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Public Health /
Healthcare
Collaboration a multi-lingual endeavor
Missouri Department of Health and Senior Services and LPHA Public Health Conference
March 21, 2017
Don Bradley, MD, MHS-CL Executive Director, The Practical Playbook
Associate Consulting Professor, Duke School of Medicine
Objectives
• Recognize gaps in population health
definitions
• Identify collaboration opportunities
between public health and healthcare
• Identify at least one tangible action you will
undertake to collaborate to improve your
community’s health and well being
Midwest and rural roots
My [Primary Care] Public Health Story
• July 1976 First Legionaire’s Disease cases
• 1977 Public Health certificate- University of Minnesota
• 1978 Teaching- Penn State Hershey
• March 1979 Three Mile Island
• June 1979 Polio outbreak- Amish
Top Strategic issues: Missouri Public Health System Partners Group, 2017
1. Access to healthcare a) Access, cost, uninsured
b) Economy
2. Modifiable risk factors a) Obesity
b) Smoking
c) Mental health/substance abuse
3. Infrastructure issues a) Mobilizing partnerships
b) Performance management/Quality improvement
c) Workforce development
http://health.mo.gov/data/pdf/mohealthimproveplan.pdf
Disclosures [and alignments]:
The
Practical
Playbook
www.practicalplaybook.org
PPB Strategic Priorities
• Promoting/providing practical tools and resources that facilitate effective cross-sector collaboration, and evaluating their use and impact
• Connecting like-minded state, national, and local organizations to generate collaboration, creativity, and interventions at scale and document results of those collaborations
• Supporting the training and development of health professionals that improve the health of the U.S. population.
Four opportunities for public health
• #1 Language and listening
• #2 Integration [collaboration]
• #3 Information and stories
• #4 Disruption: New rules,
Same goals, New opportunities
Opportunity #1:
Language and listening
Raise your hand if you :
• Work in public health
• Work in population health
• Are a health professional
• Are multi-lingual
Speak the 5 Ps:
• Provider [health care]
• Policy [legislative
and/or regulatory]
• Public health
• Payer
• Person
Health: World Health Organization
Health is a state of complete physical, mental and social well-being
and not merely the absence of disease or infirmity. The correct bibliographic citation for the definition is:
Preamble to the Constitution of the World Health Organization as adopted by the International Health
Conference, New York, 19-22 June, 1946; signed on 22 July 1946 by the representatives of 61 States (Official
Records of the World Health Organization, no. 2, p. 100) and entered into force on 7 April 1948.
The Definition has not been amended since 1948.
Population: 3 a : a body of persons or individuals having a
quality or characteristic in common http://www.merriam-webster.com/dictionary/population
Professional: c (1) : characterized by or conforming to
the technical or ethical standards of a profession (2) : exhibiting a
courteous, conscientious, and generally businesslike manner in
the workplace http://www.merriam-webster.com/dictionary/professional
Definition of Population Health
The health outcomes of a group of
individuals, including the distribution of
such outcomes within the group. It is an
approach to health that aims to improve
the health of an entire human
population. Kindig D, Stoddard G, Models for Population Health, AJPH 2003, 90(3):380-383
“Population Health” differentiated
Population Health
Management
• Current paradigm
• Attribution retroactive,
algorithm-driven
• Passive engagement
• Clinical focus
• Mostly clinical health
professionals
• Funding value-based +/-
per capita
Population Health
Improvement
• Future paradigm
• Attribution geographic
and/or population
characteristic
• Proactive engagement
• Community, public health,
and clinical health
professionals
• Funding flexible [vague]
Definition of Public Health:
Public health is the science of protecting and improving
the health of families and communities through
promotion of healthy lifestyles, research for disease and
injury prevention and detection and control of infectious
