Leveraging Public Health Capacity to Increase Health System Efficiency

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Presenter Sharon Moffatt Chief of Health Promotion and Disease Prevention with the Association of State and Territorial Health Officials, leading on prevention, access to care and health reform

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  • The majority of state public health agencies (55%) are structured as free-standing agencies, while the remaining agencies (45%) are located within an umbrella agency structure in state government.In 13 states and the District of Columbia (28%), local health services are provided by the state public health agency (centralized or no local health departments). In 19 states (37%), local health services are provided by independent local health departments (decentralized states). The remaining 18 states (35%) function with some combination of the above arrangements (hybrid states). The majority of state public health agencies (55%) are structured as free-standing agencies, while the remaining agencies (45%) are located within an umbrella agency structure in state government.In 13 states and the District of Columbia (28%), local health services are provided by the state public health agency (centralized or no local health departments). In 19 states (37%), local health services are provided by independent local health departments (decentralized states). The remaining 18 states (35%) function with some combination of the above arrangements (hybrid states). 
  • By 2014, state Medicaid programs will cover “childless adults” under age 65 at 133% of poverty, increasing insurance coverage. Overall, expanded Medicaid and CHIP programs will potentially cover 16 million more Americans. As states prepare for the coming expansions, state public health officials can collaborate with the Medicaid program to address population health and improve health status.
  • State and local public health departments are experienced in conducting outreach to eligible populations, developing programs, and convening multiple stakeholders to address population health issues and improve health outcomes. Implementation of health reform requires collaboration among multiple parties including public health, public and private insurers and other state agencies. Outreach to eligible populations: MA during their reform efforts cross trained community outreach workers to determine eligibility and increase enrollment of their newly eligible population, thereby increasing utilization of preventive services and decreasing costs. Beginning in 2011, HHS will award grants to states that provide incentives to Medicaid beneficiaries who participate in healthy lifestyle programs and demonstrate changes in health risks and outcomes. State officials can partner with Medicaid to identify evidence based prevention strategies that reduce or control the development of chronic disease. Beginning in 2013, states will receive an 1% increase in FMAP if they offer adult vaccines without cost sharing. Section 2303 will allow states to adopt family planning expansions—expanding access for women and sometimes men to reproductive health services—without a waiver. Currently 27 states use Medicaid family planning waivers. (Guttmacher)
  • Source: Section 4107 of PPACA and ASTHO section summaryTalking Points: Next slide highlights how MA collaborated with their Medicaid program, after their 2006 health reform law, to increase smoking cessation
  • Source: Medicaid Coverage for Tobacco Dependence Treatments in Massachusetts and Associated Decreases in Smoking Prevalence http://www.plosone.org/article/info:doi/10.1371/journal.pone.0009770
  • State Successes: MAMassachusetts 2006 health reform law mandated tobacco cessation coverage for the Medicaid population.Comparison of pre-benefit coverage to post-benefit coverage demonstrated a 26 percent decline in smoking rates. Smoking rates sharply decreased at a rate not seen in many years (11% of Medicaid adults used the cessation service)**Does this chart make sense? I combined my Medicaid slide with his but putting my text in as talking points, let me know what you think**
  • Competitive v. Allocated Mandatory v. Discretionary States v. Communities Authorized v. Appropriated (“Such Sums” v. $$$) Reauthorized v. New Programs Fiscal YearsMandates Direct Indirect Program Impact Direct Indirect Required Match or Maintenance of Effort
  • In November 2010, 37 states and 2 territories will have gubernatorial elections.DC will also host a mayoral election.These jurisdictions are highlighted here in yellow
  • In these 40 jurisdictions, 24 of the incumbents are either term limited or have announced they will not seek reelection.The orange states and territories on this map WILL have a new governor following the November elections.Yellow states are those in which the incumbent is running for reelection.
  • Leveraging Public Health Capacity to Increase Health System Efficiency

