklin
Warren
Brown
De Kalb
Randolph
Decatur
Lawrence
Fountain
Jennings
Hamilton
Whitley
Tippecanoe
Washington
Lagrange
Delaware
Hendricks
Tipton
Jefferson
Johnson
Steuben
Montgomery
Scott
Howard
Hancock
Crawford
Dear- born
Bartholomew
Fayette
Floyd
Union
Switzerland
Hunting- ton
Verm.
Ohio
Vander- burgh
Black- ford
Counties with the Best and Worst Infant Mortality Rates Aggregated Years 2010-2014
Infant Mortality Rates by Race Indiana
2003 - 2014
Source: Indiana State Department of Health, Epidemiology Resource Center, Data Analysis Team
Factors Contributing to Infant Mortality in Indiana
•Obesity (ISDH #2 priority) •Obese=25% chance prematurity •Morbidly Obese= 33% prematurity •Indiana is 7th most obese state in US •32% of females of childbearing age are obese
•Smoking (ISDH #3 priority) •15.1% pregnant mothers smoke (2 x US avg) •25% Medicaid Moms smoke!!! •Indiana has 7th highest adult smoking rate in US •26% of females of childbearing age currently smoke
Factors Contributing to Infant Mortality in Indiana
•Limited Prenatal Care •Only 67.5% pregnant mothers in Indiana receive PNC in 1st trimester
•White = 70.1%; Black = 55.9% •Unsafe Sleep (6.0% of deaths 2014) •Elective deliveries before 39 weeks gestation •Limited breastfeeding •Delivering at risk-appropriate facilities?
Indiana’s Plan: Promote Good Health in Women and Infants
• Statewide Infant Mortality Campaign
– Raising awareness about problem and resources
– Labor of Love (laboroflove.in.gov)
– MOMs Helpline
• Statewide Public Health Home Visiting Program
– Collaboration with Nurse-Family Partnership and Goodwill
Indiana’s Plan: Address Disparities
• If Indiana lowered the black infant mortality rate in 2014 from 14.7 per 1,000 live births to the white infant mortality rate of 5.9 per 1,000 live births, we would’ve saved over 90 infants…
Indiana’s Plan: Indiana Perinatal Quality Improvement Collaborative
Early Elective Deliveries: July 2014, Medicaid stops paying for non-medically indicated inductions before 39 weeks
Neonatal Abstinence Syndrome (NAS): December 2015, four Indiana hospitals are piloting programs to identify and report on NAS
17P: June 2015, development of recommendations for utilization of progesterone therapies to prevent prematurity
Birth Certificate: QI project that made system improvements to Indiana Death Registry System, including provision of training, feedback mechanisms, and recommendations for next phase of QI
Source: http://www.in.gov/laboroflove/664.htm
Indiana’s Plan: Perinatal Levels of Care
Vision Statement:
All perinatal care providers and all hospitals have an important role to play in assuring babies born in Indiana have the best start in life.
All babies will be born when the time is right for both the mother and the baby.
Through a collaborative effort, all women of childbearing age will receive risk-appropriate care before, during and after pregnancy.
Percent of VLBW Born in Level III Hospitals
Baby and Me, Tobacco Free™
Baby and Me, Tobacco Free™ (BMTF)
is an evidenced-based smoking cessation program for pregnant women, through her child’s first birthday
Program Components
Individualized education from BMTF certified facilitator
4 sessions prior to baby’s birth
Monthly postpartum visits until baby turns 1
Biochemical testing at every visit
Provides up to 12, $25 diaper vouchers
Laurie Adams, CEO/Executive Director Baby and Me Tobacco Free Program, Oct 16,
2013 Researched from 2006 – 2009, NY State Department of Health, Bassett
Research Institute
Baby and Me, Tobacco Free™
October 2013 – March 2016
1,532 Program Enrollees* 1,620 Vouchers distributed 369 Infants born nicotine-free • 92% born ≥ 37 weeks gestation • 95% born ≥ 5 lbs. 8 oz.
• Includes March of Dimes and Anthem affiliated Indiana sites
• Data Source: 2014 Indiana Natality Report
2014 Data 15.1% pregnant Hoosiers smoke County rates range from 2.7% to 38.5% For women on Medicaid, the number
jumps to 25.3%
Safe Sleep
Cribs for Kids® sites throughout Indiana provide safe-sleep education by distributing a Graco® Pack ‘n Play® portable crib, pacifier, and safe sleep information to families who cannot otherwise afford a safe place for their babies to sleep.
