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ncslhealth
Strong States, Strong Nation
HEALTH SEMINAR FOR
NEWER LEGISLATORS
Meeting Overview | Friday, April 13, 2018
Bipartisan membership organization
All 50 states and the territories
7,383 state legislators
All state legislative staff (30,000+)
Goals:
To improve the quality & effectiveness of state legislatures
To promote policy innovation and communication among state legislatures
To ensure states a strong, cohesive voice in the federal system
Research, education, technical assistance
National Conference of State Legislatures
Publications
Webpages and Databases
Meetings & Seminars
6
http://www.ncsl.org/meetings-training/legislative-summit-18.aspx
Meeting Sponsorship
Increase knowledge about state health issues &
opportunities to improve efficiencies & effectiveness
Network with and learn from each other
Learn more about NCSL
Have fun! ☺
Meeting Objectives
Health Issues by the Dozens
“Going through all this information
we have here is kind of like trying
to drink from a fire hydrant.” Former CO Rep. Mark Paschall
“My seatmate told me this was a
bad bill. I was going to vote no on
it until I realized it was my own
bill.” Former CO Sen. Ray Powers
50+ Unique State Legislatures
State Legislatures: Every state legislature is made
up of varying number of legislators
New Hampshire – 400 representatives 24 senators
Alaska- 40 representatives 20 senators
Nebraska- Unicameral 49 total
Friday April 13th
State Roles in Health Policy and Public Health Tour and Reception at Novartis
Please wear closed toe shoes! Saturday April 14th
Medicaid Health Insurance Issues Federal Update Access to Healthcare Services
Sunday April 15th
Prescription Drugs Behavioral Health
Meeting Sessions
Other content
Other topics NCSL has resources on:
Teen Pregnancy
Immunizations
Nutrition and Physical Activity
Health Impact Assessments
Children with special healthcare needs
Reducing injury and violence
And more!
Walk the Talk! A (mostly) Healthy Meeting!
Exercise Opportunities Fitness Center
2 optional group walks tomorrow
Trails around the hotel
Healthy Food Options
Yes, we also have bacon
Feel free to stand or stretch!
Breaks
Name
State
Position
One interesting fact 15 seconds
Participant & Staff Introductions
Test Your Awareness!
8-10 Questions
Less than 10 minutes!
Strong States, Strong Nation
HEALTH SEMINAR FOR
NEWER LEGISLATORS
State Roles in Health| Friday, April 13, 2018
State Roles in Health Policy
Purchaser
Access Broker
Regulator
Guardian of the Public’s Health
Safety Net Provider
Educator
State as Purchaser
Medicaid
State Employees
Community services (e.g., alcohol & drug abuse treatment,
mental health , etc.)
Medical care for prisoners
Other …
Is your state getting the best bang for the buck?
State as Access Broker
Insurance access
Insurance exchanges
Consumer protections
A competitive market
Other …
State as Regulator
Health professionals
Scope of practice
Licensure, certifications, etc.
Health facilities
Health insurance
Restaurants
Other …
State as Guardian of the Public’s Health
Infectious diseases, hazards
Immunizations
Injury prevention
Safe food and water, clean air
Other …
State as Safety Net Provider
Community health centers
Public hospitals
Addressing health disparities
Pharmaceutical assistance
Other …
State as Educator
Medical education
Consumer education
School health education
Other …
State Health Goals
What are your goals?
Healthy residents?
Health coverage for all?
Increased individual responsibility?
Other?
Major cost drivers …
Technological advances & increased use of
expensive care
Preventable Illness (e.g., smoking, obesity,
excessive alcohol/substance abuse, accidents,
lack of preventive care, etc.)
Unmanaged care, system inefficiencies
Consumer demands & consumer non-compliance
Over-utilization & under-utilization
Stewards of the Public Purse
Some ideas:
Invest in cost-effective programs & services: use evidence-based practices
Promote personal responsibility
Oversee health insurance premiums and insurer practices
Strengthen the private sector marketplace & options
Emphasize prevention & primary care
Increase competition and price transparency
Explore provider payment reforms & efficient delivery system models
Address end-of-life issues
Governance: State and Local Public Health Agencies
State Public Health Agency Classification: Understanding the Relationship Between State and Local Public Health, Association of State and Territorial Health Officials and NORC, at the University of Chicago
State Health Improvement Plans (SHIP)
State Departments of Health responded with the
following priority areas:
Chronic Disease Prevention
Behavioral Health/Substance Abuse
Maternal and Child Health
Access to Care
What Influences Health?
