National Perspective on Changes Impacting the Public Health System

1. 2014 North Carolina State Health Director’s Conference Raleigh, NC January 23, 2014 National Perspective on Changes Impacting the Public Health System Judith A. Monroe, MD Director, Office for State, Tribal, Local and Territorial Support Deputy Director, Centers for Disease Control and Prevention

4. 1964 2014

5. CDC Strategic Directions Improve health security at home and around the world Better prevent the leading causes of illness, injury, disability, and death Strengthen public health/health care collaboration

6. Key Features of Affordable Care Act

7. “Simply put,intheabsenceofaradicalshifttowardspreventionandpublichealth,wewillnotbesuccessful incontainingmedicalcostsorimprovingthehealthoftheAmericanpeople.”-PresidentObama

8. “…healthstrategies,interventions,and policiesappliedat the populationlevelcan advancecurrentapproaches toour nation’s most pressing healthconcernsmore efficiently andeffectivelythancanisolated, intensiveindividual-levelactionswithinthe clinicalcaresector.” -InstituteofMedicine

9. IOMActivitieswith Implicationsfor PopulationHealthin theACA • PrimaryCareand PublicHealth:Exploring IntegrationtoImprovePopulationHealth • Valuing Community-based,Non-clinical • PreventionPoliciesandWellnessStrategies • For the Public’sHealth: The Role of Measurement inActionandAccountability • The BestCareat Lower Cost:ThePathto Continuous Learning HealthCareinAmerica • Roundtable onHealthLiteracy

10. IOMActivitieswith Implicationsfor PopulationHealthin theACA(cont’d) • QualityMeasuresforthe HealthyPeople LeadingHealthIndicators • LivingWellwith ChronicDisease: Public HealthActiontoReduceDisabilityand ImproveFunctioningandQualityofLife • Roundtable on thePromotion ofHealth Equityand theEliminationofHealth Disparities

11. Resources to Prevent Illness & Keep People Healthy • ExpandedInsuranceCoverage • PreventionServices • InnovationModels • HealthEquity • HealthWorkforceIncentives • HealthHomes

12. Resourcesto Prevent Illness & KeepPeopleHealthy(cont’d) • Communitybenefitsaccountability • CommunityTransformationGrants • NationalPreventionStrategy

13. MoreSpending,LessHealth Prevention:3% Behaviors& Environment: 70% HealthCare Services: 97% Genetics:20% MedicalCare:10% NationalHealth Expenditures Factors InfluencingHealth References:BipartisanPolicyCenter.“Lots toLose:HowAmerica’s Healthand ObesityCrisis ThreatensourEconomicFuture.”June2012

15. Overview of Heath System Transformation Health Delivery System Transformation Critical Path Community Integrated Healthcare System 3.0 Community Integrated Healthcare Coordinated Seamless Healthcare System 2.0 Outcome Accountable Care Acute Care System 1.0 Episodic Non-Integrated Care • Healthy population centered • Population health focused strategies • Integrated networks linked to community resources capable of addressing psycho social/ economic needs • Population-based reimbursement • Learning organization capable of rapid deployment of best practices • Community health integrated • E-health and telehealth capable • Patient/person centered • Transparent cost and quality performance • Accountable provider networks designed around the patient • Shared financial risk • HIT integrated • Focus on care management and preventive care • Episodic health care • Lack integrated care networks • Lack quality and cost performance transparency • Poorly coordinate chronic care management Source: Neal Halfon, UCLA Center for Healthier Children, Families & Communities

16. Opportunities to Improve Population Health Through ACA Implementation • Integrate populationhealthintothe healthcare system • Elevate thepriorityfor primary preventionandhealthequity • Empower consumers & communitiesto improve healthoutcomes • Improvequalityandaccessvialanguage andculturalcompetence

17. Opportunities to Improve Population Health Through ACA Implementation (cont’d) • Bridge clinicalcareandcommunity healthinhealthhomes • Strengthenthesafetynettoalso serve theremaininguncovered • Increasecapacityandfix mal-distribution • of workforce • Incentivizeworkplacewellness

18. Opportunities to Improve Population Health Through ACA Implementation (cont’d) • Replicate CommunityTransformation Grants andInnovationModels • Communitybenefits forpopulation healthprograms

19. The Center for Medicare & Medicaid Innovation (the Innovation Center) with CMS supports the development and testing of innovative health care payment and service delivery models.

20. 2013

23. A Practical Playbook: Public Health and Primary Care Together

25. National Public Health Improvement Initiative The National Public Health Improvement Initiative (NPHII) provides support to health departments or their bona fide agents for •Accelerating public health accreditation readiness activities • Implementing performance and improvement management practices and systems • Implementing and sharing practice-based evidence

30. “Health Departments in a Brave New World” -Christopher Maylahn , David Fleming, Guthrie Birkhead (Prev Chronic Dis 2013)

31. Centers for Disease Control and Prevention 1600 Clifton Road NE, Atlanta, GA 30333 • Phone: 1-800-CDC-INFO (232-4636)/TTY: 1-888-232-6348 • E-mail: cdcinfo@cdc.gov Web: www.cdc.gov