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. U.S. Obesity Rates �

4. U.S. Obesity Rates

5. U.S. Obesity Rates

6. U.S. Obesity Rates

7. 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 -Legislation passed in the spring of 2007 called for the development of a plan for comprehensive statewide health promotion. -Staff from the Minnesota Department of Health developed this plan for statewide health promotion in consultation with our executive office and a SCHSAC ad hoc work group. Substance abuse was not included in legislation� -Summarize Steps to a HealthierMN -Legislation passed in the spring of 2007 called for the development of a plan for comprehensive statewide health promotion. -Staff from the Minnesota Department of Health developed this plan for statewide health promotion in consultation with our executive office and a SCHSAC ad hoc work group. Substance abuse was not included in legislation� -Summarize Steps to a HealthierMN

8. 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 -Model is based on Steps to a HealthierUS (a federally-funded health promotion program) and other sustainable programming principles. -Together, these nine components create a sustainable model for health promotion programs. -Community input and engagement is essential in all phases. -The model uses a population-based approach addressing each sphere of influence on individual behavior - individual, interpersonal, organizational, community and public policy. This ties directly with the focus on the four settings. -A local program advocate creates linkages within or between organizations and helps assess the needs and motivations of key stakeholders. -Evidence-based interventions as well as best and promising practices guide specific community level activities and effect change. -While the goals of existing programs are often specific to a particular chronic disease, the predominant risk factors for chronic diseases are the same: physical inactivity, poor nutrition, alcohol abuse and tobacco use. Therefore, primary prevention strategies across chronic diseases and levels of government should focus on these risk factors in the community, workplace, schools, and health care system. -Evaluation of the effectiveness and impact of programming creates accountability for adhering to performance measures. Evaluation results are used to modify programming when necessary. Core performance measures monitor all communities� progress toward the Plan�s common long-term outcomes. -As mentioned throughout the presentation, the Plan will focus on the policies and systems under which we operate and the environments in which we live. It will not focus on piecemeal interventions that have not proven to be effective. -Every program needs accountability and oversight. -Model is based on Steps to a HealthierUS (a federally-funded health promotion program) and other sustainable programming principles. -Together, these nine components create a sustainable model for health promotion programs. -Community input and engagement is essential in all phases. -The model uses a population-based approach addressing each sphere of influence on individual behavior - individual, interpersonal, organizational, community and public policy. This ties directly with the focus on the four settings. -A local program advocate creates linkages within or between organizations and helps assess the needs and motivations of key stakeholders. -Evidence-based interventions as well as best and promising practices guide specific community level activities and effect change. -While the goals of existing programs are often specific to a particular chronic disease, the predominant risk factors for chronic diseases are the same: physical inactivity, poor nutrition, alcohol abuse and tobacco use. Therefore, primary prevention strategies across chronic diseases and levels of government should focus on these risk factors in the community, workplace, schools, and health care system. -Evaluation of the effectiveness and impact of programming creates accountability for adhering to performance measures. Evaluation results are used to modify programming when necessary. Core performance measures monitor all communities� progress toward the Plan�s common long-term outcomes. -As mentioned throughout the presentation, the Plan will focus on the policies and systems under which we operate and the environments in which we live. It will not focus on piecemeal interventions that have not proven to be effective. -Every program needs accountability and oversight.

9. 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

10. 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

11. 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

12. 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

13. 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

14. SHIP Internal Structure Intervention: To plan, develop and maintain a menu of evidence-based interventions in the area of tobacco and obesity (including physical activity and nutrition) for use by Community Health Boards and Tribal Governments during SHIP implementation. In addition, this work group will provide expertise on planning, implementation and assessment of policy and environmental changes at the community level. Evaluation and Data Collection: To plan, develop, implement and oversee the SHIP data collection and evaluation plan components for purposes of assessment and reporting. Technical Assistance: Plan, develop and oversee the implementation and assessment of a system to offer technical assistance to Community Health Boards and Tribal Governments during the proposal writing as well as the community assessment, implementation, evaluation and reporting phases of SHIP. Communications: Plan, develop and oversee the implementation and assessment of the SHIP communications plan, including internal and external communications. RFP: Oversee the development of a request for proposal for SHIP funding to which Community Health Boards and Tribal Governments will apply, including guidelines for review of the proposals. This work group will also assist in the review of the received proposals. Risk Factor & Chronic Disease Integration: Provide expertise in risk factors and chronic diseases not directly addressed by SHIP (e.g. cancer, cardiovascular health, etc.) to ensure that SHIP interventions are beneficial to the reduction of other chronic diseases. Intervention: To plan, develop and maintain a menu of evidence-based interventions in the area of tobacco and obesity (including physical activity and nutrition) for use by Community Health Boards and Tribal Governments during SHIP implementation. In addition, this work group will provide expertise on planning, implementation and assessment of policy and environmental changes at the community level. Evaluation and Data Collection: To plan, develop, implement and oversee the SHIP data collection and evaluation plan components for purposes of assessment and reporting. Technical Assistance: Plan, develop and oversee the implementation and assessment of a system to offer technical assistance to Community Health Boards and Tribal Governments during the proposal writing as well as the community assessment, implementation, evaluation and reporting phases of SHIP. Communications: Plan, develop and oversee the implementation and assessment of the SHIP communications plan, including internal and external communications. RFP: Oversee the development of a request for proposal for SHIP funding to which Community Health Boards and Tribal Governments will apply, including guidelines for review of the proposals. This work group will also assist in the review of the received proposals. Risk Factor & Chronic Disease Integration: Provide expertise in risk factors and chronic diseases not directly addressed by SHIP (e.g. cancer, cardiovascular health, etc.) to ensure that SHIP interventions are beneficial to the reduction of other chronic diseases.

15. 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

16. 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!

17. 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

18. SHIP Next Steps Continue planning and implementation with our partners Award funds to roll out July 2009 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

19. QUESTIONS? SHIP Website: http://www.health.state.mn.us/healthreform/ship.html

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