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Welcome! Statewide LHIC Leadership Meeting October 10, 2012 Columbia, MD.

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Presentation on theme: "Welcome! Statewide LHIC Leadership Meeting October 10, 2012 Columbia, MD."— Presentation transcript:

1 Welcome! Statewide LHIC Leadership Meeting October 10, 2012 Columbia, MD

2 Victor A. Broccolino President and CEO, Howard County General Hospital

3 Madeleine Shea Director Office of Population Health Improvement, DHMH

4 Hospital Perspective Lisa Hillman Senior Vice President, Legislative Affairs, President, AAMC Foundation Kathleen McCollum Senior Vice President, Business Development and Ambulatory Services

5 We have one foot in the boat and one on the dock.

6 Coalition Network Academia Existing Boards, Committees & Coalitions Government Agencies Faith-Based Organizations Community-Based Organizations Health Care Providers Philanthropy Businesses Leadership & Finance Subcommittee Healthy Anne Arundel Coalition

7 Steering Committee Member Organizations: Department of Health Anne Arundel County Office of the County Executive Anne Arundel Co. Dept. of Aging and Disabilities Anne Arundel County Department of Detentions Anne Arundel Co. Dept. of Health Anne Arundel Co. Dept. of Recreation & Parks Anne Arundel Co. Dept. of Social Services Anne Arundel Co. Public Schools Anne Arundel Co. Mental Health Agency, Inc. Anne Arundel Co. Chapter of the NAACP Anne Arundel Community College Anne Arundel Community Development Services Anne Arundel Economic Development Corporation Care First Blue Cross Blue Shield City of Annapolis Mayor’s Office City of Annapolis Dept. of Recreation and Parks Community Foundation of Anne Arundel County Housing Authority of the City of Annapolis MEDSTAR Harbor Hospital Northrop Grumman People’s Community Health Centers, Inc. Rite Aid Corporation School of Public Heath, University of Maryland Walmart

8 Opportunities Working more collaboratively with the Department of Health and key players who play a role in the prevention, care and management of patients we commonly serve. To develop consensus on primary health improvement targets and address allocation of resources. Examining how the system of care - both prevention and public health - can work seamlessly together. Sharing information on high utilizers of care together in order to examine prevention efforts that can minimize their utilization for better health outcomes. Joint Community Health Needs Assessment. Provides local health data and community input into the community benefit planning process.

9 Challenges Assuring representation from key stakeholders and partners. Transition in hospital focus to population health and community benefit. Hospitals have different primary service areas that may or may not overlap and each with their own unique needs. Developing an implementation structure (5 sub-committees) that works and is manageable without being burdensome. The Coalition's focus areas of obesity prevention and co- occurring disorders are complex health issues that will take substantial amounts of resources and time to improve.

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11 Laurie Fetterman, MSW Phone: Brandon J. Johnson, MHS Phone:

12 Peter Beilenson Health Officer Howard County Health Department

13 Q & A and Discussion

14 Community Transformation Don Shell Director, Center for Tobacco Prevention & Control, DHMH

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16 Renee Fox Executive Director Institute for Healthiest Maryland

17 Institute for a Healthiest Maryland Presentation to Statewide LHIC Leadership Meeting October 10, 2012 Renee Ellen Fox, M.D. Executive Director Institute for Healthiest Maryland

18 Mission: To measurably improve the health of Maryland citizens, the Institute will support community transformation efforts, translate public health research into practice, and provide technical assistance to local health departments and community organizations. Vision: Be a guiding resource for transforming Maryland communities into healthy environments for all.

19 Initial Funding for IHM Funding from DHMH via CDC Community Transformation Grant (CTG) from the Public Health Trust Fund of the ACA. – address obesity, tobacco use, hypertension and health disparities – Partially funds Executive Director and Assistant Office of the President UMB to partially fund Executive Director and Assistant for 5 years Long Term Goal: Self-sustaining through external funding.

