delaware health and social services division of public health public health and pcmh karyl rattay,...

DELAWARE HEALTH AND SOCIAL SERVICES

Division of Public Health

Public Health and Public Health and PCMHPCMH

Karyl Rattay, MD, MSKaryl Rattay, MD, MS

DirectorDirector

Delaware Division of Public HealthDelaware Division of Public Health



Important PointsImportant Points

Health is More than Health CareHealth is More than Health Care Population HealthPopulation Health Integration of Primary care and Public Integration of Primary care and Public

HealthHealth Community EngagementCommunity Engagement We are learning from interviewing youWe are learning from interviewing you Some PCMH-related activities under waySome PCMH-related activities under way



HEALTH IS MORE THAN HEALTH IS MORE THAN HEALTH CAREHEALTH CARE



How Can You Explain This?How Can You Explain This?

Source: United Nations Development Programme Report 2007-2008. Retrieved from www.unnatuaralcauses.org

Health Care Spending vs Health OutcomesHealth Care Spending vs Health Outcomes

4



DETERMINANTS OF HEALTHDETERMINANTS OF HEALTH

5

5-10%



The REAL Causes of DeathThe REAL Causes of Death



Population-Based Services

Primary Medical Care

Secondary Medical Care

Tertiary Medical

Care

95%+ Health Care $$ Spent on Acute and Chronic Care

10% of Improvement in Health Status Attributed to Medical Care

90% Attributed to Population-Based Approaches

Adapted from J. Michael McGinnis, M.D.

Health Care Health Care PyramidPyramid



POPULATION HEALTHPOPULATION HEALTH



Population HealthPopulation Health

• An approach to health that aims to An approach to health that aims to improve the health of an entire population improve the health of an entire population

• Addresses a broad range of factors that Addresses a broad range of factors that impact health on a population-level impact health on a population-level

• A perspective recognizing the importance A perspective recognizing the importance of social determinants of health and the of social determinants of health and the relatively minor impact that medicine and relatively minor impact that medicine and healthcare have on improving health healthcare have on improving health overall. overall.



o Best outcome for individualo Treat a patient for

gastroenteritis

o Vaccinating patients

o Counseling against smoking

o Treating the consequences of obesity

o Treating STD

o Diagnosing an illness

o Community’s healtho Investigating outbreaks,

restaurant inspections, safe water

o Safety net for vaccinating medically indigent

o Advocating for smoke-free environments

o Promoting built environments conducive to physical activity

o Finding and treating exposed partners

o Conducting community health assessments

Individual Vs Population Individual Vs Population HealthHealth



Health Reform’s Opportunity to Health Reform’s Opportunity to Improve Public HealthImprove Public Health

Population Approach

+ Clinical Care

= Better Health



INTEGRATION OF PRIMARY INTEGRATION OF PRIMARY CARE AND PUBLIC HEALTHCARE AND PUBLIC HEALTH



What Do We Mean by What Do We Mean by IntegrationIntegration

The linkage of programs and The linkage of programs and activities to promote overall activities to promote overall efficiency and effectiveness and efficiency and effectiveness and achieve gains in population achieve gains in population health. health.

Can take many formsCan take many formsSource: Institute of Medicine. Primary Care and Public Health Exploring Integration to Improve Population Health, March 28 2012.



Why Integrate?Why Integrate?

Health has many contributors Health has many contributors Substantial and lasting improvements Substantial and lasting improvements

will require a common goal will require a common goal Enhance the capacity of both sectors Enhance the capacity of both sectors

to carry out their missionsto carry out their missions

Source: Institute of Medicine. Primary Care and Public Health Exploring Integration to Improve Population Health, March 28 2012.



Why Integrate Now?Why Integrate Now?

Dramatic rise in health care costsDramatic rise in health care costs Importance of social and Importance of social and

environmental determinants of healthenvironmental determinants of health New opportunities to understand and New opportunities to understand and

address community-level health address community-level health concerns concerns

ACA presents opportunitiesACA presents opportunitiesSource: Institute of Medicine. Primary Care and Public Health Exploring Integration to Improve Population Health, March 28 2012.



Principles for Successful Principles for Successful Integration Integration

Shared goal of population health Shared goal of population health improvementimprovement

Community engagementCommunity engagement Aligned leadership Aligned leadership SustainabilitySustainability The sharing and collaborative use of data The sharing and collaborative use of data

and analysis and analysis

Source: Institute of Medicine. Primary Care and Public Health Exploring Integration to Improve Population Health, March 28 2012.



