Driving Health Improvement Through Community Population

Measurement

Deryk Van Brunt, DrPHPresident and Chairman, Healthy Communities InstituteAssociate Clinical Professor, UC Berkeley School of Public Health

Pay for Performance Summit 8

• Mission‒

Improve the health, vitality and environmental sustainability of communities, counties and states

• Headquarters‒

Berkeley, California• Problem / Approach

‒

Population health data is too decentralized‒

Centralize, make understandable, lead to evidence-based action• Solution / Healthy Communities Network

‒

Provide community indicator dashboards, GIS mapping, best practice sharing tools leveraging population health data

• National Relationships / Awards / Coverage‒

2012 Health and Human Services Award: “Best Community Health App”‒

2011 Health and Human Services Award: “MyHealthyPeople: Helping Attain The Health Goals Of Healthy People 2020”

‒

VHA and CHA National Agreements‒

90+ million lives in the United Statesand

Healthy Communities InstituteCloud-based Population Health Management

and

Why Care About Population Health?

Determinants of Health

Chronic Conditions Consume 75% of Total Health Care Expenditures

Demographic and Cultural Trends

Sedentary LifestyleSmoking (although on the decline)Diet High in Fat, Sugar, Salt, Processed FoodsBuilt Environment - does not typically foster healthy lifestyle

and

Medical Care 10% Genetics 20%Environment 20%Lifestyle 50%

resulting in increased incidence and prevalence of chronic illness:

and

Hospitals/Institutions

Managing Health Risk of Populations

MetricsBest PracticesEvaluation

and

MetricsBest PracticesEvaluation

MetricsBest PracticesEvaluation

Hospitals/InstitutionsCommunity

Managing Health Risk of Populations

Community Health Factors feed utilization of our health care system.

and

Healthy Communities Network Population Health Management System

100–200 IndicatorsColor-CodedConstantly Updated

Community Dashboard

2000+ in DatabasePrograms & PoliciesEvaluation-based

Promising Practices

Form Working GroupsSet Local GoalsManage Achievement of Objectives

HP2020 TrackerLocal Priorities TrackerComparative and Longitudinal Evaluation

Evaluation & Tracking

Collaboration Centers

and

Generalized Population Health Benefits Hospital/Insurer/ACO• Helps local stakeholders perform strategic

planning• Promotes community health and development

(one source of truth)• Drives community engagement• Helps meet Public Health Accreditation Board

assessments and state requirements• Supports MAPP programs (community

partnerships, data requirements, etc.) • Helps hospitals meet Health Care Reform

and IRS 990 requirements• Promotes best practice sharing

• Map Hotspots: Identify and geo-map high risk population hotspots with expensive chronic disease.

• Drill Down: Cross-reference lifestyle, behavioral, and demographic factors to identify opportunities to mitigate risk and lower costs within hotspots.

• Best Practices: Implement community health best practices across target populations.

• Track and Evaluate Progress: Customizable Dashboards, Trackers, Report Cards, etc.

and

Features and Benefits

Indicator Hospitalizations

Risk-Adjusted Hospitalization

Rates per 100,000 population

Estimated Cost

Mental Health* 3306 440.8 $21.2 million

COPD/Asthma in Older Adults (40+) 1320 290.0 $10.0 million

Heart Failure 2230 285.8 $29.8 million

Bacterial Pneumonia 1629 210.7 $17.1 million

Low Birth Weight 794 6.2 $55.5 million

Example: Honolulu County 2011

8*Rate for this cause is unadjusted

and

Highest Preventable Hospitalization Costs

Bacterial Pneumonia Hospitalization Rates by HSA

9

and

Hawaii Health Matters Indicator Pneumonia Vaccination Rate 65+

10

and

Hawaii Health Matters Indicator Pneumonia Vaccination Rate 65+

11

and

Intervention Outcome

The HMO Group Health, Inc. encouraged influenza vaccinations with walk-in vaccination clinics, patient mailings, and nurses offering vaccines to high-risk patients1

• Reduced hospitalizations for pneumonia and influenza in the 65+ population by up to 57% (p<0.002)

• Reduced hospitalization costs for pneumonia and influenza in the 65+ population by 52% (p<0.005)

Blue Cross Blue Shield sent direct mail marketing pieces encouraging its members to get vaccinated against influenza/pneumonia2

• 2.62% (p=0.01) higher rate of influenza vaccinations, 4.61% higher rate of pneumonia vaccinations (p=0.08)

• 9.67% (p=0.136) lower rate of influenza/pneumonia inpatient admissions

• 22.64% (p=0.002) lower rate of influenza/pneumonia ED visits

• ROI: >2:1

Interventions to Reduce Influenza/Pneumonia

Hospitalizations/Costs: Examples

121. Nichol, K.L., K.L. Margolis, J. Wuorenma, and T. Von Sternberg. “The Efficacy and Cost Effectiveness of Vaccination against Influenza among Elderly Persons Living in the Community.” New England Journal of Medicine 1994; 331: 778-784. doi: 10.1056/NEJM1994092233112062. Berg, G.D., E. Thomas, S. Silverstein, C.L. Neel, and M. Mireles. “Reducing medical service utilization by encouraging vaccines: Randomized controlled trial.” American Journal of Preventive Medicine November 2004, 27(4): 284-288. doi: 10.1016/j.amepre.2004.07.001

and

Cross Pollinate Successful Strategies Nationally

and

Over 90 Million Lives Covered

• Population Health Management

• Hotspotting – Mapping and high impact practices to proactively improve poor health

Conclusion

Deryk Van Brunt | deryk@healthycities.org | BOOTH 5