Marissa Levine, MD, MPHState Health Commissioner

September 7, 2016

Virginia’s Plan for Well-Being

Outline

• Review the Process for Plan Development

• Key Points/Assumptions

• Components of the Plan

• Health in All Policies

• Next Steps

Page 2

HEALTHY, CONNECTED COMMUNITIES

• H.S. Grads Enrolled in Higher Ed

• Cost-Burdened Households

• Consumer Opportunity Index

• Economic Opportunity Index

• Districts with Collaborative Improvement

Processes

PREVENTIVE ACTIONS

• Adults Not Participating In Physical Activity

• Adults Who Are Overweight or Obese

• Households That Are Food Insecure

• Adults Using Tobacco

• Adults Vaccinated Against Influenza

• Adolescents Vaccinated Against HPV

• Adults Screened for Colorectal Cancer

• Percent of Adults With Adverse Childhood

Experiences

• Disability-free Life Expectancy

STRONG START FOR CHILDREN

• Teen Pregnancy Rate

• Kindergarteners Not Meeting PALS-K Benchmark

• Third Graders Passing Reading SOL

• Infant Mortality Rate by Race

SYSTEM OF HEALTH CARE

• Adults With A Regular Health-care Provider

• Avoidable Cardiovascular Disease Deaths

• Mental Health and Substance Abuse

Hospitalizations

• Avoidable Hospital Stays

• Adults Whose Poor Health Kept Them from Usual

Activities

• Providers With Electronic Health Records

• Health Districts With Electronic Health Records

• Entities Connected to the Health Information

Exchange

• Hospitals Meeting State Goal for Prevention of C.

difficile Infections

Virginia’s Plan for Well Being MetricsPercent of Adults Who Report Positive Well-Being

Page 3

Population Health Data Framework

Drivers Drivers

StateData

Regional Data

Regional Data

Regional Data

Regional Data

Local Data

Local Data

Local Data

Local Data

Local Data

Local Data

Local Data

Local Data

Drivers Drivers

Community Health

Assessment in Every District

Page 4

Virginia’s Plan for Well-Being

Key Points/Assumptions

• Health and well-being matters to all people in Virginia

• Dealing with the burden of disease and breaking the cycle of debilitating disease must be addressed simultaneously

• Community-led, data-driven, focused solutions are the ideal

• State efforts (executive and legislative) should intentionally facilitate the development and/or maintenance of these community efforts and be aligned for efficiency and impact

Page 5

Relative Contribution of Factors that Affect Health

Social and

Economic

Factors

Health

Behaviors

Clinical

Care

Genetics

Environment

Source: McGinnis et al, The Case for More active Policy Attention to Health Promotion, Health Affairs, 21, no. 2 (2002): 78-93

Page 6

Health Status Assessment

Data-driven decision making

and feedback

Create a System of Healthcare

Build Prevention Everywhere

Redefine Health

Strong Start

for All

Children

HEALTHY, CONNECTED COMMUNITY

Page 7

http://virginiawellbeing.com

Page 8

Aim 1: Healthy, Connected

Communities

Page 9

A composite measure comprised of 13 indices that reflect a broad array of social determinants of health

Air Quality ● Population Density ● Population Churning ● Walkability ● Affordability ● Education ● Food Access ● Material Deprivation ●Employment ● Income Inequality ● Job Participation ● Segregation ● Access to Health Care

Virginia Health Opportunity Index

Page 10

43.0%

82.8%

100.0%

0.0%

20.0%

40.0%

60.0%

80.0%

100.0%

Virginia Baseline (2015) Virginia Current (2016) Virginia Goal (2020)

Dis

tric

ts w

ith

Co

llab

ora

tive

CH

A/C

HIP

Pro

cess

esPercent of Health Planning Districts with an On-going

Collaborative Community Health Improvement Process

Page 11

Aim 2:Strong Start for

Children

Page 12

Source: William Hollinshead, Trajectories and MCH Checkpoints, 2007

Life Course Theory

PGY= Pregnancy

HEA

LTH O

UTC

OM

ES

Page 13

51.6

24.9

25.1

0

20

40

60

2005 2006 2007 2008 2009 2010 2011 2012 2013 2014

Teen

Pre

gnan

cy R

ate

per

1,0

00

Fem

ales

A

ges

15

-19

Year

Teen Pregnancy Rate per 1,000 Females Ages 15-19

Virginia Reported

Virginia Goal

27.924.9 25.1

0

10

20

30

Virginia Baseline (2013) Virginia Current (2014) Virginia Goal (2020)