    1. 1. Leveraging Public Health Capacity to Increase Health System Efficiency<br />Sharon Moffatt<br />Association of State and Territorial Health Officials<br />October 5, 2010<br />
    2. 2. State Health Agency Structure<br />
    3. 3. Primary Statutory Public Health <br />Authority in State <br />
    4. 4. State and Local Public Health Relationships<br />
    5. 5. State Health Agency Roles in Health Reform<br />Previous Roles and New Roles in Response to Affordable Care Act<br />
    6. 6. Health Reform Survey<br />ASTHO Survey 8/09<br />
    7. 7. Health Reform Survey State Partners<br />Which other government agencies and non-governmental groups have you worked with to ensure the integration of health and wellness priorities in health reform efforts?<br />ASTHO Survey 8/09<br />
    8. 8. New State Structures for Implementing Health Reform with Public Health as Identified Member<br />California<br />Colorado<br />Connecticut<br />Illinois<br />Maine<br />Maryland<br />Michigan<br />New Mexico<br />New York<br />Nevada<br />Pennsylvania<br />Vermont<br />Virginia<br />Washington State<br />Wisconsin<br />Wyoming<br />
    9. 9. Public Health and Medicaid <br />
    10. 10. District of Columbia<br />Louisiana<br />Maryland<br />Michigan<br />Missouri<br />Montana<br />Nebraska<br />New York<br />Utah<br />Wyoming<br />10 State Health Officials Have Responsibility for Medicaid<br />
    11. 11. Chronic Disease Management (§ 4108)<br />2011: HHS grants to states that provide incentives for Medicaid beneficiaries to participate in healthy lifestyle programs.<br />Immunizations (§ 4106)<br />2013: States will receive a 1% increase in FMAP if they offer adult vaccines without cost sharing<br />Expansion of Family Planning Services (§ 2303)<br />States can expand services without a waiver<br />Opportunities for Public Health and Medicaid Collaboration <br />
    12. 12. By October 1, 2010 states are required to cover comprehensive tobacco cessation services for pregnant women in Medicaid (§ 4107)<br /> State health departments have experience developing and promoting comprehensive tobacco use prevention and cessation strategies <br />Public Health and Medicaid Collaboration: Smoking Cessation<br />
    13. 13. Massachusetts 2006 health reform mandated tobacco cessation coverage for Medicaid<br />Comparison of pre-benefit coverage to post-benefit coverage demonstrated a 26% decline in smoking rates<br />Example of Public Health and Medicaid Success: Massachusetts<br />
    14. 14. Successful Public Health and Medicaid Collaboration: MA<br />14<br />Data Source: Massachusetts Behavioral Risk Factor Surveillance System<br />
    15. 15. Patient Protection and Affordable Care Act<br />Bill shown is 1,990 page House version<br />
    16. 16. CHALLENGES<br />Keeping focus on public health and prevention <br />State Budget Cuts<br />Huge volume of work for states<br />Timelines for decisions are short<br />2010 Election<br />
    17. 17. Naples Herald, March 31, 2010<br />
    18. 18. 83% of state health agencies cut jobs<br />76% made cuts in FY09 and FY10<br />38% expect to lose more staff through layoffs and attrition<br />Impact of Budget Cuts on States<br />
    19. 19. Asthma programs cut<br />Immunization outreach reduced<br />Eligibility for maternal child health programs reduced and waiting lists created<br />Teen pregnancy programs eliminated<br />Examples of State Program Budget Cuts<br />
    20. 20. March 2010<br />
    21. 21.
    22. 22. OPPORTUNITIES<br />“This is an historic, once in a lifetime investment in public health.” <br /> -Paul Halverson, DrPH, ASTHO President<br />$15B investment in public health over the next 10 years!<br />Home visiting funding<br />Section 317 immunization program reauthorized<br />Programs to address several critical health care and public health workforce shortages authorized<br />School based Health Centers: 50M<br />CMS Innovation grants<br />
    23. 23. Setting priorities within the state health agency<br />Communication of need to Executive and Legislative Branch of government<br />Identification of lead for grant applications<br />Assuring quality and alignment of grant applications given short submission periods<br />State Health Official Role Funding Opportunities and Challenges<br />
    24. 24. Strong relationship to the state health plan.<br />Strong relationship to priorities of new administration, legislature.<br />Expands or improves related initiatives already underway in Maine.<br />Support, resources and capacity available across stakeholders.<br />Minimal state funding required (dollars and in-kind funding); recognize the new funding will require new state money to be appropriated. <br />Enhances state’s ability to meet legal and financial obligations. <br />Promotes collaboration among providers and consumers and harmonization of delivery systems in communities.<br />Clear focus on broad populations and overall impact of the specific grant.<br />Flexibility of application and implementation process: Can the state delegate?<br />Sustainability after grant funding ends.<br />Promote interstate cooperation as appropriate<br />Criteria for Maine State Government to Seek and SupportGrant, Pilot and Demonstration Opportunities in the Federal Health Reform Law<br />
    25. 25. Patient Protection and Affordable Care Act, March 2010.<br />Congressional Research Service (CRS)<br />Healthreform.gov<br />References and Resources<br />
    26. 26. Sharon Moffatt <br />Chief of Health Promotion and Disease Prevention <br /> Association of State and Territorial Health Officials<br />2231 Crystal Drive, Suite 450<br />Arlington, VA 20112<br />202-371-9090<br />smoffatt@astho.org<br />www.astho.org<br />

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