redesigning preconception health service delivery to achieve health equity michael c. lu, md, mph...
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Redesigning Preconception HealthService Delivery to Achieve Health Equity
Michael C. Lu, MD, MPHDepartment of Obstetrics & GynecologyDavid Geffen School of Medicine at UCLA
Department of Community Health SciencesCenter for Healthier Children, Families and Communities
UCLA School of Public Health
Third National Summit on Preconception Health & HealthcareTampa FL
June 14, 2011
Redesigning Preconception HealthService Delivery to Achieve Health Equity
• Medical home for women’s health• Women and children’s accountable care
organization (ACO)• Best Babies Zone
The definition of insanity is doing the same thing over and over and expecting different results
Benjamin Franklin
Prenatal Care 1.0
Receptionist & Clerks
Medical Assistant
UltrasoundTechNurse Manager
Lu MC. Healthcare reform and women’s health: A life-course perspective. Curr Opin Obstet Gynecol 2010;22:487-91
Prenatal Care 2.0
Oral Health
TeratogenInformationServices
Primary &Specialty Care
Family Support
Social Services
WIC
ReceptionistMedical
Assistant
Ultrasound TechNurse Manager
High RiskOB
Mental HealthLu MC. 2010;22:487-91
Redesigning Preconception HealthService Delivery to Achieve Health Equity
Medical Homefor
Women’s Health
Prenatal Care 3.0
Genetic Counseling& Prenatal Diagnosis
UltrasoundCenter
OBHospitalist
Oral Health
Mental Health
Dietitian & WIC
Primary &PreventiveServices
Health Education
Family Planning
Family Support
& Social Services
High RiskOB
Specialty Clinics
Preconception &Interconception
Care
Prenatal Care
Lu MC. 2010;22:487-91
Women & Children’sAccountable Care
Organization
Redesigning Preconception HealthService Delivery to Achieve Health Equity
Women and Children’s ACO• Reduce costs
• Averted NICU admissions• Averted maternal morbidities• Averted disease & disability in children• Averted heart disease, diabetes, and cancer in adults?
• Improved care • Solo or small group practices to share resources & savings
with the medical home
• Promote population health• Not only from care coordination, but from optimization of
fetal (and preconceptional) origins of health & disease
Women & Children’s ACO
Genetic Counseling& Prenatal Diagnosis
UltrasoundCenter
OBHospitalist
Oral Health
Mental Health
Dietitian & WIC
Primary &Preventive
Care
Health Education
Family Planning
Family Support
& Social Services
High RiskOB
Specialty Clinics
Preconception &Interconception
Care
PrenatalCare
OB
OB
OB
OB
OB
OB
OB
OB
What Can Medicaid Do to Improve Perinatal Outcomes?
• Single largest payer of perinatal healthcare in U.S.• Pays for > 40% of all births• Spends $39 billion a year on perinatal healthcare
• $21 billion for pregnancy and delivery• $18 billion for newborn care
Andrews RM. The national hospital bill: The most expensive conditions by payer, 2006. Healthcare Cost and Utilization Project. Statistical brief #59. September 2008
Women and Children’s ACO Demonstration• Coverage for pre- and inter-conception care
• States with family planning demonstration or state option• Start-up costs
• CMMI or HRSA should provide start-up costs in under-resourced communities• Risk-sharing
• Minimize risk-sharing• Assignment rule
• Assignment should not exclude FQHC’s that provide care through team approach rather than direct physician care
• Performance measurement• Develop perinatal quality measures incl service coordination in ambulatory settings
• Collaborative learning• Support center to facilitate collaborative learning, improvement & innovation
• Integration with Kids ACO• Design in collaboration with Kids ACO demonstration
Best BabiesZone
Redesigning Preconception HealthService Delivery to Achieve Health Equity
HealthDevelopmentEducational
Development
CommunityDevelopment
Economic Development
Best BabiesZone
Best Healthcare • “Accountable care neighborhood” for women’s health
• Preconception and interconception care• Quality improvement in prenatal & intrapartum care • Comprehensive women’s health services across life course
continuum• Integrated with public health & social services programs in
the community (e.g. Nurse Family Partnership, Healthy Start)• Cost savings are reinvested in the community
Best Education
Too Much, Too Late?
Public Expenditures Children 0-17,
Sweden, 1995
Best Opportunities
• Opportunity Incubator• Macroeconomic policies • Microfinance• Business incubator & job training• Financial literacy & asset development for families• High-function safety net programs
Best Community• Healthy Community
• Clean air and water (environmental justice)
• Healthy foods & physical activities• Fatherhood & Family• Social capital• Racial equity
BBZ Incubator• Assessment• Blueprint• Capacity-Building
• Community engagement• Transformative leadership• Improvement & innovation• Measurement, mapping & evaluation• Policy & advocacy• Design thinking
• Development• Evaluation
AccountableCare
NeighborhoodPromise
Neighborhood
ChoiceNeighborhood
ByrneCriminal Justice
Innovation
Best BabiesZone
“If you want 1 year of prosperity, grow grain. If you want 10 years of prosperity, grow trees. If you want 100 years of prosperity, grow people.”
Chinese Proverb
"We must become the change we want to see.”
- MOHANDAS GANDHI