Public Health and Primary Care:
The Best of Both Worlds
Ted Wymyslo, MD
Director, Ohio Department of Health
Terry Allan, H...
Source: Image from Institute of Medicine video, “Primary Care + Public Health in the Community,”
2012, http://www.iom.edu/...
Where We Are
Fragmentation

Where We Need to be
vs.
Coordination



Multiple separate providers



Accountable medical h...
Principles of Successful Integration
• Community engagement
• Strong leadership
o Involve both clinical medicine and publi...
IOM—Integration of Public Health and Primary Care

Goal: Optimize population health.
IOM Continuum of Integration

Source:...
ODH Priorities and Cross-Cutting Strategies

6
Aligning Priorities through Integration
Initiative
Opioid Emergency Dept.
& Prescriber Guidelines

Public Health Issue
Inj...
Reduce Prematurity
Ohio Perinatal Quality Collaborative
39-Week Project: Sept 2008 - March 2013
• Successful QI project im...
Help People Quit Smoking
• Increase the number of Ohioans who have access
to cessation services at no cost.
• Promote 5 A’...
Creating Healthy Communities (CHC)

The CHC Program currently
serves high-need
communities in 16 counties,
for a collectiv...
Ensuring every Ohioan has an established
relationship with a personal healthcare
provider, in a system focused on making
h...
Patient-Centered Medical Homes (PCMH)
•
•
•
•
•
•
•

Personal Primary Care Provider
Primary Care Provider-Directed Medical...
The Medical Neighborhood

Local
Health
Department

School

Adult Son’s House

Hospice

Patient’s House

PCMH

Nursing Home...
Strengthen PCMH Capacity in Ohio
• Facilitate statewide expansion of the PCMH model of
care.
Ohio recently surpassed the 3...
PCMH Expansion: Ohio is just getting started
340 PCMH Practices
in Ohio

Population Density
in Ohio (11.5 million)

Source...
Coming Together to Transform Health in Ohio
16
o

More about Health Integration in Ohio

www.odh.ohio.gov & www.astho.org

17
Acting Locally
Working with ODH and Community
Partners in Greater Cleveland to
Advance Public Health Practice
Avg. Dist.
(Miles)

Grocery > 25,000 S.F.
Distance to Grocery (Miles)
Unweighted
0.03 to 1
1
to 1.5
1.5 or Greater
(No Pop...
Food
Balance
Score

Grocery > 25,000 S.F.
Fast Food
Food Balance Ratio
Weighted by Population Share
0 to 1
1 to 2.5
2.5 or...
Avg. Dist.
(Miles)

Fast Food
Distance to Fast Food (Miles)
Unweighted
0 to 1
1 to 1.5
1.5 to 3.3
(No Population)

Cuyahog...
Households Without Vehicles
Grocery > 25,000 S.F.
Fast Food
Food Balance Ratio
Weighted by Population Share
0 to 1
1 to 2....
Place Matters: Health, Wealth, & Life
Expectancy
Family &
Culture

Health
Health
Inequities Disparities
www.hipcuyahoga.org
Strategic Issues

Create safe &
supportive
environments

Vision
Create access
to quality &
equitable
care

Key Priorities
...
Cuyahoga County Infant Mortality
3 Year Avg. (2008 – 2010)
18%
15.5%

16%
14%
12%
9.3%

10%
8%

5.2%

6%
4%
2%
0%

2008 - ...
Burden of Infant Deaths
(2008-2010)
Ohio Equity Institute
 One of 9 communities across the state involved in
a collaborative supported by ODH with CityMatCH
...
Clinical-Public Health
Collaboration
CWRU School of Medicine and
the Cuyahoga County Board of
Health
Examples of Collaboration
• Heidi Gullett, board certified in preventive
medicine (2 year commitment)
– Co-Chair Clinical ...
Questions?

