Your SlideShare is downloading. ×
Healthy Chicago and the ACA 2.0:  Creating Opportunities for Innovation
Upcoming SlideShare
Loading in...5
×

Thanks for flagging this SlideShare!

Oops! An error has occurred.

×
Saving this for later? Get the SlideShare app to save on your phone or tablet. Read anywhere, anytime – even offline.
Text the download link to your phone
Standard text messaging rates apply

Healthy Chicago and the ACA 2.0: Creating Opportunities for Innovation

320
views

Published on

Commissioner Choucair presenting at Chicago Health Tech and Health 2.0's Spring Health 2.0 Local Conference focused on the changing landscape of opportunities after 4 years of innovations fueled by …

Commissioner Choucair presenting at Chicago Health Tech and Health 2.0's Spring Health 2.0 Local Conference focused on the changing landscape of opportunities after 4 years of innovations fueled by the Affordable Care Act requirements.


0 Comments
0 Likes
Statistics
Notes
  • Be the first to comment

  • Be the first to like this

No Downloads
Views
Total Views
320
On Slideshare
0
From Embeds
0
Number of Embeds
1
Actions
Shares
0
Downloads
8
Comments
0
Likes
0
Embeds 0
No embeds

Report content
Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

Cancel
No notes for slide
  • IT should also be in the conversation about health reform, the power and opportunity created by the HITECH Act has been lost. I think that is important for the entrepreneurial community to know and really has enabled innovation along with the Centers for Medicare and Medicaid.Meaningful Use rested on 5 pillars of health outcomes policy priorities, namely:1. Improving quality, safety, efficiency, and reducing health disparities2. Engage patients and families in their health3. Improve care coordination4. Improve population and public health5. Ensure adequate privacy and security protection for personal health information
  • As entrepreneurs in the healthcare industry, you must understand the regulatory changes that are coming, respond to them and create opportunities to improve public health.The entrepreneur always searches for change, responds to it, and uses it as an opportunity.A lot of companies get started during periods of uncertainty – we are at that time now
  • To reach these goals, the ACA institutes both insurance and health system reforms. I will discuss the insurance reforms that are working to increase coverage, provide more benefits and lower cost of care.
  • First I’ll provide a little background on the Healthy Chicago public health agenda. Then I will discuss our recent accomplishments and then I want to briefly discuss the importance of Partnerships and .
  • We also have 16 outcome measures with 2020 targets that align with the 12 priority areas.
  • The second lens that has influenced my role as a leader, comes from Tom Frieden at the CDC. This graphic builds on the Essential Services and underscores the need to focus public health efforts more broadly – not just on the health and behaviors of individuals. This framework shifts us from the old public health model of delivering services to building and monitoring system performance. By calling on public health practitioners to change the context in which decisions are made and to address socio-economic factors, this framework demands that we focus on systems, policy and environmental changes.I want to focus on this for a moment because this thinking has really re-defined the way we’re doing business at the Chicago Department of Public Health.
  • Another way CDPH is promoting enrollment is by focusing on children and implementing a Medicaid enrollment program.Through the All Kids program, Illinois children (≤18 years old, ≤ 300% poverty) qualify for Medicaid and can receive comprehensive care.Including: physician visits, hospital stays, prescription drugs, vision care, dental care and medical devices (e.g. glasses, asthma inhalers). However, up to 50,000 CPS students are still uninsured despite CPS efforts.To reach these children, CDPH issued a Request for Proposals (RFP), which will fund a Lead Organization to coordinate outreach and application completion for at least 5,000 CPS students, which wall lead to enrollment in All Kids. The LO will work with community-based organizations to reach these students.Grant period: October 2013 – September 2015Funding available: $350,000-$1,050,000
  • As of November, 125,000 applications submitted to state for approval. Officials say the expansion will generate $468 million next year for the county’s health programs, reducing the burden on taxpayers.
  • In 2013, we had some of our greatest successes in the area of tobacco use and many examples of how partnerships, policy, public awareness can come together to create change. Lets talk about the historic tobacco tax increase.
  • In late 2013, the City Council passed a 50 cent tax increase on a pack of cigarettes.With local, state and federal taxes considered, Chicago now has the highest cigarette tax in the nation at $7.17 a pack.This is just one area where our partners – many of you here today – came together in a powerful way to fight for groundbreaking change.
  • Healthy Chicago partners also came together to successfully advocate to address the challenge of flavored tobacco including menthol –In August, Mayor Emanuel directed the Board of Health to convene town hall meetings to identify solutions to reduce menthol cigarette use among our youth.Led by our Board president, Dr. Carolyn Lopez, 4 town hall meetings were convened and recommendations were forwarded to the Mayor.And at it’s December meeting, the Chicago City Council passed an ordinance which banned the sale of flavored tobacco – including menthol – within 500 feet of a school. This was a groundbreaking ordinance - the first of its kind anywhere – federal, state, or local.
