Accountable Health Organizations: Harnessing the Potential of Healthy Communities Healthy Communities: The Intersection

1. Accountable Health Organizations: Harnessing the Potential of Healthy Communities Healthy Communities: The Intersection of Community Development and Health Eduardo Sanchez, MD,MPH,FAAFP Vice President and Chief Medical Officer Blue Cross and Blue Shield of Texas September 28, 2011

2. What we are facing • Poor health status nationally – getting worse • High medical care costs nationally – increasing • Slipping competitiveness globally

3. What we know • A healthy workforce = higher productivity + lower medical costs • Fit kids = smart kids • Higher educational attainment= better health + higher income + higher likelihood of health insurance

4. What Drives Health Status and Health Care Costs? How Can We Encourage and Support Behavior Change? Source: IFTF and Center for Disease Control and Prevention, Health and Healthcare 2010, January 2000 4

5. Relationship between Social Determinants and Mortality in 2000 AJPH

6. Place Matters Determinant of Diabetes? Persons living in low-income communities are 80% more likely to be hospitalized for diabetes or related complications compared with those living in affluent areas. Source: AHRQ

7. Personal Choice or Healthy Food Accessibility? Low income areas have 1/3 fewer grocery stores than higher income neighborhoods. Corner stores and gas stations typically charge 1½ times the price of similar items in grocery stores. Not having automobile or adequate public transportation can reduce access to affordable, healthy food. Less expensive foods are often high in calories and fat. Limited time and knowledge of food preparation can increase demand and consumption of prepackaged or processed foods. Community Health and Food Access: The Local Government Role; http://icma.org/activeliving

8. National High School Graduation Rates, 2003-04 80.2% 76.2% 57.8% 53.4% 49.3% NativeAmerican Black White Latino Asian Cities in Crisis, EPE Research Center, 2008

9. Healthy Behavior Eating smart Being active Maintain healthy weight Avoid tobacco Measures of Health Healthy weight Healthy lipid profile Normal blood sugar Avoid tobacco Healthy people do healthy things

10. Healthy communities have the elements that enable healthy people • Health Promoting Factors • Accessible, affordable food • Supermarkets • Gardens and farmer’s markets • Accessible, affordable venues for activity • Safe, lighted sidewalks • Dual use schools • Parks • Fitness/Recreation Centers

11. Approaches to prevent childhood obesity Food environment Raise awareness Increase consumption of healthful food Decrease consumption of less healthy food Built environment Raise awareness Increase physical activity Decrease screen time

12. Healthy communities have the elements that enable healthy people • Health Promoting Factors (cont.) • Safe, healthy academically strong schools • Wellness supporting workplaces - jobs • Accessible, affordable primary care (medical home) • Access to “public health” services

13. Community Development • Retail • Incentives for supermarkets, fitness centers etc. • Housing • Locate in a healthy community or one that wants to be • Lighting, sidewalks, fitness • Roads – transportation • Safe streets for walking and bicycles • Rationalized mass transit • Parks and recreation • Accessible, safe • Health system – public health, medical care, health plans

14. Community Development • Health system • Medical Care • Locate “medical homes” in a healthy community • Small or not so small business – Employer • “Public health” services • Compliment medical care • Jobs and services • Food safety – retail and restaurants • Disease surveillance and control

15. The Role of Health Plans • Support evidence-based policy changes • Indoor smoking laws • Coordinated school health • Workplace wellness • PCMH (patient-centered medical home) • Systems thinking – nonclinical opportunities • Wagner’s “chronic care model” – community engagement • ACO (accountable care organization) • Systems thinking – nonclinical components • Public health (population health) consideration

16. The Role of Health Plans • Charitable contributions (BCBSTX) • CASA • CareVan • MarathonKids • American Heart Association • Organwise Guys • Kaboom • Individual level incentives (BCBSTX) • Tobacco surcharge/NRT (nicotine replacement therapy) • Fitness centers membership card • Blue Points • Metabolic syndrome program

17. The US Health Care System? “an expensive plethora of uncoordinated, unlinked, economically segregated, operationally limited microsystems each performing in ways that too often lead to suboptimal performance” (Halvorson, 2007)

18. Achieving Health Equity will RequireNon-Clinical Strategies Improve coordination of relevant agencies and organizations whose activities address determinants of health (education, housing, agriculture, employment, health) Finding ways to increase the availability of healthy, affordable food in underserved communities (encouraging major grocery chains and farmers’ markets to locate insuch communities) Promoting community-level interventions for health promotion (tobacco control programs and exercise initiatives) School-based strategies to improve graduation rates and reverse obesity trends (Smedley, Health Affairs)

19. PETE supports keeping Humpty from having a great fall

20. Accountable Health Organizations (AHOs) Manages the “Investment in Health” portfolio for a community – Health in All Policies The set of retail, public, social, health (including medical care) services associated with a defined population - accountable for the health status and outcomes for that population. The providers of services could include a local health department, health plans, employers, primary care providers, specialists, and other health and non-health professionals who share responsibility for the quality and cost of services provided to individuals and communities and for maximizing individual and community health. Attribution methodologies for accountability (credit for contribution to health and charges to fund and sustain the system). Makes money by achieving highest health status (= economic competitiveness)

21. The Accountable Health Organization to get to A Healthy Community