Wendy Davis: Leveraging Public Health Capacity to Improve Health System Efficiency
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Transcript of Wendy Davis: Leveraging Public Health Capacity to Improve Health System Efficiency
Vermont Department of Health
Leveraging Public Health Capacity to Improve Health System Efficiency
Wendy Davis, MD – CommissionerOctober 5, 2010
Vermont Department of Health
Objectives
Understand brief history of Vermont’s state health reform efforts: the Blueprint for Health initiative
Review Vermont Department of Health’s (VDH) approach to PH and Health Reform integration
Identify challenges and opportunities for synergy presented by the Patient Protection and Affordable Care Act
Vermont Department of Health
History of Vermont’s state health reform:
Or, “you don’t know where you’re
going if you don’t know where
you’ve been!”
Vermont Department of Health
Vermont Characteristics
Population = 621,760 (2009 est.) Land Area = 9.249 square miles VDH is a centralized public health
department (12 District Offices) 2009: #1 in America’s Health
Rankings (United Health Foundation)
Vermont Department of Health
“Rural”Vermont
WWAMI/RUCA Rural Health Research Center
More Cows than People?
Vermont Department of Health
Vermont Agency of Human Services
Office of the SecretaryDepartment for Children and Families (Child Dev., OCS, Family/Econ Svcs.)Department of CorrectionsDepartment of Disabilities, Aging and Independent Living (DAIL)
Department of Health (VDH)Department of Mental HealthDept. of Vermont Health Access (Medicaid: Catamount Health, Dr. Dynasaur, Blueprint for Health)
Vermont Department of Health
VDH Organization
Alcohol and Drug Abuse Programs
Health Promotion and Disease Prevention
Health Surveillance
Local Health
Maternal and Child Health
Medical Practice Board
Public Health Preparedness
Business, IT, Public Policy, Communications
Vermont Department of Health
VDH Framework: 10 Essential Public Health Services (CDC)Monitor health status to ID/solve community health problemsDiagnose and investigate health problems/hazards in the communityInform, educate, and empower people about health issuesMobilize community partnerships/ action to identify and solve health problemsDevelop policies and plans that support individual and community health efforts
Enforce laws and regulations that protect health and ensure safetyLink people to needed health services and assure provision of health care when otherwise unavailableAssure competent public and personal health care workforceEvaluate effectiveness, accessibility, and quality of personal and population-based health servicesResearch for new insights and innovative solutions to health problems
Vermont Department of Health
Vermont Department of Health
Health Disparities Report 2010
Vermont Department of Health
11
Vermont Department of Health
Vermont Blueprint History: Vermont Blueprint History: The good news . . .The good news . . .
Relatively good distribution of Primary Care Providers (PCPs) statewide
• 800 PCPs in 300 practices in 13 Hospital Service Areas
Three major health plan carriers + Medicaid + Medicare
Most PCPs participate in all plans
History of working together
Vermont Department of Health
Insurers
Providers
Health IT
Public Health
Hospitals
Benefits
ManagersContracted
Services
Pharmaceutical
Companies
Vermont Blueprint History:The Bad News!
Vermont Department of Health
Health Care Reform Goals
Increase Access Improve Quality
Contain Costs
60+ Initiatives
Vermont Department of Health
St. Albans Newport
Burlington
Middlebury
Rutland
Bennington
Barre
White River Jct.
Springfield
Brattleboro
St. Johnsbury Morrisville
History: Community Health and Wellness Grants
CHAMPPS (Coordinated Healthy Activity, Motivation, and Prevention Programs) grant program
Technical assistance provided by VDH
Community Grants
Prevention Specialists
Vermont Department of Health
Bennington
Burlington
St. Johnsbury
Barre
Windsor
Springfield2005—Initial two pilot Hospital Service Areas (Diabetes Focus)
Healthier Living Workshops
Community Physical Activity Grants
April 2007
2004—Planning
2003—Launch of the Blueprint
2006—Four new Hospital Service Areas (Diabetes Focus)
Blueprint HistoryBlueprint History
2006—Statutory Endorsement
2007— Medical Home Integrated Pilots in Statute
2008 - Integrated Medical Home Pilots(all chronic conditions + prevention)
Vermont Department of Health
Improved Outcomes-Healthier People
ProductiveInteractions
Self-Management
Support
DeliverySystemDesign
DecisionSupport
ClinicalInformation
Systems
Health System
Health Care Organization
Community Resources and
PoliciesPublic HealthPolicies, Systems,
Environment
Supportive Environment
Informed,Activated
Patient
Prepared,Proactive
Practice Team
Adapted from the chronic care model which is used by permission of “Effective Clinical Practice.”
What is the Blueprint?