  • Our third tobacco policy success and most hard fought battle concerned e-cigarettes.Following two contentious committee meetings, in early January, the City Council voted to “stand with public health” and “be on the right side of history,” by regulating electronic cigarettes. The ordinance will protect Chicago youth by Requiring e-cigarettes to be placed behind sales counters,Prohibiting sales to minorsAnd requiring e-cigarette retailers to obtain a tobacco retail license.The Council also voted to restrict e-cigarette use by including these devices under Chicago’s Clear Indoor Air Act.
  • We are increasingly using media not only to reinforce the need to behavior change among our residents, but also to generate support for our policy efforts. We had two targeted campaigns last year – “Burned by Menthol Cigarettes” and “Take Pride, Leave Cigarettes” which addressed the LGBT community.
  • All of our tobacco campaigns promote the State-funded Tobacco Quitline and as you can see in this slide, calls for cessation support from Chicagoans have increased recently.Over 24,000 calls came from Chicagoans last year, an increase of about 10,000 from 2012.
  • Finally, work continued in 2013 to increase smoke-free environments. In July, the University of Illinois at Chicago enacted a smoke-free campus policy affecting their 27,000 students, as well a faculty, staff, and hospital patients and visitors. This latest policy brings the total number of smoke-free institutions of higher education to 5 and the number of smoke-free hospital campuses to seven.CHA continued its important smoke free work, designating the Dearborn Homes and Sullivan Station smoke-free bringing the total number of smoke-free CHA developments to 6 with 610 smoke-free public housing units.
  • As you can see from this list of policy changes currently only being considered at the federal level, in 2013 Chicago established itself as a clear leader in tobacco control efforts.  None of these accomplishments would have been possible without the significant efforts of so many partners. Unfortunately, there are too many to name right now – so I would ask all of you hear who participated in these efforts to please stand so we can recognize you together.
  • We have data to show that our efforts are paying off.  The percent of adults who smoke is down from 22.6 in 2011 to 18.1 in 2012.
  • And youth smoking is down too—from 13.6% in 2011 to 10.7% in 2013.
  • And we’ve raised taxes to over 7.00 per pack..... ??
  • Work to expand access to healthy and affordable food continued in 2013 – let me share just 4 examples.  In January, Chicago’s food plan – A Recipe for Healthy Places – was approved by the City’s Plan Commission. With 6 community-based strategies to support healthy eating, the plan is our official roadmap for city planning and policymaking around food access. The Plan was developed with significant community input, the leadership of critical partners Department of Planning and Development, Family and Support Services, CDPH, and CLOCC – the Consortium to Lower Obesity in Chicago children.Also last year, the City joined CPS and the Park District by implementing a Healthy Vending policy affecting machines in all City owned and operated buildings. The Park District – strengthened their healthy vending policy by offering only low- or no-calorie options in their beverage machines.
  • The work of Neighbor Capitol and Streetwise continued and in 2013 there were 15 licensed produce carts in the city, with another 15 planned for 2014 . 20 related jobs were created and over 40 people were also trained in retail sales. And the 4th example of food access work, also includes a job development component. the City’s Farmers for Chicago initiative will initially making available 5 more acres of land for farming. Growing Power will then train local farmers and help them install needed equipment. 
  • There is much to talk about with increased opportunities for physical activity, and a lot of this work has been led by our colleagues at the Chicago Department of Transportation. In April, CDOT released Complete Street design guidelines (part of our Healthy Places initiative) with a primary emphasis on supporting walking, biking, and public transportation.
  • The Divvy bike share program was launched in June with an initial 700 bikes and 65 docking stations. By years end,  The fleet had expanded to over 2,000 bikes and 300 docking stationsOver 1M trips were taken coving more than 2M miles.12,133 annual memberships and nearly 132,000 24-hour passes were sold.On the right side of this slide you can see the before and after of the Dearborn St. Complete Street where a buffered bike lane was created. Chicago bike riders are now supported by 200 miles of protected, buffered or shared bike lanes, more than 13,000 bike racks, and by 2020, a 645-mile network of biking facilities will provide a bicycle accommodation within one half mile of every Chicagoan.
  • Our Playstreet program expanded in 2013, with 61 events and over 13,000 participants – twice as many as in 2012.  I want to recognize our Playstreet partners – Blue Cross Blue Shield, Active Transportation Alliance, LISC Chicago, and World Sport Chicago.
  • Finally in the area of obesity prevention I want to talk about our continued focus on CPS students, under the leadership of our shared chief health officer, Dr. Stephanie Whyte. CDPH has recently been enjoying a data-sharing partnership with CPS, resulting in what we believe to be the largest scale look at childhood obesity in Chicago. In February of last year, our first join report was focused on the physical exam records of over 59,000 students,The report – looking at students in kindergarten, 6th and 9th grades, revealed overall obesity prevalence was 25%, with the highest rates among 6th graders. A subsequent report focused on the most recent health records, found slight reductions in kindergarten obesity at 19%.
