State Legislative Conference 2016

1. Integration of Primary Care and Public Health
AAFP 2016 State Legislative Conference
J. Lloyd Michener, MD
Professor and Chair
Department of Community & Family Medicine
Duke University Medical Center
October 29, 2016

3. ww.iom.edu/primarycarepublichealth

6. Percent Difference Between Medicaid Recipients Enrolled in CCNC
and Those Not Enrolled in CCNC, for Rates of Asthma-Related Emergency
Department Visits and Inpatient Admissions, 2008–2012
Note. CCNC, Community Care of North Carolina. NCMJ September/October 2013, Volume 74, Number 5

7. The Practical Playbook

8. www.practicalplaybook.org
Users: 50,878 Pageviews: 252,709
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9. SAN DIEGO SCHOOL SYSTEM AND LOCAL MEDICAL RESIDENTS
JUMPSTART HEALTHY HABITS IN STUDENTS:
How Maps Helped Engage A Community and Target Interventions to
Reduce Obesity
The Situation Target Health Outcome Results
The Chula Vista Elementary
School Districts BMI data
indicated that Rice Elementary
School had one of the highest
obesity rates in the district.
Meanwhile, physicians at a
nearby clinic were frustrated by
their lack of influence of the
social and behavioral factors
affecting their patients, many of
whom were in the Rice school
district.
Promote healthy eating and
physical activity to reduce
obesity in the community, as
measured by body mass index
(BMI).
The obese or overweight range
decreased 3.2% for all students in
the target population, and there
was a 3.2 percent gain in the
normal range.

10. PHONE CALL-BACK PROGRAM REDUCES ASTHMA-RELATED ER VISITS:
Indiana partnership relies on nurses to educate patients
The Situation Target Health Outcome Results
A community health survey
showed that asthma was
causing significant school and
work absenteeism. This also
was resulting in unnecessary,
high-cost use of the emergency
department (ED).
A reduction in the number of
unnecessary asthma-related
emergency room visits – as well
as the related costs – in the
communities served.
Since their involvement in the
Asthma Call Back Initiative, 59%
of participants said they didn’t
miss any days of work or school,
and never had trouble carrying
out normal activities because of
their asthma.
The cost savings to the hospital
was substantial: after moderate
decreases in costs the first two
years. Parkview Hospital
avoided nearly $1.9 million in
ED costs in the third year.

11. Bold Innovative solutions that bring forth new ideas and approaches for addressing complex problems
Upstream Focus on social, environmental, and economic factors that have the greatest influence on health across a community,
rather than on the provision of direct services, health education, or individual behavior change
Integrated Strong commitment and partnership between a hospital or health system, a nonprofit organization, and a local public
health department, including the option to involve other industry, educational, philanthropic, or governmental
organizations
Local Focus on solutions that are deeply rooted in and led by the urban community (city of metro area of 150,000 or more)
for which the proposal is written
Data-Driven Focus on innovative uses of data and information sharing to identify key needs and opportunities, as well as to
measure outcomes
A National Challenge Program to engage communities, public health organizations and health
systems in improving health outcomes. The Program awarded $8.5M in monetary awards
and low-interest loans over two years to support 18 community-driven projects, beginning
January 1, 2015
Technical Support:

12. Technical Assistance:

15. Cleveland, Ohio
Engaging the Community in New Approaches to Health
Housing in Cleveland, Ohio is:
• Creating a Healthy Homes Zone
• Enacting prevention-based housing maintenance
• Determining feasibility of HMO reimbursements for
asthma home visits
Key Partners
• Environmental Health Watch
• The MetroHealth System
• Cleveland Department of Public Health
In partnership with:
• Stockyards Clark-Fulton Brooklyn Center
• The Cleveland Building and Housing Department
• The Hispanic Alliance and Spanish American
Community
• Cuyahoga Place Matters Team
• HIP-C (a consortium of 50 partners)
Action Plan:
ECNAHH seeks to improve asthma and lead
poisoning outcomes related to unhealthy housing,
as well as COPD and injury prevention.

16. Look out for an
announcement of a 2nd call
for applications soon!

17. National Meeting:

18. “we see CMS as playing a catalytic role. By embedding population-
based strategies in our programs and policies, CMS can help drive
transformation that aligns health care systems with public health
and social service systems and thereby accelerate progress to-
ward improved health for our whole country.”
Payors are paying attention – especially CMS:

19. U.S. Health Care Payments in APMs
Source: Primary Care Payment Models Draft White Paper. Written by: The Primary Care Payment
Model (PCPM) Workgroup. Draft for Public Release-Version Date: 10/19/2016

20. Structural Components of PCPMs in
Relation to the APM Framework
Source: Primary Care Payment Models Draft White Paper. Written by: The Primary Care Payment
Model (PCPM) Workgroup. Draft for Public Release-Version Date: 10/19/2016

21. Source: Primary Care Payment Models Draft White Paper. Written by: The Primary Care Payment
Model (PCPM) Workgroup. Draft for Public Release-Version Date: 10/19/2016

22. Supporting AAFP State Chapter Efforts to
Collaborate and Integrate for Population Health
Partnerships and consulting:
Schools of Public Health: Population
Health and Workforce Development
Mid-level practitioners using the PPB