Messages: Focus on the ABC’s of Safe Sleep practices recommended by the American Academy of Pediatrics and National Institutes of Health:
Babies should sleep Alone
On their Backs
In a Crib or bassinette
Since July 2014 approximately 6000 cribs went out to families across the state
(Re)Launched on March 1st, 2016!
♥ Provide information, referrals and resources relating to
maternal and child health care services.
♥ Connect mothers and pregnant women with a network of
prenatal and child health care services within local
communities, state agencies and health care
organizations around the state.
Labor of Love
Prevalence of Adult Obesity by State 2014 BRFSS
Percent
Rank of 7th Highest
Source: 2014 BRFSS
Obesity in Indiana
• Over two thirds (66.5%) of Indiana adults are overweight or obese*.
• 32.7% obese; 33.7% overweight
• Obesity rates are higher in minority populations and rural areas.
• Why? – We’re eating more & we’re moving less -Easy access to fast food – Fast, less nutritious food on every corner -Lack of access to fresh, affordable
healthy options. – Low income and/or low access -Increased screen time – Less opportunity to engage in physical activity
*2014 BRFSS
Prevalence of Adult Obesity by Race/Ethnicity
Indiana 2014 BRFSS
Source: 2014 BRFSS
Costs to Indiana
• Hoosiers pay $3.5 billion in obesity related medical costs
• Healthcare costs for obese individuals are on average $1,400 higher per year.
– In Indiana, 36.9% of obesity related costs are financed by Medicare and Medicaid
• Obese children miss more school than their normal weight peers
• Obese adults experience more absenteeism and presenteeism than their normal weight peers
– Costs employers over $6 billion/year in the US
Adult Current Smoking by State 2014 BRFSS
Rank of 7th highest
Source: 2014 BRFSS
Smoking during pregnancy
Indiana overall: 15.1% vs 8.7% for US -12,655 births, $4.8 mil
County rates overall: 2.7 % to 38.5% Medicaid Members: 25.3%
<10%
10-20%
21-29%
30+%
2014 Indiana Natality Report
Allen
Jay
Lake
Knox
Cass
Vigo
Jasper
Clay
White
Rush
Pike
Parke
Clark
Greene
La Porte
Ripley
Grant
Perry
Posey
Gibson
Noble
Wells
Jackson
Porter
Elkhart
Owen
Boone
Henry
Dubois
Pulaski
Shelby
Putnam
Sullivan
Miami
Wayne
Daviess
Fulton
Kosciusko
Clinton
Harrison
Carroll Benton
Orange
Marion
Wabash
Morgan
Madison
Marshall
Monroe
Newton
Warrick
Starke
Martin
Adams
Spencer
St Joseph
Franklin
Warren
Brown
De Kalb
Randolph
Decatur
Lawrence
Fountain
Jennings
Hamilton
Whitley
Tippecanoe
Washington
Lagrange
Delaware
Hendricks
Tipton
Jefferson
Johnson
Steuben
Montgomery
Scott
Howard
Hancock
Crawford
Dear- born
Bartholomew
Fayette
Floyd
Union
Switzerland
Hunting- ton
Verm.
Ohio
Vander- burgh
Black- ford
Emerging Infectious Diseases
Zika!!!
Flu
Ebola
HIV
Measles, Mumps, MERs, oh my!!!
H5N1 (bird flu)
TB
Antibiotic Resistant Organisms/ CRE
Zika
• 10 cases in IN, all with travel history
• No confirmed local transmission in US, IN considered low risk
– Primary mosquito vector is present in lower 2/3rd of state. Secondary vector in more of state, but not thought to be as good at spreading virus.
