nemours is a nonprofit pediatric health system dedicated to · adolescent health literacy:...

Nemours is a nonprofit pediatric health system dedicated to:

▪ life-changing medical care and research.

▪ training tomorrow’s pediatric experts.

▪ helping kids grow up healthy.

▪ advocating for kids nationally.

Where we offer care:

▪ Delaware

▪ Florida

▪ Georgia

▪ New Jersey

▪ Pennsylvania

Connecting Clinical Care & Population Health:

An Integrated Health System

Our Community Our Health System

Resources, Policies and System

ChangeHealth Care Organization

Health PolicyHealth Promotion

Practice Change

Self-Management

SupportDelivery System Design Decision Support

Clinical

Information

Systems

Productive Interactions

& Spreading Change

Informed, Activated Patient, Family

and Community Partners

Improved Health Among Patients

Improved Health for Delaware’s Children

Organized, Prepared, Proactive

Health Team with patient/family

Source:

Chang, Hassink, Werk,

October, 2011

Working Across and Within Systems in a Community

Community-Integrated Health System

Other

partners

Common Agenda

•Leadership and Partnership

Engagement

•Spread, Scale and

Sustainability

•Continuous Learning and

Improvement to Promote

Population-Level Solutions

Business

Community

Public

Health/

EBH

SchoolsHousingChild

Care

Transportation

Courts

Families

NeighborhoodsNon-profits/

foundations

Hospitals/

primary care

State

agencies

Other

integrators

Integrator

Faith-

based

Other

partners

Policy Learning Labs

▪ Purpose: To accelerate the spread of best practice local and institutional policies that target upstream determinants of health in an effort to improve community-wide health indicators

▪ Happy medium between collaborativesand webinars

Identify and Define the Problem

Envision and Plan for Success

Review and Select the

Policy

Develop and Adopt the

Policy

Implement and Evaluate

the Policy Engage Key Players

• 17 communities. 12 focused on food insecurity; 5 focused on asthma

• 100% affirmation- PLL informed and accelerated process more than working solo

• One year out: 79% have applied strategies or tactics provided through TA

Policy Leadership for Health Care Transformation

Context: Need to move beyond small scale projects and innovations, creating structures and functions that formalize commitment and incentivize desired behaviors at the individual, departmental, and institutional level.

Purpose:

1. Identify specific institutional policies and civic engagement strategies undertaken by 18 leading edge hospitals and health systems to codify, sustain, and scale practices that address SDOH in local communities.

2. Synthesize commonalities into a conceptual framework, backed up with real-world examples + sample documents

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Pillar # 1: Institutional Policy Strategies

Design Element 1-1: Leadership and

Board Engagement

Design Element 1-2: Accountability

Mechanisms

Design Element 1-3: Alignment

Across Key Organizational Elements

Pillar #2: Civic Engagement Strategies

Design Element 2-1: Partnership

Infrastructure

Design Element 2-2: Public

Education and Policy Advocacy

Adolescent Health Literacy: Navigating the Health Care System

▪ Context: Adolescents lack skills to navigate the healthcare system

▪ Purpose: Engage and empower adolescents to be their own health advocates through skill-based learning.

▪ Four modules; all materials available for download at no cost.

▪ Basic skills for Understanding health care terms; Preparing to Navigate the Health Care System; Understanding Your Medical History, Insurance and Privacy, and Making/Navigating Your Visit.

▪ Delaware pilot and research 2014-2017

– Strong, validated evaluation based outcomes

▪ Significantly higher content knowledge scores among students at post-test

▪ Significant increases in content knowledge were consistent regardless of instructor background

▪ Spring 2018: National expansion based on outcomes

– Nearly 100 users, representing 34 states/territories

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Early Care & Education Learning Collaborative

8

• Learning Collaborative Design

• State Partnerships

• ECELC Evaluation

• Launch of Cohort 1 ECELC center-based collaborativesin AZ, KS, NJ, FL, IN, MO

• Partnership with General Mills Foundation

• Expansion of ECELC for FCC in Contra Costa County, CA

• Launch of FCC collaborative in KS

• Launch of Spanish-only collaborative in SFL

• Cohort 1 evaluation outcomes

• Launch of Cohort 2 in VA, KY & Los Angeles, CA

• Major revision of ECELC curriculum

2013-2014

• Development of ECELC toolkit and FCC curriculum

• Launch of toolkit, mixed and hybrid collaborative

• LMCC website re-design

• End of ECELC funding for AZ and KS

• Online Learning modules

• Launch of Mini-CoIIN in IN, KY, MO

• Launch of rural learning collaborative

• Developed state integration reports

• 12- month follow-up evaluation in LA, KY and VA

2014-2015

• Mini-CoIIN in AL, FL, VA

• Final pilot test of ECELC toolkit in AK

• State team partnerships in WY, IL, TN, MS

• ECELC Overall Reach

• 201,790 children

• 2,573 ECE Programs

• 126 Collaboratives

2017-2018

2015-2016

2012-2013 2016-2017

For More Information

Allison Gertel-Rosenberg, MS

Operational Vice President, National Prevention and Practice

Nemours Children’s Health System

National Office of Policy & Prevention

[email protected]

