Health 3.0 Leadership Conference: Community Centered Health Systems with Larry Cohen
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Transcript of Health 3.0 Leadership Conference: Community Centered Health Systems with Larry Cohen
Larry Cohen Executive Director Prevention Institute
Community Centered Health Systems: Transforming Community Health and
Care Delivery Through Upstream Innovations
@preventioninst
http://www.facebook.com/PreventionInstitute.org
UC Berkeley School of Public Health Leadership Conference Transforming Community Health and Care Delivery
May 30, 2013
www.preventioninstitute.org
“Simply put, in the absence of a radical shift towards prevention and public health, we will not be successful in containing medical costs or improving the health of the American people.” - President Obama
u Prevention and Public Health Fund u Community Transformation Grants
u National Prevention Strategy u National Prevention, Health Promotion, and
Public Health Council
u Center for Medicare and Medicaid Innovation
u Funding for Community Clinic Expansion
Opportunities for Prevention in Health Reform
It is unreasonable to expect
that people will change their
behavior easily when so many
forces in the social, cultural,
and physical environment
conspire against such change.
“
” Institute of Medicine
Source: Institute of Medicine. (2000). Promoting health: Intervention strategies from social and behavioral research (B. D. Smedley & L. S. Syme, Eds.). Washington, DC: National Academies Press.
What’s Health Got To Do With It?
Photo courtesy of Latino Health Access
Photo courtesy of Latino Health Access
Photo courtesy of Latino Health Access
Photo courtesy of http://spacedust.atspace.com/soccer_archery.html
HEALTH & SAFETY
BEHAVIOR BEHAVIOR
ENVIRONMENT
355 Diseases15 Diseases
44% 56%
Citation: Kenneth Thorpe et al.. “Which Medical Conditions Account For The Rise In Health Care Spending?” Health Affairs, 10.1377, web exclusive.
A Majority of Costly Conditions are Preventable
u Medical spending increased by $199 billion (1987-2000)
u 15 diseases account for 56% of this increase
Current Health Care Spending
Factors Influencing���Health
National Health ���
Expenditures References: Bipartisan Policy Center. “Lots to Lose: How America’s Health and Obesity Crisis Threatens our Economic Future.” June 2012
70%
10%
20%
$2.2 Trillion
Behaviors & Environment
Genetics
Medical Care
Behaviors & Environment
70%
Medical Care, 10%
Genetics 20%
$2.2 Trillion
Current Health Care Spending
Factors Influencing���Health
National Health ���
Expenditures References: Bipartisan Policy Center. “Lots to Lose: How America’s Health and Obesity Crisis Threatens our Economic Future.” June 2012
Behaviors & Environment
70%
Medical Care, 10%
Genetics 20%
Prevention, 3%
Health Care Services
97%
$2.2 Trillion
Current Health Care Spending
Factors Influencing���Health
National Health ���
Expenditures References: Bipartisan Policy Center. “Lots to Lose: How America’s Health and Obesity Crisis Threatens our Economic Future.” June 2012
$1 Investment
$5.60
Return on Investment
Savings at 5 years
$16 Billion Annual Savings
In 5 Years
Return on Investment with Prevention
Reference: Prevention for A Healthy America: Investments in Disease Prevention Yield Significant Savings, Stronger Communities, Trust for America’s Health, July 2008
Prevention for a Healthier America
u $5.6:$1 ROI
u $16 billion savings in 5 years
http://preventioninstitute.org/component/jlibrary/article/id-75/127.html
Health Services
Prevention
Integrated Approach
Community-Centered Health Homes
Patient-Centered Health Homes
Medical Homes
Community-Centered Health Homes
A Different Way to Think about Health Care
Photo Credit: Daniel Bernstein
“The last time we looked in the book, the specific therapy for malnutrition was food.” Jack Geiger, MD
Medical Equipment
Oakland Chinatown
INQUIRY! ASSESSMENT! ACTION!
ENVIRONMENTAL & POLICY CHANGE!
COORDINATED CLINICAL & COMMUNITY PREVENTION
ACTIVITY!
