Health 3.0 Leadership Conference: Community Centered Health Systems with Larry Cohen

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In Spring 2013, we are on the precipice of dramatic, disruptive change in the health field that offers an unprecedented opportunity and challenge to transform health care and population health. …

In Spring 2013, we are on the precipice of dramatic, disruptive change in the health field that offers an unprecedented opportunity and challenge to transform health care and population health.

We know that traditional public health approaches along with more and better health care are not enough to improve health outcomes, equity, and cost. We must also:

- implement sustainable, fundamental "upstream" changes that address the root causes of disease and disability; and
- transform the way we deliver health care to ensure access to quality, affordable health care for all.

Enjoy this keynote panel presentation from Larry Cohen of the Prevention Institute, which was presented at the 2013 Annual Leadership Conference, co-sponsored by the Center for Health Leadership (CHL) and the California Pacific Public Health Training Center (CALPACT) at UC Berkeley's School of Public Health.

To learn more about this event, please visit:

http://calpact.org/index.php/en/events/leadership-conference


Learn more about CALPACT:
http://calpact.org/

Learn more about the CHL:
http://chl.berkeley.edu/

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  • 1. Larry Cohen Executive Director Prevention Institute Community Centered Health Systems: Transforming Community Health and Care Delivery Through Upstream Innovations @preventioninst http://www.facebook.com/PreventionInstitute.org UC Berkeley School of Public Health Leadership Conference Transforming Community Health and Care Delivery May 30, 2013 www.preventioninstitute.org
  • 2. “Simply put, in the absence of a radical shift towards prevention and public health, we will not be successful in containing medical costs or improving the health of the American people.” - President Obama
  • 3. u Prevention and Public Health Fund u Community Transformation Grants u National Prevention Strategy u National Prevention, Health Promotion, and Public Health Council u Center for Medicare and Medicaid Innovation u Funding for Community Clinic Expansion Opportunities for Prevention in Health Reform
  • 4. It is unreasonable to expect that people will change their behavior easily when so many forces in the social, cultural, and physical environment conspire against such change. “ ” Institute of Medicine Source: Institute of Medicine. (2000). Promoting health: Intervention strategies from social and behavioral research (B. D. Smedley & L. S. Syme, Eds.). Washington, DC: National Academies Press.
  • 5. What’s Health Got To Do With It?
  • 6. Photo courtesy of Latino Health Access
  • 7. Photo courtesy of Latino Health Access
  • 8. Photo courtesy of Latino Health Access
  • 9. Photo courtesy of http://spacedust.atspace.com/soccer_archery.html
  • 10. HEALTH & SAFETY BEHAVIORBEHAVIOR ENVIRONMENT
  • 11. 355 Diseases 15 Diseases 44%56% Citation: Kenneth Thorpe et al.. “Which Medical Conditions Account For The Rise In Health Care Spending?” Health Affairs, 10.1377, web exclusive. A Majority of Costly Conditions are Preventable u  Medical spending increased by $199 billion (1987-2000) u  15 diseases account for 56% of this increase
  • 12. Current Health Care Spending Factors Influencing Health National Health  Expenditures References: Bipartisan Policy Center. “Lots to Lose: How America’s Health and Obesity Crisis Threatens our Economic Future.” June 2012 70% 10% 20% $2.2 Trillion Behaviors & Environment Genetics Medical Care
  • 13. Behaviors & Environment 70% Medical Care, 10% Genetics 20% $2.2 Trillion Current Health Care Spending Factors Influencing Health National Health  Expenditures References: Bipartisan Policy Center. “Lots to Lose: How America’s Health and Obesity Crisis Threatens our Economic Future.” June 2012
  • 14. Behaviors & Environment 70% Medical Care, 10% Genetics 20% Prevention, 3% Health Care Services 97% $2.2 Trillion Current Health Care Spending Factors Influencing Health National Health  Expenditures References: Bipartisan Policy Center. “Lots to Lose: How America’s Health and Obesity Crisis Threatens our Economic Future.” June 2012
  • 15. $1 Investment $5.60 Return on Investment Savings at 5 years $16 Billion Annual Savings In 5 Years Return on Investment with Prevention Reference: Prevention for A Healthy America: Investments in Disease Prevention Yield Significant Savings, Stronger Communities, Trust for America’s Health, July 2008
  • 16. Prevention for a Healthier America u $5.6:$1 ROI u $16 billion savings in 5 years http://preventioninstitute.org/component/jlibrary/article/id-75/127.html