40
Working Together to Protect and Improve
the Health of all Ohioans.
Ted Wymyslo, M.D.
Director, Ohio Department of Health
(...
Allan & wymyslo integration 12072013 (1)
Allan & wymyslo integration 12072013 (1)
Allan & wymyslo integration 12072013 (1)
Allan & wymyslo integration 12072013 (1)
Allan & wymyslo integration 12072013 (1)
Allan & wymyslo integration 12072013 (1)
Allan & wymyslo integration 12072013 (1)
Allan & wymyslo integration 12072013 (1)
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Allan & wymyslo integration 12072013 (1)

  1. 1. Public Health and Primary Care: The Best of Both Worlds Ted Wymyslo, MD Director, Ohio Department of Health Terry Allan, Health Commissioner Cuyahoga County Board of Health Annual Practice-Based Research Festival Dec. 7, 2013
  2. 2. Source: Image from Institute of Medicine video, “Primary Care + Public Health in the Community,” 2012, http://www.iom.edu/Reports/2012/Primary-Care-and-Public-Health/Video.aspx 2
  3. 3. Where We Are Fragmentation Where We Need to be vs. Coordination  Multiple separate providers  Accountable medical home  Provider-centered care  Patient-centered care  Reimbursement rewards volume  Reimbursement rewards value  Lack of comparison data  Price and quality transparency  Outdated information technology  Electronic information exchange  No accountability  Performance measures  Institutional bias  Continuum of care  Separate government systems  Medicare/Medicaid/Exchanges  Complicated categorical eligibility  Streamlined income eligibility  Rapid cost growth  Sustainable growth over time SOURCE: Adapted from Melanie Bella, State Innovative Programs for Dual Eligibles, NASMD (November 2009) 3
  4. 4. Principles of Successful Integration • Community engagement • Strong leadership o Involve both clinical medicine and public health • Common goal of improving population health • Collaborative use of data and analysis • Sustainability o Funding, quality measures, payment reform Source: “Primary Care and Public Health Exploring Integration to Improve Population Health” Report Brief, http://www.iom.edu/~/media/Files/Report%20Files/2012/Primary-Care-and-PublicHealth/Primary%20Care%20and%20Public%20Health_Revised%20RB_FINAL.pdf
  5. 5. IOM—Integration of Public Health and Primary Care Goal: Optimize population health. IOM Continuum of Integration Source: “Primary Care and Public Health Exploring Integration to Improve Population Health” Report Brief, http://www.iom.edu/~/media/Files/Report%20Files/2012/Primary-Care-and-PublicHealth/Primary%20Care%20and%20Public%20Health_Revised%20RB_FINAL.pdf 5
  6. 6. ODH Priorities and Cross-Cutting Strategies 6
  7. 7. Aligning Priorities through Integration Initiative Opioid Emergency Dept. & Prescriber Guidelines Public Health Issue Injury Prevention ODH & WebMD Public Health Communication OPQC 39-Week Project Decrease Infant Mortality* Ohio Quit Line/Ohio Tobacco Collaborative Curb Tobacco Use* Creating Healthy Communities Reduce Obesity* OPCPCC Expand PCMH across Ohio* * An ODH Strategic Priority 7
  8. 8. Reduce Prematurity Ohio Perinatal Quality Collaborative 39-Week Project: Sept 2008 - March 2013 • Successful QI project improved birth outcomes by reducing the number of non-medically scheduled deliveries prior to 39 weeks as well as improving birth certificate accuracy. • Received ASTHO’s 2012 Vision Award for innovative and effective approach to improving maternal and infant health. 8
  9. 9. Help People Quit Smoking • Increase the number of Ohioans who have access to cessation services at no cost. • Promote 5 A’s - Ask, Advise, Assess, Assist, Arrange. www.healthyohioprogram.org 9
  10. 10. Creating Healthy Communities (CHC) The CHC Program currently serves high-need communities in 16 counties, for a collective population of 5,797,335.
  11. 11. Ensuring every Ohioan has an established relationship with a personal healthcare provider, in a system focused on making health decisions that promote wellness and achieve high value. 11
