1. Public Health & Healthcare Transformation
Patrick F. Luedtke, MD, MPH
Senior Public Health Officer
Medical Director, Community & Behavioral Health clinics Lane County Health & Human Services

2. Lane County Health & Human Services
1) Includes 4 FQHC clinics, Public Health, the County Mental Health clinic, & the Behavioral health system payer 2) I serve as the County Public Health Officer (50%) and the Medical Director of the FQHC clinics (50%) 3) I also serve on the CCO Board, the CAP, and on two CCO subcommittees (PCMH & Quality) 4.) Other H&HS employees serve on CCO Board & committees

3. Lane County: The View From Space
CCO: ~74,000 lives, Board of 21, Prevention funding of $1.33 per member per month
Public Health
Clinical: MCH, WIC, Prevention, Communicable Dz
Non-clinical: Environmental Health, Vital Records, Preparedness
Other: PH/MH authority, “soft power” convening authority (e.g., STD Summit)

4. PH-PC: Integration and Reverse Integration
Community Health Needs Assessments
Community Health Improvement Plans
Health equity & Public Health equity initiatives
Tracking health and process outcomes (e.g., patient safety, patient experience, care coordination, CHWs)
Create & implement community-based prevention guidelines (e.g., tobacco, obesity, vaccination rates)
Community initiatives based on claims data (e.g., tobacco use in pregnant women)

5. Specific Lane County Projects
1.) Tobacco use in pregnant women 2.) Falling immunization rates (AFIX program) 3.) The Good Behavior Game (lower drug/alcohol use disorders, smoking, antisocial PD, suicidal ideation, delinquency, incarceration)

6. Tobacco Cessation Incentive Program
Vital statistics birth data review.
Federally qualified health centers pregnant patient chart review.
Public Health (PH)
“We have too many preemies and pre-term labor cases.”
Obstetrics/Gynecology (OB/GYN)
Claims data review for preemie/pre-term labor costs. (CCO)
PH-PCP-OB/GYN steering committee
“All my pregnant patients smoke!”
Primary Care Physicians (PCP)
Nicotine testing & incentive $$ for pregnant smokers

7. Smoking in Pregnancy
Data Source: Oregon Health Authority

8. Lane County: Smoking in Pregnancy
Age
Smoking Rate
Patient Number
<20
27%
294
20–24
25%
860
25–29
16%
1,147
30–34
11%
843
35–39 9%
348
>/= 40 81
NOTE: Survey of current use rates: FQHC, PeaceHealth hospitals/clinics, Douglas county.
Data Source: Lane County Vital Statistics: 2009

9. Clinical Expectations
Prenatal smoking is associated with:
30% of small for gestational age (SGA) infants
10% of preterm infants
5% of infant deaths*
Expected quit rate, without incentives is ~37%**
Decreased ear infections and asthma attacks in child
*MMWR 58(ss04);1-29 May 26, ** PRAMS 2005

10. Medicaid Savings Preventing 1 SGA birth = $45,000 savings
$1 spent on cessation = $3.50 in neonatal savings
Data Source: CDC, Smoking-Attributable Mortality, Morbidity, and Economic Costs (SAMMEC)

11. Lane County Medicaid Neonatology Costs (2012)
Fiscal Data
Lane County Medicaid Neonatology Costs (2012)
Line item cost
$7,643,967
# of Episodes
1,773
Cost/Episode
$4,311
Unique members
1,715
Monetary goal: 10% cost reduction/yr (ROI = 7.6)

12. Tobacco Cessation Incentive Program
Program goal: Tobacco cessation in 30% of program participants
Participation goal: 80% of pregnant Medicaid patients

13. Questions?