  • 17. Health Services Prevention Integrated Approach
  • 18. Community-Centered Health Homes Patient-Centered Health Homes Medical Homes
  • 19. Community-Centered Health Homes
  • 20. A Different Way to Think about Health Care Photo Credit: Daniel Bernstein
  • 21. “The last time we looked in the book, the specific therapy for malnutrition was food.” Jack Geiger, MD
  • 22. Medical Equipment
  • 23. Oakland Chinatown
  • 24. INQUIRY! ASSESSMENT! ACTION! ENVIRONMENTAL & POLICY CHANGE! COORDINATED CLINICAL & COMMUNITY PREVENTION ACTIVITY! IDENTIFY PRIORITY HEALTH ISSUES! COMPREHENSIVE STRATEGY DEVELOPMENT! PARTNERSHIP FORMATION! •  Health Care! •  Public Health! •  Community Organizations! DATA COLLECTION! CLINICAL/COMMUNITY POPULATION HEALTH INTERVENTION MODEL OUTCOMES! IMPROVED HEALTH! ! COST SAVINGS! ! EVIDENCE-BASE FOR EFFECTIVE PRACTICE! Existing Clinician Skills PATIENT INTAKE DIAGNOSIS TREATMENT
  • 25. Emerging Opportunities Ø  Payment mechanisms & incentives n  maximize healthcare quality, minimize costs, incentivize prevention and an integrated health system Ø  Population health data innovation n  track population health trends n  reveal the links between determinants and health outcomes n  uncover the best interventions for improving health Ø  Metrics to promote health in the first place n  incentivize prevention and move away from individual-based assessment n  capture the leading indicators of successful community prevention n  assess the impact of community-level change Ø  Workforce innovations n  advance the roles of community health workers, promotoras, integrators, navigators Ø  Intersectoral community partnerships and advocacy n  support true engagement and partnerships for sustainable community change
  • 26. How Can We Pay for a Healthy Population? ♦  Wellness Trusts ♦  Social Impact Bonds and Health Impact Bonds ♦  Community Benefits from Non- Profit Hospitals ♦  Accountable Care Organizations
  • 27. Connecting Clinical & Population Perspectives Through Data u Collecting community driven data u Creating interoperable data sets u Tracking population health trends
  • 28. Engage Stakeholders: Effective Collaboration Healthcare Institutions / Systems Prevention Advocates EducationPlanners / Transportation Public Health Service Providers Elected Officials CommunityMembers
  • 29. “We are bringing together the health and human rights voices in south LA and beyond to discuss the healthcare crisis and how we build a movement for the right to health.” -Jim Mangia, CEO St. John’s
  • 30. National: Health System that Integrates Prevention/Public Health/ Healthcare Statewide: Community-Centered Health System Accountable Care Community Local: Community Centered Health Home Accountable Care Community Local: Community Centered Health Home
  • 31. NORMS sanction behavior attitudes,beliefs,ways of being based in culture & tradition taken for granted more than a habit behavior shapers communicate regularity in behavior
  • 32. Child Restraint & Safety Belt Use
  • 33. Oh, Britney…
  • 34. Pharmacy Tobacco Ban
  • 35. Folsom-Cordova School District
  • 36. Building a Movement
  • 37. Photo  courtesy  of:  Jonathan  Moreau  
  • 38. “You can do more than bail out these medical disasters after they have occurred, and go upstream from medical care to forge instruments of social change that will prevent such disasters from occurring in the first place.” —Jack Geiger, MD Photo Credit: Daniel Bernstein
  • 39. “Prevention is better than cure” -Hippocrates
  • 40. www.preventioninstitute.org Photo credit: Emily Barney TOOLS
  • 41. Community-Centered Health Homes
  • 42. www.youtube.com/preventioninstitute
  • 43. Influencing Policy & Legislation Changing Organizational Practices Fostering Coalitions & Networks Educating Providers Promoting Community Education The Spectrum of Prevention Strengthening Individual Knowledge & Skills
  • 44. Take 2 Steps to Prevention Health Care Services Exposures & Behaviors Environment
  • 45. Collaborator 4 Expertise: Desired Outcomes: Key Strategies: Collaborator 3 Expertise: Desired Outcomes: Key Strategies: Collaborator 1 Expertise: Desired Outcomes: Key Strategies: Collaborator 2 Expertise: Desired Outcomes: Key Strategies: Shared Outcomes Partner Strengths Joint Strategies Collaboration Multiplier
  • 46. Developing Effective Coalitions: The 8-Step Process 1.Analyze program objectives, determine whether to form a coalition 2. Recruit the right people 3. Devise preliminary objectives and activities 4. Convene the coalition 5. Anticipate necessary resources 6. Develop a successful structure 7. Maintain coalition vitality 8. Improve through evaluation
  • 47. Communities Taking Action
  • 48. 221 Oak Street Oakland, CA 94607 Tel: (510) 444-7738 Sign up for our media alerts: http://www.preventioninstitute.org/alerts www.preventioninstitute.org Follow us on: