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Improving Health Outcomes and Assuring Access to High Quality, Affordable Health Care for All Oklaho

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Prevention and health promotion. Access to care. Quality and Cost control ... 1: Improving health outcomes through prevention and health promotion ... – PowerPoint PPT presentation

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Title: Improving Health Outcomes and Assuring Access to High Quality, Affordable Health Care for All Oklaho


1
Improving Health Outcomes and Assuring Access to
High Quality, Affordable Health Carefor All
Oklahomans
  • Mike Crutcher, MD, MPH
  • Commissioner of Health
  • Oklahoma State Department of Health

2
Improving Health Outcomes and Assuring Access to
High Quality, Affordable Health Carefor All
Oklahomans(includes physical and behavioral
health)
  • Prevention and health promotion
  • Access to care
  • Quality and cost control
  • Equity / Health disparities
  • Workforce development

3
Recent Reports Assessing Health Outcomes and
Health Systems in the U.S.
  • United Health Foundation Report, 2007
  • Commonwealth Fund Report, 2007
  • Robert Wood Johnson Foundation A Checkup on
    Health Care Markets, 2007
  • Institute of Medicine Report Crossing the
    Quality Chasm, 2001

4
United Health Foundation Report, Oklahoma
  • 2007 2006
  • Overall Rank 47 44
  • Health Outcomes Data Rank Data Rank
  • Poor Mental Health Days 4.3 47 3.6 41
  • Poor Physical Health Days 4.5 48 4.1
    44
  • Infant Mortality (/1,000) 8.0 40 8.2
    43
  • Cancer Deaths (/100,000) 215.2 43
    216.5 44
  • Premature Death (yrs/100,000) 9,307 43
    9,290 43
  • CVD Deaths (/100,000) 412.1 50
    416.4 50

5
Total Mortality U.S. 2004(U.S. 801 deaths /
100,000 pop)
  • Lowest
  • 1. Hawaii 624
  • 2. Minnesota 691
  • 3. North Dakota 694
  • 4. Connecticut 709
  • 5. California 717
  • Highest
  • 45. Oklahoma 946
  • 46. Tennessee 953
  • 47. W. Virginia 970
  • 48. Louisiana 986
  • 49. Alabama 991
  • 50. Mississippi 992

Centers for Disease Control and Prevention,
National Center for Health Statistics. Compressed
Mortality File 1999-2004.
6
(No Transcript)
7
Percent of People Below Poverty 2005 Past 12
months
Source U.S. Census Bureau, 2005 American
Community Survey
8
Risk Factors for Health(OK Rank)
  • Income (lt25,000) (47)
  • Education (ltHS, lt Col) (41, 47)
  • Health Insurance (44)
  • Tobacco use (47)
  • Nutrition (50)
  • Exercise (47)
  • Obesity (44)
  • Mental illness (50)
  • Prevalence of diabetes (46)
  • Prevalence of HBP (45)

Behavioral Risk Factor Surveillance System
2005 BRFSS
9
Commonwealth Fund Report, 2007OK Ranking
  • Overall rank Tied with MS 50
  • Health outcomes 47
  • Access to care 49
  • Quality 43
  • Avoidable hospital use and costs 50
  • Equity 50

10
7 Attributes of a Highly-Functioning Health Care
MarketRWJF A Checkup of Health Care Markets
Apr 2007
  • Community leadership
  • Quality improvement
  • Performance management
  • Public reporting
  • Provider financial incentives
  • HIT incentives and infrastructure
  • Consumer engagement

11
The health care system should work to ensure that
all Americans receive care that is
  • Safe
  • Effective
  • Patient centered
  • Timely
  • Efficient
  • Equitable
  • Ref Crossing the Quality Chasm, IOM, 2001

12
Health care constituencies should work together
to create an environment that fosters and rewards
improvements by
  • Creating an infrastructure to support evidenced
    based practice
  • Facilitating the use of information technology
  • Aligning payment incentives
  • Preparing the workforce to better serve patients
    in a world of expanding knowledge and rapid
    change
  • Ref Crossing the Quality Chasm, IOM, 2001

13
Healthcare constituencies should work together to
redesign healthcare processes in accordance with
the following rules
  • Care based on continuous healing relationships
  • Customization based on patient needs and values
  • The patient as the source of control
  • Shared knowledge and the free flow of info.
  • Evidenced-based decision making
  • Safety as a system priority
  • The need for transparency
  • Anticipation of needs
  • Continuous decrease in waste
  • Cooperation among clinicians
  • Ref Crossing the Quality Chasm, IOM, 2001

