PARTNERING TO ADVANCE THE TRIPLE AIM AND IMPROVE PUBLIC HEALTH IN MINNESOTA. Triple Aim of Health Reform 9/17/2014

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1 PARTNERING TO ADVANCE THE TRIPLE AIM AND IMPROVE PUBLIC HEALTH IN MINNESOTA Edward P. Ehlinger, MD, MSPH Commissioner Minnesota Department of Health September 13, 2014 Triple Aim of Health Reform Institute for Healthcare Improvement MN #1 in Health Care System Performance Access, Quality, Cost, Outcomes 1

2 State Ranking in Child Health System Performance Pharmacists are increasingly important in achieving the Triple Aim Pharmacist workforce is the third largest category of health professionals in the United States, after nurses and physicians. Prescription drugs are the 3 rd largest health care cost. University of South Carolina, Arnold School of Public Health, Dept. of Health Services Policy and Management, HSPM J712, 2

3 E-Prescribing Adoption and Use Minnesota: No. 2 in Surescripts' 2013 Safe-Rx Awards 61 percent of prescriptions routed electronically Delaware No. 1 Benefits of e-prescribing Improved safety Increased efficiency Reduces cost personnel and financial Number of e-prescriptions per month Percentage of pharmacies e-prescribing 3

4 Pharmacists are increasingly important Shifting from managing medication distribution systems to more clinically oriented roles medication management services PDMP Immunizations raising awareness and increasing access care coordination diagnostic and screening tests with on-site patient education Pharmaceutical needs have changed Increasing importance of pharmacists Models of physician-pharmacist collaboration have demonstrated that primary care services delivered by pharmacists can improve patient outcomes, promote patient involvement, increase costefficiency, and reduce demands affecting the health care system. Giberson et al 4

5 Challenges Policy, legislation, and compensation barriers. Pharmacists are appropriately trained to contribute to primary care, pharmacists should receive recognition as health care providers, compensation policies need to be altered if clinical services in pharmacies are to be sustainable, and access and clinical services provided by the US pharmacy workforce are aligned with the goals of health reform. Health Aff November : ; Minnesota s State Innovation Model Implications/Opportunities for Pharmacists Expanding Accountable Care Organizations Interoperalble e-health records Accountable Communities for Health Walter Reed born September 13, 1851 US Army Surgeon, Ob/Gyn Proved mosquitoes transmit yellow fever If it happens, it happens... We can't stop living. 5

6 Support for Marijuana Legalization in the United States Has Reached Unprecedented Levels Sources: Gallup and GSS 16 Triple Aim of Health Reform Better Health for Populations Institute for Healthcare Improvement 0 Minnesota Is a Healthy State Minnesota s State Health Ranking Source: United Health Foundation 6

7 MN has 2 nd longest life expectancy at birth 6 th longest length of life after age Hawaii 2. Florida 3. California 4. Arizona 5. Connecticut 6. Minnesota MN Infant Mortality Rate is Best in the US Health of MN Seniors Ranked #1 1. Minnesota Vermont New Hampshire Massachusetts Iowa Hawaii Connecticut Colorado Utah Maryland Tennessee Nevada Georgia Alabama Kentucky Arkansas West Virginia Louisiana Oklahoma Mississippi

8 How did we get to be a healthy state? We had a good healthcare system We invested in the public good. Well being increases as economic well being increases 8