20 MOU from DHMH to UMB – Provide Technical Assistance to Local Health Departments through Academic Partners – UMB Law, Pharmacy, Medicine and Nursing – UMBC Tobacco Quit Program – UMCP SPH – JHU Bloomberg School of Public Health

21 IHM Structure

22 IHM Role in CTG Conduct Local Health Departments’ needs assessment Compile, develop, disseminate resources and best practices Communication strategies Training and technical assistance Use the existing evidence based interventions Contribute to the knowledge base.

23 Contact Info Renee Ellen Fox, MD, Executive Director Phone Greer Huffman

24 Nicole Stallings Asst. VP, Quality Policy & Advocacy Maryland Hospital Association

25 Supporting Policy Innovation to Improve Population Health Statewide LHIC Leadership Meeting October 10, 2012 Nicole Stallings, MPP Assistant Vice President, Quality Policy & Advocacy Maryland Hospital Association

26 Population Health Prevention Care Coordination Quality & Patient Safety

27 Population Health Management in the ACA Community Health Needs Assessment requirements Expansion of prevention and wellness services Hospital Readmissions Reduction Program Community-based Care Transitions Program Accountable Care Organizations Patient Centered Medical Homes Increased funding for health centers

28 Opportunities for Hospitals to Explore Quality of Care Efficiency Access Physician Training Health Information Technology Physician Employment Care Integration and Coordination Behavioral Health Access Disparities Cultural and Linguistic Access Disease Management Provider Supply

29 Example: Total Patient Revenue Hospitals Sources: HSCRC 2012

30 Source: HFMA. Value in Health Care: Current State and Future Directions. June 2011.

31 Hospitals’ State of Readiness Focus on population health is already occurring; variation in level of investment Partnerships are essential for success – Physicians and other clinicians – Post-acute care providers – Employers – Government and commercial payers – Social and community services – Public Health agencies – Local, State and Federal Policy

32 Thank You! QUESTIONS? Contact:

33 Reducing Readmissions and Medicare Opportunities Fredia Wadley CEO, Delmarva Foundation

34 Laura Herrera Chief Medical Officer DHMH

35 Overview of “State Innovation Models” Grant Proposal Laura Herrera, MD, MPH Chief Medical Officer Maryland Department of Health and Mental Hygiene

36 State Innovation Models (SIM) Grant Solicitation Released by Center for Medicare & Medicaid Innovation (CMMI) at CMS Purpose: Develop, implement, and test new health care payment and service delivery models at the state-level 2 tracks: – Model Design: Planning grant to fund the development of a comprehensive state innovation plan; $1-3 million over 6 months – Model Testing: Funds implementation and testing of an existing state innovation plan; $20-60 million over 3.5 years Maryland applied for Model Design – Funding period: December 2012 – June 2013 – Opportunity to apply for Model Testing in 2013

37 Proposed Model: Community-Integrated Medical Home Integration of a multi-payer medical home model with community health resources 4 pillars: 1)Primary care 2)Community health 3)Strategic use of new data 4)Workforce development Two parallel stakeholder engagement processes 1)Payers and Providers 2)Local Health Improvement Coalitions 1)All-stakeholder summit to form policy recommendations and develop plan for Model Testing application

38 Proposed Model: Community-Integrated Medical Home

39 Payer and Provider Engagement Process Develop a governance structure for medical homes Establish a public utility to administer payment and quality analytics processes Set programmatic standards, such as – Criteria for practice inclusion – Quality assessment – Analytics – Shared savings Hilltop and its contractor will conduct actuarial modeling of health costs to demonstrate savings expected from CIMH

40 Local Health Improvement Coalition Engagement Process Complement medical care by linking high-need patients with wrap-around community-based health services Capacity of LHICs will be strengthened – Will be asked to help develop new models to carry out CIMH activities (e.g., 501(c)3, integration with LHD, etc.) Community health workers may play role of coordinating with practices – LHICs will be asked to help define responsibilities and required skills/education for CHWs Use new data and mapping resources to “hot-spot” high utilizers and bring them into CIMH – LHICs will review prototypes of these resources

41 New Data Resources and Workforce New data resources – Data for “hot-spotting:” Real-time hospital admissions data – Data for population health monitoring: Health status, claims, administrative, and survey data Workforce development – Maryland Learning Collaborative will develop resources and help prepare practices for community integration – MLC will partner with AHECs for training, especially in southern Maryland Example of hot-spotting with admission data

42 Michael Abrams Senior Research Analyst Hilltop Institute

43 Coordination of Care for Persons with Substance Use Disorders under the Affordable Care Act Maryland State Local Health Improvement Coalition Leadership Meeting Howard County General Hospital October 10th, 2012 Michael T. Abrams, M.P.H. Funding: Baltimore Substance Abuse Systems, Inc.