Policy Learning Lab

▪ https://www.movinghealthcareupstream.org/mhcus-policy-learning-labs/

Policy Leadership for Health Care Transformation

▪ https://www.movinghealthcareupstream.org/policy-leadership-for-health-care-transformation/

Adolescent Health Literacy

▪ https://www.movinghealthcareupstream.org/navigating-the-health-care-system/

Early Care & Education

▪ https://healthykidshealthyfuture.org/about-ecelc/national-project/

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GEORGIA DEPARTMENT OF PUBLIC HEALTH

Moving Public Health Upstream

Bridging Community and Health Care

Community Integrated Health Conference / Shana Scott / December 11, 2018


Chronic Disease Burden


A Snapshot of Some of the Problems

• Quality of Care

• U.S. residents receive about 50% of care that is recommended.1 Is this good? Acceptable?

• Individual Expenditures

• By 2025, average family premium will EQUAL median income.2

• This means 50% of Americans will spend EVERY dollar they make on health insurance policy.

1McGlynn EA, Asch SM, Adams J et al. The Quality of Health Care Delivered to Adults in the United States. NEngl J Med. 2003;348:2635-2645.

2Sager A, Socolar D. Data brief No. 8: Health costs absorb one-quarter of economic growth, 2000-2005. Boston, MA: Boston University School of Public Health, 2005


$40,000,000,000The cost of chronic diseases to the State of Georgia annually.


Staff Teams and ProgramsAdolescent and School Health

• Asthma Control Program• Adolescent Health and Youth Development• Teen Pregnancy Prevention/PREP• Sexual Violence Prevention• Youth Tobacco Prevention

Prevention, Screening and Treatment

• Cancer State Aid Program• Breast and Cervical Cancer Screening• HBOC Genomics • Health Systems Change/Quality Improvement• Diabetes Self-Management and Education• Colorectal Cancer Screening • Tobacco Quitline

Community Policy, Systems and Environmental Change

• Tobacco-Free and Smoke-Free Places • Nutrition• Physical Activity• Worksite Wellness • Adult Heart Disease• SNAP-ED

Planning and Partnerships

• District Communications Coordination• Comprehensive Cancer and Control Planning • Oral Health Partnership• Chronic Disease Council • Chronic Disease University


Population health opportunity

“…[M]any see attention to population health as a potent opportunity for health care delivery systems, public health agencies, community-based organizations, and many other entities to work together to improve health outcomes in the communities they serve.” (Stoto, 2013)

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Evidence Based Chronic Disease Programs

GEORGIA DEPARTMENT OF PUBLIC HEALTHA Model for Diagnosis and Management of Chronic Diseases in Georgia Health Systems 21


CATAPULT

Model for improving the diagnosis and quality of care for chronic conditions in health systems

Aims to create a uniform and systematic approach to improve the control and management of hypertension, diabetes and related chronic conditions

Collaboration with health systems

• Commit to participating

• Assess your practice or system

• Training

• Activate your community resources

• Plan of Action

• Utilize your plan

• Leverage data

• Test and implement approaches


CATAPULT

Offers several Quality Improvement (QI) plans:

• Improve management of patients with hypertension

• Identify patients with undiagnosed hypertension

• Improve management of patients with diabetes

• Identify patients at risk for diabetes

• Implement diabetes prevention lifestyle change programs


CATAPULT

Framework incorporates evidence-based strategies for quality improvement

• Use of Health Information Technology and Clinical decision-support systems

• Self-measured blood pressure monitoring interventions

• Team-based care to improve blood pressure control

• Self-management support and education

• Diabetes Prevention Program


Diabetes Initiatives


Burden of Prediabetes in Georgia


Burden of Diabetes in Georgia


Diabetes Self-Management Education and Support

Diabetes Self-Management Education and Support (DSMES) programs assist the participant in achieving better blood glucose control by self-managing diabetes through life choices.

• Participants lean how to manage their diabetes through healthy behaviors and problem solving

• Lessons include information on healthy eating, being active, effective monitoring, taking medications, problem solving, reducing risk and healthy coping

DSMES has been shown to have an produce an average A1c reduction of 0.57% per patient.

