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Health 3.0: What does
it look like and how do
we get there
Nebraska Hospital Association
Advocacy Day
March 8, 2017
Don Bradley, MD, MHS-CL
Duke Health
Objectives
• Recognize gaps between how [Public] Health
[care] [3.0] is defined and used by healthcare,
health policy, and public health professionals
• Identify opportunities for building collaborative
partnerships amongst healthcare, public health
and policy makers [legislators] to improve the
health and well being of Nebraska
communities and individuals
Disclosures:
The
Practical
Playbook
Four opportunities
• #1 Language and listening
• #2 Integration [collaboration]
• #3 Information and stories
• #4 Disruption: New rules,
Same goals
Opportunity #1:
Language and listening
Raise your hand if you :
• Are a health system CEO
• Are a health system CMO
• Are a health system CFO
• Are in health government relations
• Are multi-lingual
Raise your hand if your key health
issue is:
• Equity
• Effectiveness/Quality
• Efficiency
• Economy/Jobs
• Sustainability/Viability
• Something else
Raise your hand if you think the
key health issue for the legislature
is:
• Equity
• Effectiveness/Quality
• Efficiency
• Economy/Jobs
• Sustainability/Viability
• Something else
The pace of reform is accelerating
http://www.commonwealthfund.org/publications/issue-briefs/2015/jun/medicare-payment-reform-aligning-incentives
Seeing some significant improvements
http://www.commonwealthfund.org/publications/issue-briefs/2015/may/aca-payment-and-delivery-system-reforms-at-5-years
ACOs are struggling to meet
financial targets
http://www.commonwealthfund.org/publications/issue-
briefs/2015/may/aca-payment-and-delivery-system-reforms-at-5-
years
America’s Health Rankings
http://www.americashealthrankings.org/
Nebraska
Ranked No. 12
Variable outcomes by county, 2016
http://www.countyhealthrankings.
org/app/nebraska/2016/rankings/
outcomes/overall
Where does that leave us?
Insanity: doing the same thing over and
over again and expecting different
results.
Opportunity #2:
Integration, collaboration, & evolution
Speak the 5 Ps:
• Provider [health care]
• Policy [legislative
and/or regulatory]
• Public health
• Payer
• Person
Definition of Population Health
The health outcomes of a group of
individuals, including the distribution of
such outcomes within the group. It is an
approach to health that aims to improve
the health of an entire human
population.Kindig D, Stoddard G, Models for Population Health, AJPH 2003, 90(3):380-383
Population Health:
Management and Improvement
• Attribution
• Passivity or Proactivity
• Clinical or community focus
• Current or future paradigm
• Health professionals
• Funding clarity
“Integration” definedInstitute of Medicine:
‘the linkage of programs and activities to promote overall efficiency
and effectiveness and to achieve gains in population health.’
Principles of Integration:
Shared goal of population health
Aligned leadership
Community engagement
Sustainability
Collaborative use of data
If you want to go fast, go alone.
If you want to go far, go together.
Public Health System
http://www.cdc.gov/nphpsp/essentialservices.html
“Health[care] 3.0”
• Health informatics 3.0 [Web 3.0]
• 3.0 Transformation Framework
• Public Health 3.0
• Integrative medicine 3.0
• Health management 3.0
Health 3.0 evolution
Health Affairs 33(11):2003-11
November 2014
www.healthypeople.gov/ph3
National Academy of Medicine (IOM) Roundtable
on Obesity Solutions, 2015
Common characteristics for the 3.0’s
• Progression from prior state
• Precipitated by sub-optimal performance
• Broader perspective
– Focus outside the walls of the health system
– Individual and community engagement
– Application of informatics and information
technology
– Consumerism
– Collaboration
Moving to Action for Population Health
https://essentialhospitals.org/essential-
hospitals-institute/population-health/
Opportunity # 3: Information and Stories
San Diego collaboration
https://www.practicalplaybook.org/success/story/san-diego-school-system-and-local-medical-
residents-jumpstart-healthy-habits-students
How does Healthy Homes Des Moines work?
Through Healthy Homes Des Moines, households with children
suffering from asthma will receive home repairs to address
asthma triggers, and families will receive tailored health
education to self-manage asthma and maintain a healthy
home.
http://www.healthyhomesdesmoines.org/ http://buildhealthchallenge.org/our-communities/
Opportunity # 4:
New Rules, Same goals
Health[care] and the Federal Budget:
Where our money
goes:And what it gets us:
Healthcare Transformation-
• Value-based payment/ MACRA
• Accountable care organizations (ACOs)/
Accountable Health Communities
• Patient-centered medical homes/medical
neighborhood
• On-line and digital care, telehealth
• Alternative providers of care
• Limited and/or tiered networks [and formularies]
• Transparency, consumerism and self-management
Take home opportunities
• Become multi-lingual and listen
• Look for opportunities to collaborate/align
• Use information [data] to tell compelling
stories
• View disruption as a positive lever rather
than an inconvenience
Connecting with the Practical Playbook:
• Follow us: @PracPlaybook
• Like our page: Practical Playbook
• Follow us: Practical Playbook
• Follow us: Practical Playbook
https://practicalplaybook.org/
Thank you!
Addendum
A deeper look at integration:
• Advocacy
• Data exchange
• Financing
• Governance/Regulation
• Bidirectional referrals
• Engagement technology
• CommunicationNational Academy of Medicine (IOM)
Roundtable on Obesity Solutions, 2015
Degrees of Integration
• What does each degree mean?– Isolation – Ignorant of others.
– Mutual awareness – Conscious but independent of others.
– Cooperation – Share resources and plans with others.
– Collaboration – Coordinate plans and execution with others.
– Partnership – Appear to the end user as one entity.
– Merger – Operate as one entity.
• Do you have to reach merger to be successful?
NO!IOM, 2012
Largest
Impact
Smallest
Impact/ highest individual effort
Examples
Condoms, eat
healthy, be
physically active
Rx for high blood
pressure, high
cholesterol
Poverty, education, housing, inequality
Immunizations, brief
intervention, cessation
treatment, colonoscopy
Fluoridation, 0g trans
fat, iodization, smoke-
free laws, tobacco tax
Socioeconomic Factors
Changing the Context
to Make Individuals’ Default
Decisions Healthy
Long-lasting
Protective Interventions
Clinical
Interventions
Counseling
& Education
Factors That Affect Health
Frieden TR. A framework for public health action. Am J Public Health. 2010;100(4):590–595.
