Statewide Health Improvement Program (SHIP)

1. Statewide Health Improvement Program (SHIP) Minnesota Department of Health Cara McNulty, MS SHIP Manager Cara.McNulty@state.mn.us

2. Setting the Stage for SHIP • Health care costs increased 60% since 2000 in Minnesota • Minnesota’s historically strong private health insurance market has eroded, and % uninsured has risen • Quality of health care is unevenly distributed for different segments of the state and population • For many, quality is well below a level we should expect for the money we are spending • Rising rates of unhealthy behaviors (tobacco use, poor nutrition and physical inactivity) and prevalence of chronic illness • Chronic diseases are among the most prevalent, costly, and preventable of all health problems

3. Initial Legislation and Plan • In response to increasing rates of chronic disease and rising health care costs, legislation passed in 2007 called for creation of plan to fund and implement comprehensive statewide health improvement • Plan developed in consultation with State Community Health Services Advisory Committee (SCHSAC) and MDH Executive Office • Addresses risk factors for preventable deaths, decreased quality of life and financial costs from chronic diseases in four settings: • Community • Worksites • Schools • Health care • Incorporates expert knowledge from the state and local level • Based on federally funded Steps to a HealthierMN

4. Model for Statewide Health Improvement Community input into planning, implementation and evaluation Adherence to socio-ecological model Health promotion in four settings: community, schools, worksites, health care Local program advocates Informed by evidence-based interventions Focus on common risk factors Extensive and comprehensive evaluation linked to program planning Policy, systems, and environmental change that supports healthy behavior Accountability and oversight

5. The Process – Summer and Fall 2007 MDH developed plan for SHIP based on Steps to a HealthierMN model in Summer 2007 MDH Executive Office and advisory committee (SCHSAC) adopted plan Fall 2007 Plan presented to Governor’s Health Care Transformation Task Force and legislative committees including Health Care Access Committee Details of evidence, cost-effectiveness of prevention, and examples of state/local policies provided to committees Governor’s Task Force included plan in recommendations to Governor Pawlenty for health care reform Plan introduced by legislature as part of broader health reform bill

6. The Process – 2008 and 2009 2008 Minnesota State Legislative Session: Plan included in both House and Senate versions of health reform bill Public health element in addition to other reforms in: Health care coverage/affordability Chronic care management Payment reform and price/quality transparency Administrative efficiency Health care cost containment Signed into law May 2008 as part of health reform bill 2009 Minnesota State Legislative Session: Funding sustained by legislature Final budget completed by Governor Pawlenty on June 30, 2009

7. Description of SHIP Signed into law as integral public health component of Health Reform Initiative SHIP intended to reduce obesity and tobacco use in Minnesota through policy, systems, and environmental changes $47 million appropriated 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

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

9. SHIP Description Continued MDH will: • Set outcomes to support obesity and tobacco goals • Measure baseline status • Provide content expertise, technical expertise, and training • Conduct comprehensive biennial evaluation • Provide biennial reports to legislature

10. SHIP Internal Structure

11. SHIP Planning and Implementation • Workgroups began meeting in Fall 2008 • Involved key stakeholders such as local public health, tribal governments, CDC, and others including SCHSAC SHIP Ad Hoc Workgroup • Utilizing/modifying existing data collection, assessment, and reporting systems • Explicit guidance provided for implementing and evaluating evidence-based policy, systems, and environmental interventions to reduce obesity and tobacco use and exposure • Technical assistance and training opportunities previously offered and more under development • Internal and external communications put in place

12. Opportunities Building on existing prevention efforts to expand and not duplicate work that is already being done Enhancing capacity of local public health and tribal governments to implement policy, systems, and environmental changes Integrating with other Health Reform Initiative components to support overall health reform transformation Developing a statewide system to demonstrate that reductions in risk factors  decreases in chronic disease  substantial health care savings!

13. SHIP Applications and Grant Awards • Request for Proposals (RFP) released February 2009 • Applications due April 2009 • Applications received from all 53 CHBs and 8/11 tribes, including up to 14 counties collaborating on policy, systems, and environmental change • 39 grant awards made based on $47 million in funding • Grant agreements signed and rolled out July 2009

14. SHIP Next Steps Continue planning and implementation with our partners Provide technical assistance to grantees to ensure successful implementation Secure future funding 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 • Contact legislators and ask them to ask YOU to prepare a plan or report • Expect to work hard and quickly • Expect to partner with and incorporate input from stakeholders and experts at every stage (plan  program implementation  evaluation  reporting) • Expect multiple revisions of all documents

16. Lessons Learned, continued • Prepare for process with legislative committees, legislative session, and planning - Do not be discouraged • Allow sufficient time to plan for program implementation • Prepare high quality communications systems and materials (which require resources) to make sure interested parties can access information easily • Prepare sound justification for program ready to share with interested parties

17. QUESTIONS? Contact Information: Cara McNulty, MS Statewide Health Improvement Initiatives Manager Cara.mcnulty@health.state.mn.us (651) 201-5438 SHIP Website: http://www.health.state.mn.us/healthreform/ship.html SHIP Email: Health.ship@state.mn.us

18. Contact Information: Cara McNulty, MS Statewide Health Improvement Initiatives (SHIP) Manager Cara.mcnulty@health.state.mn.us (651) 201-5438 THANK YOU!