Determinants of Health Model based on frameworks developed by: TarlovAR. Ann NY AcadSci 1999; 896: 281-93; and KindigD, Asada Y, BooskeB. JAMA2008; 299(17): 2081-2083.
Contact Information
Tahra Johnson, MPH
Program Manager
Office: 303-856-1389
Cell: 720-447-3775
La Jolla, CA| April 13-15, 2018
HEALTH SEMINAR FOR
NEWER LEGISLATORS
Shifting the Health of our
Communities through
State and Local Collaboration
April 13, 2018
Health is a state of complete physical, mental and social well-
being and not merely the absence of disease or infirmity.
World Health Organization
What is Public Health?Original Focus Areas – Public Health 2.0
• Prevents epidemics and the spread of communicable disease.
• Promotes and encourages healthy behaviors.
• Prevents injuries.
• Promotes accessible and quality health services.
• Plans disaster response and preparedness.
• Protects against environmental hazards.
• Disease surveillance and monitoring.
Long Beach Public HealthCommunity Health
• Chronic Disease & Injury Prevention
• Women, Infants and Children (WIC)
• Public Health Nursing
• Health Insurance Enrollment (Medicaid, Open Enrollment)
• Tobacco and Cannabis Education
Environmental Health
• Food Facility and Water Inspections
• Vector Control
• Hazardous Materials Program
• Lead Hazard Abatement & Healthy Homes Program
• Tobacco Control/Enforcement
• Community Asthma & Air Quality Resource Education (CAARE) Program
Long Beach Public HealthPhysician Services
• Public Health Laboratory
• Clinical Services (Immunization, HIV/STD, Family Planning, TB)
• Birth and Death Records
Public Health Emergency Management
• Plans Disaster Response and Preparedness.
• Disease Surveillance and Monitoring (epidemiology, disease investigation)
Human Services and Housing Programs
• Violence Prevention and Trauma
• Strengthening Families and Fatherhood Initiatives
• Housing Authority
• Homeless Services
Evolution of Health Practices
Public Health Framework for Reducing Health Inequities
SOCIALFACTORS
What is Public Health?Role is Expanding – Public Health 3.0
Public health is what we do as a society to ensure the conditions in which everyone can be healthy.
• Strives to reduce health disparities across the City through policy, planning, community, and services.
• Serves as Chief Health Strategist and backbone for health.
• Structured, cross-sector partnerships
• Health in All Policies
• Blended and braided funding strategies
Public Health: Going Upstream
Physical
environment
10%
Genetics
10%
Clinical Care
10%
Social &
Economic
Factors
40%Health
Behaviors
30%
Determinants of Health Model based on frameworks developed by: TarlovAR. Ann NY AcadSci 1999; 896: 281-93; and KindigD, Asada Y, BooskeB. JAMA2008; 299(17): 2081-2083.
Social Determinants of Health
The complex social andeconomic circumstances, inwhich people are born, growup, live, and work. Thesecircumstances are shaped by awider set of forces includingeconomics, social policies, andpolitics. Examples of socialdeterminants of well‐beinginclude…
Social Determinants of Health
• Social Support
• Healthcare Services
• Transportation
• School Systems
• Education Quality
• Public Safety
• Violence
• Poverty
• Housing
• Physical Environment
• Food Security
• Child Development
• Culture
• Trauma
• Working Conditions
Going Upstream: Prevention
Physical
environment
10%
Genetics
10%
Clinical Care
10%
Social &
Economic
Factors
40%Health
Behaviors
30%
Based on emerging evidence that addressing health-related social needs through enhanced clinical-community linkages can improve health outcomes and reduce costs.