14
DHHS Four Cornerstones for Value-Driven Health
Care 2006
  • Interoperable health IT
  • Transparency of cost
  • Transparency of quality
  • Promote quality and efficiency of care

15
We Can Do Better Improving the Health of the
American People
  • Addressing unhealthy behavior
  • Tobacco
  • Obesity
  • Addressing health disparities
  • Ref Schroeder, N Engl J Med, Sept 20, 2007

16
Obama Health Plan
  • Provide affordable, accessible health coverage
    for all
  • Promote prevention and strengthen public health
  • Lower costs and improve the quality of our health
    system
  • Invest in health IT systems
  • Support disease management programs
  • Require full transparency of quality and costs
  • Align incentives for excellence
  • Address disparities in health outcomes and access
    to care
  • Reform medical malpractice

17
Improving Health Outcomes and Assuring Access to
High Quality, Affordable Health Carefor All
Oklahomans(includes physical and behavioral
health)
  • Prevention and health promotion
  • Access to care
  • Quality and Cost control
  • Equity / Health disparities
  • Workforce development

18
1 Improving health outcomes through prevention
and health promotion
  • Efforts to decrease poor health due to heart
    disease, cancer, stroke, chronic lung disease,
    diabetes, obesity and other chronic diseases
  • Tobacco use prevention
  • Nutrition and fitness promotion
  • Chronic Disease Management
  • Clinical preventive services

19
Oklahoma Health Improvement Plan
  • Vision Oklahomans will achieve optimal
    physical, mental, and social health, and the
    state health status will be in the top quartile
    of the states by 2013
  • Mission Working together to lead a process to
    improve and sustain the physical, social, and
    mental well being of all people in Oklahoma
  • Initial focus areas Tobacco, Obesity, Child
    Health

20
Tobacco Use Prevention and Cessation
  • OSDH Tobacco Use Prevention Service
  • Oklahoma Alliance on Tobacco or Health
  • Tobacco Use Prevention and Cessation Advisory
    Committee
  • Tobacco Settlement Endowment Trust
  • Cherokee and Muscogee Creek Nations Tobacco
    Tribal Support Centers
  • Turning Point
  • OSMA Physicians Campaign for a Healthier Oklahoma

21
Promotion of Improved Fitness and Nutrition
  • Strong and Healthy Oklahoma Initiative
  • Fit Kids Coalition
  • Schools for Healthy Lifestyles / Its All About
    Kids
  • Tribal REACH Projects
  • Turning Point
  • OSMA Physicians Campaign for a Healthier Oklahoma

22
2 Increase Availability and Accessibility of
Health Services
  • Expand/improve utilization of existing publicly
    funded programs
  • Develop new public/private systems to expand
    access
  • Increase number of Community Health Centers
    (FQHCs)
  • Improve coordination of existing health services
  • IHS and tribal services
  • Expand volunteered health services
  • Telemedicine

23
3 Improve the Quality of the Health Care System
and Control Costs
  • Community leadership
  • Health Information Technology
  • Quality Improvement / Performance Management
  • Transparency of cost and quality (Public
    reporting)
  • Provider incentives for quality care (Pay for
    Performance)
  • Consumer engagement
  • Medical liability reform
  • Medical home

24
Health Information Technology
  • Electronic Medical Records (EMR)
  • Electronic Health Record (EHR)
  • Personal Health Record (PHR)
  • E-prescribing
  • Information exchanges (RHIOs)
  • Electronic credentialing for health care
    providers
  • Collection, analysis and accessibility of health
    information

25
Oklahoma Health Care Quality Improvement Advisory
Committee
  • Hospitals and Home Health
  • Long Term Care
  • Outpatient Care (Prevention)

26
Proposed Activities to Improve Quality Indicators
  • Provider education
  • Accountability measures
  • Consumer engagement
  • Incentives

27
4 Equity
  • Addressing disparities in health outcomes and
    access to care based upon race/ ethnicity,
    income, education, gender, disability or place of
    residence

28
5 Workforce Development Assure Adequate Supply
of Well Trained Health Professionals
  • Assessment and coordination of health care
    workforce needs
  • Emphasis on primary care training and placement
    in rural areas
  • Pay alignment for primary care
  • Scope of practice issues for Physician Assistants
    and Advanced Practice Nurses

29
Recommendations to Improve Health Outcomes and
Quality
  • Remove current exemptions on smoking in public
    places, including stand-alone bars
  • Publish an annual report on quality indicators
    for medical facilities, nursing homes and home
    health agencies
  • Require coverage by payers for annual
    examinations, at low or no charge, to detect
    preventable diseases
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