“ Setting the Stage: The Case for Regional Action to Strengthen the Safety Net” Lon M. Berkeley Health & Medicine Policy Research Group Regional Health Care Safety Net Summit June 23, 2009

OVERVIEW Progress to Date/History of the Initiative Key Assumptions & Terminology Demographic Snapshot of Region - Russell J. Pietrowiak, CMAP On-going Efforts to Strengthen the Safety Net Introduction to Preliminary Recommendations & Small Group Action Planning

Progress to Date/History of the Initiative

Key Assumptions & Terminology

Demographic Snapshot of Region

- Russell J. Pietrowiak, CMAP

On-going Efforts to Strengthen the Safety Net

Introduction to Preliminary Recommendations & Small Group Action Planning

“ MOVING THE BALL DOWN THE FIELD” Crisis in funding for Cook County Health Services New Cook County Health & Hospitals Systems (CCHHS) Board created CMAP (Chicago) Metropolitan Agency for Planning) begins “Go To 2040” plan 1) Plan & Convene initial meeting 2) Draft “Roadmap” 3) Steering Committee & 6 committees meet 4) Conduct key informant county meetings 5) Assemble County Profiles 6) Research other county models & approaches 7) Research local activities Convene/organize the players Define the Problem Collect/analyze Data Shape the scope Stage I (1/06-8/08) OTHER IMPORTANT DEVELOPMENTS METHODS & ACTIVITIES TASK PHASES (TIMING)

Crisis in funding for Cook County Health Services

New Cook County Health & Hospitals Systems (CCHHS) Board created

CMAP (Chicago) Metropolitan Agency for Planning) begins “Go To 2040” plan

Convene/organize the players

Define the Problem

Collect/analyze Data

Shape the scope

Endorsements to Convene the Regional Health Care Safety Net Summit Alivio Medical Center Chicago Department of Public Health (CDPH) Chicago Hispanic Health Coalition (CHHC) Chicago Metropolitan Agency for Planning (CMAP) Chicago Partnership for Public Health Community Nurse Health Association Melanie Dreher, Dean, College of Nursing, Rush University Medical Center William T. Foley, Chief Executive Officer, Cook County Health & Hospitals System Patricia Gross, MSPH Illinois Maternal and Child Health Coalition (IMCHC) Illinois Public Health Institute (IPHI) Institute of Medicine of Chicago (IOMC) Latinos for a Healthy Illinois Metropolitan Chicago Healthcare Council (MCHC) Near North Health Services Corporation Northern Illinois Public Health Consortium (NIPHC) Alderman Toni Preckwinkle, 4th Ward, City of Chicago Resurrection Health Care UIC Latino Health Research, Training & Policy Center

Alivio Medical Center

Chicago Department of Public Health (CDPH)

Chicago Hispanic Health Coalition (CHHC)

Chicago Metropolitan Agency for Planning (CMAP)

Chicago Partnership for Public Health

Community Nurse Health Association

Melanie Dreher, Dean, College of Nursing, Rush University Medical Center

William T. Foley, Chief Executive Officer, Cook County Health & Hospitals System

Patricia Gross, MSPH

Illinois Maternal and Child Health Coalition (IMCHC)

Illinois Public Health Institute (IPHI)

Institute of Medicine of Chicago (IOMC)

Latinos for a Healthy Illinois

Metropolitan Chicago Healthcare Council (MCHC)

Near North Health Services Corporation

Northern Illinois Public Health Consortium (NIPHC)

Alderman Toni Preckwinkle, 4th Ward, City of Chicago

Resurrection Health Care

UIC Latino Health Research, Training & Policy Center

“ MOVING THE BALL DOWN THE FIELD” New US President New IL Governor CCHHS initiates strategic planning Economic crisis Convene Pre-summit conference Meetings of Summit Planning Committee Solicit written feedback Prepare “Call for Summit” Prioritize Problems Draft & Vet preliminary recommendations Plan Summit Stage II (9/08-5/09) OTHER IMPORTANT DEVELOP-MENTS METHODS & ACTIVITIES TASK PHASES (TIMING)

New US President

New IL Governor

CCHHS initiates strategic planning

Economic crisis

Convene Pre-summit conference

Meetings of Summit Planning Committee

Solicit written feedback

Prepare “Call for Summit”

