Chapter Sponsors The Wisconsin Chapter of ACHE would like to thank our sponsors whose support has helped to bring you this exciting and informative program. Premier Sponsor: Preferred Sponsors: If your organization is interested in sponsoring the Wisconsin Chapter of ACHE, please visit our website: www.ache-wi.org, or contact Bill Calhoun at (920) 223-0504 Incorporating Population Health into Strategic Planning: Where to Start George Kerwin, FACHE, CEO Bellin Health System, Inc
Thomas R. Oliver, PhD, MHA Professor of Population Health Sciences University of Wisconsin School of Medicine and Public Health Kim Miller, FACHE, President & Ceo Beaver Dam Community Hospitals, Inc Models, Measures, and Mobilization for Population Health Improvement Tom Oliver Department of Population Health Sciences University of Wisconsin School of Medicine and Public Health Prepared for the Regional Networking and Education Program of the Wisconsin Chapter of the American College of Healthcare Executives, 17 June 2011.
A New Paradigm for Population Health Improvement: Health in All Policies Features of HiAP Models Identify a broad range of determinants of health and well being Focus on upstream causes and solutions aimed at changing systems as well as individual behaviors Highlight the impact of health inequalities on overall levels of population health Assert responsibility for health improvement rests not only with governmental health agencies and providers of personal health services but also with individuals and organizations across many sectors of society Fielding, Teutsch, and Breslow 2010
Health Focus Areas in the Healthiest Wisconsin 2020 Plan Section 5. Health Focus Areas Adequate, appropriate, and safe food and nutrition Alcohol and other drug use Chronic disease prevention and management Communicable disease prevention and control Environmental and occupational health Healthy growth and development Injury and violence Mental health Oral health Physical activity Reproductive and sexual health Tobacco use and exposure Pillar Objectives of the Healthiest Wisconsin 2020 Plan Section 3. Pillar Objectives and Overarching Focus Areas Comprehensive data to track health disparities Resources to eliminate health disparities Policies to reduce discrimination and increase social cohesion Policies to reduce poverty Policies to improve education Improved and connected health service systems Youth and families prepared to protect their health and the health of their community Environments that foster health and social networks Capability to evaluate the effectiveness and health impact of policies and programs Resources for governmental public health infrastructure
Mobilizing Action Toward Community Health: The MATCH Project WHO University of Wisconsin Population Health Institute Robert Wood Johnson Foundation WHAT County Health Rankings http://www.countyhealthrankings.org/ Improving Population Health blog http://www.improvingpopulationhealth.org/blog/ Essays on population health metrics, incentives, and partnerships published in 2010 in CDC online journal Preventing Chronic Disease http://www.cdc.gov/pcd/issues/archive.htm Study of multi sector partnerships in population health improvement 6/21/2011
6/21/2011 A call to action The first annual checkup for every county in the nation Provides information on the many factors that influence community health Shows that health is everyone s business
Health Outcomes Health Factors Programs and Policies
Health Outcomes Mortality Morbidity 50% 50% Health behaviors 30% Health Factors Clinical care 20% Social & economic factors 40% Programs and Policies Physical env. 10% Mortality 50% 50% Years of Potential Life Lost Health Outcomes Morbidity 50% 10% 10% 10% Self-reported health Physical unhealthy days Mental unhealthy days 20% Low birth weight 10% Tobacco use Health behaviors 30% 10% 5% 5% Obesity Alcohol use Unsafe sex Health Factors Clinical care 20% 10% 10% Access to care Quality of care Programs and Policies Social & economic factors Physical env. 40% 10% 10% 10% 10% 5% 5% 5% 5% Education Employment Income Family & social support Community safety Environmental quality Built environment
www.countyhealthrankings.org 19
What Works? Policies and Programs to Improve Health Description of programs/policies Level of implementation Intended beneficial outcomes Evidence rating Potential population reach Potential impact on disparities Decision makers who could enact
The Old Public Health System
INSTITUTE NATIONAL ACADEMIES OF THE The New Public Health System THE FUTURE OF THE PUBLIC S HEALTH in the 21st Century OF MEDICINE MATCH Study of Multi sector Partnerships in Population Health Improvement LITERATURE REVIEW: KEY FACTORS IN EFFECTIVENESS Partnership resources: sufficiency, sustainability, flexibility Common vision among partners, shared by community being served Leadership: sponsors and organizational development skills Organizational structure: must generate trust among diverse and unequal partners
