bridging hospitals and community health: community benefit and health reform 2010 nnphi conference...
TRANSCRIPT
Bridging Hospitals and Community Health:
Community Benefit and Health Reform
2010 NNPHI ConferenceNavigating Emerging Opportunities
June 8, 2010
Kevin Barnett, Dr.P.H., M.C.P.Senior Investigator
Public Health Institute
Outline
• Evolution of CB practices and policies
• Health reform – Emerging opportunities
• The case for hospital – public health collaboration
• A sampling of exemplary practices
Evolution of National/State Policies• IRS redefinition of charity 1969/83• Local class actions in 70s• Intermountain Health Care – 1985• National congressional initiative (Roybal-Donnelly – 1990)• State statutes: UT, NY, TX, MA, CA, PN, NH
– Commonalities and distinctions
• Yale-New Haven case (2005) – the game changer• Congressional hearings (2006-2009)• Illinois Supreme Court ruling on Provena
– Next chapter - Grassley and Rush
• IRS 990 Schedule H• National Health Reform and the coming change
Imperative for PH Engagement• National / State Policy Development
– Narrow interpretation of CB by IRS and Finance Committee
– Lack of understanding of implications and opportunities in community needs assessment requirement.
• Regional / Local Innovation– Integrate utilization data, social determinants into
assessment process to regionalize care coordination– Focus on expanded care management with uninsured
populations helps build population health capacity and demonstrates commitment to optimal stewardship.
– Significant potential for transformation of traditional relationships - increased efficiency and effectiveness
Near Term Potential Savings
• In 2002, half of Medicare beneficiaries treated for 5+ conditions, and accounted for 75% of Medicare spending. Thorpe, KE, Howard, DHl, “The rise in spending among Medicare beneficiaries: the role of chronic disease prevalence and changes in treatment intensity,” Health Affairs (Millwood), 2006:25(5): 378 – 388
• Estimated costs for preventable hospitalizations for 2004 were $29 billion, approximately 10% of total hospital expenditures.Russo, Allison, et al, “Trends in Potentially Preventable Hospitalizations among Adults and Children, 1997-2004,” Statistical Brief #36, Healthcare Cost and Utilization Project, AHRQ, August 2007
• Readmissions on 18% of all hospital stays - $12B (80%) of which are potentially avoidable.Miller, M., Executive Director, Medicare Payment Advisory Commission, Report to Congress: Reforming the Delivery System, Testimony to Senate Finance Committee, September 16, 2008
Community Benefit and Health Reform
Primary Prevention Community Problem
Solving
Community-Based
Preventive Services
Clinical Service Delivery
PAYMENT MODELSFee for Service Episode-Based Partial---Full Risk Global Budgeting
Reimbursement CapitationINCENTIVESConduct Evidence-Based Expanded Care Reduce Obstacles toProcedures Medicine Management Behavior ChangeFill Beds Clinical PFP Risk-adjusted PFP Address Root Causes
METRICSNet Revenue Improved Reduced PreventableAggregate Improvement
Clinical Outcomes Hospitalizations/ED in HS and QOLReduced Readmits Reduced Disparities Reduced HC Costs
Opportunities for Hospital – PH Collaboration
Community needs assessment
Analysis/mapping of data to reduce preventable ED/inpatient utilization
Community-based health education programs/campaigns
Comprehensive community initiatives
Influence local policy development to reinforce/sustain efforts
Monitor health status to ID community health problems.
Diagnose and investigate health problems and health hazards in the community.
Inform, educate, and empower people about health issues.
Mobilize community partnerships to ID and solve health problems.
Develop policies and plans that support individual and community health efforts.
PH 10 Essential Functions Hospital Community Benefit
Opportunities for Hospital – PH Collaboration
Enforce laws and regulations that protect health and ensure safety.
Link people to health services and assure access to health care
Assure a competent public health and health care workforce.
Evaluate effectiveness, accessibility, and quality of HC and population health services.
Research for new insights and innovative solutions to health problems.
Tobacco/alcohol sales to minors; neighborhood watch groups
CHOWs / partnerships with CHCs
Youth mentoring / pipeline programs; engagement of academic affiliates
Expanded care management strategies with un/underinsured populations
Research demonstrations to reduce health disparities
PH 10 Essential Functions Hospital Community Benefit
Strategy for Hospital Engagement• Focus on problem solving – ID issues relevant to
utilization and cost, and gradually move upstream
• Emphasize shared accountability (over “watchdog” orientation)
• Bring positive examples of desired institutional behavior to the table (sources of exemplary practices: ACHI, CHA, CDC, PHI)
• Demonstrate understanding of practical challenges
A Sampling of Exemplary Practices
• Backyard Initiative (Allina Hospitals and Clinics)– 10 yr, $100 million investment in south Minneapolis
neighborhoods around flagship medical center – Central focus on social determinants, e.g., environmental
and policy change around tobacco, nutrition and obesity.– Safety net insurance program to link primary care and
community-based preventive services.
• Bell Hill Initiative (UMASS Memorial Health System)– Problem solving approach to health improvement in
diverse low income neighborhood adjacent to flagship medical center.