  • As health systems adopt more patient-centered and primary care-oriented models under health care reforms, improved understanding among providers as to how mobile technology may be used effectively will help them to meet the goals of the Triple Aim through improving their ability to provide greater connectivity between patients and their care providers, improving patient experiences with care, and activating and engaging patients in managing their own care.
  • To develop and promote innovative efforts, the ACA established the Center for Medicare and Medicaid Innovation within the Centers for Medicaid and Medicare Services (CMS). The Innovation Center, was established in 2010 with the goal to test innovative payment and delivery models that reduce expenditures for Medicare, Medicaid and the Children’s Health Insurance Program (CHIP), while improving or maintaining care quality.Through the Center, as well as other efforts, the ACA is working to develop more cost-effective health care services by shifting the standard provider reimbursement model from “payment for volume” to “payment for value.”
  • The Innovation Center will test models that are either:Congressionally-mandated or have been promoted by health policy experts or New ideas that demonstrate compelling approaches to reducing costs while improving care and quality. This second component is important, as the ACA is not just putting more money into the same old approaches but forcing innovative thinking to achieve improved outcomes and greater efficiencies. To identify new approaches, the Innovation Center issued its Innovation Challenge, which issues grants between $1-$30 million (for a total of $1 billion).Overall, the models currently being tested include:Accountable Care Organizations (Defined by Kaiser Permanente as “…a network of doctors and hospitals that shares responsibility for providing care to patients. In the new law, an ACO would agree to manage all of the health care needs of a minimum of 5,000 Medicare beneficiaries for at least three years)Dual-eligible beneficiaries (Developing care models people who are eligible for both Medicaid and Medicare, such as low-income seniors and younger persons with disabilities. Models are looking many aspects, including: care coordination and prescription plans)Bundled payments (This model aligns payments for all services provided during a specific course of treatment (heart bypass, hip replacement) rather than paying for services separately.  Helps to incentivize doctors and hospitals to coordinate care.)
  • To identify new approaches, the Innovation Center issued its Innovation Challenge, which issues grants between $1-$30 million (for a total of $1 billion).The University of Chicago received a $6.1 M grant to test the comprehensive care physician (CCP) model. The trial will enroll patients from the South Side of Chicago who are predicted to spend an average of 10 days a year in the hospital. Many of these patients are expected to be general medicine patients with chronic diseases, geriatric patients living in residence homes or patients with renal disease receiving regular dialysis treatment. Five CCPs will be recruited to serve as team leaders for the demonstration project, which is expected to begin in fall 2012. U of C also received a $5.9M grant to create CommunityRx which links patients to health and social services resources.The State of Illinois received a state health care innovation grant in the spring of last year. This 6-month planning grant brought together policy makers, public health, health care providers, payers, insurers, business and community development to create a plan to establish a new model for integrated health care delivery in IL.The Plan is working to achieve the Triple Aim of (1) improved health status, (20 improved efficiency and effectiveness of clinical care, and (3) reduced costs.To do this, the Alliance for Health’s Plan proposed five objectives:1. Create comprehensive, integrated delivery systems, along with payment reforms to support them.2. Ensure additional supports and services for people with specific needs.3. Enhance public health efforts focusing on environmental and social factors that negatively affect large segments of the population.4. Ensure an adequate workforce that has the appropriate education, training and compensation to staff integrated delivery systems andenhance public health.5. Expand the state's leadership role in promoting continuous improvement in public health and health care systems.
  • The Patient-Centered Outcomes Research Institute (PCORI) is authorized by Congress to conduct research to provide information about the best available evidence to help patients and their health care providers make more informed decisions. PCORI’s research is intended to give patients a better understanding of the prevention, treatment and care options available, and the science that supports those options.The University of Illinois Hospital & Health Sciences System has been awarded a $4 million, three-year contract by the Patient-Centered Outcomes Research Institute to coordinate a multi-center trial to investigate treatments for uncontrolled asthma in minority children. Working with eight other medical centers:UI Health, Sinai Health System, the Ann & Robert H. Lurie Children’s Hospital of Chicago, University of Chicago Medicine, Rush University Medical Center, John H. Stroger, Jr. Hospital of Cook County, NorthShore University Health System and Northwestern University The trial is called the Coordinated Healthcare Interventions for Childhood Asthma Gaps in Outcomes Trial, or CHICAGO. They will recruit children who come to the ED with pediatric asthma and connect them with Community Health Workers to help identify and alleviate environmental triggers in their homes. The CHWs will also help interface with the primary care provider.CDPH is involved also with providing technical assistance on Healthy Homes inspections.
