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Health 3.0 Leadership Conference: Population Health in Detroit with David Law


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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.

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 Bright Spot presentation with David Law of Joy-Southfield Community Development Corporation, 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:

Learn more about CALPACT:

Learn more about the CHL:

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Health 3.0 Leadership Conference: Population Health in Detroit with David Law

  1. 1. Dave Law, PhD, Executive DirectorJoy-Southfield Community Development CorporationPopulation Health in Detroit:Clinical- and Community-Based PreventionUC Berkeley School of Public Health,Center for Health Leadership5th Annual Leadership ConferenceHealth 3.0: Transforming Community Health and Care DeliveryUpstream Innovations in an Era of Health Reform
  2. 2. Why Go Upstream?Even though “GoingUpstream” is hardwork, there is acompelling reason todo so…… “Goin’ with theFlow” is harmful andlethal!
  3. 3. Overview of the U.S. Health Care SystemDisease• Common chronic diseases such as type-2 diabetes,hypertension & CVD account for 70% of deaths *• Chronic diseases account for 75% of annual $2.5 trillion inhealthcare costs *• Communities of color and low SES individuals experienceincreased morbidity & mortality (preventable)• Obesity epidemic is creating a tsunami of CD• Access to care is important, but SDOH are also key• Place and Race Matter (See Policy Link/CA Endowment)* A Healthier America 2013: Strategies To Move From Sick Care To Health Care In The NextFour Years. Trust for America’s Health, January 2013. www.healthyamericans.org
  4. 4. Closing the racial/ethnic disparities gap would save more than83,000 African American lives every year( D, Fryer Jr. GE, McCann J, Troutman A, Woolf SH, Rust G. 2005. What IfWe Were Equal? A Comparison of the Black-White Mortality Gap in 1960 and 2000.Health Affairs 24:459-464.36.449.936.6Uninsured(Millions)9.5306.1279.5Population(Millions)% Inc.20102000Income, Poverty, and Health Insurance Coverage in the United States: 2010U.S. Census Bureau. Sep 2011.Racial Health Inequality is Lethal
  5. 5. Racial Health Inequality is LethalMichigan Department of Community Health 2009 Health Disparities Report, February 2010,1607,7-132-2940_2955_2985---,00.htmlExamples of Black-White Health Disparities (MI):•  Overall mortality - 136%•  Infant mortality - 284%•  CVD mortality - 149%•  Stroke mortality - 136%•  HIV-AIDS prevalence - 858%•  Diabetes incidence - 201%•  Diabetes mortality - 156%•  Cancer incidence - 112%•  Cancer mortality - 127%How can the U.S. legitimately criticize other nations for human rights violations?
  6. 6. County Health Rankings in
  7. 7. 2013 County Health ranking = 82 (dead last)Bad news > mobilize action > create good news
  8. 8. Ecological Approach to Promoting Health Equity
  9. 9. PPACA: Increased Access to Healthcare a Necessary ButInsufficient First Step Toward Health EquitySource: CBO Briefing to House Speaker Pelosi, Mar 2010Health Disparities Persist Even in Countries with Universal AccessAlter DA, et al. "Lesson from Canadas Universal Care: Socially disadvantaged patientsuse more health services, still have poorer health" Health Affairs 2011; 30(2): 274-283.Number ofuninsured could behigher depending onthe extent ofMedicaid expansion.
  10. 10. PPACA: Framework for Improved Health & Reduced CostsPrevention = ê Healthcare Costs é Health Outcomes  PREVENTION  STRATEGY  
  11. 11. Healthy & SafeCommunityEnvironmentsClinical & CommunityPreventive ServicesEmpoweredPeopleElimination ofHealthDisparitiesNPS Model RevisitedRevised NPS Model: D. Law, Dec 2012
  12. 12. Promoting Health Equity at theGrassroots LevelJoy-Southfield Health and Education Center6 Treatment Rooms (1 dental)TriageReception DispensaryClinicAdminModular ClassroomsHealth Educ/CDMCDCAdminCDCAdminKitchenLunchroomCookingDemosMech.Stor.Stor. WCWCWC CopierFAX
  13. 13. Ecological Approach: Clinical Care• Free primary & preventive care for uninsured adults• Pediatric care for uninsured & insured• HFHS HANK• Preventive health education• Chronic disease management• Telehealth support• Pharmacy, labs/diagnostics (including POC)• Selected specialty care (diabetes, hypertension); referral for others• Oral health, behavioral health added to scope in 2012• Health IT to measure outcomes• Diverse pool of volunteer providers
  14. 14. Ecological Approach: Clinical Care•  3,266 Adult Free Clinic Visits in 2012•  8,047 Prescriptions (worth $550,230)• Volunteer in-kind value $81,314Where would you have gone if thisclinic were not available?n = 1547No Care51.1% ER/ED 41.9%Private Dr.3.2%Other Free Clinic3.8%
  15. 15. Patient Satisfaction 2012Treated with respectVery Good 89.6%Good9.7%Fair0.7%n = 1704Clarity of instructionsGood11.0%Fair0.6%Very Good 88.4%n = 1691Wait timeGood16.8%Fair5.6%Poor1.0%VeryPoor0.5%Very Good 76.1%n = 1488Good11.1%Fair0.7%Very Good 88.2%Overall satisfactionn = 1688
