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Public Health & Healthcare Transformation. Patrick F. Luedtke , MD, MPH Senior Public Health Officer Medical Director, Community & Behavioral Health clinics Lane County Health & Human Services. Lane County Health & Human Services.
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Public Health & Healthcare Transformation Patrick F. Luedtke, MD, MPH Senior Public Health Officer Medical Director, Community & Behavioral Health clinics Lane CountyHealth & Human Services
Lane County Health & Human Services 1) Includes 4 FQHC clinics, Public Health, the County Mental Health clinic, & the Behavioral health system payer 2) I serve as the County Public Health Officer (50%) and the Medical Director of the FQHC clinics (50%) 3) I also serve on the CCO Board, the CAP, and on two CCO subcommittees (PCMH & Quality) 4.) Other H&HS employees serve on CCO Board & committees
Lane County: The View From Space • CCO: ~74,000 lives, Board of 21, Prevention funding of $1.33 per member per month • Public Health • Clinical: MCH, WIC, Prevention, Communicable Dz • Non-clinical: Environmental Health, Vital Records, Preparedness • Other: PH/MH authority, “soft power” convening authority (e.g., STD Summit)
PH-PC: Integration and Reverse Integration • Community Health Needs Assessments • Community Health Improvement Plans • Health equity & Public Health equity initiatives • Tracking health and process outcomes (e.g., patient safety, patient experience, care coordination, CHWs) • Create & implement community-based prevention guidelines (e.g., tobacco, obesity, vaccination rates) • Community initiatives based on claims data (e.g., tobacco use in pregnant women)
Specific Lane County Projects 1.) Tobacco use in pregnant women 2.) Falling immunization rates (AFIX program) 3.) The Good Behavior Game (lower drug/alcohol use disorders, smoking, antisocial PD, suicidal ideation, delinquency, incarceration)
Tobacco Cessation Incentive Program Nicotine testing & incentive $$ for pregnant smokers • Vital statistics birth data review. • Federally qualified health centers pregnant patient chart review. • Public Health (PH) “We have too many preemies and pre-term labor cases.” Obstetrics/Gynecology (OB/GYN) Claims data review for preemie/pre-term labor costs. (CCO) PH-PCP-OB/GYN steering committee “All my pregnant patients smoke!” Primary Care Physicians (PCP)
Smoking in Pregnancy Data Source: Oregon Health Authority
Lane County: Smoking in Pregnancy NOTE: Survey of current use rates: FQHC, PeaceHealth hospitals/clinics, Douglas county. Data Source: Lane County Vital Statistics: 2009
Clinical Expectations • Prenatal smoking is associated with: • 30% of small for gestational age (SGA) infants • 10% of preterm infants • 5% of infant deaths* • Expected quit rate, without incentives is ~37%** • Decreased ear infections and asthma attacks in child *MMWR 58(ss04);1-29 May 26, 2009 ** PRAMS 2005
Medicaid Savings • Preventing 1 SGA birth = $45,000 savings • $1 spent on cessation = $3.50 in neonatal savings Data Source: CDC, Smoking-Attributable Mortality, Morbidity, and Economic Costs (SAMMEC)
Fiscal Data Monetary goal: 10% cost reduction/yr (ROI = 7.6)
Tobacco Cessation Incentive Program • Program goal: Tobacco cessation in 30% of program participants • Participation goal: 80% of pregnant Medicaid patients
