Practical Playbook: Making the Connection between Public Health and Primary Care

Illinois Alliance to Prevent ObesitySeptember 17, 2015Lloyd Michener, MD

Don Bradley, MD, MHS-CL

Duke Medicine

Objectives

• Recognize or cite the best practices of clinical and community integration

• Describe how to use the Practical Playbook in clinical and community settings

• Identify opportunities to connect patients with community resources to address adult and childhood obesity.

Duke Medicine

Take home messages

• Health, healthcare, and health insurance are not synonymous

• Coverage for obesity-related services varies by state and by health plan

• Disconnects and controversy: policies, politics, effectiveness and efficiency

• An integrated, collaborative approach is most likely to succeed, and will take time, persistence, and patience

Duke Medicine

http://www.rwjf.org/en/library/research/2014/09/the-state-of-obesity.html , accessed 08/01/2015

The State of Obesity in the US, 2014

Duke Medicine

ACA healthcare impacts

• Essential Health Benefits determined by state (including coverage for bariatric surgery, obesity meds)

• Coverage for USPSTF level A or B services with no out of pocket costs (including counselling for obesity)

• Whether Medicaid expanded or not, Disproportionate Share Hospital (DSH) payments reduced

• Community Health Benefit Program for not-for-profit hospitals (including CHNA and support)

• CMMI and incentives and pilots for value-based care (including Accountable Care Organizations)

Duke Medicine

Illinois Medicaid/CHIP

• Illinois expanded Medicaid with the ACA• Over 2/3 covered by Managed Medicaid plans• Over 3 million enrollees• Enrollment up over 500K (19.2%) from July

2013

http://www.medicaid.gov/medicaid-chip-program-information/by-state/illinois.html , accessed 09/01/2015

Duke Medicine

Weight loss (Commercial) coverage by state,2012

STOP Obesity Alliance, 2012

Duke Medicine

http://www.stopobesityalliance.org/wp-content/themes/stopobesityalliance/pdfs/Medicaid%20FFS%20Treatment%20of%20Obesity%20Interventions%202014.pdf , accessed 09/01/2015

Duke Medicine

http://www.stopobesityalliance.org/wp-content/themes/stopobesityalliance/pdfs/Medicaid%20FFS%20Treatment%20of%20Obesity%20Interventions%202014.pdf, accessed 09/01/2015

Duke Medicine

Inside the mind of a payer: 10 key determinants of coverage1. Customer demand/preference for a benefit/service2. Cost (as low as possible, predictable)3. Evidence for effectiveness and efficiency4. Deliverable quality outcomes (especially NCQA

metrics)5. Network for delivery6. Customer satisfaction/experience7. Ease of administration8. Compliance9. Risk (legal, financial, regulatory, public relations,

network)10.Profitability/margin

Duke Medicine

Cost-effectiveness results for selected interventions evaluated in Australia

Lancet Volume 378, No. 9793, p838–847, 27 August 2011 Duke Medicine

Framework for Integrated Clinical and Community Systems of Care

Care Delivery

•Information Systems•Decision Support•Delivery System Design•Self Management Support•Local Patient Environment•Clinicians

CommunitySystems

Equity

Training & Education

Metrics

IntegrationConvener, Advocacy, Data Exchange, Financing, Governance/Regulation, Referral

Processes, Communication

Family & Individual Empowerment and Engagement

Population Health

•Resources•Services•Supportive Environment•Social Norms

IOM Roundtable for Obesity Solutions, 2015

Duke Medicine

A Practical Playbook:Public Health and Primary Care Together

http://practicalplaybook.org/

Practical Playbook Overview

Practical Playbook Overview

The Eight “Easy” StepsFor Community Health Improvement1. Getting Things Started2. Building a Case3. Gathering Allies4. Identifying Stakeholders5. Walking a Mile in Someone Else’s Shoes6. Creating a Compelling Vision7. Developing a Strategy8. Communicating Your Vision and Mission

1. Getting Things StartedResources• Robert Wood Johnson Foundation

2. Building a CaseResources• Practical Playbook: Finding data• The Community Tool Box: Analyzing Problems and Goals

toolkit

Success stories & lessons learned

Focus- childhood obesityInitiation- Physical Education teacher began BMI screening in her school district (2010)- 40% of children with an unhealthy weightPartners-

• LJ Rice Elementary School• Scripps Family Medicine Residency• San Diego Healthy Weight Collaborative

o Public healtho Primary careo Local governmento Neighborhood organizations

Intervention- 5-2-1-0

https://www.practicalplaybook.org/success-story/collaboration-jumpstarts-healthy-habits-chula-vista-students-and-families , accessed 09/01/2015

Your turn:How have you used data to drive collaboration between the community and clinical settings?What data did you collect and how did you use it to make the case?

3. Gathering Allies:Resources• “Tactics for Communicating”

4. Identifying StakeholdersResources• Practical Playbook: Community Engagement

Success stories & lessons learned

Advocates for Healthy Youth (AFHY) CoalitionFocus- Integrating medical, public health, and community efforts to address child obesityInitiation- Pediatrician at Cheshire Medical Center reached out to her health system Department of Community Health, which connected to community partnersPartners-

• Cheshire Medical Center (CMC) [primary care]• CMC Community Health Department [health system]• Local school district & colleges• City government• Public health• YMCA• Community Mental Health

Intervention- 5-2-1-0

http://citizenshealthinitiative.org/sites/citizenshealthinitiative.org/files/media/2010/AdvocatesforHealthyYouthCoalitionSummary.pdf , accessed 09/01/2015

Your turn:What issues have you found in engaging the community?What tactics have you found to be useful in communicating and engaging with the community?

Your turn:Other thoughts, stories, comments?

Take home messages• Health, healthcare, and health

insurance are not synonymous• Coverage for obesity-related services

varies by state and by health plan• Disconnects and controversy: policies,

politics, effectiveness and efficiency• An integrated, collaborative approach is

most likely to succeed, and will take time, persistence, and patience

Duke Medicine

Thank you!

Bariatric Surgery (Commercial) Coverage by State2012

STOP Obesity Alliance, 2012 Duke Medicine

http://www.stopobesityalliance.org/wp-content/themes/stopobesityalliance/pdfs/Medicaid%20FFS%20Treatment%20of%20Obesity%20Interventions%202014.pdf , accessed 09/01/2015

Duke Medicine

http://www.stopobesityalliance.org/wp-content/themes/stopobesityalliance/pdfs/Medicaid%20FFS%20Treatment%20of%20Obesity%20Interventions%202014.pdf , accessed 09/01/2015

Duke Medicine