diseases. http://www.cdcfoundation.org/content/what-public-health
Public health promotes and protects the health of
people and the communities where they live, learn,
work and play. https://www.apha.org/what-is-public-health
Essential
Public Health
Services
http://www.cdc.gov/nphpsp/es
sentialservices.html
Opportunity #2: Integration/collaboration
https://www.cdc.gov/nchs/data/databriefs/db267.pdf
Missouri overall health ranking, 2016
http://www.americashealthrankings.org/learn/reports/2016-
annual-report/findings
Missouri
#37
And health outcomes are variable [2016]
http://www.countyhealthrankings.org/app/missouri/2016/overview
Missouri core measures impact-
positive, 2015
http://www.americashealthrankings.org/explore/2015-annual-
report/measure/Overall/state/MO
Mo. core measures impact, 2015
http://www.americashealthrankings.org/explore/2015-annual-
report/measure/Overall/state/MO
ACOs are struggling to meet targets
http://www.commonwealthfund.org/publications/issue-
briefs/2015/may/aca-payment-and-delivery-system-reforms-at-5-years
Despite some significant improvements
http://www.commonwealthfund.org/publications/issue-briefs/2015/may/aca-
payment-and-delivery-system-reforms-at-5-years
The pace of reform is accelerating
http://www.commonwealthfund.org/publications/issue-
briefs/2015/jun/medicare-payment-reform-aligning-incentives
Health 3.0 evolution
www.healthypeople.gov/ph3
“Integration” defined
Institute of Medicine:
‘the linkage of programs and activities to promote overall efficiency
and effectiveness and to achieve gains in population health.’
Principles of Integration:
Shared goal of population health
Aligned leadership
Community engagement
Sustainability
Collaborative use of data
If you want to go fast, go alone.
If you want to go far, go together.
Public Health System
http://www.cdc.gov/nphpsp/essentialservices.html
National Academy of Medicine (IOM) Roundtable
on Obesity Solutions, 2017
https://nam.edu/a-model-framework-that-integrates-community-
and-clinical-systems-for-the-prevention-and-management-of-
obesity-and-other-chronic-diseases/
A deeper look at the population health framework:
Opportunity # 3: Information and Stories
San Diego collaboration
How does Healthy Homes Des Moines work?
Through Healthy Homes Des Moines, households with children
suffering from asthma will receive home repairs to address
asthma triggers, and families will receive tailored health
education to self-manage asthma and maintain a healthy
home.
http://www.healthyhomesdesmoines.org/ http://buildhealthchallenge.org/our-communities/
Opportunity # 4: new rules, same goals, New Opportunities
Health[care] and the Federal Budget:
Where our money
goes: And what it gets us:
Largest
Impact
Smallest
Impact/ highest individual effort
Examples
Condoms, eat
healthy, be
physically active
Rx for high blood
pressure, high
cholesterol
Poverty, education, housing, inequality
Immunizations, brief
intervention, cessation
treatment, colonoscopy
Fluoridation, 0g trans
fat, iodization, smoke-
free laws, tobacco tax
Socioeconomic Factors
Changing the Context
to Make Individuals’ Default
Decisions Healthy
Long-lasting
Protective Interventions
Clinical
Interventions
Counseling
& Education
Factors That Affect Health
Frieden TR. A framework for public health action. Am J Public Health. 2010;100(4):590–595.
Healthcare Transformation-
• Block grants to states
• Value-based payment/ MACRA
• Accountable care organizations (ACOs)/
Accountable Health Communities
• Patient-centered medical homes/medical
neighborhood
• On-line and digital care, telehealth
• Alternative providers/sites of care
• Limited and/or tiered networks [and formularies]
• Transparency, consumerism and self-management
If you’re not at the table, you’re on the menu!
For more information, connect with us on social media.
Follow us: @PracPlaybook
Like our page: Practical Playbook
Follow us: Practical Playbook
Follow us: Practical Playbook
https://practicalplaybook.org/
Take home opportunities
• Become multi-lingual and listen
• Look for opportunities to collaborate/align
• Use information [data] to tell compelling
stories
• View disruption as a positive lever rather
than an inconvenience
Thank you!