44 Even smart people are unclear about what’s in the ACA -44-

45 The Report &st=tbl_Publications &st=tbl_Publications Affordable Care Act (ACA) review (U.S. Public Laws and ) Literature review Existing program review (Behavioral Health Integration) Opportunities and barriers in the recently passed federal health care law (the ACA) regarding the development of overall health care coordination for persons with SUD? -45-

46 Essential Health Benefits (A) Ambulatory patient services (B) Emergency services (C) Hospitalization (D) Maternity and newborn care (E) Mental health and substance abuse services, including behavioral health treatment (F) Prescription drugs (G) Rehabilitative and habilitative services and devices (H) Laboratory services (I) Preventive and wellness services and chronic diseases management (J) Pediatric services, including oral and vision -46- (ACA § 1302(b)(1)(E) – p. 59)

47 A health home provider is… -47- “a physician, clinical practice or clinical group practice, rural clinic, community health center, community mental health center, home health agency, or any other entity or provider (including pediatricians, gynecologists, and obstetricians) that is judged by the State and approved by the Secretary to be qualified to be a health home for eligible individuals with chronic conditions on the basis of documentation showing that the physician, practice, or clinic – (A) has the systems and infrastructure in place to provide health home services; and (B) satisfied the qualification standards established by the Secretary” (ACA § 2703(a)(h)(5)(A and B) – p. 232)

48 Medicaid Subgroups: Health Home Targets -48- Latent Class Grouping VariableAdult - High Somatic MorbidityAdult - High Psychological Morbidity N3,7323,258 Mean Age (stdev)46 (11)38 (12) Alcohol Dependence30%38% Opioid Dependence44%47% Cocaine Dependence12%28% Anxiety disorders10%63% Tobacco use9%71% Schizophrenia spectrum1%67% Depression3%85% Cardiovascular97%61% Gastrointestinal/Hepatic96%53% Hematologic72%15% Musculoskeletal93%74% Neurologic90%65% Renal80%29% Respiratory94%51% Source: Abrams et al., 2012,

49 Barriers Payment reform (Finkelstein et al., 2011; Lindly et al., 2011; Croze et al., 2011) – Burden of new data monitoring and collection (Medical Directors Council, 2005) – Avoid “double-billing” for the same service (Integrated Care Resource Center, 2012) Essential benefits too vague (Buck, 2011; Garfield et al., 2010; Takach, 2011) Inertia (Croze et al., 2011) -49-

50 Barriers continued Medical culture (Kunins, Sohler, Roose, & Cunningham, 2009; Davidson & White, 2007) Stigma (Davidson & White, 2007; Edlin et al., 2005) – For substance use disorders especially Confidentiality (Lindly et al., 2011) -50-

51 Opportunities Social justice argument (Boyer & Indyk, 2006; Edlin et al., 2005; Secker et al., 2006) Technology FQHC expansion/leveraging (Abrams et al., 2011) ACA language and grant support – Includes many types of efforts, venues, provider types Strong leadership (Lindly et al., 2011) -51-

52 Contact Information -52- Michael T. Abrams, MPH Senior Research Analyst The Hilltop Institute University of Maryland, Baltimore County (UMBC)

53 Q & A and Discussion

54 Break!

55 Margaret Fowler Director, Community Wellness Calvert Memorial Hospital

56 Community Health Improvement Roundtable Calvert County’s Local Health Improvement Coalition LHIC Leadership Meeting October 10, 2012

57 Background CMH has coordinated the Community Health Improvement Roundtable since Membership: Calvert Memorial Hospital, Calvert County Health Department, Calvert County Government, Calvert County Public Schools, Hospice, Department of Social Services, Clergy, Health Impact Council, Oral Health Task Force, Tobacco/Cancer Coalition, Health Ministry Network, IPOP Integrated SHIP objectives into Community Health Needs 2011.

