1. Population Health Improvement in Maryland: Moving Toward Sustainability All-Zone Meeting on Sustainability April 14, 2016 Russ Montgomery, PhD Director, Office of Population Health Improvement

2. DEFINING POPULATION HEALTH Population health is both: –the health outcomes of a group of individuals, and –the distribution of such outcomes within the group Improving population health requires both: –clinical management of individuals in the group, and –addressing underlying determinants of health status across the group

3. 3 VISION FOR MARYLAND HEALTH SYSTEM M ARYLAND P OPULATION H EALTH S UMMIT · A PRIL 6, 2016 All Payer Patient-Centered Value-Based Competitive Care Delivery and Financing Surrounded by a Support Team Surrounded by a Support Team Engaged and Health Literate Engaged and Health Literate Patient HEZ Address Social Needs Address Social Needs Achieve Health Equity Achieve Health Equity Population Focus on Needs of the Community Focus on Needs of the Community

4. EXISTING POPULATION HEALTH INFRASTRUCTURE State Health Improvement Process –State level improvement targets across 39 measures using common platform –Data available by at the county level –Data used to monitor population health changes under All Payer Model Local Health Improvement Coalitions –County-level (except Lower Shore) –Less formal, typically driven by local health department –Use SHIP data to set common action plans and monitor progress Regional Partnerships –More formal, led by hospitals (or groups of hospitals) –Initial planning phase in 2015 via competitive grant applications –Recently submitted applications for competitive implementation funding NEW

5. TRANSFORMATION PROGRESSION Hospital Global Budgets Financial Alignment Total Cost of Care 2014 – 2015 2016 – 2018 2019 and Beyond SHIP and LHICs Formal Partnerships & Infrastructure Sustainable Population Health Models ALL-PAYER MODEL POPULATION HEALTH HEZ

6. Care coordination Disease management Information sharing Clinical integration Patient safety initiatives Addressing health determinants Potentially Avoidable Utilization  Time  ↓ Readmissions ↓ Admissions ↓ HAIs ↓ Admissions NEED FOR MANAGEMENT AND IMPROVEMENT Health Care Management Population Health Public Health Improvement Population Health

7. INTERVENTION FRAMEWORK: 3 BUCKETS OF PREVENTION Traditional Clinical Intervention Community-Based Intervention Total Community/ Population Prevention Health Care Management Population Health Public Health Improvement Population Health Increase use of evidence-based clinical services Provide services outside the clinical setting Implement interventions that reach whole population Adapted from Auerbach, J, Public Health Management Practice, 2016 HEZ

8. LEVELS OF RISK AND TIME HORIZONS Medium Range Impact Long Range Impact A B C Chronically ill but under control Healthy High utilizer Chronically ill at risk of being high utilizer Short Range Impact

9. HOSPITAL SPENDING ON CHRONIC CONDITIONS Data source: HSCRC/CRISP

10. SHIP MEASURES NOT IMPROVING Adult obesity/overweight Flu vaccinations Children with recommended vaccinations Low birthweight Early prenatal care Pedestrian injuries on roads Affordable housing Chlamydia infections Suicide Fall related deaths Drug induced deaths Diabetes ED visits Hypertension ED visits Mental health related ED visits Addictions related ED visits

11. COUNTY HEALTH RANKINGS MARYLAND SUMMARY Better than US MedianWorse than US Median HEALTH OUTCOMES Premature deathLow birthweight Poor or fair health Poor physical health days Poor mental health days HEALTH BEHAVIORS Adult smokingFood environment index Adult obesityAlcohol‐impaired driving death Physical inactivitySexually transmitted infections Access to exercise opportunities Teen births CLINICAL CARE Uninsured Primary care physicians Dentists Mental health providers Preventable hospital stays Mammography screening SOCIAL AND ECONOMIC FACTORS Some collegeHigh school graduation UnemploymentIncome inequality Children in povertyChildren in single‐parent household Injury deathsSocial associations Violent crime PHYSICAL ENVIRONMENT Driving alone to workAir pollution – particulate matter Severe housing problems Long commute – driving alone

12. SUSTAINABILITY SCENARIO Fund or Partnership Fund or Partnership Evidence-Based Interventions Other entities at-risk Community benefit Public/private grants Global Budget Hospital Spending  Time  Non-Constrained Spending Additional Hospital Savings Savings to Hospital ✓ Savings to Payers Improved health status

13. POTENTIAL FUNDING OPPORTUNITIES Reducing ED visits and hospitalizations has a direct positive impact on finances of hospitals, MCOs, and private insurers Hospitals see need for community based services –Many are hesitant to administer directly and are looking for partners Approach potential partners with data on reduced utilization and highlight potential ROI Additional opportunities in the pipeline –Medicare Diabetes Prevention Program –HSCRC Population Health Workforce Support RFP

14. Questions? Comments? russ.montgomery@maryland.gov (410) 767-5612