  • The CMMI and several healthcare organizations across country have invested heavily in telemedicine pilot and other remote healthcare services. Also, the ruling does not affect any provisions for managed and accountable care, medical homes, and care coordination where telemedicine can provide quality, cost effective healthcare services. Over time, healthcare organizations will continue to increase the adoption of telemedicine/remote patient monitoring projects increasing quality of care and patient satisfaction.PolicymHealthDigital HealthStartupsInfographicsResearchEvents3 Areas Where the ACA Ruling Will Accelerate Technology InnovationShare the post "3 Areas Where the ACA Ruling Will Accelerate Technology Innovation"1Facebook10TwitterGoogle+8LinkedInE-mail3 key areas where the recent Supreme Court ACA ruling will spur technology innovation in the healthcare industryLast week, the Supreme Court upheld the ACA (Affordable Care Act’s) individual mandate ruling it constitutional as a tax or penalty. The mandate would require everyone to have health insurance beginning in 2014 forever changing the way the country views healthcare. With this announcement, we can now move forward with the modernization of healthcare delivery through technology innovation.I think it is important to look at some areas where the ruling will help accelerate technology innovation in the healthcare industry. Here are three areas where the recent ACA ruling will help accelerate technology innovation:Telemedicine/Remote Patient Monitoring: The ruling protects the previous investments in telemedicine made by the Center for Medicare and Medicaid Innovation (CMMI) making the funding status unaffected. The CMMI and several healthcare organizations across country have invested heavily in telemedicine pilot and other remote healthcare services. Also, the ruling does not affect any provisions for managed and accountable care, medical homes, and care coordination where telemedicine can provide quality, cost effective healthcare services. Over time, healthcare organizations will continue to increase the adoption of telemedicine/remote patient monitoring projects increasing quality of care and patient satisfaction.Big Data: Consumers will increasingly demand for access to their health information making big data “ analytics” a vital area as the consumer becomes increasingly more proactive approach to managing their own healthcare. Innovation in analytics provides immense value across the entire healthcare ecosystem allowing healthcare organizations to analyze and leverage clinical, financial, claims, bio-medical, and public health information. Some of the key challenges that will spur innovation in analytics is being able to effectively decipher this information and building the appropriate infrastructure to support this.mHEALTH: As the healthcare systems moves away from a fee for service  model and more towards an outcomes based reimbursement model, this will  increase the adoption of mobile health apps. Mobile health applications will provide an economic solution for improving the health outcomes of consumers and provide consumers with tools to  effectively monitor/manage chronic diseases.
  • In Chicago, we face a public health infrastructure that was developed over 100 years ago. There is a long history and lots of tradition. But with that can come a “That’s the way we’ve always done it” attitude, and inertia gets in the way of change efforts.In Chicago, like anywhere else, you have to consider the political landscape. CDPH is just one of more than 30 agencies demanding resources and support from City Hall. And just like anywhere else in the country, it takes more than just business as usual to keep public health in the spotlight. Also, while I report directly to the Mayor, I also am accountable to 50 City Council members. They are all elected officials and their positions are not always aligned with that of the administration, so this can be somewhat of a balancing act.Finally, we also have to balance the demands of multiple interest groups against what’s in the best interest of public health. ------For these types of challenges – sound management is not enough. I can’t just have a department that’s doing a more efficient job at what we’ve done in the past. It’s just not enough. We need to be able to manage change and drive innovation. And to do that, a framework is required. I have been applying two lenses in efforts to move CDPH from our organizational structure and the delivery of routine health services to agency that innovates.
  • Recent releases:Medicare Provider Utilization and Payment DataSet of information products and analytics examining chronic conditions among Medicare
  • In Chicago, we face a public health infrastructure that was developed over 100 years ago. There is a long history and lots of tradition. But with that can come a “That’s the way we’ve always done it” attitude, and inertia gets in the way of change efforts.In Chicago, like anywhere else, you have to consider the political landscape. CDPH is just one of more than 30 agencies demanding resources and support from City Hall. And just like anywhere else in the country, it takes more than just business as usual to keep public health in the spotlight. Also, while I report directly to the Mayor, I also am accountable to 50 City Council members. They are all elected officials and their positions are not always aligned with that of the administration, so this can be somewhat of a balancing act.Finally, we also have to balance the demands of multiple interest groups against what’s in the best interest of public health. ------For these types of challenges – sound management is not enough. I can’t just have a department that’s doing a more efficient job at what we’ve done in the past. It’s just not enough. We need to be able to manage change and drive innovation. And to do that, a framework is required. I have been applying two lenses in efforts to move CDPH from our organizational structure and the delivery of routine health services to agency that innovates.
  • When a health issue is caused by a shared social or environmental factor, the local health department can act at a community level. For example, local health departments can engage local media to raise awareness of the problem or develop public education campaigns. If you have ever seen a public service announcement about wearing a seat belt, washing your hands to prevent flu, or vaccinating against disease, you probably have your public health department to thank. These public health messages can have an even greater impact when they are tailored to specific neighborhoods and coordinated with health care providers. As a government agency, the local health department has regulatory and statutory options, which it can leverage to change health policies and promote regulations that directly address the root causes of disease.
  • This is an opportunity to think about chronic disease programs as a result of the ACA like Digital Therapeutics which digital programs that reliably and remotely deliver clinical outcomes.3 out of 4 of us will die from a preventable, chronic condition — something that could potentially be reversed with the right behavior change therapies.The world urgently needs better ways to bring landmark behavioral science interventions to the masses, and advancements in digital technology have finally enabled the necessary ingredients required to get real results.Omada’s Prevent is an example of a digital therapeutics program that helps the 1 out of 3 Americans with prediabetes lose weight and make the sort of changes needed to reduce their risk of type 2 diabetes.In 5 years, I have no doubt that public health will recommend a digital program for your chronic illness or cessation services instead of, or in addition to, a pill. Your treatment for insomnia, kidney stones, or lower back pain might be centered around an iOS app. Prevention may be centered around multiple app and web platforms. We can clearly see a future where a public health intervention sends you to an immersive digital experience as often as it does to a pharmacy.
  • We are learning more about social interactions on Twitter to improve communication.
  • Here is a tweet from a Chicago resident that our app discovered and a report was submitted.
  • These are the themes that have been very important in our work: Partnerships, Policy, Technology and Public Awareness. Each of these components plays a distinctive and critical role to the success of our work at the Chicago Department of Public Health. However, one component alone does not provide a success, but it is the sum of all these components working together that has and will continue to help us transform the health of Chicago and attain our goal of making Chicago the healthiest city in the nation.
  • In Chicago, we face a public health infrastructure that was developed over 100 years ago. There is a long history and lots of tradition. But with that can come a “That’s the way we’ve always done it” attitude, and inertia gets in the way of change efforts.In Chicago, like anywhere else, you have to consider the political landscape. CDPH is just one of more than 30 agencies demanding resources and support from City Hall. And just like anywhere else in the country, it takes more than just business as usual to keep public health in the spotlight. Also, while I report directly to the Mayor, I also am accountable to 50 City Council members. They are all elected officials and their positions are not always aligned with that of the administration, so this can be somewhat of a balancing act.Finally, we also have to balance the demands of multiple interest groups against what’s in the best interest of public health. ------For these types of challenges – sound management is not enough. I can’t just have a department that’s doing a more efficient job at what we’ve done in the past. It’s just not enough. We need to be able to manage change and drive innovation. And to do that, a framework is required. I have been applying two lenses in efforts to move CDPH from our organizational structure and the delivery of routine health services to agency that innovates.
  • In Chicago, we face a public health infrastructure that was developed over 100 years ago. There is a long history and lots of tradition. But with that can come a “That’s the way we’ve always done it” attitude, and inertia gets in the way of change efforts.In Chicago, like anywhere else, you have to consider the political landscape. CDPH is just one of more than 30 agencies demanding resources and support from City Hall. And just like anywhere else in the country, it takes more than just business as usual to keep public health in the spotlight. Also, while I report directly to the Mayor, I also am accountable to 50 City Council members. They are all elected officials and their positions are not always aligned with that of the administration, so this can be somewhat of a balancing act.Finally, we also have to balance the demands of multiple interest groups against what’s in the best interest of public health. ------For these types of challenges – sound management is not enough. I can’t just have a department that’s doing a more efficient job at what we’ve done in the past. It’s just not enough. We need to be able to manage change and drive innovation. And to do that, a framework is required. I have been applying two lenses in efforts to move CDPH from our organizational structure and the delivery of routine health services to agency that innovates.
  • Transcript