– Central focus on affordable housing, youth leadership development, strengthening social support systems, and environmental improvements
• Diabetes Wellness Center (Baylor HC System)– $15 million investment to renovate and expand historical
youth development center in South Dallas.– Primary focus on creating opportunities for physical activity
and nutritional knowledge and access.– 13% of residents diagnosed with diabetes; diabetes
hospitalization 30% higher than citywide rate
• Bread of Healing Free Clinic (Aurora Health System)– Developed urban health curriculum with med student
rotations– Provide administrative/clinical staffing, lab and radiology
svs.– Established a collaborative of free clinics and created
MedShare program for pooled purchase of pharmaceuticals
• Healthy Start Program (St. Charles Health System)– Partnership with Deschutes County PHD to provide
prenatal services for uninsured women– Co-location of medical services, WIC, and family
planning.– Secured change in public transportation services.– Provide administrative/clinical staffing, lab and
pharmacy svs.– Secured SAMHSA grant to link services for children and
mothers.
• Regional Research Demonstration Taking CB to Scale (SF/Dallas)– Establish regional clearinghouse for detailed analysis and
mapping of hospital utilization data* and social determinants
– Engage FT Epidemiologist in SF DPH– Institute established at Dallas Hospital Council– Use evidence base as mechanism for shared, strategic
investment by hospitals. – Supplement care management strategies with place-
based collaborative investments in impacted neighborhoods * With unique patient identifiers, by diagnosis, payer source, and institution
• Minnesota GAMC– Fairview HS, HCMC, Health Partners– Global payment from State– Coordinated system of services beyond health care
• Orange County (CA) Mgd Care Plan– Partnership between CalOptima and hospitals– Shared investment in capitated model of enrollment– Focus on medically indigent population
• Project Access (Dallas)– Voluntary model involving hospitals, providers, CHCs– Coordinated through Medical Society– Focus on medically indigent with chronic conditions
CDC – NNPHI Partnership
• Convene regional and/or statewide community benefit roundtables with hospital and public health leadership.
• Review accomplishments to date, review ASACB standards, and secure commitments to deepen engagement
• Colorado• Florida• Georgia• Louisiana• North Carolina
NNPHI Roundtables – Next steps• North Carolina Institute for Public Health
(March 8-9)– Integrate CB elements into statewide PH-hospital master plan – Explore regional initiatives (ACS-Readmissions)– Cross fertilization of local/regional meetings/content
• Georgia Health Policy Center (March 11)– Invited PH community to serve on state CB committee– Explore replication of innovations (e.g., rural model)– Explore data mapping, regional CB initiative (Atlanta)
• Florida Public Health Institute (June 3)– Document positive examples of hospital-PH collaboration– Examine current use of data (incl. utilization data)– Mapping with common indicators
Emerging Funding Opportunities• ARRA stimulus package
– $650 million for wellness and prevention– $1.1 billion for comparative effectiveness research ($300M to
AHRQ)
• National Health Reform– Prevention and public health fund ($2b/yr)– CDC TA on workplace wellness (TBD)
• CMS Center for Innovation ($10b through 2019)– Five year demonstration to improve quality, outcomes, and reduce
costs through patient-centered strategies, care coordination
• Private foundations – Expanding focus on prevention, care coordination
Contact Information
• Kevin Barnett, Dr.P.H., M.C.P.Public Health Institute555 12th Street, 10th FloorOakland, CA 94607Tel: 925-939-3417 Mobile: 510-917-0820Email: [email protected]
• ASACB standards, tools, and model programs available on website @ www.asacb.org
WE BUILD A BRIGHTER FUTURE
kp.org/communitybenefit
together
Health Systems and Public Health:Spreading Health to Build Healthy Communities Raymond J. Baxter, PhDSenior Vice President, Community Benefit, Research and Health Policy
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What: Kaiser Permanente’s Community Benefit Strategy
Make a Measurable Impacton Health
Fulfill Our Charitable Mission
Be the Model for Community Benefit in the
Field
Build a Performance Culture to Ensure Operational
Excellence
Embed Community Benefit as a Core Principle of Kaiser
Permanente
Health Knowledge
Health Access
Healthy Environments
Community Health Initiatives Environmental Stewardship Educational Theater Program
Medicaid and CHIP Charitable Care and
Coverage Safety Net Partnerships
Research Workforce Development Public Education U.S. and International Policy
Elim
inate
Health
Dis
paritie
s
together
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Why: Behavior and Environment Drive Health
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Why: Place and Race Shape Health
Source: KP Utility for Care Data Analysis, 2009
Obesity and Park Access
together
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Why: Environment and Behavior Shape Health
County Health Rankings Model
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How: Working in Partnership
Our Community Work Our National Work
Safety net partners
PHIs
State and local
health departments
CommunityCoalitions
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Why PHIs must Engage the Delivery System
• The reality: public health is crumbling• State deficits• Local deficits• Retirement and replenishment• Bunker mentality
• The opportunity: Willie Sutton• $30 billion in community benefit
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• Community-based prevention• Environmental Stewardship• Policy change as a tool• Becoming Accountable Organizations
The Opportunity: Going Upstream