1. Addressing the CDC’s 6|18 Initiative Preventive Medicine 2017 May 24, 2017
Office of Health Systems Collaboration
Office of the Associate Director for Policy

2. CDC Strategic Directions
Improve health security at home and around the world
Better prevent the leading causes of illness, injury, disability, and death
Strengthen public health/ health care collaboration
These are CDC’s three overall strategic directions.
The 6|18 Initiative is a key component of CDC’s third strategic direction – “strengthening collaboration between public health and the health care sector” in the context of the rapidly transforming health system.

3. Opportunity Knocks: The Transforming Health System
“Other” Insurance Coverage:
Other Private – 6%
Other Public – 2%
About 90% of All Americans are Insured
as of 2014
Change in health care coverage
Payment reform: volume  value
Clinical care models more patient-centered
Opportunities to deliver prevention
"Health Insurance Coverage of the Total Population." State Health Facts. The Kaiser Family Foundation,
The US health care system is undergoing unprecedented change, driving towards a system that is “better, smarter, [and] healthier.” (Secretary Burwell, 2015)
Major trends in health care are providing new opportunities for prevention and population health:
Increased numbers of Americans now have health insurance
According to the National Health Interview Survey, 27.3 million persons of all ages (8.6%) were uninsured during the first 3 months of 2016 — 21.3 million fewer persons than in 2010.
Widespread payment reform is underway. There is active movement away from the current FFS payment and delivery model to alt payment models, where providers are incentivized for the quality of the care and health of the patient, not the quantity of care delivered
Value-based alternative payment models (such as Accountable Care Organizations and Patient-Centered Medical Homes) are more patient centered and facilitate the delivery of more comprehensive care, with new opportunities to deliver preventive services.
*There are some rounding issues that make the chart add up to 101%, but I went back and checked the data from the Census Bureau, and it is true that 90.6% of the US population in insured with a 0.1% margin of error.
Juliette Cubansk; Barbara Lyons; Tricia Neuman; Laura Snyder; Anne Jankiewicz; David Rousseau. (2015). Medicaid and Medicare at 50. The Journal of the American Medical Association, 314(4), doi: /jama

4. Collaboration between public health, health care purchasers, payers, and providers to promote adoption of evidence-based interventions 6 | 18
Evidence-based interventions that can improve health and save money
High-burden health conditions
Major agency wide effort to promote adoption of a set of evidence based interventions directly by those who pay for and deliver care. Initiative has given us a framework around which to create an action oriented and sustainable partnership between HC and PH. Allowing us to prove the concept that we can do this together. Content is a starting point for current and future work, where burden, interventions, and impact align.
We are defining a pathway/approach to collaboratively – across sectors- accelerate evidence into action – focusing coverage and deployment of prevention on an initial set interventions that can quickly improve health and control costs. And of course the approach has a wider application wherever evidence based interventions and impact align.
Framework around which to create a sustainable partnership between PH and HC
Hester, J. A., J. Auerbach, L. Seeff, J. Wheaton, K. Brusuelas, and C. Singleton CDC’s 6|18 Initiative: Accelerating evidence into action.
National Academy of Medicine, Washington, DC.

5. 6|18 Initiative Goals Improve health and control costs using
specific evidence-based interventions
Establish sustainable cross-sector
partnerships between public health and
health care purchasers, health plans, and
providers to address shared health priorities
CDC has developed the 6|18 Initiative to promote adoption by health care purchasers, payers, and providers of evidence-based interventions to improve health and control costs in the short term – in less than 5 years.
The name “6|18” comes from the initial focus on 6 high-burden high-cost health conditions and 18 evidence-based interventions that can improve health and control costs.

6. High- burden Costly Preventable Scalable Purchasers & payers
These conditions were selected because they meet the following criteria:
They affect large numbers of people
They are associated with high health care costs
Evidence-based interventions are available to prevent or control these conditions in a short time horizon (less than 5 years)
The evidence-based interventions can be implemented by the health care sector - health care purchasers, health plans, and providers.

7. Eighteen Evidence-Based Interventions

8. CDC is working with 9 State Medicaid Agency-Public Health Department teams to understand best practices related to implementation of 6|18 interventions in a State Medicaid Agency setting and help disseminate them to other states.
The initial focus for this collaboration is on 3 of the 6 health conditions - asthma, tobacco use, and unintended pregnancy - because these conditions are prevalent among Medicaid beneficiaries. Across these 9 states, the 6/18 Initiative has the potential to reach up to 17 million Medicaid enrollees with prevention interventions that work.
These 9 states are participating in this effort because of the following factors critical for success:
They had active control efforts in place related to one or more of the 3 priority health conditions.
They were working to implement the specific interventions highlighted within the set of 18.
The state supported the Medicaid Agency and the Department of Public Health working on this initiative in partnership.
State Medicaid Agencies and Health Department teams in these 9 states are making tangible progress towards adoption of select interventions from among the 18. This includes participation in a Shared Learning Platform to facilitate peer-to-peer learning across states, where states have identified working on priorities such as the development of State Plan Amendments to broaden coverage of services and the assessment of baseline coverage of interventions among managed care organizations as a first step towards contract negotiations.

9. Visit the 6|18 Website
CDC.gov/SixEighteen
Evidence Summaries
Detailed summaries of the 6|18 interventions, based on scientific studies and expert consultations
FAQs
Answers to common questions about the 6|18 Initiative including goals, strategy, and the intervention selection process
Coming soon!
Additional Tools:
Readiness checklist
How to be a 6|18 Partner
The 6|18 Initiative is quite dynamic and there have been lots of activities that we would like to update you on during our webinar next month on …