The Practical Playbook National Meeting 2016 www.practicalplaybook.org Bringing Public Health and Primary Care Together: The Practical Playbook National Meeting was at the Hyatt Regency in Bethesda, MD, May 22 - 24, 2016. The meeting was a milestone event towards advancing robust collaborations that improve population health. Key stakeholders from across sectors – representing professional associations, community organizations, government agencies and academic institutions – and across the country came together at the National Meeting to help catalyze a national movement, accelerate collaborations by fostering skill development, and connect with like-minded individuals and organizations to facilitate the exchange of ideas to drive population health improvement. The National Meeting was also a significant source of tools and resources to advance collaboration. These tools and resources are available below and include: Session presentations and materials Poster session content Photos from the National Meeting The conversation started at the National Meeting is continuing in a LinkedIn Group "Working Together for Population Health" and Twitter. Use #PPBMeeting to provide feedback on the National Meeting. The Practical Playbook was developed by the de Beaumont Foundation, the Duke University School of Medicine Department of Community and Family Medicine, the Centers for Disease Control and Prevention (CDC), and the Health Resources & Services Administration (HRSA).

2. Building Capacity to
Improve Population Health using a
Social Determinants of Health Framework
Yumi Shitama Jarris, MD
Denise Koo, MD, MPH
Sharon Moffatt, RN, BSN, MS
Virginia Watson, MA

3. Turn to your neighbors…
• Introduce yourself
• Answer one of the following, EITHER;
• Do you participate in collaborations that involve or should include training around the
social determinants of health?
• What is your experience with teaching about SDOH?
• What do you hope to gain from this workshop?
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5. Discussion of Map
 What do you see in this map?
 What factors not visible in the picture also affect
health?
 What factor has greatest
impact on health of your
community?

6. Training the Health Care Workforce to Improve
Population Health: Collaborating with Public
Health Partners
Yumi Shitama Jarris, MD
Assistant Dean for Population Health & Prevention
Georgetown University School of Medicine
Sharon Moffatt, RN BSN MS
Interim Executive Director
Association of State and Territorial Health Officials

7. Objectives
1. Describe methods to integrate population health training into
health professions curricula to gain appreciation for the broader
context of what determines health.
2. Apply steps to create successful collaborations between
health profession institutions and public health organizations for
meaningful experiential learning.
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8. • 2012 AAMC graduation questionnaire, % of students reporting “inadequate
instruction”:
• Health policy (40%)
• Occupational medicine (37%)
• Health care systems (35%)
• Environmental health (34%)
• Community health & social service agencies (24%)
Are we doing well enough in teaching
population health in medical school?
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9. Healthy People Curriculum Task Force “Clinical
Prevention and Population Health Framework”
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http://www.teachpopulationhealth.org/

10. Three Distinct and Integrated Levels of the Population Health and
Prevention Curriculum at the Georgetown University
School of Medicine
MD/MPH
Degree
Population Health Scholar
Track
Longitudinal Integrated Population Health &
Prevention Curriculum for all students
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11. Determinants of Health –
Proportional Contribution to Premature Death
Determinants of Health and their
Contribution to Premature Death
(Adapted from McGinnis, et al., 2002) Genetic Predisposition
30%
Medical Care
10%
Social Circumstances
15%
Environmental Conditions
5%
Behavioral Patterns
40%

12. Population Health Scholar Track
• Comprehensive, longitudinal curriculum in population health.
• Opportunities to apply population health concepts to clinical practice and use
data to improve the health of individuals, communities, and populations.
• Tools to thrive and lead change in a transformed health care system.
• Special distinction at graduation as a Population Health Scholar.
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13. Collaborating with Public Health Partners
• Allows students to gain appreciation for the broader context
of what determines health.
• Learn how program and policy interventions can address the
social determinants of health and reduce disparities in
preventable chronic conditions.
• Teaches the value of the integration of primary care and
public health.
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14. • Gain exposure to state public health via a “day in the life of a state health
official”
• Gain exposure to public health and health policies issues and programs
• Complete a defined work product (e.g. Issue brief, journal article, webinar,
learning module)
• Shadowing public health leaders to primary care/public health national
meetings, as appropriate
Primary Aims of ASTHO’s work with
Medical Students
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15. • Patient-Centered Medical Home
• Reducing Preterm Births through a Health Policy Approach
• Identifying Common Language on Return on Investment
• Role of State Health Departments in Supporting Breastfeeding in the
Workplace
• Medication Adherence Interventions in Hypertensive Minority Populations
• Role of State Health Agency in Working with Hospitals on CHNAs
ASTHO Projects
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16. What a Public Health Community Can Offer
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• Gain appreciation for the role of policy in improving health
• Provides insight into state and local population health trends (emerging
infectious diseases and incidence of chronic disease).
• Allows opportunities for individual and group practice engagement and
influence in local and state health policy development through community health
impact and needs assessments.
• Provides experience in use of tools for health equity: Data for hot-spotting;
Health Impact Assessments.
• Establish bi-directional relationships with public health professionals to improve
individual and community health.