  12. 12. Patient-Centered Medical Homes (PCMH) • • • • • • • Personal Primary Care Provider Primary Care Provider-Directed Medical Practice Whole Person Orientation Coordinated and Integrated Care Care is Safe and High-Quality Enhanced Access Payment Reform 12
  13. 13. The Medical Neighborhood Local Health Department School Adult Son’s House Hospice Patient’s House PCMH Nursing Home Academic Institution Pharmacy Rural Access Center Dietitian Critical Access Hospital Counseling Center Urgent Care Dentist Office Laboratory 13
  14. 14. Strengthen PCMH Capacity in Ohio • Facilitate statewide expansion of the PCMH model of care. Ohio recently surpassed the 300th PCMH Practice Milestone! • Align statewide expansion activities with existing regional and other PCMH initiatives. • Support efforts to utilize PCMHs as workforce training sites. 14
  15. 15. PCMH Expansion: Ohio is just getting started 340 PCMH Practices in Ohio Population Density in Ohio (11.5 million) Source: Patient-Centered Medical Home, www.odh.ohio.gov, Nov., 2013. 15
  16. 16. Coming Together to Transform Health in Ohio 16
  17. 17. o More about Health Integration in Ohio www.odh.ohio.gov & www.astho.org 17
  18. 18. Acting Locally Working with ODH and Community Partners in Greater Cleveland to Advance Public Health Practice
  19. 19. Avg. Dist. (Miles) Grocery > 25,000 S.F. Distance to Grocery (Miles) Unweighted 0.03 to 1 1 to 1.5 1.5 or Greater (No Population) Cuyahoga 1.4 Suburbs 1.3 Cleveland 1.6
  20. 20. Food Balance Score Grocery > 25,000 S.F. Fast Food Food Balance Ratio Weighted by Population Share 0 to 1 1 to 2.5 2.5 or More (No Population) Cuyahoga 2.5 Suburbs 2.0 Cleveland 4.5
  21. 21. Avg. Dist. (Miles) Fast Food Distance to Fast Food (Miles) Unweighted 0 to 1 1 to 1.5 1.5 to 3.3 (No Population) Cuyahoga 0.5 Suburbs 0.7 Cleveland 0.4
  22. 22. Households Without Vehicles Grocery > 25,000 S.F. Fast Food Food Balance Ratio Weighted by Population Share 0 to 1 1 to 2.5 2.5 or More (No Population)
  23. 23. Place Matters: Health, Wealth, & Life Expectancy
  24. 24. Family & Culture Health Health Inequities Disparities
  25. 25. www.hipcuyahoga.org
  26. 26. Strategic Issues Create safe & supportive environments Vision Create access to quality & equitable care Key Priorities Eliminate race as a Social Determinant of Health Improved nutrition & physical activity Improve chronic disease management Improve coordination between clinical care & public health
  27. 27. Cuyahoga County Infant Mortality 3 Year Avg. (2008 – 2010) 18% 15.5% 16% 14% 12% 9.3% 10% 8% 5.2% 6% 4% 2% 0% 2008 - 2010 Overall White_N/H Black_N/H
  28. 28. Burden of Infant Deaths (2008-2010)
  29. 29. Ohio Equity Institute  One of 9 communities across the state involved in a collaborative supported by ODH with CityMatCH to improve overall birth outcomes and reduce racial and ethnic disparities in infant mortality across the state by addressing inequities.  Will assess local capacity and data to develop plans, tools, and strategies for reducing inequities in birth outcomes.
  30. 30. Clinical-Public Health Collaboration CWRU School of Medicine and the Cuyahoga County Board of Health
  31. 31. Examples of Collaboration • Heidi Gullett, board certified in preventive medicine (2 year commitment) – Co-Chair Clinical and Public Health Subcommittee of HIP Cuyahoga – Assist with field practicum coordination for University Hospitals Preventive Medicine Residency – Linkage with FQHC’s and hospitals systems – Identify opportunities in ACA – Identify academic/public health research opportunities – Assist with accreditation preparation – Participant in ASTHO PHC/PH Collaboration
  32. 32. Questions? 40
  33. 33. Working Together to Protect and Improve the Health of all Ohioans. Ted Wymyslo, M.D. Director, Ohio Department of Health (614) 466-2253 Terry Allan, Health Commissioner Cuyahoga County Board of Health tallan@ccbh.net www.odh.ohio.gov 41

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