Prioritize Problems

Draft & Vet preliminary recommendations

Plan Summit

“ MOVING THE BALL DOWN THE FIELD” National Health Care Reform Deliberations Federal stimulus funding for health information technology Convene Summit Conference with HRSA co-sponsorship Presentations on regional models Endorse Regional Health Pact & Call to Leaders Implement pilot project(s)? “ Field trips” to other counties outside NE IL? Finalize regional blueprint Identify & engage additional implementers To Do: Solicit funding & political support To Do: Identify leadership for next steps Stage III (6/09 - ?) OTHER IMPORTANT DEVELOPMTS METHODS & ACTIVITIES TASK PHASES

National Health Care Reform Deliberations

Federal stimulus funding for health information technology

Convene Summit Conference with HRSA co-sponsorship

Presentations on regional models

Endorse Regional Health Pact & Call to Leaders

Implement pilot project(s)?

“ Field trips” to other counties outside NE IL?

Finalize regional blueprint

Identify & engage additional implementers

To Do: Solicit funding & political support

To Do: Identify leadership for next steps

KEY TERMINOLOGY OF INITIATIVE Health Safety Net Regional Vulnerable Populations

Health

Safety Net

Regional

Vulnerable Populations

KEY TERMS OF INITIATIVE Health is not merely the absence of illness or disability, but also the attainment of mental, physical, and spiritual or social well-being. (WHO) It is a fundamental human right and that the attainment of the highest possible level of health is a most important world-wide social goal whose realization requires the action of many other social and economic sectors in addition to the health sector.

Health is not merely the absence of illness or disability, but also the attainment of mental, physical, and spiritual or social well-being. (WHO)

It is a fundamental human right and that the attainment of the highest possible level of health is a most important world-wide social goal whose realization requires the action of many other social and economic sectors in addition to the health sector.

WHAT DO WE NOT MEAN BY THE “HEALTH CARE SAFETY NET”?

WHAT DO WE NOT MEAN BY THE “HEALTH CARE SAFETY NET”?

WHAT DO WE MEAN BY THE “HEALTH CARE SAFETY NET”? Providers that … organize and deliver a significant level of health care and other related services… to uninsured, Medicaid, and other vulnerable populations (IOM), as well as other population-based health services.

Providers that …

organize and deliver a significant level of health care and other related services…

to uninsured, Medicaid, and other vulnerable populations (IOM), as well as other population-based health services.

WHAT DO WE MEAN BY THE “HEALTH CARE SAFETY NET”?

WHAT DO WE MEAN BY “Regional”? INCLUDES COUNTIES OF: > Cook > DuPage > Kane > Kendall > Lake > McHenry > Wil l

INCLUDES COUNTIES OF:

> Cook > DuPage

> Kane > Kendall

> Lake > McHenry

> Wil l

WHAT DO WE MEAN BY “Vulnerable Populations”? Residents who are vulnerable because health services are: unavailable inaccessible under-subsidized or not subsidized at all by public or private programs Includes the uninsured, under-insured, and people on Medicaid

Residents who are vulnerable because health services are:

unavailable

inaccessible

under-subsidized or

not subsidized at all by public or private programs

Includes the uninsured, under-insured, and people on Medicaid

KEY ASSUMPTIONS OF INITIATIVE There is no mandate or requirement to pursue this regional approach. We don’t have to do this There is no sponsor 2) Planning that includes the public and private sector increases the probability of attaining our goals and desired outcomes.

There is no mandate or requirement to pursue this regional approach.

We don’t have to do this

There is no sponsor

2) Planning that includes the public and private sector increases the probability of attaining our goals and desired outcomes.

KEY ASSUMPTIONS OF INITIATIVE 3) Collective regional action will strengthen: Planning Resource sharing Advocacy Patient Referrals Service Coordination, and Research Opportunities. Other successful regional efforts exist that have improved outcomes or operations

3) Collective regional action will strengthen:

Planning

Resource sharing

Advocacy

Patient Referrals

Service Coordination, and

Research Opportunities.

Other successful regional efforts exist that have improved outcomes or operations

KEY ASSUMPTIONS OF INITIATIVE 4) Improving health status and quality of life requires a multi-sectoral approach that extends beyond the multiple layers of traditional medical care and public health (see “Who Takes Care of Your Health?” diagram below).

4) Improving health status and quality of life requires a multi-sectoral approach that extends beyond the multiple layers of traditional medical care and public health (see “Who Takes Care of Your Health?” diagram below).