17. • Prevention Focus: integrate a holistic and interdisciplinary approach to treating
patients.
• Public Health Policy: provide leadership on areas impacting social determinants of
health; partner with local and/or state agencies, NGOs, private foundations, and
philanthropic organizations that have an interest in reducing health inequities.
• Data Collection: collect relevant data and measures impacting social determinants of
health and share with partners.
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Expanding the Solution Set

18. Population Health Scholar Track Summer
Practicum Sites and Mentors
Scholar Research
Mentor
Practicum Site Capstone Projects
Meghan Davis Rachel Scott, MD, MPH MedStar Washington Hospital Center
Pregnancy outcomes of women living with HIV: a retrospective cohort
study at MedStar Washington Hospital Center from 2004 to 2015
Yuchen (Jake) Liu Matthew Levy, MD, MPH MedStar Community Pediatrics
Baseline Assessment of Asthma Management Practices for Kids Mobile
Medical Clinic
Margaret McCarthy Steven Schwartz, MD Potomac Physician Associates (PPA) Strategies for Improving the CMS Quality Measure PREV-1
Katherine Mullins
Lacy Fehrenbach, MPH
Andria Cornell, MSPH
Association of Maternal and Child Health Programs
(AMCHP)
Maternal Levels of Care: Highlights from a Systematic Analysis of State
Activities
Jack Penner Jeff Weinfeld, MD, MBI MedStar Spring Valley Family Medicine
Improving PCV13 vaccination rates in the Medicare population at MedStar
Family Medicine Spring Valley
Brandon Quinn Larry Wolk, MD, MSPH Colorado Department of Public Health & Environment
Population Health Tiers: Opportunities for Reimbursement
of Colorado’s Local Public Health Agencies
Zachary Smith
Katie Sellers, DrPH
Lisa Waddell, MD, MPH
Association of States and Territorial Health Officials
(ASTHO)
Medication Adherence Interventions in Hypertensive Minority Populations:
A Review
Christopher
Wynkoop
Christine Goeschel, ScD, MPA,
MPS, RN
MedStar Pellegrini Quality Improvement
Improving HCV Recognition and Linkage to Care Among the Baby Boomer
Generation
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19. • Plan mutually beneficial projects that can be disseminated and published.
• Additional activities can include taking minutes at meetings, doing a literature
search, shadowing.
• Participate in projects already off the ground in which the student can “own” a
specific part.
• Decide on a clear deliverable to be completed by the end of the practicum
(webinar, issue brief, poster).
• Choose a mentor who is at a mid-level place in the organization who has the time
and passion to guide the student experience.
Summer Practicum: Lessons Learned
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20. • “Most valuable part for me has been working with the faculty who
attend our meetings and provide feedback on our projects. It is
helpful to hear how these experts discuss issues in population health,
and to hear about the work that they have conducted in the field.”
• “I gained very practical experience in the public health field and
navigating the complexities of the health department, qualitative
interviewing, and an opportunity to present to a diverse group of
stakeholders.”
Student Feedback
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21. • Health professions schools should partner with
community organizations and public health
agencies to engage in a win-win collaboration.
• Through these integrated population health
initiatives, our hope is to educate physicians
who are capable of bridging the gap between the
health of individual patients and the health of
their communities.
Improved Population Health
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22. Health and Well-Being for All (HWFA)
Accelerating Learning About
Social Determinants of Health
Using a Meeting-in-a-Box Approach
Denise Koo, MD, MPH
Advisor to the Associate Director for Policy, CDC
Virginia Watson, MA
Instructional Designer
The CDCE Legacy Project
U.S. Department of Health and Human Services
Centers for Disease Control and Prevention

23. Health Workforce Needs
 Critical thinking
 Systems thinking/public health approaches
 Team skills
 Community engagement
 Collective action

24. Background for HWFA Meeting-in-a-Box
 Origin of case study: CDC Experience 1-year Applied
Epidemiology Fellowship for medical students
 Purpose: empower graduates to participate
collaboratively in community health improvement
(not just within health care system)
 Additional goal: skill-building in leadership and being
change agents
 Critical need: persons with systems thinking and
approaches to solve complex problems that span the
health system

25. Goal for Health and Well-Being for All
Meeting-in-a-Box
Practitioners empowered to advocate for an
upstream approach to addressing root causes of
illness

26. Meeting-in-a-Box Learning Objectives
 Discuss the determinants of health, including
socioeconomic, behavioral, environmental and other
factors
 Compare and contrast the internal and external
issues faced by key stakeholders
 Identify strategies for moving from group alignment
to collective action
 Recognize that partnership with other sectors is the
best way to achieve Health and Well-being for All

27. Components of HWFA Meeting-in-a-Box
 Box with handle to carry contents
 Fabric poster/map, 3’ x 5’
 3 Modules: asthma, gang violence, obesity
 Dialogue guides for each module
 A patient story to motivate change
 Cards to educate and to stimulate discussion
 Coming together with Others Who
Care (role play for gang violence,
shorter variation for the other 2)
 All contents brightly colored,
appealing
 Modeled after Promedica’s
Hunger as a Health Issue
(produced by same company)