• Mosquito control (repellent, screens, no standing water), avoid travel if pregnant or trying, avoid unprotected sex for 6 months
• www.CDC.gov/zika and ISDH websites have regular updates)
Tackling the Prescription Drug and Opioid Abuse Epidemic
Suryaprasad Clin Infect Dis; 2014, 59(10):1411-1419
2006 2012
Prescribing correlates with IDU, unsafe injection practices
Expanding epidemic of injection drug use heralded by dramatic increase in acute HCV infections…
Number of Deaths: Motor Vehicle Accidents
and Accidental Drug Poisonings Indiana Residents, 2000-2014
Source: 2000-2014 Indiana mortality data
0
200
400
600
800
1,000
1,200
1,400
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014
Nu
mb
er
Year
Motor Vehicle Accident Drug Overdose
Scott County HIV Outbreak
• Rural injection of Rx oral opioid = largest ever HIV outbreak in IN, largest IDU HIV outbreak in US
• 200 HIV cases in a rural county that never had more than 3 in one year
• Almost all cases report injection of the opioid analgesic oxymorphone (Opana® ER and generic ER)
• Male = female, all white, significant poverty (19.0%), unemployment (8.9%), lack of education (21% no high school), and lack of insurance
Adapted from and with permission of Phil Peters, CDC
HIV Infection: Tip of a High-Mortality Iceberg
HIV
Infection
Overdose, Bacterial infections
Hepatitis C virus Infection
Injection Drug Use
Substance Use Disorder
200 diagnoses
5 deaths during contact tracing
282 total, 95% coinfected
Network of over 525 PWID
Paying attention Now?
Slowing transmission…
Epidemic Curve 6.6.2016
1 12
11
8
3
5
9 9
1
9
7
18
14
11
22
17
9
5 5
33
5
21 11
2
43
1 1 1 1 11 1
Specimen Collection Date
Case
Count
12
1 1 1 1
HIV Care Continuum May15, 2015 –July 7, 2016
Nu
mb
er
of
Pati
ents
Outbreak Control Interventions
• Very few insured: established “one-stop shop”
• No HIV/HCV care: state provided resources (IU), HRSA, PREP
• Little HIV awareness: multiple educational efforts including billboards, infographics, webinars, TV/radio, newspaper, Jeannie White Ginder community event at Austin HS. #URNotAlone*
• Syringe exchange illegal: executive orders followed by new law
• Limited addiction services (methadone moratorium): raise awareness of MAT, train and accredit providers to prescribe Suboxone®, local mental health provider designated as a FQHC, SAMHSA collaboration
Where can you weigh in?
• MAT: People don’t understand the concept, or the options: Methadone vs Suboxone® vs Vivitrol®
– Think we are substituting one addiction for another
• Drug Court/ Diversion Programs: Can’t incarcerate our way out of this problem – Most local jails over capacity, but lots of fear that weaker enforcement
hurts the case. Need both sticks and carrots to change behavior
• What comes treatment? Need more housing, halfway houses, jobs… – “Veterans win the war and come home a hero, addicts win one war
and come home to another war.”
– “I’ve been clean 6 months, but I know I can never go home.”
– “The best drug recovery program is a good job”
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Healthy Indiana Plan (“1.0”)
• First Medicaid plan with strong consumer-directed features (2008) – HDHP
– POWER Account
– Consumer choice + Provider engagement
• Proven Results – Improves healthcare utilization
– Promotes personal ownership of health care
• High Member and Provider Satisfaction – Enhanced coverage
– Enhanced provider reimbursement
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State of the Uninsured in Indiana (pre-“HIP 2.0”)
1. SHADAC Health Insurance Analysis. (2011). American Community Survey data. Retrieved from www.nationalhealthcare.in.gov.
TOTAL UNINSURED = 881,291 (13.6%)
Coverage Gap
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HIP 2.0 vs. Medicaid Expansion
Health Improvement
Access
Coverage Medicaid
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HIP 2.0 Eligibility
• Indiana residents ages 19 to 64
• income under 138% of the federal poverty level (FPL)
• who are not eligible for Medicare or otherwise eligible for Medicaid
• Includes individuals previously enrolled in:
Healthy Indiana Plan (HIP 1.0)
Hoosier Healthwise (HHW)
Who is eligible for HIP 2.0?
