1. Nicole Alexander-Scott, MD, MPH Director, Rhode Island Department of Health President, Association of State and Territorial Health Officials December 6, 2018

2. The Rhode Island Department of Health (RIDOH)’s Strategic Priorities
Outline
The Rhode Island Department of Health (RIDOH)’s Strategic Priorities
Two approaches to shift investments and promote health equity:
Clinic-to-community investments
Direct community investments
2019 ASTHO President’s Challenge

3. Life Expectancy vs. Healthcare Spending (1970-2014)

4. Investing in Social Services and Community
In OECD, for every $1 spent on health care, about $2 is spent on public health and social services.
In the US, for every $1 spent on health care, about 55 cents is spent on public health and social services.

5. The Case for Investing at the Community Level
Determinants of Health Model based on frameworks developed by: Tarlov AR. Ann N Y Acad Sci 1999; 896: ; and Kindig D, Asada Y, Booske B. JAMA 2008; 299(17):

6. Address the Socioeconomic and Environmental Determinants of
RHODE ISLAND STATEWIDE INTEGRATED POPULATION HEALTH LEADING PRIORITIES, STRATEGIES, AND GOALS
Three Leading Priorities Guide Our Work
Eliminate the Disparities of Health in Rhode Island and Promote Health Equity
Ensure Access to Quality Health Services for Rhode Islanders, Including Our Vulnerable Populations
Address the Socioeconomic and Environmental Determinants of
Health in
Rhode Island
Five Strategies Will Move Us Forward
23 Integrated Population Health Goals and Metrics Align with Statewide Healthcare Planning

7. The Rhode Island Department of Health (RIDOH)’s Strategic Priorities
Outline
The Rhode Island Department of Health (RIDOH)’s Strategic Priorities
Two approaches to shift investments and promote health equity:
Clinic-to-community investments
Direct community investments
2019 ASTHO President’s Challenge

8. Community Health Workers
Hired for their understanding of the populations they serve (rather than just from expertise due to formal education).
Examples include:
Chronic disease case managers
Substance use disorder peer recovery coaches
Bi-lingual health systems navigators
Public Housing Resident Coordinators

9. Community-Based Licensed Health Professionals Community Health Workers
Important Workforce Distinction
Community-Based Licensed Health Professionals
Licensed Health Professional
May or may not obtain additional certification
Travels out to the patient’s home or community
Focuses on clinical education tailored to the recipient
Community Health Workers
No previous health professional license
Obtains CHW certification
Focuses on helping to navigate social services

10. Community Health Workers
CHW Certification Credentialing
RIDOH and community partners, include Rhode Island College, established a Community Health Worker certification credential through the RI Certification Board
Community Health Worker
Certified Community Health Worker
Certified Specialty Community Health Worker
Community Health Worker Association of Rhode Island
Re-established as a pathway for professional advancement
Next Steps
Continue to develop payment opportunities for a CHW workforce pipeline in the health system

11. ROI with Community Health Workers in RI
Home Asthma Response Program
After a child visits the ED for asthma, three home visits assess home environment, remove/mitigate triggers, educate caregivers on medications and environmental control options.
Certified Asthma Educators and CHWs ensure caregiver understands how to obtain and use medications and/or devices, thus enhancing compliance with physician Asthma Action Plan.
For families who don’t have an Action Plan, the Asthma Educator does outreach to get one from the primary care provider and reviews it with the caregiver.