28. Discussion of Social Determinants of Health
 Cards to stimulate discussion
 2 Definitions (WHO, Healthy People)
 3 Brief Descriptions/phrases (Robert Wood Johnson Foundation)
 Which of the 5 resonated the most and why?
 Each discusses an example of a personal, social,
economic, or environmental factor that impacted
them, a patient, or someone they know

29. Module Focus
 Patient story to motivate change (patient impacted by
recurrent asthma, gang violence, or obesity)
 SDOH Examples relevant to each story
 Graphics, data, maps
 Discussion, including whose problem is it?, role of
health professionals and impact on society
 Set up for 6 steps

30. Six Steps to Health and Well-being for All
 (1) Seeing the Bigger Picture
 Begin to see interrelationships of parts of a whole
 (2) Focusing on What’s Important
 Determine and communicate the magnitude of the problem
 (3) Finding Others Who Care
 Harness the power of champions and recognize impacted groups
 (4) Walking a Mile in Someone Else’s Shoes
Empower a coalition of the willing
 (5) Acting on What’s Important
 Develop and document a future vision that’s desired and then
implement your plan
 (6) Communicating Your Vision and Mission
 Sell it, sell it, sell it!

31. 1: Seeing the Bigger Picture
Begin to see the interrelationships of
parts of a whole
• Discuss examples of SDOH from
the scenario (start with how they
might have impacted the
individual in the story)
• Do they affect the
whole community?
• Are they preventable?
from Obesity module

32. 2: Focus on What’s Important
Determine and communicate the
magnitude of problem
• Know What Affects
Health – modifiable risk
factors
• Finding data to support
your case
• Discuss need for
community-wide
agreement for change

33. 3: Finding Others Who Care
Harness the power of champions and
recognize impacted groups…
• Brainstorming a list of possible stakeholders,
supportive and reluctant

34. 4: Walking a Mile in Someone Else’s Shoes
Empower a coalition of the willing
• The purpose of this step is for participants to
consider perspectives of other stakeholders
• Take turns sharing the perspectives that need to
be considered as you continue through the rest
of the steps of the case study
• Each module offers a different way to “walk in
someone else’s shoes”

35. Walking a Mile in Someone Else’s Shoes
Gang violence (60+ minutes): full role play with
motivation, “friends/foes,” hidden agendas
ROLES (STAKEHOLDERS)
• Clinician
• Public health representative
• Former gang member
• City Council member
• Police officer
• School counselor
• Hospital administrator

36. Walking a Mile in Someone Else’s Shoes
Obesity (20-30 minutes): discussion of strengths,
points of agreement, sources of conflict, obstacles
ROLES (STAKEHOLDERS)
• Clinic receptionist
• Clinic director
• Public health representative
• City manager
• Parks & recreation director
• Business owner
• Religious leader

37. Walking a Mile in Someone Else’s Shoes
Asthma (20-30 minutes): discussion of how a group
might come together (forming, storming, norming)
ROLES (STAKEHOLDERS)
• Parent
• Parent representative
• Clinician
• Public health representative
• School system representative
• Hospital administrator
• City Housing Authority
representative

38. 5: Acting on What’s Important
Develop and document a future vision
that’s desired and then implement your
plan…
• Given the points of agreement from prior step,
choose an action the group could pursue
together
• Use PDSA as model for
change/improvement

39. 6: Communicating Your Vision and Mission
Sell it, sell it, sell it!
• Tailor communications based on the audience
• Overcoming barriers

40. Coming Together for Sustainable Change
• Reflection / Take-aways
• My Commitment

41. Supplemental Resources
 Available Soon on CDC Foundation website:
 Extra copies of dialogue guides, cards, poster image
 Video about San Francisco Wraparound project (gang violence)
 Facilitator guide and additional tips
 Resources for how to find data, evidence-based interventions
 Support for each of the 6 steps
 Webinar links
 Video of teaching in
Action (possible)

42. Possible Audiences?

43. Who do you see as possible audiences for this tool?
 Health professionals in training (students, residents)
 Undergraduates or younger students
 Interdisciplinary orientation
 Community coalition—early meeting
 Faculty Development
 Public health department staff
 Boards or senior leaders of health systems
 Community developers
 Urban planners
 Other disciplines

44. Possible Uses
 Map as standalone, with initial discussion questions
 Gang violence module with role play (3 hours)
 Asthma module (2+ hours)
 Obesity module (2+ hours)
 Foundational: beginning of education (any module)
or community engagement process
 Problem-based learning: explore any aspect in more detail
 Investigate data about the issue and its determinants
 Create role plays
 One step/lesson, with homework before next lesson

45. Health and Well-Being for All Meeting-in-a-Box available
via this link to the Public Health Foundation:
http://bitly.com/PurchaseHWFA
 Code DRKOO gives you $20 off your purchase through end of
August

46. • In groups of two or three, discuss your approaches to training
the public health and primary care workforce to collaborate to
address the social determinants of health
• How might you use or have you used methods similar to what
was presented here?
• Report to the larger group what you plan to do as a result of
this workshop
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Group discussion