58 LOCAL HEALTH IMPROVEMENT COALITION (LHIC)

59 SHIP Target Area Priority Area #1 Smoking – Objective #32 – Objective #33 Priority Area #2Obesity – Objective #30:Increase health weight of adults Priority Areas #3 & #4Death Rates – Objective #25:Reduce Heart Related Deaths – Objective #26: Reduce Cancer Related Deaths Priority Area #5Disparities Objective #27Reduce ER Utilization for Diabetes Objective #28Reduce ER Utilization for Hypertension Objective #39Access to Care

60 Disparity Addressed ER Utilizations for Diabetes Related Visits – 4.5 times the rate of Caucasians – Why? ER Utilization for Hypertension Related Visits – 4.75 times the rate of Caucasians – Why?

61 New Initiatives Data Analysis Creation of education tools – Diabetes Boot Camp – Diabetes Survival Guide – A1c Screening – Health Literacy Community Coordination Care Team

62 Previous Care Coordination PATIENT Emergency Room Visit Care Transition Coach PCP Care Coordinator Access To Primary Care Physician (PCP) Health Ministry Team Network Living Well Program Diabetes Self Management Mental Health Services Substance Abuse Services

63 Community Coordination Care Team PATIENT Emergency Room Visit Care Transition Coach PCP Care Coordinator Access To Primary Care Physician (PCP) Health Ministry Team Network Living Well Program Diabetes Self Management Diabetes Boot Camp Mental Health Services Substance Abuse Services Diabetes Care Coordinator

64 Debbie Goeller Health Officer, Worcester County & Lower Shore Coalition Lead

65 National Diabetes Prevention Program Model for Lower Shore Tri-County Health Improvement Deborah Goeller, R.N., M.S.N., Health Officer Worcester County 10/10/12

66 Lower Shore Maryland 14.3% of Lower Shore residents have been diagnosed with diabetes, almost double the State of Maryland at 8.3%. (2009 Community Health Assessment) 2010 HSCRC data revealed Lower Shore rate for emergency department visits due to primary diabetes diagnosis exceeded the State of Maryland (565.5 vs )

67 History of Worcester County Health Department Experience with NDPP Preventive Health and Health Services (PHHS) Block Grant funding to focus on Diabetes “ Lifestyle Balance” Utilized NDPP curriculum and evaluation tools Group Intervention- Education + Exercise Team Taught- Registered Dietitian, American College of Sports Medicine Certified Clinical Exercise Specialist, Health Educator

68 Implemention in Worcester 16 Week Program “ Coaching” Food/Activity Journals Locations- Workplaces, Recreation Centers, Community Sites, YMCA

69 Outcomes July May 2012, 344 individuals have participated in the program 219 (64%) individuals have completed the program (attended at least 75% of classes) 17 sixteen-week programs have been completed Offered at 13 different locations

70 Fruit and Vegetable Intake

71 Physical Activity

72 Body Mass Index

73 COOP Quality of Life Assessment

74 National Diabetes Prevention Program Somerset, Wicomico, and Worcester Counties received CDC “partial recognition” for NDPP Grant funding used to sponsor “Lifestyle Coach” training conducted by DTTAC, Emory University, in June Local Health Department Staff from 3 lower shore counties completed the training

75 NDPP Implementation in Tri County Grant Funding will support one full year (16 core sessions and 6 post-core monthly)of the NDPP in each of the 3 Counties. 20 individuals will complete the program which will be offered in each of the 3 counties (60 participants total) Somerset, Wicomico, and Worcester County Health Departments collaborate to market the program through Local News Media, Tri County PIOs, Websites, Social Media, News Releases, and Local Public Television.