IDENTIFY PRIORITY
HEALTH ISSUES!
COMPREHENSIVE STRATEGY
DEVELOPMENT!
PARTNERSHIP FORMATION!
• Health Care!• Public Health!• Community
Organizations!
DATA COLLECTION!
CLINICAL/COMMUNITY POPULATION HEALTH INTERVENTION MODEL
OUTCOMES!
IMPROVED HEALTH!!
COST SAVINGS!!
EVIDENCE-BASE FOR EFFECTIVE
PRACTICE!
Existing Clinician Skills PATIENT INTAKE DIAGNOSIS TREATMENT
Emerging Opportunities Ø Payment mechanisms & incentives
n maximize healthcare quality, minimize costs, incentivize prevention and an integrated health system
Ø Population health data innovation n track population health trends n reveal the links between determinants and health outcomes n uncover the best interventions for improving health
Ø Metrics to promote health in the first place n incentivize prevention and move away from individual-based assessment n capture the leading indicators of successful community prevention n assess the impact of community-level change
Ø Workforce innovations n advance the roles of community health workers, promotoras, integrators,
navigators
Ø Intersectoral community partnerships and advocacy n support true engagement and partnerships for sustainable community change
How Can We Pay for a Healthy Population?
♦ Wellness Trusts
♦ Social Impact Bonds and Health Impact Bonds
♦ Community Benefits from Non-Profit Hospitals
♦ Accountable Care Organizations
Connecting Clinical & Population Perspectives Through Data
u Collecting community driven data
u Creating interoperable data sets
u Tracking population health trends
Engage Stakeholders: Effective Collaboration
Healthcare Institutions /
Systems
Prevention Advocates
Education Planners / Transportation
Public Health
Service Providers
Elected Officials
Community Members
“We are bringing together the health and human rights voices in south LA and beyond to discuss the healthcare crisis and how we build a movement for the right to health.” -Jim Mangia, CEO St. John’s
National: Health System that Integrates
Prevention/Public Health/ Healthcare
Statewide: Community-Centered
Health System
Accountable Care Community
Local: Community Centered
Health Home
Accountable Care Community
Local: Community Centered
Health Home
NORMS sanction behavior
attitudes, beliefs, ways of being
based in culture & tradition
taken for granted
more than a habit
behavior shapers
communicate regularity
in behavior
Child Restraint & Safety Belt Use
Oh, Britney…
Pharmacy Tobacco Ban
Folsom-Cordova School District
Building a Movement
Photo courtesy of: Jonathan Moreau
“You can do more than bail out these medical disasters after they have occurred, and go upstream from medical care to forge instruments of social change that will prevent such disasters from occurring in the first place.” —Jack Geiger, MD
Photo Credit: Daniel Bernstein
“Prevention is better than cure”
-Hippocrates
www.preventioninstitute.org Photo credit: Emily Barney
TOOLS
Community-Centered Health Homes
www.youtube.com/preventioninstitute
Influencing Policy & Legislation
Changing Organizational Practices
Fostering Coalitions & Networks
Educating Providers Promoting Community Education
The Spectrum of Prevention
Strengthening Individual Knowledge & Skills
Take 2 Steps to Prevention
Health Care Services
Exposures & Behaviors
Environment
Collaborator 4
Expertise:
Desired Outcomes:
Key Strategies:
Collaborator 3
Expertise:
Desired Outcomes:
Key Strategies:
Collaborator 1
Expertise:
Desired Outcomes:
Key Strategies:
Collaborator 2
Expertise:
Desired Outcomes:
Key Strategies:
Shared Outcomes
Partner Strengths
Joint Strategies
Collaboration Multiplier
Developing Effective Coalitions: The 8-Step Process
1. Analyze program objectives, determine whether to form a coalition
2. Recruit the right people
3. Devise preliminary objectives and activities
4. Convene the coalition
5. Anticipate necessary resources
6. Develop a successful structure
7. Maintain coalition vitality
8. Improve through evaluation
Communities Taking Action
221 Oak Street Oakland, CA 94607 Tel: (510) 444-7738
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