HMPRG Safety Net Initiative History- Lon Berkeley

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“Setting the Stage: The Case for Regional Action to

Strengthen the Safety Net”

Lon M. BerkeleyHealth & Medicine Policy Research GroupRegional Health Care Safety Net Summit

June 23, 2009

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OVERVIEW• Progress to Date/History of the Initiative

• Key Assumptions & Terminology

• Demographic Snapshot of Region- Russell J. Pietrowiak, CMAP

• On-going Efforts to Strengthen the Safety Net

• Introduction to Preliminary Recommendations & Small Group Action Planning

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PHASES (TIMING)

TASK METHODS &ACTIVITIES

OTHERIMPORTANT

DEVELOPMENTS

Stage I(1/06-8/08)

Convene/organize the players

Define the Problem

Collect/analyze Data

Shape the scope

1) Plan & Convene initial meeting

2) Draft “Roadmap”3) Steering

Committee & 6 committees meet

4) Conduct key informant county meetings

5) Assemble County Profiles

6) Research other county models & approaches

7) Research local activities

o Crisis in funding for Cook County Health Services

o New Cook County Health & Hospitals Systems (CCHHS) Board created

o CMAP (Chicago) Metropolitan Agency for Planning) begins “Go To 2040” plan

“MOVING THE BALL DOWN THE FIELD”

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Endorsements to Convene the Regional Health Care Safety Net Summit

• Alivio Medical Center• Chicago Department of Public Health (CDPH)• Chicago Hispanic Health Coalition (CHHC)• Chicago Metropolitan Agency for Planning (CMAP)• Chicago Partnership for Public Health• Community Nurse Health Association• Melanie Dreher, Dean, College of Nursing, Rush University Medical Center• William T. Foley, Chief Executive Officer, Cook County Health & Hospitals System • Patricia Gross, MSPH• Illinois Maternal and Child Health Coalition (IMCHC)• Illinois Public Health Institute (IPHI)• Institute of Medicine of Chicago (IOMC)• Latinos for a Healthy Illinois• Metropolitan Chicago Healthcare Council (MCHC)• Near North Health Services Corporation• Northern Illinois Public Health Consortium (NIPHC)• Alderman Toni Preckwinkle, 4th Ward, City of Chicago• Resurrection Health Care• UIC Latino Health Research, Training & Policy Center

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PHASES (TIMING)

TASK METHODS & ACTIVITIES

OTHER IMPORTANT DEVELOP-

MENTS

Stage II(9/08-5/09)

Prioritize Problems

Draft & Vet preliminary recommendations

Plan Summit

1) Convene Pre-summit conference

2) Meetings of Summit Planning Committee

3) Solicit written feedback

4) Prepare “Call for Summit”

o New US President

o New IL Governor

o CCHHS initiates strategic planning

o Economic crisis


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PHASES

TASK METHODS & ACTIVITIES OTHER IMPORTANT DEVELOPMTS

Stage III(6/09 - ?)

Finalize regional blueprint

Identify & engage additional implementers

To Do: Solicit funding & political support

To Do: Identify leadership for next steps

1) Convene Summit Conference with HRSA co-sponsorship

2) Presentations on regional models

3) Endorse Regional Health Pact & Call to Leaders

4) Implement pilot project(s)?

5) “Field trips” to other counties outside NE IL?

o National Health Care Reform Deliberations

o Federal stimulus funding for health information technology


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KEY TERMINOLOGY OF INITIATIVE

Health

Safety Net

Regional

Vulnerable Populations

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KEY TERMS OF INITIATIVE

• Health is not merely the absence of illness or disability, but also the attainment of mental, physical, and spiritual or social well-being. (WHO)– It is a fundamental human right and that the

attainment of the highest possible level of health is a most important world-wide social goal whose realization requires the action of many other social and economic sectors in addition to the health sector.

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WHAT DO WE NOT MEAN BY THE “HEALTH CARE SAFETY NET”?

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WHAT DO WE NOT MEAN BY THE “HEALTH CARE SAFETY NET”?

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WHAT DO WE MEAN BY THE “HEALTH CARE SAFETY NET”?

• Providers that … – organize and deliver a significant level of

health care and other related services…– to uninsured, Medicaid, and other vulnerable

populations (IOM), as well as other population-based health services.

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WHAT DO WE MEAN BY THE “HEALTH CARE SAFETY NET”?

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WHAT DO WE MEAN BY “Regional”?

• INCLUDES COUNTIES OF:> Cook > DuPage

> Kane > Kendall

> Lake > McHenry

> Will

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WHAT DO WE MEAN BY “Vulnerable Populations”?

• Residents who are vulnerable because health services are:

• unavailable • inaccessible • under-subsidized or • not subsidized at all by public or private programs

• Includes the uninsured, under-insured, and people on Medicaid

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KEY ASSUMPTIONS OF INITIATIVE

1) There is no mandate or requirement to pursue this regional approach.

- We don’t have to do this- There is no sponsor

2) Planning that includes the public and private sector increases the probability of attaining our goals and desired outcomes.

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3) Collective regional action will strengthen: Planning Resource sharing Advocacy Patient Referrals Service Coordination, and Research Opportunities.

• Other successful regional efforts exist that have improved outcomes or operations

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4) Improving health status and quality of life requires a multi-sectoral approach that extends beyond the multiple layers of traditional medical care and public health (see “Who Takes Care of Your Health?” diagram below).