MATCH Study of Multi sector Partnerships in Population Health Improvement Membership: tradeoff between representativeness and effectiveness, build on established relationships Quality of relationships, cohesion Community context: values, readiness, timing, selection of priority issues OVERALL, THERE IS VERY LITTLE OBJECTIVE EVIDENCE OF IMPACT OF MULTI SECTOR PARTNERSHIPS ON POPULATION HEALTH Source: Woulfe, Julie, Thomas R. Oliver, Susan J. Zahner, and Kirstin Q. Siemering. 2010. The Role of Multi sector Partnerships in Population Health Improvement: Expectations and Evidence. Preventing Chronic Disease: Public Health Research, Practice, and Policy 7 (6). http://www.cdc.gov/pcd/issues/2010/nov/pdf/10_0104.pdf
MATCH Study of Multi sector Partnerships in Population Health Improvement EARLY PATTERNS Community Context Contrasting social and political values: underlying support for population health initiatives through government and liberal activism versus more conservative approach through charity, focus on kids and families Role of local governmental public health: shift from service provider to coordinator, convener, and systems analyst Recent immigration as source of needs and opportunities MATCH Study of Multi sector Partnerships in Population Health Improvement EARLY PATTERNS Key combination of factors: Top down frameworks and investment Bottom up social and policy entrepreneurship New tools for population health improvement
MATCH Study of Multi sector Partnerships in Population Health Improvement NEW TOOLS FOR POPULATION HEALTH IMPROVEMENT Broader uses of hospital community benefit funds Expanding applications of health impact assessment Network development among leaders as well as community members Media advocacy aimed at systems and policy change Opportunities for Participation in Population Health Improvement Initiatives Participate in Community Health Improvement Processes and Plans (CHIPP) Directions of key trends in health factors or outcomes Comparison with other communities Comparison with state and national goals Use community benefit funds for policy, systems, and environmental change as well as education and services Participate in community teams or coalitions Healthy Wisconsin Leadership Institute Wisconsin Partnership Program Community Academic Partnership grants program (planning or implementation grants) CDC Community Transformation Grants to address chronic disease
Population Health Planning for a Rural Area ACHE Wisconsin Chapter June 17, 2011 Kim Miller, FACHE Chief Executive Officer Amy Nyberg Chief Strategy Officer
Service Area Demographics 77,000 people 14% elderly Minority growth (6 to 9%) Relatively rural Amish population Beaver Dam Fond du Lac Madison
Population Health Study Highlights Unhealthy behaviors High rate of alcohol use Teen alcohol use Early sexual activity Tobacco use Low rates of cancer screening Mammography Colonoscopy PSA tests Health Rankings Rankings out of 72 Wisconsin Counties 35 35 Mortality: 32 Morbidity: 41 Healthy Behaviors: 47 Clinical Care: 25 Social/Economic: 26 Physical/Environment: 63 Source: UW Population Health Institute 2010
Key Health Factors Data Alcohol Use Source: 2007 Community Health Assessment Planning Process Gather Data Community Surveys: 2006 and 2008 Public Health Study: Quantitative Data Focus Groups Physician Interviews Service Lines: Diagnostic focus Financial data
Strategic Planning Evolution New Facility New CEO Plan Pain Clinic ENT Service Line Study Clinical Priorities Start 5-Year Plan Primary Care Hospitalists 2006 2007 2008 2009 2010 2011 Community: ER -Improve ER -ENT -Primary Care -Pain Public Health Study Retail Clinics Community: -Better -Primary Care Clinical Priorities Finish Expand Clinics Planning Process Clinical Priorities Committee Review all internal and external data Hear from all specialties Review trends Interview colleagues Present priorities to the committee Deliberate as a committee make recommendations to administration Regular check-ins with management Loud message: build primary care across the region
Conclusions Serve the region Regional locations Complete the continuum Build primary care Recruit family practice Develop hospitalist program Strengthen OB services Strengthen mental health services Strengthen secondary care services Access to needed services locally Prevent unnecessary drive/complexity Regional Locations Today
Conclusions, continued Focus on the triple aim Quality Service Cost Continue support for Church Health Free clinic in churches Foundation funding to expand regionally Provide diagnostics, surgery, inpatient