76 Recognition Leads to Billing and Sustainability All 3 LHDs will pursue “Full Recognition” from the CDC for the National Diabetes Prevention Program requiring data reports every six months for the next 24 months. Full Recognition allows billing and program sustainability as fee for service.

77 Reducing Behavioral Health ED Visits Amy Baker Program Director, Care Coordination Unit Carroll County Health Department

78 Sharon Lipford Deputy Director, Community Services Harford County

79 Harford County Local Health Improvement Plan Behavioral Health: Emergency Room Diversion Susan Kelly, Harford Co. Health Dept. Health Officer Sharon Lipford, Harford Co. Dept. Community Services Deputy Director/ LHIP Behavioral Health Chair

80 Baseline Data (per 100,000): Demographic IndicatorsHarford County MarylandCounty 2014 Target Behavioral health-related admissions to E.R.1,243.71,206.31,183.4 Suicide rate Drug-induced death rate % 12. 8% HARFORD MARYLAND Harford County’s death rate from intoxication was the in Maryland Source: Health Services Cost Review Commission; CDC Behavioral Risk Factor Surveillance System; Office of the State Medical Examiner

81 Behavioral Health Workgroup Strategic Direction  Develop mechanisms to integrate mental health and substance abuse treatment  Improve the delivery of behavioral health services Progress to Date  Youth Behavior Survey ~170 parents across Harford County Parents believe substance abuse is a problem among youth, with alcohol being a primary concern, followed by drugs Anxiety is also of concern among parents  Focus group with Emergency Room Staff from Upper Chesapeake Health and Harford Memorial Hospital  Bazelon Center for Mental Health Law Behavioral Health/Criminal Justice Review  Prescription Drug Take-Backs

82 Next Steps: Prevention, Intervention, Recovery Focused  Use Primary Care/Urgent Care Doctor as a first line of intervention - depression/suicide screening  Expand training for Law Enforcement- EP/ED Diversion  Multi-disciplinary ~information sharing and cross-training of addiction and mental health services  Promote recovery and support through peers, families and faith-based communities

83 Sue V. Raver Health Officer Allegany County Health Department

84 Allegany County Health Planning Coalition Partners: Allegany County Health Department Western Maryland Health System Allegany County Board of Education Tri-State Community Health Center Western Maryland Area Health Education Center County United Way Allegany County Human Resources Development Commission

85 Local Health Improvement Plan: Priority 5: Substance Abuse – Alcohol & Drugs Priority 5.B.4

86 Purpose: To reduce alcohol related crashes through educational awareness initiatives. Funding: Community Health Resources Commission (CHRC) Grant Partners: Western Maryland Health System ACHD Prevention Program Maryland State Police Breathalyzer Project

87 Consultation Legal Issue: The Network for Public Health Law – University of MD “The education benefit (e.g. knowing what being over the limit ‘feels like’) seems to trump the legal risks.” Maryland State Police in Garrett County

88 What We Do Personnel: DRE Maryland State Police Officers Drug Resistance Education (DRE) ACHD Prevention Staff Location: Large public events where alcohol is served/purchased Provided Services: Non-threatening education Voluntary breathalyzer (Maryland State Police) Alcohol consumption information Dangers of driving under the influence Facts and myths about alcohol

89 Events To-Date EVENT VOLUNTARY PARTICIPANTS OVER LEGAL LIMIT (0.8) Friday After Five196 Frostburg Block Party 93 F-Bar in Frostburg* (10/2) 3224 Frostburg Homecoming (10/12) Not yet available * Funded through Strategic Prevention Framework (SPF) Grant. Some initiatives undertaken by the F-Bar include the addition of food to their menu, Tuesday trivia night, and TIPS (Training for Intervention ProcedureS) training for employees (to recognize potential alcohol-related problems and intervene to prevent alcohol-related tragedies).