Teen

Pre

gnan

cy R

ate

per

1,0

00

Fe

mal

es A

ges

15

-19

Page 14

14.4

11.2

5.9

4.95.2

0.0

2.0

4.0

6.0

8.0

10.0

12.0

14.0

16.0

2005 2006 2007 2008 2009 2010 2011 2012 2013 2014

Infa

nt

Mo

rtal

ity

Rat

e

Year

Infant Mortality Rate Per 1,000 Live BirthsVirginia Reported [Black]Virginia Reported [White]Virginia Goal

12.211.2

5.2 4.9 5.2

0.0

2.0

4.0

6.0

8.0

10.0

12.0

14.0

Baseline (2013) Reported (2014) Baseline (2013) Reported (2014) Virginia Goal(2020)

Infa

nt

Mo

rtal

ity

Rat

e

BLACK

WHITE

Page 15

Page 16

Aim 3:Preventive Actions

Page 17

23.7%

19.4%

12.0%

0.0%

5.0%

10.0%

15.0%

20.0%

25.0%

2011 2012 2013 2014 2015

Tob

acco

Use

rs

Year

Percent of Adults Who Reported Using Tobacco

Virginia Reported

Virginia Goal

21.9%19.4%

12.0%

0.0%

5.0%

10.0%

15.0%

20.0%

25.0%

Virginia Baseline (2014) Virginia Current (2015) Virginia Goal (2020)

Tob

aco

o U

sers

Page 18

Aim 4:System of Health Care

Page 19

69.3% 71.1%

85.0%

0.0%

25.0%

50.0%

75.0%

100.0%

Virginia Baseline (2014) Virginia Current (2015) Virginia Goal (2020)

Perc

ent

of

Ad

ult

s w

ith

Hea

lth

care

Pro

vid

erPercent of Adults Who Reported

Having a Regular Healthcare Provider

Page 20

38.5% 38.3%

100.0%

0.0%

25.0%

50.0%

75.0%

100.0%

Virginia Baseline (2013) Virginia Current (2014) Virginia Goal (2020)

Perc

ent

of

Ho

spit

als

Mee

tin

g Pr

even

tio

n G

oal

Percent of Hospitals Meeting Virginia's Goal for Prevention of Hospital-Onset Clostridium difficile Infections

Page 21

1931.8

1765.5

1559.9

1216.4

894.7

0

500

1000

1500

2000

2500

Very Low HOI Low HOI Moderate HOI High HOI Very High HOI

Prevention Quality Indicators (PQI) Overall Composite Index by HOI by Quintiles *

* Per 100,000 Population ages 18 years and older

Page 22

966.7

793.0

656.0

508.1

364.5

1086.2

954.0

818.3

583.4

396.8

0.0

200.0

400.0

600.0

800.0

1000.0

1200.0

Very Low HOI Low HOI Moderate HOI High HOI Very High HOI

Diabetes Hospitalization Rate COPD Hospitalization Rate* Per 100,000 Population ages 18 years and older

Page 23

Proposal – Define The Issue In Collaboration With Stakeholders And Appropriate Data

Stage 1- Foundation

DATAAnalyze Existing Data

Including ROI

LAW & Legislative ActivityAnalyze Existing Laws,

Prior Legislative ActivityBills & Fiscal Impact Statements

STAKEHOLDER Analyze & Identify Existing and

Future Stakeholders

Stage 3- Consolidation & Decisions

Consolidate All Analyses &

Input

Develop Proposal,

Alternative or Stop

Model Process for Developing Public Health Policy

Evaluations & AnalysesReview articles, studies and

reports

Best Practices

Key Principles Data Driven

Stakeholder Engagement Thorough Vetting

Broad Based Benefit

AssumptionsNot A Linear ProcessNo Fixed Time Table

Stage 2- Action

Stage 4- Evaluate

Implementation ChallengesPolitical Will

Emotional ConstituentsHow Much is Enough?

Resulting Policy Changes Evaluated For Effectiveness

Page 24

References

• Virginia’s Plan for Well-Being

– http://virginiawellbeing.com/

• Virginia Health Opportunity Index

– https://www.vdh.virginia.gov/omhhe/hoi/

• Health in All Policies - NCSL

– http://www.ncsl.org/research/environment-and-natural-resources/health-in-all-policies.aspx

Page 25

Summary and Questions

Page 26