9 Life expecanty in Years Percent 9/17/2014 White Paper: Income and Health Life expectancy by median household income group of ZIP codes, Twin Cities Adults reporting "fair" or "poor" health status by income, Minnesota Less than $35,000 to $45,000 to $60,000 to $75,000 or $35,000 $44,999 $59,999 $74,999 more Less $20 to $35 to $50 to $75,000 DK - $20,000 $34,999 $49,999 $79,999 or more refused Source: The unequal distribution of health in the Twin Cities, Wilder Research Analyses were conducted by Wilder Research using mortality data from the Minnesota Department of Health and data from the U.S. Census Bureau (population, median household income, and poverty rate by ZIP code Source: 2011 Behavioral Risk Factor Surveillance System Genes and Biology 10% Physical Environment 10% What Creates Health? Social and Economic Factors 40% Clinical Care 10% Health Behaviors 30% We can t treat our way into good health. Health Equity Report Advancing Health Equity February 1, 2014 in Minnesota the opportunity to be healthy is not equally available everywhere or for everyone in the state. 9

10 Life Expectancy in Twin Cities MN: Mortality Ratios by Race or Ethnicity Disparities in Health Disparities are not just because of lack of access to health care or to poor individual choices. Disparities are mostly the result of policy decisions that systematically disadvantage some populations over others. Especially, populations of color and American Indians, GLBT, and low income Structural Racism 10

11 Percent Below Poverty Per Capita Income in Dollars White/Black Disparity Ratio 9/17/2014 Social Determinants of Health Comparison of Big 10 (CIC) States Poverty, 2012 ACS 45.0 Black US Black Black/White Disparity Ratio IL IN IA MD MI MN NE NJ OH PA WI US Big Ten States Per Capita Income, 2012 ACS 30,000 Black US Black White/Black Disparity Ratio ,005 25,000 22, , ,670 16,086 15,958 16,054 16,057 16,987 18,102 15,000 14,820 14,615 13, , , IL IN IA MD MI MN NE NJ OH PA WI US Big Ten States

12 Percent of Owner Occupied Housing Graduation Rate White/Black Disparity Ratio 9/17/2014 Owner Occupied Housing, 2012 ACS 60.0 Black US Black White/Black Disparity Ratio IL IN IA MD MI MN NE NJ OH PA WI US Big Ten States Four Year High School Graduation, SY Black White/Black Disparity Ratio IL IN IA MD MI MN NE NJ OH PA WI Big Ten States 0.0 Social Vulnerability Index Themes Housing/Transportation Theme Socioeconomic theme Minority status/language Theme Agency for Toxic Substances and Disease Registry American Community Survey 12

13 Minnesota! Where the women are strong, The men are good looking, And all our health statistics are above average Unless you are a person of color or an American Indian. Why is addressing health equity important? 50% 40% 30% 20% 10% Percent Of Color U.S. 36% 24% 17% 0% Source: mncompass.org What Would It Take To Assure the Good Life for All Minnesotans? Change the narrative about what creates health Health is not determined by just clinical care and personal choices Health is determined by physical and social determinants Health is determined by policies, systems, and the physical and social environment 13

14 Create a public health framework for health reform Healthy Communities SHIP Healthy Living Public Health Medical System Chronic Disease Care Hospitalization Our goal is to work upstream to keep Minnesotans from falling in the river of medical care and going over the waterfall of hospitalization. World Health Organization Commission on Social Determinants of Health Commission on Social Determinants of Health. (2010). A conceptual framework for action on the social determinants of health. Geneva: World Health Organization. Rebalance our investment in health Distribution of Resources Medical Care Public Health

15 Total Investment in Health and Human Services Ratio of Human Service Spending to Health Care Spending What Would It Take To Assure the Good Life for All Minnesotans? Adopt a Health in All Policies approach Hold decision-makers accountable for policies, programs Organize resources to advance health/health equity 15

16 What Would It Take To Assure the Good Life for All Minnesotans? Engage all of the population in creating health Empower communities to create the conditions for health Optimize your professional and civic roles Public health is what we, as a society, do collectively to assure the conditions in which (all) people can be healthy. -Institute of Medicine (1988), Future of Public Health Edward P. Ehlinger, MD, MSPH Commissioner, MDH P.O. Box St. Paul, MN Ed.ehlinger@state.mn.us Advancing health equity is not about averages It s about creating opportunities to be healthy 16