90 Comments Interested to know how drinking affected BAC (blood alcohol content) level Interested to know what factors are involved: Sex Weight Food Consumption Time Frame of Consumption Prevalent Myth: Drinking coffee can make one sober

91 Q & A and Discussion

92 Joshua M. Sharfstein Secretary DHMH

93 SHIP Data Development and Plans Madeleine Shea

94 Maryland SHIP 2012 Update Statewide LHIC Leadership Meeting October 10, 2012 Howard County General Hospital Wellness Center

95 Maryland SHIP 2012 Statewide Update Objectives 7-12

96 National Data Source: Healthy People 2020, National Child Abuse And Neglect Reporting System Maryland Data Source: Maryland Department of Human Resources (DHR)

97 National Data Source: Healthy People 2020, National Center for Education Statistics Maryland Data Source: Maryland State Department of Education (MSDE)

98 Data Source: Maryland Health Services Cost Review Commission (HSCRC)

99 Maryland SHIP 2012 Update County-level data Data Source: Maryland Youth Tobacco Survey (MYTS)

100 Maryland SHIP 2012 Update County-level data Data Source: Maryland DHMH Vital Statistics Administration

101 Maryland SHIP 2012 Update County-level data Data Source: Maryland Health Services Cost Review Commission (HSCRC)Data Source: Maryland Health Services Cost Review Commission (HSCRC) IMPORTANT: Only visits made by Maryland residents to Maryland hospitals were used for the analysis; emergency department visits made by Maryland residents to out-of-state hospitals were not included. Data are coded by patient’s county of residence.

102 Maryland SHIP 2012 Update County-level data Data Source: Maryland Health Services Cost Review Commission (HSCRC)Data Source: Maryland Health Services Cost Review Commission (HSCRC) IMPORTANT: Only visits made by Maryland residents to Maryland hospitals were used for the analysis; emergency department visits made by Maryland residents to out-of-state hospitals were not included. Data are coded by patient’s county of residence.

103 Maryland SHIP 2012 Update Disparities

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106 Tricia Supik Executive Director & CEO Partnership for a Healthier Carroll County, Inc.

107 Connecting people. Inspiring action. Strengthening community.

108 The Partnership Mission Connecting people, Inspiring action, Strengthening community Established in 1999 by Carroll Hospital Center and CC Health Department. Collaborate to build the capacity of individuals and organizations to improve the health and quality of life in our community. Influence policies, form leadership teams (mini coalitions), drive change, promote engagement/ accountability, measure results and advance a healthy community vision. Track and interpret health data to “check the pulse” of our community/results. Current structure includes eleven Core Health Improvement Areas (e.g., Prevention and Wellness, Elder Health, Access to Health Care etc.)

109 1.Provide information needed for development of a CHC Community Benefit Plan in compliance with their charitable organization Mission and elements of the 2010 Affordable Care Act 2.CHC Strategic planning 3.The Partnership's operational and organizational strategic planning 4.Inform the CHC Cancer Committee ongoing accreditation process 5.SHIP/LHIP compliance expectations Purposes driving the 2012 CHNA:

110 Common Themes Prevalent Issues High Impact Issues Components of the 2012 Community Health Needs Assessment 1. Community Health Surveys and Key Informant Surveys 2. SHIP/LHIP and Secondary Data Analysis 3: Focus Groups, Carroll County Health Rankings, CC Transit Development Plan

111 Targeted Populations Focus Groups Five focus groups conducted: 1.African American (Completed with NAACP ) 2.Hispanic (Completed with CCC ESOL Program at B.E.R.C.) 3.Low Income (Completed with CC Head Start of Taneytown and with Human Services Program of Carroll County) 4.Older Adult Providers (Completed with Elder Health Leadership Team) Online profile collected, sessions recorded For Hispanic program, Interpreters provided by CCHD

112 Information from Key Informant Survey Obesity most frequently identified concern, but not listed as most urgent concern to be addressed. Health care access was not listed as a primary concern. Goal was a 70% return rate or about 95 Key Informant responses. 136 persons, ranging from private practice doctors to law enforcement to private business owners. Geographies were considered.

113 Integrating the SHIP - LHIP with other Carroll County Specific Secondary Data

114 Q & A and Discussion

115 SHIP Next Steps Madeleine Shea

116 Thank You!


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