For every $1 spent on DSMES, there is a net savings of up to $8.76.1

1. Klonoff DC, Schwartz DM. An economic analysis of interventions for diabetes. Diabetes Care. 2000 Mar;23(3):390-404. (http://www.ncbi.nlm.nih.gov/pubmed/10868871)

http://www.ncbi.nlm.nih.gov/pubmed/10868871


National Diabetes Prevention Program

One year lifestyle change program

• 16 sessions in the first 6 months

• 6 sessions in the second 6 months

Facilitated by a trained lifestyle coach

Follow an approved curriculum

Goals are to lose 5-7% of body weight and increase activity to 150 minutes per week

Medicare began covering in-person DPP delivery starting April 2018


Cardiovascular Disease Initiatives


Target: BP

Free program launched by the American Heart Association (AHA) and the American Medical Association (AMA) in 2015

Goal to improve blood pressure control across the nation and reduce the number of Americans who have heart attacks and strokes

Support for physicians and care teams – tools and resources

Recognition for participation and for reaching 70% BP control

Any health–related organization can join: pharmacies, YMCAs, employers who provide health screenings


Who can participate?

Any health system is encouraged to utilize the CATAPULT framework

Priority systems:• Federally Qualified Health Centers (FQHC)

• Public Health Districts

• Hospital-based health system with affiliated primary care practices (HPCP)

• Health Plans and Health Maintenance Organizations (HMO)

• Rural Health Centers (RHCs)

• Care Management Organizations (CMO)

Current implementation: 12 systems in Georgia


Questions


Contact Information

Shana M. Scott, JD, MPH

Health Systems Lead

Georgia Department of Public Health – Chronic Disease Prevention Section

2 Peachtree Street, NW,16th Floor

Atlanta, Georgia 30303

Office: 404-657-6635

Email: [email protected]

mailto:[email protected]

MEALS ON WHEELS AMERICA

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• Represents over 5,000 community-based senior nutrition programs in U.S.

• 2 million volunteers serving 2.4 million seniors

• Programs provide nutritious meals, friendly visits, safety check, and other services dedicated to improving health and well-being of seniors

• Programs have gained trusted access to the homes of millions of seniors, helping them to “Age in Place” with dignity

• The Meals on Wheels network exists in virtually every community in America and enables America’s seniors to live nourished lives with independence and dignity

CHALLENGES FACING OUR NETWORK

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• Increasing need for nutrition (and related) services

• Funding not keeping pace

• Increasingly crowded charity space

• Mounting for-profit competition

INCREASING NEED

38

• 83 million seniors will have 3+ chronic illnesses by 2030 • Chronic disease cost $46T between 2016-2030 • 6 out of 10 seniors need help with personal care• Individuals using paid long-term care services will DOUBLE from 13M to 27M by 2050• 1 in 5 seniors feels lonely

• 26% more likely to face premature death• Increases risk of stroke, heart disease, and dementia• Social isolation costs $6.7 billion in federal spending

• 8.7 million seniors are food insecure seniors• 65% more likely to be diabetic• 57% more likely to have heart failure• 30% more likely to have physical limitation• $51B in healthcare expenses

• Addressing social determinants of health can save an estimated $1.7T in healthcare costs

T H E C A S E FO R M EA L S O N W H E E L S P R E V E N T I O N VS T R EAT I N G I L L N ES S

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• Among recently discharged hospital patients:• fewer emergency department visits1

• fewer days in length of stay when admitted1

• 38% reduction in 30-day hospital readmission rate2

• Cost benefit ratio of $3.87 for every $1.00 spent2

• Among nutritionally at-risk individuals:• $156 less in healthcare costs compared to no meals; $570 less with medically-tailored meals3

• Monthly healthcare costs reduced by 28% (=$10k)4

• Discharged to home versus long-term care or rehab facility

• Among older adults (in general)• Reduced nutritional risk5,6

• Reduced feelings of loneliness6,7

• Reduced likelihood of falling7

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SOCIALIZATIONProving social interaction that

contributes to overall physical and emotional well-being

SAFETYHelping at-risk seniors feel safe and

more secure in their own homes

Serving as the “eyes and ears” in the home to monitor client change in condition and connect seniors to needed services in the

community

NUTRITION Meeting the nutritional needs of

at-risk seniors

F U RT H E R D E V E LO P O U R U NIQ U E D I F F E R E N T I ATO RS

INTEGRATING WITH HEALTHCARE

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• Showing up -- Launched Meals on Wheels Health, Direct outreach, Conferences

• Evidence building research

• Value enhancing services, e.g., Change of Condition monitoring, Social Isolation intervention testing

• Conducting multiple pilots with a healthcare system, Medicare Advantage plans, and a state Medicaid program

• Educating network year-round on partnering with healthcare organizations and providing opportunities for them to share learnings, e.g., Healthcare Resource Center

WHAT WE HAVE LEARNED: THE CHALLENGES

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• Finding the right door

• Demonstrating the differentiators – service vs commodity

• Showing impact in quantifiable financial terms

• Internal processes of healthcare entities

• Network capacity building and supporting processes/systems

TOGETHER, WE CAN DELIVER®

nemours is a nonprofit pediatric health system dedicated to · adolescent health literacy:...

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