Who Takes Care of Your Health? Other Sectors: Housing, Education Tranportation, etc Public Health Services : Environmental, Prevention, Disaster Preparedness, etc Health Care Services: Dental, Behavioral, Home Care, etc Medical Care: Primary Care, Specialist, Acute, Rehab, etc Family Self-Care

KEY ASSUMPTIONS OF INITIATIVE 5) There is a continuum of health care services that can be categorized into both vertical and horizontal dimensions. 6) We accept the World Health Organization’s systems building blocks of a health system conceptual framework 7) We accept the Institute of Medicine’s six specific aims for improving the health care system.

5) There is a continuum of health care services that can be categorized into both vertical and horizontal dimensions.

6) We accept the World Health Organization’s systems building blocks of a health system conceptual framework

7) We accept the Institute of Medicine’s

six specific aims for improving the health care system.

THE WHO Health System Conceptual Framework Source: WHO Health System Strengthening Strategy 2007

KEY ASSUMPTIONS OF INITIATIVE Six Aims for Improvement (Institute of Medicine) Safe : avoiding injuries to patients from the care intended to help them. Effective : providing services based on scientific knowledge to all who could benefit, and refraining from providing services to those not likely to benefit. Patient-centered : providing care that is respectful of and responsive to individual patient preferences, needs, and values, and ensuring that patient values guide all clinical decisions. Timely : reducing waits and sometimes harmful delays for both those who receive and those who give care. Efficient : avoiding waste, including waste of equipment, supplies, ideas, and energy. Equitable : providing care that doesn’t vary in quality due to personal characteristics such as gender, ethnicity, geographic location, & socioeconomic status.

Six Aims for Improvement (Institute of Medicine)

Safe : avoiding injuries to patients from the care intended to help them.

Effective : providing services based on scientific knowledge to all who could benefit, and refraining from providing services to those not likely to benefit.

Patient-centered : providing care that is respectful of and responsive to individual patient preferences, needs, and values, and ensuring that patient values guide all clinical decisions.

Timely : reducing waits and sometimes harmful delays for both those who receive and those who give care.

Efficient : avoiding waste, including waste of equipment, supplies, ideas, and energy.

Equitable : providing care that doesn’t vary in quality due to personal characteristics such as gender, ethnicity, geographic location, & socioeconomic status.

KEY ASSUMPTIONS OF INITIATIVE 8) Health & Medicine Policy Research Group’s (HMPRG) role is to facilitate the process only - currently supported by one foundation grant and in-kind contributions - similar to approach with other successful projects.

8) Health & Medicine Policy Research Group’s (HMPRG) role is to facilitate the process only

- currently supported by one foundation grant and in-kind contributions

- similar to approach with other successful projects.

KEY ASSUMPTIONS OF INITIATIVE 9) All problem statements, priorities, and recommendations, are “works-in-progress,” … - with recognition and apologies to any overlooked organizations, projects, and people that are interested in contributing to this initiative.

9) All problem statements, priorities, and recommendations, are “works-in-progress,” …

- with recognition and apologies to any overlooked organizations, projects, and people that are interested in contributing to this initiative.

A Demographic Snapshot of the Region Russell J. Pietrowiak Associate Planner Chicago Metropolitan Agency for Planning

Total Population Change by County from 1990 - 2006 County 1990 2000 2006 Net Change Pct. Change Cook 5,105,067 5,376,741 5,288,655 +183,588 4% DuPage 781,666 904,161 932,670 +151,004 19% Kane 317,471 404,119 493,735 +176,264 56% Kendall 39,413 54,544 88,158 +48,745 124% Lake 516,418 644,356 713,076 +196,658 38% McHenry 183,241 260,077 312,373 +129,132 70% Will 357,313 502,266 668,217 +310,904 87% Region 7,300,589 8,146,264 8,496,884 +1,196,295 16%

Changing Demographics in Cook County

Constant growth over more than 3 decades (*6 counties)

Latinos have the highest rates of uninsured persons in Illinois

Ongoing Efforts to Strengthen the Safety Net HMPRG compiling a “Summary of Actions” Federal & State Legislation re: Community Building/Coalitions for Safety Net Improvements Workforce, IT, Financing Metro-area Initiatives The Chicago Access Puzzle: Fitting the Pieces Together Healthy San Francisco Initiative Detroit/Wayne County Health Authority Mid-America Reg’l Council & KC Metro Health Access Access DuPage Access to Care

HMPRG compiling a “Summary of Actions”

Federal & State Legislation re:

Community Building/Coalitions for Safety Net Improvements

Workforce, IT, Financing

Metro-area Initiatives

The Chicago Access Puzzle: Fitting the Pieces Together

Healthy San Francisco Initiative

Detroit/Wayne County Health Authority

Mid-America Reg’l Council & KC Metro Health Access

Access DuPage

Access to Care

CMAP GoTo 2040 : The Plan For Health

CMAP GoTo 2040 : The Plan For Health The GoTo 2040 Plan is a comprehensive plan for the seven county region of the Chicago Metropolitan Agency for Planning (CMAP). [1] This report presents the plan for health. Purpose: “To position the region to be competitive in a global economy and create an environment in which all diverse residents will benefit from, and contribute to, the vitality of the region.” [1] The Illinois counties of Cook, DuPage, Kane, Kendall, Lake, McHenry, and Will.

The GoTo 2040 Plan is a comprehensive plan for the seven county region of the Chicago Metropolitan Agency for Planning (CMAP). [1]

This report presents the plan for health.

Purpose: “To position the region to be competitive in a global economy and create an environment in which all diverse residents will benefit from, and contribute to, the vitality of the region.”

[1] The Illinois counties of Cook, DuPage, Kane, Kendall, Lake, McHenry, and Will.

CMAP GoTo 2040 : The Plan For Health The scope of the plan was guided by: 3 decade planning horizon Limitation of no more than 15 indicators Emphasis on the determinants of health Unsustainable cost and quality of life burden of chronic disease; and Focus on what can be accomplished in the region to improve health and not on those factors that are beyond regional control.

The scope of the plan was guided by:

3 decade planning horizon

Limitation of no more than 15 indicators

Emphasis on the determinants of health

Unsustainable cost and quality of life burden of chronic disease; and

Focus on what can be accomplished in the region to improve health and not on those factors that are beyond regional control.

CMAP GoTo 2040 : The Plan For Health 4 Recommended Strategies: Integrated prevention and health promotion strategy that will integrate the regional planning agenda with health policy issues and integrate the participants in the process. Move toward an all data-real time concept that builds on electronic medical records. Address workforce concerns. Strengthen the public health infrastructure in response to early signs of deterioration.

4 Recommended Strategies:

Integrated prevention and health promotion strategy that will integrate the regional planning agenda with health policy issues and integrate the participants in the process.

Move toward an all data-real time concept that builds on electronic medical records.

Address workforce concerns.

Strengthen the public health infrastructure in response to early signs of deterioration.

KEY TERMINOLOGY FOR SUMMIT Preliminary Recommendations May not be complete or the best Blueprint Vision with guidelines Strengthening Existing services need support Moving Recommendations to Action Building on past progress

Preliminary Recommendations

May not be complete or the best

Blueprint

Vision with guidelines

Strengthening

Existing services need support

Moving Recommendations to Action

Building on past progress

BUILDING A BETTER WORLD CURRENT STATE TRANSITIONAL STATE IMPROVED STATE DESIRED STATE

CURRENT STATE

TRANSITIONAL STATE

IMPROVED STATE

DESIRED STATE

Moving Recommendations to Action Preliminary Recommendation Categories Data/IT Workforce Access Health Equity Finance Planning Approaches

Preliminary Recommendation Categories

Data/IT

Workforce

Access

Health Equity

Finance

Planning Approaches

Moving Recommendations to Action Preliminary Recommendation Format Problem Statement Vision Recommendation Local/Regional Examples Rate Level of Support Your Role in Implementing the Recommendation > Leadership > Participant > Resource > Stay Informed >Not Interested

Preliminary Recommendation Format

Problem Statement

Vision

Recommendation

Local/Regional Examples

Rate Level of Support

Your Role in Implementing the Recommendation

> Leadership > Participant

> Resource > Stay Informed >Not Interested

RECAP We are not waiting to be told that we can strengthen the health care safety net by working across geographic boundaries. As we continue to “move the ball down the field” we hope to gain some momentum from today’s efforts. We need you to weigh in with your comments, ideas, energy, and action to help implement this vision.

We are not waiting to be told that we can strengthen the health care safety net by working across geographic boundaries.

As we continue to “move the ball down the field” we hope to gain some momentum from today’s efforts.

We need you to weigh in with your comments, ideas, energy, and action to help implement this vision.

Japanese Proverb “ Vision without action is a daydream ….. … action without vision is a nightmare.”

“ Vision without action is a daydream …..

… action without vision is a nightmare.”