Public Health and PCMH

1
Public Health and PCMH

• Karyl Rattay, MD, MS
• Director
• Delaware Division of Public Health

2
Important Points

• Health is More than Health Care
• Population Health
• Integration of Primary care and Public Health
• Community Engagement
• We are learning from interviewing you
• Some PCMH-related activities under way

3
Health is more than health care
4
How Can You Explain This?
Health Care Spending vs Health Outcomes
4
Source United Nations Development Programme
Report 2007-2008. Retrieved from
www.unnatuaralcauses.org
5
DETERMINANTS OF HEALTH
5-10
5
6
The REAL Causes of Death
7
Health Care Pyramid
Tertiary Medical Care
95 Health Care Spent on Acute and Chronic
Care
Secondary Medical Care
Primary Medical Care
Population-Based Services
10 of Improvement in Health Status Attributed to
Medical Care 90 Attributed to Population-Based
Approaches Adapted from J. Michael McGinnis,
M.D.
8
Population Health
9
Population Health

• An approach to health that aims to improve the
  health of an entire population
• Addresses a broad range of factors that impact
  health on a population-level
• A perspective recognizing the importance of
  social determinants of health and the relatively
  minor impact that medicine and healthcare have on
  improving health overall.

10
Individual Vs Population Health

• Best outcome for individual
• Treat a patient for gastroenteritis
• Vaccinating patients
• Counseling against smoking
• Treating the consequences of obesity
• Treating STD
• Diagnosing an illness

• Communitys health
• Investigating outbreaks, restaurant inspections,
  safe water
• Safety net for vaccinating medically indigent
• Advocating for smoke-free environments
• Promoting built environments conducive to
  physical activity
• Finding and treating exposed partners
• Conducting community health assessments

11
Health Reforms Opportunity to Improve Public
Health
Population Approach Clinical Care
Better Health
12
Integration of primary care and public health
13
What Do We Mean by Integration

• The linkage of programs and activities to promote
  overall efficiency and effectiveness and achieve
  gains in population health.
• Can take many forms

Source Institute of Medicine. Primary Care and
Public Health Exploring Integration to Improve
Population Health, March 28 2012.
14
Why Integrate?

• Health has many contributors
• Substantial and lasting improvements will require
  a common goal
• Enhance the capacity of both sectors to carry out
  their missions

Source Institute of Medicine. Primary Care and
Public Health Exploring Integration to Improve
Population Health, March 28 2012.
15
Why Integrate Now?

• Dramatic rise in health care costs
• Importance of social and environmental
  determinants of health
• New opportunities to understand and address
  community-level health concerns
• ACA presents opportunities

Source Institute of Medicine. Primary Care and
Public Health Exploring Integration to Improve
Population Health, March 28 2012.
16
Principles for Successful Integration

• Shared goal of population health improvement
• Community engagement
• Aligned leadership
• Sustainability
• The sharing and collaborative use of data and
  analysis

Source Institute of Medicine. Primary Care and
Public Health Exploring Integration to Improve
Population Health, March 28 2012.
17
(No Transcript)
18
Community engagement
19
Health in all Policies

• Looks at all public- and private-sector policy
  making through a health lens
• Objective is to promote and protect the health of
  the population
• Addresses the social and physical environment
  influences on health

20
What is a Healthy Community?
Source Prevention Institute. Community-Centered
Health Homes Bridging the gap between health
services and community prevention. Feb. 2011.
21
DPHs Role
22
DPH Stakeholder Interviews

• A work in progress
• More than 15 interviews
• Government
• Healthcare
• Business
• Community

23
Interview Themes So Far

• Population Health
• Integration of Primary Care and Public Health
• Community Engagement
• Convening Role
• Data, research and evaluation
• Policy Input (as opposed to policy development)
• Implementation of policy

24
DPHs Priorities and current related activities
25
Health Reform is a DPH StrategicPriority
26
Care Coordination
Integration

• A partnership between DPH, hospitals and large
  Delaware Health Centers.
• Assistance with access to care, cancer screening,
  cancer care coordination, diabetes education and
  chronic disease management.
• Cancer Screening Nurse Navigators in five acute
  care hospital systems
• Cancer Care Coordinators in six hospital systems
• Community healthcare access coordinators in three
  hospitals and large health centers.
• Certified Diabetes Educators in large health
  centers (FQHCs and Claymont)
• Chronic Disease Nurses in the DPH Chronic Disease
  Bureau

27
Help Me Grow
Integration
28
Healthy Weight Collaborative
Integration

• Objectives
• Organize and manage a Healthy Weight Learning
  Collaborative utilizing quality improvement
  methods.
• Establish innovative partnerships between public
  health, primary care, and community
  organizations.
• Support sustainable change and foster
  collaboration through technology.

29
Community Health Workers
Community Engagement

• Bridging cultural mediation between communities
  and the health care system
• Providing culturally appropriate and accessible
  health education and information, often by using
  popular education methods
• Assuring that people get the services they need
• Providing informal counseling and social support
• Advocating for individuals and communities within
  the health and social service systems
• Build individual and community capacity

30
Summary

• Public health wants to be involved in reforming
  our delivery system because health is more than
  health care
• As we think about PCMH, integration of primary
  care and public health, population health, and
  community engagement are among the essential ways
  in which public health can contribute.
• While DPH has some efforts under way in all of
  these areas, we are actively learning about how
  we can evolve as a value added partner.

31
Questions