Vermont Department of Health
Vermont State Health Reform Components:
Advanced Primary Care foundation (PCMHs + CHTs)
Multi-Insurer Payment Reforms
A focus on prevention (public health health care delivery)
A statewide health information exchange
An evaluation infrastructure to support ongoing improvement
Facilitators & support for a learning health system
Vermont Department of Health
State Public Health Leadership Role in Comprehensive Health Reform:
Advanced Primary Care foundation (PCMHs + CHTs)
Multi-Insurer Payment Reforms—Policies/Systems
A focus on prevention (public health health care delivery)—All levels of “the Egg”
A statewide health information exchange-PH data/registries
An evaluation infrastructure to support ongoing improvement
Facilitators & support for a learning health system—PH EBP
Vermont Department of Health
Primary Care PCMH-Docs-NPs-Staff
Community Care Team (CCT)e.g. NP, RN, MSW, Dietician,Behavior Specialist, Community Health Worker, VDH Public Health Specialist
Referrals &Communication
Vermont Health Information Platform (VITL)
Hospital-Educators-Transitional care-Ambulatory center (wellness programs)
Referral & care support Education & Improvement Public Health & Prevention
Policies and SystemsLocal, state, and federal policies and laws, economic and cultural influences, media
CommunityPhysical, social and cultural
environment
OrganizationsSchools, worksites, faith-based
organizations, etc
RelationshipsFamily, peers, social networks, associations
IndividualKnowledge, attitudes,
beliefs
Adapted from: McElroy KR, Bibeau D, Steckler A, Glanz K. An ecological perspective on health promotion programs. Health Education Quarterly 15:351-377, 1988.
Support for evidence basedpublic health, prevention, & policy
Model for Health & Prevention
Vermont Department of Health
Central – Public Health Prevention Team•State level assessments•State level strategic planning•Data review & interpretation•Design campaigns / programs•Technical assistance / support
Regional – Public Health Prevention Teams•Local assessments•Local intervention planning•Organizing & coordination•Multidisciplinary Services
Surveillance
HPDP
ADAP
Blueprint
MCH
Preparedness
Rural Health
Business Office
•Program content•Best practices•Domain expertise•Data analysis•Reporting
Transportation
Education
Labor
Medicaid
Corrections
Mental Health
Children & Families
DAIL
•Input•Review•Domain expertise•Coordination•Planning
Departments VDH Programs
State & Local Coalitions
Community Groups
Community Stakeholders
Community Health Teams
VDH Prevention Teams
Functional Map – Public Health Operations
Community Care Team # 1
Community Care Team # 2
Community Care Team # 3
Community Care Team # 4
Vermont Department of Health
Health IT Framework
Global Information Framework
Evaluation Framework
Operations
PCMH
PCMH
PCMH
PCMHHospitals
Public Health Prevention
Community Health TeamNurse Coordinator
Social WorkersDieticians
Community Health WorkersOVHA Care Coordinators
Public Health Prevention Specialist
Behavioral Health &
Substance Abuse Services
Prevention Programs
Policies and SystemsLocal, state, and federal policies and laws, economic and cultural influences, media
CommunityPhysical, social and cultural environment
OrganizationsSchools, worksites, faith-based organizations, etc
RelationshipsFamily, peers, social networks, associations
IndividualKnowledge, attitudes, beliefs
Blueprint Integrated PilotsCoordinated Health System
Vermont Department of Health
Prevention Strategies for Tobacco Use
• Increased tax on tobacco
products
• Smoking restrictions
(workplaces, schools,
restaurants, public places)
• Reduced access to underage
youth
• Community coalitions
• Media
• Smoking cessation services
• Provider counseling
Vermont Department of Health
Community Health Team
Public Health District Office Director, Prevention specialist (chronic disease), Prevention consultant (ADAP)
Care Delivery NP, RN, MSW, Dietician, Behavior Specialist, Community Health Worker
VDH Health Promotion Disease Prevention Programs
Diabetes Substance Abuse / Alcohol
Exercise Cardiovascular Disease
Nutrition Tobacco
Asthma Cancer
VDH Surveillance
Data Integration
Analyses
Report Generation
Routine Assessment
• Coalesce Community Partners• Community Assessments• Prevention Planning & Implementation• Public Health Services• Ongoing Tracking & Quality Improvement
Data Sources
Behavioral Risk Factor Surveillance Survey Data
Adult Tobacco Study Data
Hospital Discharge Data
Vital Statistics Data (Deaths)
Department of Transportation Data
US Census Data
Department of Labor Data
Medical Practice Board Survey Data
Community Snapshots•Rates of risk factors in each community•5 Year Aggregate Data (2002 – 2006)•2006 Statewide Comparison
State Level Assessment•Factors assoc with hospitalizations & costs•10 year trend analysis•Univariate & multivariate modeling
Program products•Tools, Resources•Services & Technical support•Training
Vermont Department of Health
•Quit Tools•Quit Net•Quit By Phone•Quit In Person
Blueprint Integrated Pilots: Coordinated Health System
Patient Centered MedicalHome
Community HealthTeam
Vermont Quit
NetworkCoordinated care & referrals
Health Information InfrastructureEMRs – HIE – DocSite
Access for Program CoachesTrack ReferralsSelf Management GoalsReports for outreach & evaluation
Training to enhance counseling skills
Vermont Department of Health
Health IT Framework
Global Information Framework
Evaluation Framework
Operations
PCMH
PCMH
PCMH
PCMHHospitals
Public Health Prevention
Community Health TeamNurse Coordinator
Social WorkersDieticians
Community Health WorkersOVHA Care Coordinators
Public Health Prevention Specialist
Behavioral Health &
Substance Abuse Services
Prevention Tobacco Cessation
Community messaging & education, facilitate linkages and broad access to cessation programs
Coordinated referrals & patient support between PCMHs + CHTs + Tobacco Cessation Services (phone based counselors, community based group programs)
Expand counseling capacity by training behavioral health counselors and social workers on CHTs. Trained counselors as part of the CHT who can broadly support enhanced self management.