12. ROI with Community Health Workers in RI
Received actual claims from three insurers (N=158 eligible cases with claims for analysis)
75% reduction in overall costs
80% reduction in costs for high utilizers
92% reduction in asthma-related hospital and ED costs

13. Transforming Practices with CHWs

14. System Transformation Premise

15. System Transformation Strategies

16. Transforming Practices with CHWs

17. The Rhode Island Department of Health (RIDOH)’s Strategic Priorities
Outline
The Rhode Island Department of Health (RIDOH)’s Strategic Priorities
Two approaches to shift investments and promote health equity:
Clinic-to-community investments
Direct community investments
2019 ASTHO President’s Challenge

18. Rhode Island Department of Health (RIDOH) Health Equity Zones
Nine local collaboratives that represents the diverse strengths of the community.
Equip residents and partners to collaborate to create healthy places for people to live, learn, work, and play.
Innovative, community-led, place- based approach to building the infrastructure needed for sustained systems and policy change.
Health Equity Zones

19. RIDOH Health Equity Zones: Public Health Principles in Action
Organize a collaborative of diverse partners from the community’s self-defined zone, ranging in size from a neighborhood to a county.
Conduct a baseline needs assessment of socioeconomic and environmental factors that drive health outcomes for better living.
Create a Plan of Action targeting measurable objectives based on effective strategies shown to be successful.
Implement and evaluate the Plan of Action.

20. RIDOH Health Equity Zones: Policy Change in Action
Rhode Island Health Equity Zones have:
Facilitated the passage and implementation of a town-wide ordinance banning cigarettes and vaping in parks.
Partnered with the city planning department to develop a Complete and Green Streets ordinance enabling safe access to community roads for all users, regardless of age, ability or mode of transportation.

21. Hospital Community Health Needs Assessments
Through the State’s Hospital Conversions Act, Rhode Island has required some health systems to:
Invest in their local Health Equity Zones as a condition for approving applications for certain changes.
Collaborate with their local Health Equity Zones when conducting needs assessments to fulfill Patient Protection and Affordable Care Act community benefit requirements.

22. The Rhode Island Department of Health (RIDOH)’s Strategic Priorities
Outline
The Rhode Island Department of Health (RIDOH)’s Strategic Priorities
Two approaches to shift investments and promote health equity:
Clinic-to-community investments
Direct community investments
2019 ASTHO President’s Challenge

23. Aligned with the National Association of County and City Health Officials (NACCHO) and the U.S. Surgeon General’s focus on community health and economic prosperity
Calls on health officials to change how we work with communities and who our partners should be – to support investments in community
2019 ASTHO President’s Challenge: Building Healthy and Resilient Communities
Governmental public health has an important role to play in changing our mindset about how we should work with communities and who our partners should be.

24. 1. Provide tools that equip health officials to mobilize community-led, place-based models (like RI’s HEZ) that are ready for investment. 2. Connect public health officials by reaching across sectors to business leaders and policymakers who want to invest in community and advance economic development.
Two Goals
Calls on health officials to establish or scale up community-led, place-based initiatives like Rhode Island’s Health Equity Zones.
Strengthens efforts to promote positive social connectedness and community resilience.

25. Additional Highlights of the ASTHO President’s Challenge:
“The opposite of addiction isn’t only sobriety. It’s connectedness.”
- Jonathan Goyer
Expert Advisor to the RI Governor’s Overdose Prevention and Intervention Task Force
Promote Positive Social Connectivity: so communities can combat issues such as substance use disorders, emotional suffering, and social isolation.
Improve Community Resilience: so communities can resist, respond to, and recover from adversity and “bounce forward” to better conditions, like fewer adverse childhood experiences and eliminating HIV or Hep C.

26. To reverse the life expectancy trend, we can keep moving from “talk” to action by working together to achieve the goals of the President’s Challenge:
By shifting investments to support ready-made opportunities at the community level
By engaging diverse partners to call for community development that does not cause community displacement.
Our Role
Has an important role to play in changing our mindset about how we should work with communities and who our partners should be.
Together, we can implement both President’s Challenge goals by:
Supporting outcome-driven, community-led, place-based collectives
Attracting diverse investments from business leaders and policymakers who can help communities transform conditions for better living long-term.
Strengthens efforts to promote positive social connectedness and community resilience.

27. Nicole Alexander-Scott, MD, MPH
Director, Rhode Island Department of Health
President, Association of State and Territorial Health Officials