Iowa Public Health and Health Reform Gerd Clabaugh Deputy Director Iowa Department of Public Health November 17, 2011

Outline Components of Iowa’s current public health services system Building blocks of ACA relevant to Iowa health delivery system change Opportunities for public health delivery change in Iowa – ACO – Immunization – Community Utility

Selected Health Reform Themes Public accountability Value-based Purchasing – triple aim – Better care for individuals – Better health for populations – Lower growth in expenditures Organizing care around the patient Information Systems More covered lives from among previously uninsured

Iowa’s Current PH Delivery System Iowa’s PH delivery system focuses on access gaps: – Immunizations for children – Maternal and child health – Enable geographic and financial access Safety net Supplement to the private care delivery system

PH Opportunity PH brings skillsets that will be greatly valued under reform – Outreach – Population-based health – Community education – Use of data in driving decisionmaking

PH Realizes the Opportunity… Understanding PH’s value in the community Building the business case for value Being sophisticated about communicating PH performance Being a partner and leader in the local delivery system Looking for localized, collaborative solutions

ACA’s impact on Iowa PH ACO Immunizations Community Utility Maternal Health

ACO needs… Strong primary care base which understands the primary care medical home concept Accessible care Ability to collect data and report performance Manage to total patient savings, not by payer Engaged patients Capability to serve all patients

Accountable for what? Total patient care Population health outcomes Patient care experiences Cost The Commonwealth Fund, April 2011

Public Health opportunity… Understanding of primary care Practices as a medical home Competency is delivery of care to underinsured, a target population of ACA

Immunizations Medicaid – Medicaid coverage expansion for low-income adults could result in more demand – Payment rates for physician administration of vaccine will increase Insurance Exchange-provided insurance will include immunization coverage unless grandfathered

Delivery System needs… Cost effective methods of reaching their covered population Experience outreaching to previously underserved communities Additional capacity

Community Utility A resource shared by multiple community service providers or practices in order to achieve efficiencies in operation and management and improvements in quality Ed Schor, 2011

Community Utility Care coordination Health education Information Technology Quality improvement Home visiting Mental health consultation Ed Schor, 2011

PH Opportunity PH positioned to serve geographic areas with outreach type efforts Utility model is shared by all PH is a connector to community services

Example: Readmissions 13% of Medicare readmissions are avoidable - $12 billion CMS Innovation Center now working to connect hospitals to CBO’s to reduce readmissions for select conditions Emphasis in care transitions, connection to community resources out of the hospital

Conclusions Population health has been integrated into the ACA Greater levels for financial, outcomes, and access accountability will exist for all stakeholders Understanding current performance and best practices will be important to success Best practices deployed in the community will drive improved outcomes

References HIGH PERFORMANCE ACCOUNTABLE CARE: BUILDING ON SUCCESS AND LEARNING FROM EXPERIENCE, Stuart Guterman, Stephen C. Schoenbaum, Karen Davis, Cathy Schoen,Anne-Marie J. Audet, Kristof Stremikis, and Mark A. Zezza, April 2011, The Commonwealth Fund, ance_accountable_care_v3.pdf ance_accountable_care_v3.pdf THE AFFORDABLE CARE ACT: U.S. Vaccine Policy and Practice, Alexandra M. Stewart, Orriel L. Richardson, Marisa A. Cox, Katherine Hayes, Sara Rosenbaum, Fall, George Washington University Medical Center, 9D20-3D060D0C87B4585D.pdf 9D20-3D060D0C87B4585D.pdf Creating Shared Resources to Improve Child Health & Well-Being in Communities, Edward L. Schor, MD, Senior Vice President for Programs and Partnerships, The Lucile Packard Foundation for Children’s Health, Oct 12, 2011,