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Driving Health Improvement Through Community Population
Measurement
Deryk Van Brunt, DrPHPresident and Chairman, Healthy Communities InstituteAssociate Clinical Professor, UC Berkeley School of Public Health
Pay for Performance Summit 8
• Mission‒
Improve the health, vitality and environmental sustainability of communities, counties and states
• Headquarters‒
Berkeley, California• Problem / Approach
‒
Population health data is too decentralized‒
Centralize, make understandable, lead to evidence-based action• Solution / Healthy Communities Network
‒
Provide community indicator dashboards, GIS mapping, best practice sharing tools leveraging population health data
• National Relationships / Awards / Coverage‒
2012 Health and Human Services Award: “Best Community Health App”‒
2011 Health and Human Services Award: “MyHealthyPeople: Helping Attain The Health Goals Of Healthy People 2020”
‒
VHA and CHA National Agreements‒
90+ million lives in the United Statesand
Healthy Communities InstituteCloud-based Population Health Management
and
Why Care About Population Health?
Determinants of Health
Chronic Conditions Consume 75% of Total Health Care Expenditures
Demographic and Cultural Trends
Sedentary LifestyleSmoking (although on the decline)Diet High in Fat, Sugar, Salt, Processed FoodsBuilt Environment - does not typically foster healthy lifestyle
and
Medical Care 10% Genetics 20%Environment 20%Lifestyle 50%
resulting in increased incidence and prevalence of chronic illness:
and
Hospitals/Institutions
Managing Health Risk of Populations
MetricsBest PracticesEvaluation
and
MetricsBest PracticesEvaluation
MetricsBest PracticesEvaluation
Hospitals/InstitutionsCommunity
Managing Health Risk of Populations
Community Health Factors feed utilization of our health care system.
and
Healthy Communities Network Population Health Management System
100–200 IndicatorsColor-CodedConstantly Updated
Community Dashboard
2000+ in DatabasePrograms & PoliciesEvaluation-based
Promising Practices
Form Working GroupsSet Local GoalsManage Achievement of Objectives
HP2020 TrackerLocal Priorities TrackerComparative and Longitudinal Evaluation
Evaluation & Tracking
Collaboration Centers
and
Generalized Population Health Benefits Hospital/Insurer/ACO• Helps local stakeholders perform strategic
planning• Promotes community health and development
(one source of truth)• Drives community engagement• Helps meet Public Health Accreditation Board
assessments and state requirements• Supports MAPP programs (community
partnerships, data requirements, etc.) • Helps hospitals meet Health Care Reform
and IRS 990 requirements• Promotes best practice sharing
• Map Hotspots: Identify and geo-map high risk population hotspots with expensive chronic disease.
• Drill Down: Cross-reference lifestyle, behavioral, and demographic factors to identify opportunities to mitigate risk and lower costs within hotspots.
• Best Practices: Implement community health best practices across target populations.
• Track and Evaluate Progress: Customizable Dashboards, Trackers, Report Cards, etc.
and
Features and Benefits
Indicator Hospitalizations
Risk-Adjusted Hospitalization
Rates per 100,000 population
Estimated Cost
Mental Health* 3306 440.8 $21.2 million
COPD/Asthma in Older Adults (40+) 1320 290.0 $10.0 million
Heart Failure 2230 285.8 $29.8 million
Bacterial Pneumonia 1629 210.7 $17.1 million
Low Birth Weight 794 6.2 $55.5 million
Example: Honolulu County 2011
8*Rate for this cause is unadjusted
and
Highest Preventable Hospitalization Costs
Bacterial Pneumonia Hospitalization Rates by HSA
9
and
Hawaii Health Matters Indicator Pneumonia Vaccination Rate 65+
10
and
Hawaii Health Matters Indicator Pneumonia Vaccination Rate 65+
11
and
Intervention Outcome
The HMO Group Health, Inc. encouraged influenza vaccinations with walk-in vaccination clinics, patient mailings, and nurses offering vaccines to high-risk patients1
• Reduced hospitalizations for pneumonia and influenza in the 65+ population by up to 57% (p<0.002)
• Reduced hospitalization costs for pneumonia and influenza in the 65+ population by 52% (p<0.005)
Blue Cross Blue Shield sent direct mail marketing pieces encouraging its members to get vaccinated against influenza/pneumonia2
• 2.62% (p=0.01) higher rate of influenza vaccinations, 4.61% higher rate of pneumonia vaccinations (p=0.08)
• 9.67% (p=0.136) lower rate of influenza/pneumonia inpatient admissions
• 22.64% (p=0.002) lower rate of influenza/pneumonia ED visits
• ROI: >2:1
Interventions to Reduce Influenza/Pneumonia
Hospitalizations/Costs: Examples
121. Nichol, K.L., K.L. Margolis, J. Wuorenma, and T. Von Sternberg. “The Efficacy and Cost Effectiveness of Vaccination against Influenza among Elderly Persons Living in the Community.” New England Journal of Medicine 1994; 331: 778-784. doi: 10.1056/NEJM1994092233112062. Berg, G.D., E. Thomas, S. Silverstein, C.L. Neel, and M. Mireles. “Reducing medical service utilization by encouraging vaccines: Randomized controlled trial.” American Journal of Preventive Medicine November 2004, 27(4): 284-288. doi: 10.1016/j.amepre.2004.07.001
and
Cross Pollinate Successful Strategies Nationally
and
Over 90 Million Lives Covered
• Population Health Management
• Hotspotting – Mapping and high impact practices to proactively improve poor health
Conclusion
Deryk Van Brunt | [email protected] | BOOTH 5