SHIP: Health Reform through Health Improvement CDC - DNPAO Policy Webinar Series:

1. SHIP: Health Reform through Health Improvement CDC - DNPAO Policy Webinar Series: Informing the Development of Policies to Address Obesity August 12, 2010

2. Overview • Development • Activities • Lessons learned

3. SHIP: Statewide Health Improvement Program • What is SHIP? • SHIP, an integral part of Minnesota’s 2008 health reform law, strives to help Minnesotans lead longer, healthier lives by reducing the chronic diseases caused by tobacco use and exposure, poor nutrition and physical inactivity.

4. SHIP Development • History • 2007 Legislation for statewide health improvement • Establishes and funds a Statewide Health Improvement Program (SHIP) • Part of comprehensive health reform package • Governor Pawlenty signed health reform bill into law May 2008

5. SHIP Development • History • $47 million appropriated for SHIP for fiscal years 2010 and 2011 • Competitive grants to Community Health Boards and Tribal Governments rolled out beginning July 1, 2009 • SHIP funding will not supplant other funds

6. SHIP Development • Foundation • Steps to a HealthierMN • Four cities • Minnesota Obesity Plan 2008-2013 • Comprehensive plan • Emphasizes policy, systems and environmental change • NPAO grant 2008 • Grant funded staff helped design SHIP • Offering technical assistance

7. The model Community input into planning, implementation and evaluation Adherence to socio-ecological model Policy, systems, and environmental change Informed by evidence-based interventions Focus on common risk factors SHIP Development

8. The model Health promotion in four settings Community/Worksites Schools/Health care Comprehensive evaluation linked to program planning Accountability and oversight Local program advocates SHIP Development

9. Program Description • Community Health Boards and Tribal Governments required to: • Match 10% of funding • Submit community action plans, establish partnerships, and develop community leadership team • Develop policy, systems, and environmental changes in four settings • Work with MDH to evaluate programs

10. Program Description • MDH required to: • Set outcomes to support obesity and tobacco goals • Measure current status (baseline) • Provide content expertise, technical expertise, and training • Conduct comprehensive biennial evaluation • Provide biennial reports to legislature

11. Program Description • Menu of Interventions • Address three risk factors (tobacco, physical activity, nutrition) • Occur in four settings (school, community, worksite or health care) • Population-based versus individual-based • Emphasize prevention versus individual treatment • Address policy, systems, or environmental change • Evidence-based or practice-based • Have associated evaluation outcomes

12. Map of SHIP Grantees July 2009 awarded 40 grants – covers all 87 MN counties and 8 tribes • Tribal Grantees • = lead agency • *Leech Lake with Partners: Mille Lacs, Bois Forte, Grand Portage, Red Lake, White Earth, Fond du Lac • *Upper Sioux Multi-Grantee Interventions * = lead agency *Minnapolis ewith partners: Hennepin County, Bloomington, Edina, Richfield *Otter Tail with partners: Clay-Wilkin , Becker, Douglas, Mid-State (Grant, Stevens, Traverse, Pope)

13. Implementation of SHIP • Interventions and the number of grantees implementing As of 7/01/2010

14. SHIP Next Steps • Continue planning and implementation with our partners • Provide technical assistance to grantees to ensure successful implementation and evaluation of our results • Secure future funding beyond 2011 to achieve goals of reducing obesity and tobacco use and exposure in Minnesota • Reduce the burden of chronic disease to generate future health care-related cost savings

15. Lessons learned: Obstacles • State budget shortfalls • Taking a long-term view a challenge • Skepticism about prevention • Belief that prevention simply doesn’t work, that there will be no savings to look forward to • No funds were provided for planning • Design and implementation of SHIP involved approximately 135 MDH staff, about 10% of the entire MDH workforce • CDC allowed Steps staff to plan for SHIP

16. Overcoming the Obstacles • Starting point • Full support from the Commissioner of Health • Support from the Governor • Via • SHIP as part of Minnesota's Health Reform Initiative --One solution to rising healthcare costs

17. Overcoming the Obstacles • Focus on our strengths • Reliable data, trusted research • Pick the right interventions • Well-proven, evidence-based • Demonstrate success • Experience with the Steps to a HealthierMN model • Emphasis on local control

18. Overcoming the Obstacles • Input from outside of MDH • State Community Health Services Advisory Committee (SCHSAC) • Steps State Leadership Team • CDC

19. Overcoming the Obstacles • Support from key stakeholders • Blue Cross Blue Shield of Minnesota • Local Public Health Association • MN’s Business Community • CDC • Support from key legislators

20. What We Learned • Language matters • Hearing concrete evidence of community readiness for SHIP was important to decision-makers • Health improvement champions cannot back down - Reframe the message • Public-private partnerships are critical • Data can drive decision-making

21. Questions? Martha Roberts Martha.roberts@state.mn.us SHIP Website: http://www.health.state.mn.us/healthreform/ship Minnesota Physical Activity and Nutrition Program http://www.health.state.mn.us/mnpan