COMMUNITY ENGAGEMENTCOMMUNITY ENGAGEMENT



Health in all PoliciesHealth in all Policies

Looks at all public- and private-sector Looks at all public- and private-sector policy making through a health lens policy making through a health lens

Objective is to promote and protect the Objective is to promote and protect the health of the population health of the population

Addresses the social and physical Addresses the social and physical environment influences on healthenvironment influences on health



What is a What is a Healthy Healthy

Community?Community?

Source: Prevention Institute. Community-Centered Health Homes: Bridging the gap between health services and community prevention. Feb. 2011.



DPH’S ROLEDPH’S ROLE



DPH Stakeholder InterviewsDPH Stakeholder Interviews

A work in progressA work in progress More than 15 interviewsMore than 15 interviews

GovernmentGovernment HealthcareHealthcare BusinessBusiness CommunityCommunity



Interview Themes So FarInterview Themes So Far

Population HealthPopulation Health Integration of Primary Care and Public HealthIntegration of Primary Care and Public Health Community EngagementCommunity Engagement Convening RoleConvening Role Data, research and evaluationData, research and evaluation Policy Input (as opposed to policy Policy Input (as opposed to policy

development)development) Implementation of policyImplementation of policy



DPH’S PRIORITIES AND CURRENT DPH’S PRIORITIES AND CURRENT RELATED ACTIVITIESRELATED ACTIVITIES



HEALTH HEALTH REFORM IS REFORM IS

A DPH A DPH STRATEGICSTRATEGICPRIORITYPRIORITY

25



Care CoordinationCare Coordination A partnership between DPH, hospitals and large Delaware A partnership between DPH, hospitals and large Delaware

Health Centers. Health Centers. Assistance with access to care, cancer screening, cancer Assistance with access to care, cancer screening, cancer

care coordination, diabetes education and chronic disease care coordination, diabetes education and chronic disease management. management.

Cancer Screening Nurse Navigators in five acute care Cancer Screening Nurse Navigators in five acute care hospital systemshospital systems

Cancer Care Coordinators in six hospital systemsCancer Care Coordinators in six hospital systems Community healthcare access coordinators in three hospitals Community healthcare access coordinators in three hospitals

and large health centers.and large health centers. Certified Diabetes Educators in large health centers (FQHCs Certified Diabetes Educators in large health centers (FQHCs

and Claymont)and Claymont) Chronic Disease Nurses in the DPH Chronic Disease BureauChronic Disease Nurses in the DPH Chronic Disease Bureau



Help Me GrowHelp Me Grow



Healthy Weight CollaborativeHealthy Weight Collaborative

ObjectivesObjectives Organize and manage a Healthy Organize and manage a Healthy

Weight Learning Collaborative utilizing Weight Learning Collaborative utilizing quality improvement methods.quality improvement methods.

Establish innovative partnerships Establish innovative partnerships between public health, primary care, between public health, primary care, and community organizations. and community organizations.

Support sustainable change and foster Support sustainable change and foster collaboration through technology. collaboration through technology.



Community Health WorkersCommunity Health Workers

Bridging cultural mediation between Bridging cultural mediation between communities and the health care systemcommunities and the health care system

Providing culturally appropriate and accessible Providing culturally appropriate and accessible health education and information, often by using health education and information, often by using popular education methodspopular education methods

Assuring that people get the services they needAssuring that people get the services they need Providing informal counseling and social supportProviding informal counseling and social support Advocating for individuals and communities Advocating for individuals and communities

within the health and social service systemswithin the health and social service systems Build individual and community capacityBuild individual and community capacity



SummarySummary Public health wants to be involved in Public health wants to be involved in

reforming our delivery system because health reforming our delivery system because health is more than health careis more than health care

As we think about PCMH, integration of As we think about PCMH, integration of primary care and public health, population primary care and public health, population health, and community engagement are health, and community engagement are among the essential ways in which public among the essential ways in which public health can contribute.health can contribute.

While DPH has some efforts under way in all While DPH has some efforts under way in all of these areas, we are actively learning about of these areas, we are actively learning about how we can evolve as a value added partner.how we can evolve as a value added partner.



QuestionsQuestions

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