Healthy Public Health 2016: A Four-Year View Jeffrey Levi, PhD Open Forum Meeting for Quality Improvement National Network of Public Health Institutes Charlotte, NC December 7, 2012

Context Affordable Care Act implementation Prevention and Public Health Fund Fiscal cliff or fiscal slope New funding hard to come by “Improve many things when focus on a few things” Short-term investment to modernize for long-term savings It’s all about partnerships

Four years, four goals Creating health equity by building the culture of “health in all policies” Prioritizing prevention – especially community change/prevention – as part of the redesign of the US health care system and how it is financed Restructuring health programs and agencies to break down silos and reflect new health infrastructure Providing a stable base of funding for state and local public health

Create health equity through HIAP Addressing social determinants of health requires new partnerships National Prevention Council/National Prevention Strategy as a federal base Building new constituencies for HIAP—and accessing new resources Building social capital through engagement and policy/programmatic change

National Prevention Council= New Partnerships Bureau of Indian Affairs Department of Labor Corporation for National and Community Service Department of Transportation Department of Agriculture Department of Veterans Affairs Department of Defense Environmental Protection Agency Department of Education Federal Trade Commission Department of Health and Human Services Office of Management and Budget Department of Homeland Security Office of National Drug Control Policy Department of Housing and Urban Development White House Domestic Policy Council Department of Justice

Coming together Education Community Development Climate Change/Environment Transportation In various constellations Across government and private sector Building social capital builds resilience and health

National Prevention Strategy

National Prevention Council Commitments Consider prevention and health within departments and encourage partners to do so voluntarily as appropriate. Increase tobacco free environments within its departments and encourage partners to do so voluntarily as appropriate. Increase access to healthy, affordable food within its departments and encourage partners to do so voluntarily as appropriate.

New partnerships with health Structural integration of prevention and public health—from Accountable Care Organizations to Accountable Care Communities Making the ROI case for prevention – within the health system and more broadly Inclusion of prevention/public health funding as part of any global budget initiatives Defining the need and what it would look like Expand use of new tools such as community benefit

Improving Population Health Outcomes Depends on Transforming the Health System to Coordinate and Integrate Primary Care, Public Health and Community Prevention Efforts Incentives for providers to achieve pop. health out-comes and improve quality Incentives for plans/ACOs to address population health outcomes Funding mechanisms that enable braiding of financing streams Health Care System/ Primary Care Primary care & team based care Patient assessments include personal data and SDOH regarding patients’ homes and communities Quality improvement Leveraging, linkages and referrals to community resources Data collection & EHRs contribute to community health data base Coordination with community health outreach workers Chronic disease mgmt Payers, Insurers, and ACOs Community Prevention/ Social Determinants of Health (SDOH) Interventions at the intersection of primary care, public health and the social determinants of health require: Common agendas and goals Shared responsibility A compelling story Partnerships and collaboration Leadership and Integrators Data Financing systems Accountability mechanisms Public Health Interventions At The Intersection Social and support services Disease prevention and management programs Outreach and referral to clinicians Education, including health education Coalitions and advocacy to address SDOH Community engagement Policy leadership on programs and policies that improve community health Community health assessments Educating policymakers, agencies, and stakeholders regarding pop. health Population health data tracking and analytic tools Public policy is a critical lever to support all of these activities Improved Population Health, Health Outcomes, and Lower Costs (Triple Aim)

Decentralization of ACA decision making New partnerships with health insurance exchanges, Medicaid programs, hospital system, ACOs, etc. New language, new ways of making our case, new expertise PATIENCE

Partners, Accountable Care Community

ACC Coalition Community Members Medicine Public Health Government & Philanthropy Higher education Secondary education Safety-net health services National Health Coalitions Academic researchers Health Systems & Healthcare providers Alcohol/drug services Mental health services Faith community Community programs Collaborative partnerships leverage multi-sector resources to improve community health. Benefits of partnership: Addresses broad range of issues with greater breadth and depth Coordinates services and prevents redundant efforts Increases public support Allows individual organizations to influence community on a larger scale Includes diverse perspectives Strengthens connections between existing resources Provides shared frame of inquiry for community health concerns

Public Health and Health Care Cost Containment: Making ROI Case

How does public health change? (1) Foundational capabilities first Information systems and resources; Health planning; Partnership development and community mobilization; Policy development analysis and decision support; Communication; and Public health research, evaluation and quality improvement. Every American served by these capabilities

How does public health change? (2) True modernization of core systems Surveillance and epidemiology as case study Streamlined categorical programs Break down silos Emphasize approaches that have cross cutting impact – within health Focus investment in partnerships CTGs model for leadership and sharing resources

How does public health change? (3) Payer of last resort Doing what public health must do, not necessarily what it has always done Restructuring of federal public health agencies to reflect the new reality

Create stable funding for public health Federal mandate to demonstrate foundational capabilities Develop federal-state relationship similar to Medicaid Federal government provides very high match (90-100%) for foundational capabilities States determine how they assure achieved for every resident Federal government provides diminishing match for lower priorities Incentives to merge similar categorical efforts; if core addressed, less funding needed for categorical

Can we do it? Four years ago we considered the following to be dreams or too much of a stretch Accreditation Health reform National Prevention Council, Strategy Mandatory funding for public health Major new prevention programming Status quo is not an option

Healthy Public Health 2016 Accreditation tied to assured funding for foundational capabilities Population health integrated into new systems of health care delivery and financing Health inequities reduced by partnership across sectors Healthier and more resilient nation