Integrating Public Health into Health Care Reform

1. Integrating Public Health into Health Care Reform The Maine Experience Edward Miller VP for Health Promotion and Public Policy American Lung Assoc of New England

2. Health Care Reform vs Health Reform Making the health care system more accessible, efficient and effective is not sufficient to improve health status

3. Health Care Reform vs Health Reform Without continued public health success in disease prevention and health promotion, demand for medical care will always exceed supply

4. Health Care Reform vs Health Reform Preventing disease is not the same as health services designed to detect disease early

5. Health Care Reform vs Health Reform Without the significant impact of public health successes our health care system would already be bankrupt

6. Imagine the Cost of Health Care Today Without: • Reduced smoking rates • Drunk driving laws • Seat belts and air bags • Air quality improvements • Clean water • Improved workplace safety and health

7. Dirigo Health Reform Act 2005 • Dirigo Health Insurance • Maine Quality Forum • Advisory Council on Health Systems Development

8. Advisory Council on Health Systems Development • Develop and Monitor the State Health Plan • Set Capital Investment Fund Limit • Advise on Certificate of Need • Produce an Annual Cost Driver Report

9. State Health Plan Goal: “To make Maine the healthiest state in the United States” This required: • Creating a statewide public health system • Organizing public health interventions • Addressing social determinants of health • Assuring access to quality, affordable care

10. Public Health System • 8 Public Health Districts created • Private/public partnership with State Health Dept and community coalitions • State Health Dept. reorientation- personnel and funding • District health profiles created

11. Public Health System • First State Health Plan recommended creation of a statewide system • Three year stakeholder process with intense state and local involvement • Focus on essential public health functions

12. Public Health Interventions • Foundation is the Fund for a Healthy Maine- $18m from Tobacco Settlement • 10 yr old Statewide system of Healthy Maine Partnership

13. Public Health Interventions • Increasing connections between coalitions and health care system • Multi-source funding including local sources • Supporting a tobacco treatment system connected to health care system

14. Social Determinants • State Health Plan acknowledges the role of social determinants • Education-Statewide and Health District forums using PBS “Unnatural Causes” • District health profiles provide data

15. Social Determinants • Special studies eg Medicaid health profile • Dirigo law amended to require minority health expertise on the Council • Work within health districts to address local health disparities issues

16. Final Thoughts • Broadening the reform discussion beyond medical care is difficult but worth it • State government can collaborate and innovate but must be leaders • Public/private partnerships are essential

17. Final Thoughts • Legislator involvement critical • Public health successes are well kept secrets • Significant opportunities and benefits result • Governor’s support was vital