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Other Sectors:Housing, EducationTranportation, etc

Public Health Services: Environmental, Prevention,Disaster Preparedness, etc

Health Care Services: Dental, Behavioral,Home Care, etc

Medical Care:Primary Care, Specialist,Acute, Rehab, etc

Family

Self-Care

Who Takes Care of Your Health?

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5) There is a continuum of health care services that can be categorized into both vertical and horizontal dimensions.

6) We accept the World Health Organization’s systems building blocks of a health system conceptual framework

7) We accept the Institute of Medicine’s six specific aims for improving the health care system.

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THE WHO Health System Conceptual Framework

Source: WHO Health System Strengthening Strategy 2007

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Six Aims for Improvement (Institute of Medicine) • Safe: avoiding injuries to patients from the care intended to help them. • Effective: providing services based on scientific knowledge to all who could

benefit, and refraining from providing services to those not likely to benefit.

• Patient-centered: providing care that is respectful of and responsive to individual patient preferences, needs, and values, and ensuring that patient values guide all clinical decisions.

• Timely: reducing waits and sometimes harmful delays for both those who

receive and those who give care. • Efficient: avoiding waste, including waste of equipment, supplies, ideas,

and energy.

• Equitable: providing care that doesn’t vary in quality due to personal characteristics such as gender, ethnicity, geographic location, & socioeconomic status.

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8) Health & Medicine Policy Research Group’s (HMPRG) role is to facilitate the process only

- currently supported by one foundation grant and in-kind contributions

- similar to approach with other successful projects.

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9) All problem statements, priorities, and recommendations, are “works-in-progress,” …

- with recognition and apologies to any overlooked organizations,

projects, and people that are interested in contributing to this initiative.

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A Demographic Snapshot of the Region

Russell J. PietrowiakAssociate Planner

Chicago Metropolitan Agency for Planning

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County 1990 2000 2006 Net Change Pct. Change

Cook 5,105,067 5,376,741 5,288,655 +183,588 4%

DuPage 781,666 904,161 932,670 +151,004 19%

Kane 317,471 404,119 493,735 +176,264 56%

Kendall 39,413 54,544 88,158 +48,745 124%

Lake 516,418 644,356 713,076 +196,658 38%

McHenry 183,241 260,077 312,373 +129,132 70%

Will 357,313 502,266 668,217 +310,904 87%

Region 7,300,589 8,146,264 8,496,884 +1,196,295 16%

Total Population Change by County from 1990 - 2006

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Changing Demographics in Cook County

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Constant growth over more than 3 decades(*6 counties)

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Latinos have the highest rates of uninsured persons in Illinois

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Ongoing Efforts to Strengthen the Safety Net

• HMPRG compiling a “Summary of Actions”• Federal & State Legislation re:

– Community Building/Coalitions for Safety Net Improvements

– Workforce, IT, Financing

• Metro-area Initiatives– The Chicago Access Puzzle: Fitting the Pieces Together

– Healthy San Francisco Initiative– Detroit/Wayne County Health Authority– Mid-America Reg’l Council & KC Metro Health Access– Access DuPage– Access to Care

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CMAP GoTo 2040: The Plan For Health

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• The GoTo 2040 Plan is a comprehensive plan for the seven county region of the Chicago Metropolitan Agency for Planning (CMAP).[1]

• This report presents the plan for health.

• Purpose: “To position the region to be competitive in a global economy and create an environment in which all diverse residents will benefit from, and contribute to, the vitality of the region.”

[1] The Illinois counties of Cook, DuPage, Kane, Kendall, Lake, McHenry, and Will.

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• The scope of the plan was guided by:– 3 decade planning horizon – Limitation of no more than 15 indicators– Emphasis on the determinants of health– Unsustainable cost and quality of life burden

of chronic disease; and – Focus on what can be accomplished in the

region to improve health and not on those factors that are beyond regional control.

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4 Recommended Strategies:1. Integrated prevention and health promotion

strategy that will integrate the regional planning agenda with health policy issues and integrate the participants in the process.

2. Move toward an all data-real time concept that builds on electronic medical records.

3. Address workforce concerns.

4. Strengthen the public health infrastructure in response to early signs of deterioration.

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KEY TERMINOLOGY FOR SUMMIT

Preliminary Recommendations May not be complete or the best

Blueprint Vision with guidelines

Strengthening Existing services need support

Moving Recommendations to Action Building on past progress

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BUILDING A BETTER WORLD

• CURRENT STATE

TRANSITIONAL STATE

IMPROVED STATE

DESIRED STATE

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Moving Recommendations to Action

• Preliminary Recommendation Categories– Data/IT– Workforce– Access– Health Equity– Finance– Planning Approaches

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Moving Recommendations to Action

• Preliminary Recommendation Format – Problem Statement– Vision– Recommendation– Local/Regional Examples– Rate Level of Support– Your Role in Implementing the

Recommendation> Leadership > Participant> Resource > Stay Informed >Not Interested

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RECAP• We are not waiting to be told that we can

strengthen the health care safety net by working across geographic boundaries.

• As we continue to “move the ball down the field” we hope to gain some momentum from today’s efforts.

• We need you to weigh in with your comments, ideas, energy, and action to help implement this vision.

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Japanese Proverb

“Vision without action is a daydream …..

…action without vision is a nightmare.”