Practical Playbook: Making the Connection Between Public Health and Primary Care
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This document provides an overview of a practical playbook for making connections between public health and primary care to address obesity. It discusses recognizing best practices for clinical and community integration and identifying opportunities to connect patients with community resources. The document outlines the ACA's impacts on healthcare and Medicaid coverage in Illinois. It presents frameworks for integrated clinical and community systems of care and provides resources and success stories for collaboration between sectors.
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Practical Playbook: Making the Connection Between Public Health and Primary Care
- 1. Practical Playbook: Making the Connection between Public Health and Primary Care Illinois Alliance to Prevent Obesity September 17, 2015 Lloyd Michener, MD Don Bradley, MD, MHS-CL Duke Medicine
- 2. Objectives • Recognize or cite the best practices of clinical and community integration • Describe how to use the Practical Playbook in clinical and community settings • Identify opportunities to connect patients with community resources to address adult and childhood obesity. Duke Medicine
- 3. Take home messages • Health, healthcare, and health insurance are not synonymous • Coverage for obesity-related services varies by state and by health plan • Disconnects and controversy: policies, politics, effectiveness and efficiency • An integrated, collaborative approach is most likely to succeed, and will take time, persistence, and patience Duke Medicine
- 4. http://www.rwjf.org/en/library/research/2014/09/the- state-of-obesity.html , accessed 08/01/2015 The State of Obesity in the US, 2014 Duke Medicine
- 5. ACA healthcare impacts • Essential Health Benefits determined by state (including coverage for bariatric surgery, obesity meds) • Coverage for USPSTF level A or B services with no out of pocket costs (including counselling for obesity) • Whether Medicaid expanded or not, Disproportionate Share Hospital (DSH) payments reduced • Community Health Benefit Program for not-for-profit hospitals (including CHNA and support) • CMMI and incentives and pilots for value-based care (including Accountable Care Organizations) Duke Medicine
- 6. Illinois Medicaid/CHIP • Illinois expanded Medicaid with the ACA • Over 2/3 covered by Managed Medicaid plans • Over 3 million enrollees • Enrollment up over 500K (19.2%) from July 2013 http://www.medicaid.gov/medicaid-chip-program-information/by- state/illinois.html , accessed 09/01/2015 Duke Medicine
- 7. Weight loss (Commercial) coverage by state, 2012 STOP Obesity Alliance, 2012 Duke Medicine
- 10. Inside the mind of a payer: 10 key determinants of coverage 1. Customer demand/preference for a benefit/service 2. Cost (as low as possible, predictable) 3. Evidence for effectiveness and efficiency 4. Deliverable quality outcomes (especially NCQA metrics) 5. Network for delivery 6. Customer satisfaction/experience 7. Ease of administration 8. Compliance 9. Risk (legal, financial, regulatory, public relations, network) 10. Profitability/margin Duke Medicine
- 11. Cost-effectiveness results for selected interventions evaluated in Australia Lancet Volume 378, No. 9793, p838–847, 27 August 2011 Duke Medicine
- 12. Framework for Integrated Clinical and Community Systems of Care Care Delivery •Information Systems •Decision Support •Delivery System Design •Self Management Support •Local Patient Environment •Clinicians Community Systems Equity Training & Education Metrics Integration Convener, Advocacy, Data Exchange, Financing, Governance/Regulation, Referral Processes, Communication Family & Individual Empowerment and Engagement Population Health •Resources •Services •Supportive Environment •Social Norms IOM Roundtable for Obesity Solutions, 2015 Duke Medicine
- 13. A Practical Playbook: Public Health and Primary Care Together http://practicalplaybook.org/
- 14. Practical Playbook Overview Practical Playbook Overview
- 15. The Eight “Easy” Steps For Community Health Improvement 1. Getting Things Started 2. Building a Case 3. Gathering Allies 4. Identifying Stakeholders 5. Walking a Mile in Someone Else’s Shoes 6. Creating a Compelling Vision 7. Developing a Strategy 8. Communicating Your Vision and Mission
- 16. 1. Getting Things Started Resources • Robert Wood Johnson Foundation
- 17. 2. Building a Case Resources • Practical Playbook: Finding data • The Community Tool Box: Analyzing Problems and Goals toolkit
- 18. Success stories & lessons learned Focus- childhood obesity Initiation- Physical Education teacher began BMI screening in her school district (2010)- 40% of children with an unhealthy weight Partners- • LJ Rice Elementary School • Scripps Family Medicine Residency • San Diego Healthy Weight Collaborative o Public health o Primary care o Local government o Neighborhood organizations Intervention- 5-2-1-0 https://www.practicalplaybook.org/success-story/collaboration-jumpstarts-healthy-habits-chula- vista-students-and-families , accessed 09/01/2015
- 19. Your turn: How have you used data to drive collaboration between the community and clinical settings? What data did you collect and how did you use it to make the case?
- 20. 3. Gathering Allies: Resources • “Tactics for Communicating”
- 21. 4. Identifying Stakeholders Resources • Practical Playbook: Community Engagement
- 22. Success stories & lessons learned Advocates for Healthy Youth (AFHY) Coalition Focus- Integrating medical, public health, and community efforts to address child obesity Initiation- Pediatrician at Cheshire Medical Center reached out to her health system Department of Community Health, which connected to community partners Partners- • Cheshire Medical Center (CMC) [primary care] • CMC Community Health Department [health system] • Local school district & colleges • City government • Public health • YMCA • Community Mental Health Intervention- 5-2-1-0 http://citizenshealthinitiative.org/sites/citizenshealthinitiative.org/files/media/2010/Ad vocatesforHealthyYouthCoalitionSummary.pdf , accessed 09/01/2015
- 23. Your turn: What issues have you found in engaging the community? What tactics have you found to be useful in communicating and engaging with the community?
- 24. Your turn: Other thoughts, stories, comments?
- 25. Take home messages • Health, healthcare, and health insurance are not synonymous • Coverage for obesity-related services varies by state and by health plan • Disconnects and controversy: policies, politics, effectiveness and efficiency • An integrated, collaborative approach is most likely to succeed, and will take time, persistence, and patience Duke Medicine
- 26. Thank you!
- 27. Bariatric Surgery (Commercial) Coverage by State 2012 STOP Obesity Alliance, 2012 Duke Medicine
Editor's Notes
- The Practical Playbook is built for a variety of audiences – individuals who have not worked together in the past or don’t have an understanding of the value of working with partners to improve community health; those who are interested in starting to work with partners; and those who are already working with partners. The Practical Playbook is divided into three main portals – Learn: Learning about the value of working together and the principles of integration; Do: For those who are interested in starting a project or moving their project forward with tools and resources Share: For those who are interested in learning from what others are doing.
- We realize that there’s an artificiality about doing this in less than a day—our emphasis, thus, is not on completeness or exacting details. There is no right answer. It’s about working with others to come to an approach. It should be about having fun.
- Background: 40% kids at unhealthy weight Lessons learned: 1. Forming a sustainable team required aligning leadership and sharing resources 2. Testing campaigns on a small scale before wider dissemination ensured acceptability 5- fruits/veges per day 2- no more than 2 hours screen time 1- hour activity per day 0- sugary drinks
- lessons learned; Start- 1. Start with interests of coalition members 2. Identify skills and resources of members of the coalition 3. Find an organizational home 4. Pay attention to management of the coalition Implementation- Use a strategic planning process 2. Expect some ebb & flow 3. Diversify activities Start small and ramp up Don’t reinvent the wheel Change is incremental Maintaining and sustaining- Train the trainer Develop a sustainability plan Show value for coalition members to maintain interest