Incorporating Population Health into Strategic Planning: Where to Start Presented to the Wisconsin Chapter of the ACHE Friday, June 17, 2011
Bellin Health Story Bellin s Problem Huge healthcare costs measured as PEPY: $5,440 in 2001 $6,237 in 2002 Double-digit increases: 13% 2001 to 2002 30% projected 2002 to 2003 if no changes made to plan Unknown health status and issues facing employees individually & collectively Heavy healthcare users Fear of culture impact if changes made Marketplace credibility need to sell Business Health Solutions by example but were unable to do so Bellin s Solution Encourage proper utilization, improve health, and create smart healthcare consumers by: 1. Redesigning our health plan Higher deductibles Stabilized premiums 100% prevention coverage Funded Personal Benefit Accounts Incentives for primary care prevention screenings and HRA results 2. Assessing and helping to manage the health status of the total employee base, with focus on improving decision making Health Risk Assessments Personal Health Coaches 3. Utilizing our partners to receive the lowest cost/best value and providing targeted wholesale on-site services Bellin s Results Lower healthcare costs measured as PEPY: $4,816 in 2003 $5,142 in 2004 $5,523 in 2005 $6,434 in 2006 (PBA) $6,768 in 2007 $7,806 in 2008 $8,612 in 2009 $8,556 in 2010 (projected) Averaging 11% below the national average for 8 yrs totaling over $10 million less than average Strong culture maintained Employees as empowered healthcare consumers Improved health (increasing HRA scores) We now have a story! Three Dimensions of Value Population Health Experience of Care Per Capita Cost
Triple Aim 101 Identify population Articulate how much by when for each of the three aims Develop measures to support your aims Develop a portfolio of projects that will accomplish the three aims No individual project can accomplish the Triple Aim but a portfolio of projects that are executed well can move closer to the aims For a work of this magnitude it must be strategic Determinants of Health Sweden
Population Segments Total Population = 600,000 people Employers Children & Families 324,000 People (54%) $3,742/person Medicare 96,000 People (16%) $6,951/person Medicaid 108,000 People (18%) $1,440/person Uninsured 72,000 People (12%) $70/person Triple Aim Journey- Employers
Integrated Total Health Management Insurance Company/TPA Broker Employer Leadership Support Culture Access Quality Data Health Risk Appraisals/Employer Clinics Work and Productivity Services Leadership & Culture Listening AIM: To develop a culture of health and wellness designed for the needs of the population resulting in improved productivity and profitability for employers. DRIVERS OF SUCCESS: { Ownership by top management { Adequate resources { Employee involvement
Health Knowledge Listening AIM: To provide timely, meaningful and accurate data for decision making. FORMULA FOR SUCCESS Solution based design able to support and sustain desired change Costs Health status Employee satisfaction and experience Health Advancement Designing AIM: Engage individuals in their own health thereby improving the health status and reducing costs for the population. FORMULA FOR SUCCESS: Confidence to manage health Work/Life and EAP program to address root behavioral cause of physical lifestyle challenges PCP relationship/medical Home
Productivity Enhancement Designing AIM: To decrease costs and enhance. productivity and profitability by finding the right employees and keeping them on the job. FORMULA FOR SUCCESS: { Trusted team to manage the full continuum of workplace health and productivity (H&P) { Active management { Loss prevention plan which makes safety a priority Bellin Health Access Platform $$$$ Compare Care Cost & Quality Comparisons Visits to Onsite Provider FastCare Just $52 (incl. Lab) AIM: To facilitate timely and appropriate access in the right place and at the lowest cost for the identified health need. FORMULA FOR SUCCESS: Knowledgeable consumer Access platform designed for the needs of the population Integrated system of care coordination Free His Health Assessment & Her Health Luncheons Free 24/7 Nurse On Call
Bellin Health Health Plan Cost and Health Measure Trends 1.4 78 Percent of Average Bellin Cost per Health Plan vs. Average National 1.2 1 0.8 0.6 0.4 0.2 76 74 72 70 68 Average Bellin Health Risk Appraisal Score 0 PEPY: 2002 2003 2004 2005 2006 2007 2008 2009 2010 proj. Year $6,237 $4,816 Bellin vs. National $5,142 $5,523 $6,434 Bellin HRA Scores $6,768 $7,806 $8,501 $8,556 66 Note: Average costs based on Hewitt data Conclusion: Please complete electronic survey that will be coming via email Thank You