  16. 16. Ecological Approach: Clinical CareLaura W. - “I don’t know what I would have done without you.”Robert M. - “They saved my life. I had no medicine for my pressure and theygave me the pills and took care of me.”Anonymous - “When I come to this place, I never want to go home. I cansit and be happy.”Anonymous client survey - Q: “ Where would you have gone if the clinic werenot available?” A: “Grave.”Johnny C. - “This clinic help me to get medicine for my health. They have beengood helping me and others to stay well and get help that we need. Please letthis place stay open so it can help with low or no income like me.”Linda C. - “God Bless you all. Thanks a million!”Mario A. - “I need this clinic like I need oxygen. The clinic has been a blessingbeyond what I can think of.”
  17. 17. Ecological Approach: Clinical Care•  Patient feedback is compelling & valuable,however it is limited by its subjectivity• Utilizing a health IT intervention to improve healthoutcomes and efficiency•  Chronic disease management, quality assurance(HEDIS*), prompting & reminding, rapid outcomesmeasurements•  Web-based, secure and HIPAA-compliant• Pharmacy management software to enhanceadherence* Healthcare Effectiveness Data and Information Set(nationally recognized set of key health indicators)
  18. 18. Ecological Approach: Clinical CareSuccessful Health InterventionsUltimately Boil Down to RespectLosing her jobwas “a blessingin disguise.”Message tohealth carereformers:Spend moretime withpatients!
  19. 19. Ecological Approach: Physical EnvironmentDowntowns of Promise Economic Redevelopment Strategy• Grant from the Michigan State Housing Development Authority(MSHDA)• Provided detailed assessments, asset mapping and communityengagement to provide framework strategy for redeveloping the localcommercial corridor (Joy Rd from Evergreen to Southfield)• Currently identifying partners for implementation over the next 3 to5 years, including: City of Detroit, Wayne County, MSHDA, federalgovernment, TCAUD, Ross Business School, & many others• 11 new businesses to date• Façade improvement grants totaling $250,000 (matching funds)
  20. 20. Downtowns of Promise Economic Redevelopment Strategy
  21. 21. Downtowns of Promise Economic Redevelopment StrategyCommercial Façade Improvements
  22. 22. Safe & Functional Places to Exercise:Renovating Local 25-Acre Park
  23. 23. Knowledge is Power:Especially When it Comes to HealthHealth IT Tools for Quality Improvement:• BP cuffs with memory• Glucometers with memory• Pharmacy management software toimprove prescription drug adherenceWe use the carrot99% of the time.Sticks don’t work,especially for the“under-served”.
  24. 24. Kidney RockKnowledge is Power:Especially When it Comes to HealthTrip to Berkeley
  25. 25. Empowerment: Health Education•  Showing is betterthan telling• Extended family =extended lifespan
  26. 26. Treatment, Education, Management & Prevention•  Mission: To reduce ethnic healthdisparities in ESRD (kidney failure)•  Detroit among 6 U.S. cities withexceptionally high ESRD rates•  NIH-funded study (Howard University) totest efficacy•  Developing a similar intervention fortype-2 diabetes (Howard University)
  27. 27. Empowerment: Bringing Healthy Options to the Table• Addressing the food desert issue• Community gardening with youth involvement• Sowing Seeds, Growing Futures Farmers Market• Healthy Corner Stores Project (WSU SEED)“We just wanted to bring a sense ofunity back into the neighborhood.”- Kaleb, 7th grade visionary forcommunity gardens & farmers market
  28. 28. What About the Last Piece of the Pie?Saving the Best for Last
  29. 29. Public Policy Advocacy“It has long been understood that many factors beyond health care actuallyinfluence health. Social and economic determinants of health include income,education, physical environment, social isolation, and concentration of poverty.Given this reality, there is a growing realization of the potential for synergiesbetween work to revitalize low-income communities and the need to promote andimprove health.”
  30. 30. Conclusions• The resources exist to provide universal access toquality health care• Runaway health care costs can be mitigated byincreasing prevention• Effective patient engagement reduces costs &improves health outcomes• Health IT improves quality & efficiency• Reducing/Eliminating health disparities requires anecological approach, i.e. addressing all determinants• RESPECT is key to engaging previously under-servedpopulations• Health SYSTEM reform will require multi-disciplinaryintervention, but will pay for itself over time
  31. 31. Conclusions (cont.)• ACA implementation is necessary, but not sufficient toreduce health disparities• Need more integration of medicine & public health(PCMH meets population health)• The persistence of disparities adversely affects healthoutcomes for all people (particularly uninsured &underserved)• Partnerships between health systems and CBOs willenhance development of place-based health strategies• CBOs & safety net organizations will remain anintegral part of a reformed health care system
  32. 32. Contact Info:Dave Law, Executive 581-7773, ext.