Public Health and Primary Care: The Best of Both Worlds

Ted Wymyslo, MD Director, Ohio Department of Health

Terry Allan, Health Commissioner

Cuyahoga County Board of Health

Annual Practice-Based Research Festival Dec. 7, 2013

2 Source: Image from Institute of Medicine video, “Primary Care + Public Health in the Community,” 2012, http://www.iom.edu/Reports/2012/Primary-Care-and-Public-Health/Video.aspx

Fragmentation vs. Coordination

Multiple separate providers

Provider-centered care

Reimbursement rewards volume

Lack of comparison data

Outdated information technology

No accountability

Institutional bias

Separate government systems

Complicated categorical eligibility

Rapid cost growth

Accountable medical home

Patient-centered care

Reimbursement rewards value

Price and quality transparency

Electronic information exchange

Performance measures

Continuum of care

Medicare/Medicaid/Exchanges

Streamlined income eligibility

Sustainable growth over time

SOURCE: Adapted from Melanie Bella, State Innovative Programs for Dual Eligibles, NASMD (November 2009)

Where We Are Where We Need to be

3

Principles of Successful Integration

• Community engagement

• Strong leadership

o Involve both clinical medicine and public health

• Common goal of improving population health

• Collaborative use of data and analysis

• Sustainability

o Funding, quality measures, payment reform

Source: “Primary Care and Public Health Exploring Integration to Improve Population Health” Report Brief,

http://www.iom.edu/~/media/Files/Report%20Files/2012/Primary-Care-and-Public-

Health/Primary%20Care%20and%20Public%20Health_Revised%20RB_FINAL.pdf

IOM—Integration of Public Health and Primary Care

Goal: Optimize population health.

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IOM Continuum of Integration

Source: “Primary Care and Public Health Exploring Integration to Improve Population Health” Report Brief,

http://www.iom.edu/~/media/Files/Report%20Files/2012/Primary-Care-and-Public-

Health/Primary%20Care%20and%20Public%20Health_Revised%20RB_FINAL.pdf

ODH Priorities and Cross-Cutting Strategies

6

Aligning Priorities through Integration

7

Public Health Issue Injury Prevention Public Health Communication Decrease Infant Mortality* Curb Tobacco Use* Reduce Obesity*

Expand PCMH across Ohio*

Initiative Opioid Emergency Dept. & Prescriber Guidelines ODH & WebMD OPQC 39-Week Project Ohio Quit Line/Ohio Tobacco Collaborative Creating Healthy Communities

OPCPCC

* An ODH Strategic Priority

Reduce Prematurity

Ohio Perinatal Quality Collaborative

39-Week Project: Sept 2008 - March 2013

• Successful QI project improved birth outcomes by

reducing the number of non-medically scheduled

deliveries prior to 39 weeks as well as improving birth certificate accuracy.

• Received ASTHO’s 2012 Vision Award for innovative

and effective approach to improving maternal and

infant health.

8

Help People Quit Smoking

• Increase the number of Ohioans who have access to cessation services at no cost.

• Promote 5 A’s - Ask, Advise, Assess, Assist, Arrange.

9 www.healthyohioprogram.org

The CHC Program currently serves high-need communities in 16 counties, for a collective population of 5,797,335.

Creating Healthy Communities (CHC)

Ensuring every Ohioan has an established relationship with a personal healthcare provider, in a system focused on making

health decisions that promote wellness and achieve high value.

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Patient-Centered Medical Homes (PCMH)

• Personal Primary Care Provider

• Primary Care Provider-Directed Medical Practice

• Whole Person Orientation

• Coordinated and Integrated Care

• Care is Safe and High-Quality

• Enhanced Access

• Payment Reform

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The Medical Neighborhood

Adult Son’s House School

Urgent Care

Patient’s House

Nursing Home

Pharmacy

Rural Access

Center

Laboratory

Local

Health

Department

Hospice

Academic

Institution

Critical Access

Hospital

Dentist

Office

Dietitian

PCMH

Counseling Center

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Strengthen PCMH Capacity in Ohio

• Facilitate statewide expansion of the PCMH model of

care.

Ohio recently surpassed the 300th PCMH Practice Milestone!

• Align statewide expansion activities with existing regional and other PCMH initiatives.

• Support efforts to utilize PCMHs as workforce training sites.

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340 PCMH Practices in Ohio

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Population Density in Ohio (11.5 million)

PCMH Expansion: Ohio is just getting started

Source: Patient-Centered Medical Home, www.odh.ohio.gov, Nov., 2013.

Coming Together to Transform Health in Ohio 16

More about Health Integration in Ohio o

17 www.odh.ohio.gov & www.astho.org

Acting Locally

Working with ODH and Community

Partners in Greater Cleveland to

Advance Public Health Practice

Distance to Grocery (Miles)

Unweighted

0.03 to 11 to 1.51.5 or Greater(No Population)

Grocery > 25,000 S.F. Avg. Dist.

(Miles)

Cuyahoga 1.4

Suburbs 1.3

Cleveland 1.6

Food Balance Ratio

Weighted by Population Share

0 to 11 to 2.52.5 or More(No Population)

Grocery > 25,000 S.F.

Fast Food

Food

Balance

Score

Cuyahoga 2.5

Suburbs 2.0

Cleveland 4.5

Distance to Fast Food (Miles)

Unweighted

0 to 11 to 1.51.5 to 3.3(No Population)

Fast Food Avg. Dist.

(Miles)

Cuyahoga 0.5

Suburbs 0.7

Cleveland 0.4

Food Balance Ratio

Weighted by Population Share

0 to 11 to 2.52.5 or More(No Population)

Grocery > 25,000 S.F.

Fast Food

Households Without Vehicles

Place Matters: Health, Wealth, & Life

Expectancy

Fa

mil

y &

Cu

ltu

re

Health

Inequities

Health

Disparities

www.hipcuyahoga.org

Vision

Eliminate race as a Social

Determinant of Health

Improved nutrition &

physical activity

Create access to quality &

equitable care

Improve chronic disease management

Improve coordination

between clinical care & public health

Create safe &

supportive

environments

Strategic Issues Key Priorities

Cuyahoga County Infant Mortality

3 Year Avg. (2008 – 2010)

9.3%

5.2%

15.5%

0%

2%

4%

6%

8%

10%

12%

14%

16%

18%

2008 - 2010

Overall White_N/H Black_N/H

Burden of Infant Deaths

(2008-2010)

Ohio Equity Institute

One of 9 communities across the state involved in

a collaborative supported by ODH with CityMatCH

to improve overall birth outcomes and reduce

racial and ethnic disparities in infant mortality

across the state by addressing inequities.

Will assess local capacity and data to develop

plans, tools, and strategies for reducing inequities

in birth outcomes.

Clinical-Public Health

Collaboration

CWRU School of Medicine and

the Cuyahoga County Board of

Health

Examples of Collaboration

• Heidi Gullett, board certified in preventive medicine (2 year commitment)

– Co-Chair Clinical and Public Health Subcommittee of HIP Cuyahoga

– Assist with field practicum coordination for University Hospitals Preventive Medicine Residency

– Linkage with FQHC’s and hospitals systems

– Identify opportunities in ACA

– Identify academic/public health research opportunities

– Assist with accreditation preparation

– Participant in ASTHO PHC/PH Collaboration

Questions?

40

www.odh.ohio.gov 41

Working Together to Protect and Improve the Health of all Ohioans.

Ted Wymyslo, M.D.

Director, Ohio Department of Health

(614) 466-2253

Terry Allan, Health Commissioner

Cuyahoga County Board of Health

tallan@ccbh.net