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HIP 2.0: Three Pathways to Coverage
• Initial plan selection for all members
• Benefits: Comprehensive coverage with enhanced benefits, including vision, dental, bariatric, pharmacy
• Cost sharing:
• Monthly POWER account contribution required
• Contribution is 2% of income with a minimum of $1 per month
• ER copayments only
HIP Plus
• Fall-back for members with income <100% FPL who do not make POWER account contribution
• Benefits: Minimum coverage, no vision or dental coverage
• Cost sharing:
• Must pay copayment ranging from $4 to $75 for doctor visits, hospital stays, and prescriptions
HIP Basic
• Employer plan premium assistance paired with HSA-like account
• Enhanced POWER account to pay for premiums, deductibles and copays in employer-sponsored plans
• Provider reimbursement at commercial rates
HIP Link 51
HIP Plus: POWER Account Contributions
• POWER account contributions are approximately 2% of member income – Minimum contribution is $1 per month* – Maximum contribution is $100 per month (individual enrollee in a 9 person
household earning $62,000/year)
• Employers & not-for-profits may assist with contributions – Employers and not-for-profits may pay up to 100% of member PAC – Ideally, payments are made by individual directly to member’s selected managed
care entity
• PAC amount based on family income
• If spouses both enrolled, they split the monthly PAC amount
*Approximately 20% of HIP eligible population will have an income the corresponds with the minimum $1 PAC
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• Since announcing the approval of the HIP waiver on January 27, 2015, enrollment in our program has grown to ~ 400,000 members.
• Since HIP began, almost 70 percent of enrolled individuals have elected to make contributions to their POWER account.
– Of this group, 83 percent are earning below the poverty level, some making at least a $1 per-month contribution.
HIP 2.0 turns one!
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• Once HIP members start making contributions, our data tells us that 94 percent continue making them.
• Nearly one-third of HIP members report asking their doctors about the cost of their health care.
– 52 percent of HIP members check the balance of their POWER account
– Just over one-third check that balance at least once a month
HIP 2.0 turns one!
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• According to analyses performed by two MCEs, HIP members who transitioned from the traditional Medicaid program Hoosier Healthwise to HIP 2.0 have had over a 40% reduction in Emergency room utilization.
• In the last year, we’ve added over 5,300 new providers to serve both Medicaid and HIP members.
HIP 2.0 turns one!
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• 86 percent of HIP Plus members were satisfied or very satisfied with the program
• 94 percent of all HIP members would re-enroll
• 83 percent would pay more to be in the program
• 55 percent of providers surveyed indicate they have seen a decline in the number of people without insurance
• Almost 40 percent have seen a decline in the requests for charity care
HIP 2.0 turns one!
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• HIP Link helps employees pay for the costs of their employer coverage.
• HIP Link members get a $4,000 POWER account.
• Members receive a monthly check to help cover the cost of employer premiums.
• Like HIP, HIP Link members contribute 2% of their income towards the costs of coverage.
• POWER account also helps cover member cost sharing.
• Members can use their HIP Link card to pay for copayments, deductibles and coinsurance.
HIP Link Overview
HIP Link Premium Assistance Program
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Employer Participation
• More employees may be able to enroll in the employer’s group health plan.
• An increase in employees may help to meet industry and marketplace participation rates or lower group premium rates.
• Employees can better manage health care costs with their HIP Link POWER Account and Health Reimbursement Account (HRA), if offered by employer.
• Potential to expand employee base and increase retention by being listed as an approved HIP Link Employer.
• Possible tax benefits for small employers using the Health Insurance Marketplace.
• HIP Link does not disrupt the current group health plan offered or cost sharing structure and can be incorporated at any time.
Why should employers participate in HIP Link?
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In summary: HIP 2.0…
• Is Indiana-specific solution
– Establishes our own priorities
– Builds off of successful program
• Expands coverage AND improves access
• Consumer-directed (ownership)
– Price transparency
– Patient/provider partnership
– Focus is on healthy outcomes
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Help us get the word out!
• HIP.IN.gov is your primary resource
– About HIP
– Am I Eligible? Includes eligibility and income calculator
– How to Enroll?
– Links to “Find a Navigator”
– Provider links – health plans, pharmacy
– Helpful Tools (to download)
• Brochures, articles, graphics, training slides
• 1-877-GET-HIP-9
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Contact Information
Jerome Adams, MD, MPH
State Health Commissioner
@jeromeadamsMD
Jennifer Walthall, MD, MPH
Deputy State Health Commissioner
Joan Duwve, MD, MPH
Chief Medical Officer
Eric Miller
Chief of Staff
