1. DELAWARE HEALTH AND SOCIAL SERVICES Division of Public Health Public Health and PCMH Karyl Rattay, MD, MS Director Delaware Division of Public Health

2. DELAWARE HEALTH AND SOCIAL SERVICES Division of Public Health Important Points Health is More than Health Care Health is More than Health Care Population Health Population Health Integration of Primary care and Public Health Integration of Primary care and Public Health Community Engagement Community Engagement We are learning from interviewing you We are learning from interviewing you Some PCMH-related activities under way Some PCMH-related activities under way

3. DELAWARE HEALTH AND SOCIAL SERVICES Division of Public Health HEALTH IS MORE THAN HEALTH CARE

4. DELAWARE HEALTH AND SOCIAL SERVICES Division of Public Health How Can You Explain This? Source: United Nations Development Programme Report 2007-2008. Retrieved from www.unnatuaralcauses.org Health Care Spending vs Health Outcomes 4

5. DELAWARE HEALTH AND SOCIAL SERVICES Division of Public Health DETERMINANTS OF HEALTH 5 5-10%

6. DELAWARE HEALTH AND SOCIAL SERVICES Division of Public Health The REAL Causes of Death

7. DELAWARE HEALTH AND SOCIAL SERVICES Division of Public Health Population-Based Services Primary Medical Care Secondary Medical Care Tertiary Medical Care 95%+ Health Care $$ Spent on Acute and Chronic Care 10% of Improvement in Health Status Attributed to Medical Care 90% Attributed to Population-Based Approaches Adapted from J. Michael McGinnis, M.D. Health Care Pyramid

8. DELAWARE HEALTH AND SOCIAL SERVICES Division of Public Health POPULATION HEALTH

9. DELAWARE HEALTH AND SOCIAL SERVICES Division of Public Health Population Health An approach to health that aims to improve the health of an entire population An approach to health that aims to improve the health of an entire population Addresses a broad range of factors that impact health on a population-level Addresses a broad range of factors that impact health on a population-level A perspective recognizing the importance of social determinants of health and the relatively minor impact that medicine and healthcare have on improving health overall. A perspective recognizing the importance of social determinants of health and the relatively minor impact that medicine and healthcare have on improving health overall.

10. DELAWARE HEALTH AND SOCIAL SERVICES Division of Public Health o Best outcome for individual o Treat a patient for gastroenteritis o Vaccinating patients o Counseling against smoking o Treating the consequences of obesity o Treating STD o Diagnosing an illness o Community’s health o Investigating outbreaks, restaurant inspections, safe water o Safety net for vaccinating medically indigent o Advocating for smoke-free environments o Promoting built environments conducive to physical activity o Finding and treating exposed partners o Conducting community health assessments Individual Vs Population Health

11. DELAWARE HEALTH AND SOCIAL SERVICES Division of Public Health Health Reform’s Opportunity to Improve Public Health Population Approach + Clinical Care = Better Health

12. DELAWARE HEALTH AND SOCIAL SERVICES Division of Public Health INTEGRATION OF PRIMARY CARE AND PUBLIC HEALTH

13. DELAWARE HEALTH AND SOCIAL SERVICES Division of Public Health What Do We Mean by Integration The linkage of programs and activities to promote overall efficiency and effectiveness and achieve gains in population health. The linkage of programs and activities to promote overall efficiency and effectiveness and achieve gains in population health. Can take many forms Can take many forms Source: Institute of Medicine. Primary Care and Public Health Exploring Integration to Improve Population Health, March 28 2012.

14. DELAWARE HEALTH AND SOCIAL SERVICES Division of Public Health Why Integrate? Health has many contributors Health has many contributors Substantial and lasting improvements will require a common goal Substantial and lasting improvements will require a common goal Enhance the capacity of both sectors to carry out their missions Enhance the capacity of both sectors to carry out their missions Source: Institute of Medicine. Primary Care and Public Health Exploring Integration to Improve Population Health, March 28 2012.

15. DELAWARE HEALTH AND SOCIAL SERVICES Division of Public Health Why Integrate Now? Dramatic rise in health care costs Dramatic rise in health care costs Importance of social and environmental determinants of health Importance of social and environmental determinants of health New opportunities to understand and address community-level health concerns New opportunities to understand and address community-level health concerns ACA presents opportunities ACA presents opportunities Source: Institute of Medicine. Primary Care and Public Health Exploring Integration to Improve Population Health, March 28 2012.

16. DELAWARE HEALTH AND SOCIAL SERVICES Division of Public Health Principles for Successful Integration Shared goal of population health improvement Shared goal of population health improvement Community engagement Community engagement Aligned leadership Aligned leadership Sustainability Sustainability The sharing and collaborative use of data and analysis The sharing and collaborative use of data and analysis Source: Institute of Medicine. Primary Care and Public Health Exploring Integration to Improve Population Health, March 28 2012.