    • 1. Chicago Department of Public Health Commissioner Bechara Choucair, M.D. City of Chicago Mayor Rahm Emanuel
    • 2. 2 • • •
    • 3. 3
    • 4. • • • •
    • 5. Chicago Department of Public Health Commissioner Bechara Choucair, M.D. City of Chicago Mayor Rahm Emanuel 6
    • 6. Counseling and Education Clinical Interventions Long-Lasting Protection Interventions Changing the Context to Make Individuals’ Default Decisions Healthy Socioeconomic Factors Increasing Population Impact Increasing Individual Effort Needed
    • 7. 10
    • 8. • • • •
    • 9. • •
    • 10. 1 5 •  ’ •  • • • •
    • 11. • • • •     • • •
    • 12. • • • • • • •
    • 13. Through CHA events and partners, 537 residents have either enrolled or started the insurance enrollment process Operation Warm
    • 14. Prevention and Public Health Fund • •
    • 15. PPHF in Chicago
    • 16. 24 • • •
    • 17. 25
    • 18. 26 • • • • • • •
    • 19. 27 • • • • • “ ” • “ ”
    • 20. 29 • • • •
    • 21. • • • • 30
    • 22. 31 • • •
    • 23. 32
    • 24. 33
    • 25. 34
    • 26. 35 • • •
    • 27. • • • • • • • • •
    • 28. • • • • • • • •
    • 29. • • • • • • •
    • 30. • • •
    • 31. . • •
    • 32. Public Health & Medicine
    • 33. • • •
    • 34. • • • – – –
    • 35. • • • • • • •
    • 36. • •
    • 37. • • • •
    • 38. 5 0
    • 39. 5 1
    • 40. 5 2
    • 41. 5 3 • •
    • 42. 5 4
    • 43. • • •
    • 44. • • • •
    • 45. • • • • • • • • • •
    • 46. While Data Mining for the Analytics Project… • • •
    • 47. City Participation is Growing

    ×