DocSite clinical tracking & reporting that supports outreach by Tobacco Cessation Counselors and coordination between care delivery and cessation programs
VDH Surveillance generates population indicators re prevalence, risk behaviors & exposures, co-morbidities, healthcare utilization & costs. Supports policy making, planning for care delivery and public health strategies, quality improvement, and tracking of program impacts.
Policies and Systems
Community
Organizations
Relationships
Individuals
Blueprint Integrated Pilots
Vermont Department of Health
Prevention Strategies for Obesity• Menu labeling
• Built environment (rail trails)
• Community gardens
• Changes in school cafeteria
selections (Farm to School)
• Running/bike/hiking clubs
• Weight control programs
• Increased awareness
• Health care provider recommendation
Vermont Department of HealthSt. Johnsbury Family HCChronic Care Coor .5 FTEBeh. Health Spec. .5 FTE
Concord Health Ctr.Chronic Care Cood .5 FTEBeh. Health Spec. .5 FTE
Danville Health CenterChronic Care Coor .5 FTEBeh. Health Spec .5 FTE
Corner MedicalChronic Care Coor 1 FTEBeh. Health Spec 1 FTE
OtherDVHA Care ManagersHospital Care ManagersHospital-based CC EducatorsCommunity-based Advocates
Community ConnectionsCommunity Health WorkersCC Comm. Health Worker
VDH District OfficePublic Health SpecialistLadies First CoordinatorCalodenia Int. Medicine
Chronic Care Cood .5 FTEBeh. Health Spec. .5 FTE
St. Johnsbury Community Health TeamCare Integration Coordinator
1 FTE
Vermont Department of Health
Public Health Integrated Prevention Teams
VDH Strategic Plan Goal: “Communities will have the capacity to respond to public health needs• Capacity building efforts integrated and aligned
internally and with (external) community partners Training
• “Prevention and Health Promotion Basics” Team development
• Central office—cross disciplinary mgt. team• District (local) office—cross disciplinary fcnl. teams
Vermont Department of Health
Pilot Locationsthru July 2010
Vermont Department of HealthJuly
2008Jan 2009
July 2009
Jan 2010
July 2010
Jan 2011
July 2011
Jan 2012
July 2012
Jan 2013
July 2013
Pilot # 1 St Johnsbury HSA St Johnsbury HSA Expansion
Pilot # 2 Burlington HSA Burlington HSA Expansion
Readiness Pilot # 3 Barre HSA Barre HSA Expansion
Readiness HSA # 4 Rollout
Readiness HSA # 5 Rollout
Readiness HSA # 6 Rollout
Readiness HSA # 7 Rollout
Readiness HSA # 8 Rollout
Readiness HSA # 9 Rollout
Readiness HSA # 10 Rollout
Readiness HSA # 11 Rollout
Readiness HSA # 12 Rollout
Readiness HSA # 13 Rollout
Implementation Phase Demonstration Phase (Medicare?)
Target Population% of VT Population# CHTs
42,1796.7%
2
126,28620%
6
316,66250%16
508,1780%25
637,130100%
32
Blueprint Integrated Health System - Proposed Expansion
04/11/23 31
Vermont Department of Health
Health IT Framework
Evaluation Framework
BP Integrated Pilots: Building an Integrated System of Health
PCMH
PCMH
PCMH
PCMHHospitals
Public Health Prevention
Community Health TeamNurse Coordinator
Social WorkersDieticians
Community Health WorkersOVHA Care Coordinators
Public Health Prevention Specialist
Mental Health & Substance
Use Disorders
Integrated Health Service Model
Payment Reform to support prevention & health maintenance
Health Information Infrastructure
Evaluation Infrastructure
Generalizable (other services)
Scalable (larger populations)
Sustainable (financially)
PCMH
Vermont Department of Health
Community Health Team
Patient Centered Medical Homes
Multi-insurer payment reform
Health Information Infrastructure
Evaluation Infrastructure
AM
PC
Foundation
Blueprint: A Foundation for integrated services
Targeted S
ervices
Specialty Care
Disease Management Programs
Case Management
Social Services
Economic Services Areas of FocusFamily Wellness & Children's ServicesMental Health & Substance UseMedicaid Care CoordinationSenior Services (SASH)Disease Specific (CHF)
StepsClinical Services ModelFinancial Impact ModelPayment ReformsIT Infrastructure & EnhancementsImplementation PlanEvaluation Plan
Vermont Department of Health
Even silos can be systematic!
Vermont Department of Health
QUESTIONS???
Web address:
www.healthvermont.gov