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Population Health in Nebraska: Why Now and Steps for Moving Forward

Population Health in Nebraska: Why Now and Steps for Moving Forward. Dave Palm College of Public Health Nebraska Rural Health Association Annual Conference September 19, 2018. Outline of Presentation. What is Population Health?. Views of Payers, Providers, and Public Health Professionals.

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Population Health in Nebraska: Why Now and Steps for Moving Forward

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  1. Population Health in Nebraska: Why Now and Steps for Moving Forward Dave Palm College of Public Health Nebraska Rural Health Association Annual Conference September 19, 2018

  2. Outline of Presentation

  3. What is Population Health?

  4. Views of Payers, Providers, and Public Health Professionals

  5. Public Health Perspective Continued

  6. Social Determinants of Health

  7. “Loneliness and isolation is as negative a health effect as heart disease or cancer.” - Dr. David Feinberg, CEO of Geisinger Health

  8. “If medical schools and residency programs are serious about burnout, they have to teach us about collective action – teach us to ask, what can we do? To fight burnout, we should never worry alone about the social determinants of health that patients face. To fight burnout, organize.” - Leo Eisenstein, “To Fight Burnout, Organize,”NEJM, August 9, 2018.

  9. Why Now??? • New goals for the health system – The Triple Aim • HCE are unsustainable • There are many drivers of change for both health care providers and public health officials • There is a growing recognition that better health outcomes involve improving individual care and creating a healthier environment in communities

  10. Triple Aim

  11. U. S. Spending by Disease Condition (2016 JAMA Study)

  12. Reducing Preventable Deaths The CDC reported that these percentages of all deaths are preventable: • 30% of heart disease deaths • 15% of cancer deaths • 43% of unintentional injuries • 36% of chronic lower respiratory disease • 28% of strokes

  13. Preventable Heart Disease Deaths, 2016

  14. Drivers of Change – Medical Care

  15. Drivers of Change – Public Health

  16. Challenges of Population Health • What populations should be targeted (broad versus narrow)? • What prevention/health promotion strategies and services should be emphasized? • What are the potential funding sources?

  17. Challenges Continued • The cultural divide between medical care and public health • individual treatment vs whole populations • Short-term vs long-term results • Shortages of medical and public health professionals • Difficult to share information • Willingness and ability to form collaborative partnerships

  18. Population Health and Care CoordinationExamples

  19. New Federal Programs and Policies

  20. State Level CMMI Projects

  21. Medicaid Reforms • Many examples of ACO value-based payment models • Support for providers that focus on the social determinants • Health Homes option under the ACA (21 states but not NE) • Nebraska requires MCOs to have staff trained on the social determinants and be familiar with community resources

  22. CDC Three Bucket Approach

  23. Bucket 1: Focus on Preventive care

  24. Indicators – The Clinical Components

  25. Bucket 2:Focus on Preventive Care

  26. To address asthma:

  27. Bucket 3: Focus on Preventive Care

  28. Nebraska Population Health Initiatives

  29. Highest Priorities: Small Rural Nonprofit Nebraska Hospitals

  30. Evaluating the CHNAs and IPs • Most nonprofit hospitals (70%) worked closely with their LHD and the priorities were consistent with the CHIP • Most of the CHNAs met the IRS requirements • Many IPs lacked specific action steps and did not identify the role of their partners • For this process to be effective, the hospital, the LHD, and other community partners need to develop a cohesive implementation strategy that includes performance measures to track progress

  31. Linkages between LHDs and Physician Clinics in Nebraska

  32. Linkages between LHDs and Physician Clinics

  33. Some Options for Sustainable Funding • Use some of the savings from keeping people healthy (e.g., diabetes and hypertension) and reallocate to prevention programs and addressing the social determinants of health • Between 2017 and 2021, CDC is projecting 11,900 preventable deaths in Nebraska at a cost of $800 million dollars • Better target community benefits spending - nonprofit hospitals in rural NE spent about $13 million on community health initiatives in 2014 • Encourage Medicaid and private insurers to fund promising care coordination projects and evaluate their outcomes

  34. Funding Options Continued:

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