Accountable Health Communities-An Opportunity
• Screening to identify certain unmet health-related social needs
• Referral to increase awareness of community services
• Providing navigation services to assist high-risk with accessing community services
• Encouraging alignment between clinical and community services to ensure that community services are available and responsive to the needs of individuals and families.
Accountable Health Communities-Promotes Clinical-Community Collaboration
• Increase in access to medication and medication utilization
• Reduction in conditions that lead to asthma
Example: Asthma and the Community Health Worker
Reduced collateral impacts
Missed work days: 180 61
Missed school days: 154 79
Missed caregiver work days: 337 141
Reduced indirect and collateral costs
Missed work days1
$61,380 $20,801
Missed school days2
$26,257 $13,467
Caregiver missed work days1
$114,917 $48,081
Example: Asthma and the Community Health Worker
Reduced Emergency Services Use
Hospitalizations: 317 125
Emergency department visits: 521 226
Unscheduled office/clinic visits: 1,004 474
Asthma wellness visits: 1,706 1,558
Reduced Direct Care Costs
Inpatient Hospitalizations1
$10,698,433 $4,218,625
Emergency & unscheduled visits2
$1,563,000 $678,000
Unscheduled office/clinic visits3
$1,004,000 $474,000
Asthma wellness visits4
$170,600 $155,800
A Local Story:The City of Long Beach
Poverty
28%
46%
31%29%
23%24%
16%
9%
5%7%
5%
0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
50%
90802 90813 90804 90806 90810 90805 90814 90807 90808 90815 90803Zip Code
Individuals with a High School Education
84%
55%
77%
69%72%
68%
93% 91%95% 95% 97%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
90802 90813 90804 90806 90810 90805 90814 90807 90808 90815 90803Zip Code
Life Expectancy
76
77 77 77 77 77
81 81
82
83
82
72
74
76
78
80
82
84
90802 90813 90804 90806 90810 90805 90814 90807 90808 90815 90803
Life Expectancy at Age 1
Zip Code
Socio-Economic Index Life Expectancy in Long Beach
Social Determinants of Health Central EastLA
CountyPeople of Color 86% 20% 70%
Living under 2X Poverty Rate 69% 18% 39%
Unemployment Rate 11% 8% 9%
Median Income $31,030 $75,817 $60,566
Adults Without HS Education 45% 2% 26%
Open Space Acres per 1,000 Residents .26 8.8 6.2
Age-Eligible Children Not Enrolled in
Preschool
55% 31% 43%
Health OutcomesLow Birth Weight 5.4% 4.9% 5.2%
Uninsured 28.8% 7.4% 22.6%
Life Expectancy 76.7 81.7 80.3
Diabetes Hospitalizations* 48.5 8.1 19.9
Asthma Hospitalizations* 20.9 4.2 9.7
Hypertension Hospitalizations* 14.1 2.6 4.8*Rate per 10,000
Source: Health Disadvantage Index, http://phasocal.org/ca-hdi/
Focus of Health in the US…
Comparing internationally.
A key difference…
the focus of spending
Shifting the Conversation from a Health Care System
to a
Health System
Collective ImpactMultiple Players Working Together to Solve Complex Issues
• All working toward the same goal and measuring the same things
• Cross-sector alignment with government, nonprofit, philanthropic, faith-based and corporatesectors as partners
• Organizations actively coordinating their action and sharing lessons learned
Healthy Community
Focus Areas in CaliforniaHealth Care
• Increasing access and affordability of health care coverage
• Health care cost containment
• Reducing health care disparities
• Preventing prescription drug price spikes
Social Determinants
• Adverse Childhood Events (ACEs) and Trauma
• Violence Prevention
• Early Childhood supports
• Homelessness
State Level Opportunities• Increasing access and affordability of health care coverage
• Utilizing a social determinant lens in decision making
• Designing policies and funding to support:
• Health Prevention
• Early Childhood Health and Education Programs
• Violence Prevention
• Active Infrastructure
• Social Supports/Trauma Informed Systems
• Mental Health Treatment/Substance Use Prevention & Treatment
• Increased possibilities for blending and braiding funding
Updated document. Original from Dr. Eric Walsh Presentation, April, 2014
Kelly ColopyDirector, Long Beach Health and Human
562-570-4016
Thank you!
