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Public Health & Healthcare Transformation

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Presentation on theme: "Public Health & Healthcare Transformation"— Presentation transcript:

1 Public Health & Healthcare Transformation
Patrick F. Luedtke, MD, MPH Senior Public Health Officer Medical Director, Community & Behavioral Health clinics Lane County Health & Human Services

2 Lane County Health & Human Services
1) Includes 4 FQHC clinics, Public Health, the County Mental Health clinic, & the Behavioral health system payer 2) I serve as the County Public Health Officer (50%) and the Medical Director of the FQHC clinics (50%) 3) I also serve on the CCO Board, the CAP, and on two CCO subcommittees (PCMH & Quality) 4.) Other H&HS employees serve on CCO Board & committees

3 Lane County: The View From Space
CCO: ~74,000 lives, Board of 21, Prevention funding of $1.33 per member per month Public Health Clinical: MCH, WIC, Prevention, Communicable Dz Non-clinical: Environmental Health, Vital Records, Preparedness Other: PH/MH authority, “soft power” convening authority (e.g., STD Summit)

4 PH-PC: Integration and Reverse Integration
Community Health Needs Assessments Community Health Improvement Plans Health equity & Public Health equity initiatives Tracking health and process outcomes (e.g., patient safety, patient experience, care coordination, CHWs) Create & implement community-based prevention guidelines (e.g., tobacco, obesity, vaccination rates) Community initiatives based on claims data (e.g., tobacco use in pregnant women)

5 Specific Lane County Projects
1.) Tobacco use in pregnant women 2.) Falling immunization rates (AFIX program) 3.) The Good Behavior Game (lower drug/alcohol use disorders, smoking, antisocial PD, suicidal ideation, delinquency, incarceration)

6 Tobacco Cessation Incentive Program
Vital statistics birth data review. Federally qualified health centers pregnant patient chart review. Public Health (PH) “We have too many preemies and pre-term labor cases.” Obstetrics/Gynecology (OB/GYN) Claims data review for preemie/pre-term labor costs. (CCO) PH-PCP-OB/GYN steering committee “All my pregnant patients smoke!” Primary Care Physicians (PCP) Nicotine testing & incentive $$ for pregnant smokers

7 Smoking in Pregnancy Data Source: Oregon Health Authority

8 Lane County: Smoking in Pregnancy
Age Smoking Rate Patient Number <20 27% 294 20–24 25% 860 25–29 16% 1,147 30–34 11% 843 35–39 9% 348 >/= 40 81 NOTE: Survey of current use rates: FQHC, PeaceHealth hospitals/clinics, Douglas county. Data Source: Lane County Vital Statistics: 2009

9 Clinical Expectations
Prenatal smoking is associated with: 30% of small for gestational age (SGA) infants 10% of preterm infants 5% of infant deaths* Expected quit rate, without incentives is ~37%** Decreased ear infections and asthma attacks in child *MMWR 58(ss04);1-29 May 26, ** PRAMS 2005

10 Medicaid Savings Preventing 1 SGA birth = $45,000 savings
$1 spent on cessation = $3.50 in neonatal savings Data Source: CDC, Smoking-Attributable Mortality, Morbidity, and Economic Costs (SAMMEC)

11 Lane County Medicaid Neonatology Costs (2012)
Fiscal Data Lane County Medicaid Neonatology Costs (2012) Line item cost $7,643,967 # of Episodes 1,773 Cost/Episode $4,311 Unique members 1,715 Monetary goal: 10% cost reduction/yr (ROI = 7.6)

12 Tobacco Cessation Incentive Program
Program goal: Tobacco cessation in 30% of program participants Participation goal: 80% of pregnant Medicaid patients

13 Questions?

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