17. DELAWARE HEALTH AND SOCIAL SERVICES Division of Public Health

18. DELAWARE HEALTH AND SOCIAL SERVICES Division of Public Health COMMUNITY ENGAGEMENT

19. DELAWARE HEALTH AND SOCIAL SERVICES Division of Public Health Health in all Policies Looks at all public- and private-sector policy making through a health lens Looks at all public- and private-sector policy making through a health lens Objective is to promote and protect the health of the population Objective is to promote and protect the health of the population Addresses the social and physical environment influences on health Addresses the social and physical environment influences on health

20. DELAWARE HEALTH AND SOCIAL SERVICES Division of Public Health What is a Healthy Community? Source: Prevention Institute. Community-Centered Health Homes: Bridging the gap between health services and community prevention. Feb. 2011.

21. DELAWARE HEALTH AND SOCIAL SERVICES Division of Public Health DPH’S ROLE

22. DELAWARE HEALTH AND SOCIAL SERVICES Division of Public Health DPH Stakeholder Interviews A work in progress A work in progress More than 15 interviews More than 15 interviews Government Government Healthcare Healthcare Business Business Community Community

23. DELAWARE HEALTH AND SOCIAL SERVICES Division of Public Health Interview Themes So Far Population Health Population Health Integration of Primary Care and Public Health Integration of Primary Care and Public Health Community Engagement Community Engagement Convening Role Convening Role Data, research and evaluation Data, research and evaluation Policy Input (as opposed to policy development) Policy Input (as opposed to policy development) Implementation of policy Implementation of policy

24. DELAWARE HEALTH AND SOCIAL SERVICES Division of Public Health DPH’S PRIORITIES AND CURRENT RELATED ACTIVITIES

25. DELAWARE HEALTH AND SOCIAL SERVICES Division of Public Health HEALTH REFORM IS A DPH STRATEGIC PRIORITY 25

26. DELAWARE HEALTH AND SOCIAL SERVICES Division of Public Health Care Coordination A partnership between DPH, hospitals and large Delaware Health Centers. A partnership between DPH, hospitals and large Delaware Health Centers. Assistance with access to care, cancer screening, cancer care coordination, diabetes education and chronic disease management. Assistance with access to care, cancer screening, cancer care coordination, diabetes education and chronic disease management. Cancer Screening Nurse Navigators in five acute care hospital systems Cancer Screening Nurse Navigators in five acute care hospital systems Cancer Care Coordinators in six hospital systems Cancer Care Coordinators in six hospital systems Community healthcare access coordinators in three hospitals and large health centers. Community healthcare access coordinators in three hospitals and large health centers. Certified Diabetes Educators in large health centers (FQHCs and Claymont) Certified Diabetes Educators in large health centers (FQHCs and Claymont) Chronic Disease Nurses in the DPH Chronic Disease Bureau Chronic Disease Nurses in the DPH Chronic Disease Bureau

27. DELAWARE HEALTH AND SOCIAL SERVICES Division of Public Health Help Me Grow

28. DELAWARE HEALTH AND SOCIAL SERVICES Division of Public Health Healthy Weight Collaborative Objectives Organize and manage a Healthy Weight Learning Collaborative utilizing quality improvement methods. Organize and manage a Healthy Weight Learning Collaborative utilizing quality improvement methods. Establish innovative partnerships between public health, primary care, and community organizations. Establish innovative partnerships between public health, primary care, and community organizations. Support sustainable change and foster collaboration through technology. Support sustainable change and foster collaboration through technology.

29. DELAWARE HEALTH AND SOCIAL SERVICES Division of Public Health Community Health Workers Bridging cultural mediation between communities and the health care system Bridging cultural mediation between communities and the health care system Providing culturally appropriate and accessible health education and information, often by using popular education methods Providing culturally appropriate and accessible health education and information, often by using popular education methods Assuring that people get the services they need Assuring that people get the services they need Providing informal counseling and social support Providing informal counseling and social support Advocating for individuals and communities within the health and social service systems Advocating for individuals and communities within the health and social service systems Build individual and community capacity Build individual and community capacity

30. DELAWARE HEALTH AND SOCIAL SERVICES Division of Public Health Summary Public health wants to be involved in reforming our delivery system because health is more than health care Public health wants to be involved in reforming our delivery system because health is more than health care As we think about PCMH, integration of primary care and public health, population health, and community engagement are among the essential ways in which public health can contribute. As we think about PCMH, integration of primary care and public health, population health, and community engagement are among the essential ways in which public health can contribute. While DPH has some efforts under way in all of these areas, we are actively learning about how we can evolve as a value added partner. While DPH has some efforts under way in all of these areas, we are actively learning about how we can evolve as a value added partner.

31. DELAWARE HEALTH AND SOCIAL SERVICES Division of Public Health Questions