This document provides an overview of a practical playbook for making connections between public health and primary care to address obesity. It discusses recognizing best practices for clinical and community integration and identifying opportunities to connect patients with community resources. The document outlines the ACA's impacts on healthcare and Medicaid coverage in Illinois. It presents frameworks for integrated clinical and community systems of care and provides resources and success stories for collaboration between sectors.
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Practical Playbook: Making the Connection Between Public Health and Primary Care
1. Practical Playbook: Making the
Connection between Public Health
and Primary Care
Illinois Alliance to Prevent Obesity
September 17, 2015
Lloyd Michener, MD
Don Bradley, MD, MHS-CL
Duke Medicine
2. Objectives
• Recognize or cite the best practices of clinical
and community integration
• Describe how to use the Practical Playbook in
clinical and community settings
• Identify opportunities to connect patients
with community resources to address adult
and childhood obesity.
Duke Medicine
3. Take home messages
• Health, healthcare, and health insurance are
not synonymous
• Coverage for obesity-related services varies by
state and by health plan
• Disconnects and controversy: policies, politics,
effectiveness and efficiency
• An integrated, collaborative approach is most
likely to succeed, and will take time,
persistence, and patience
Duke Medicine
5. ACA healthcare impacts
• Essential Health Benefits determined by state
(including coverage for bariatric surgery, obesity meds)
• Coverage for USPSTF level A or B services with no out
of pocket costs (including counselling for obesity)
• Whether Medicaid expanded or not, Disproportionate
Share Hospital (DSH) payments reduced
• Community Health Benefit Program for not-for-profit
hospitals (including CHNA and support)
• CMMI and incentives and pilots for value-based care
(including Accountable Care Organizations)
Duke Medicine
6. Illinois Medicaid/CHIP
• Illinois expanded Medicaid with the ACA
• Over 2/3 covered by Managed Medicaid plans
• Over 3 million enrollees
• Enrollment up over 500K (19.2%) from July
2013
http://www.medicaid.gov/medicaid-chip-program-information/by-
state/illinois.html , accessed 09/01/2015
Duke Medicine
10. Inside the mind of a payer:
10 key determinants of coverage
1. Customer demand/preference for a benefit/service
2. Cost (as low as possible, predictable)
3. Evidence for effectiveness and efficiency
4. Deliverable quality outcomes (especially NCQA
metrics)
5. Network for delivery
6. Customer satisfaction/experience
7. Ease of administration
8. Compliance
9. Risk (legal, financial, regulatory, public relations,
network)
10. Profitability/margin
Duke Medicine
11. Cost-effectiveness results for selected interventions
evaluated in Australia
Lancet Volume 378, No. 9793, p838–847, 27 August 2011 Duke Medicine
12. Framework for Integrated Clinical and Community Systems of Care
Care Delivery
•Information Systems
•Decision Support
•Delivery System Design
•Self Management Support
•Local Patient Environment
•Clinicians
Community
Systems
Equity
Training &
Education
Metrics
Integration
Convener, Advocacy, Data Exchange, Financing, Governance/Regulation, Referral
Processes, Communication
Family & Individual
Empowerment and Engagement
Population Health
•Resources
•Services
•Supportive
Environment
•Social Norms
IOM Roundtable for Obesity
Solutions, 2015
Duke Medicine
15. The Eight “Easy” Steps
For Community Health Improvement
1. Getting Things Started
2. Building a Case
3. Gathering Allies
4. Identifying Stakeholders
5. Walking a Mile in Someone Else’s Shoes
6. Creating a Compelling Vision
7. Developing a Strategy
8. Communicating Your Vision and Mission
16. 1. Getting Things Started
Resources
• Robert Wood Johnson Foundation
17. 2. Building a Case
Resources
• Practical Playbook: Finding data
• The Community Tool Box: Analyzing Problems and Goals toolkit
18. Success stories
& lessons
learned
Focus- childhood obesity
Initiation- Physical Education teacher began BMI screening in her school
district (2010)- 40% of children with an unhealthy weight
Partners-
• LJ Rice Elementary School
• Scripps Family Medicine Residency
• San Diego Healthy Weight Collaborative
o Public health
o Primary care
o Local government
o Neighborhood organizations
Intervention- 5-2-1-0
https://www.practicalplaybook.org/success-story/collaboration-jumpstarts-healthy-habits-chula-
vista-students-and-families , accessed 09/01/2015
19. Your turn:
How have you used data to drive
collaboration between the community
and clinical settings?
What data did you collect and how did
you use it to make the case?
22. Success stories
& lessons
learned
Advocates for Healthy Youth (AFHY) Coalition
Focus- Integrating medical, public health, and community efforts to
address child obesity
Initiation- Pediatrician at Cheshire Medical Center reached out to
her health system Department of Community Health, which
connected to community partners
Partners-
• Cheshire Medical Center (CMC) [primary care]
• CMC Community Health Department [health system]
• Local school district & colleges
• City government
• Public health
• YMCA
• Community Mental Health
Intervention- 5-2-1-0
http://citizenshealthinitiative.org/sites/citizenshealthinitiative.org/files/media/2010/Ad
vocatesforHealthyYouthCoalitionSummary.pdf , accessed 09/01/2015
23. Your turn:
What issues have you found in
engaging the community?
What tactics have you found to be
useful in communicating and engaging
with the community?
25. Take home messages
• Health, healthcare, and health insurance
are not synonymous
• Coverage for obesity-related services
varies by state and by health plan
• Disconnects and controversy: policies,
politics, effectiveness and efficiency
• An integrated, collaborative approach is
most likely to succeed, and will take time,
persistence, and patience
Duke Medicine
The Practical Playbook is built for a variety of audiences – individuals who have not worked together in the past or don’t have an understanding of the value of working with partners to improve community health; those who are interested in starting to work with partners; and those who are already working with partners.
The Practical Playbook is divided into three main portals –
Learn: Learning about the value of working together and the principles of integration;
Do: For those who are interested in starting a project or moving their project forward with tools and resources
Share: For those who are interested in learning from what others are doing.
We realize that there’s an artificiality about doing this in less than a day—our emphasis, thus, is not on completeness or exacting details. There is no right answer. It’s about working with others to come to an approach. It should be about having fun.
Background: 40% kids at unhealthy weight
Lessons learned:
1. Forming a sustainable team required aligning leadership and sharing resources
2. Testing campaigns on a small scale before wider dissemination ensured acceptability
5- fruits/veges per day
2- no more than 2 hours screen time
1- hour activity per day
0- sugary drinks
lessons learned;
Start-
1. Start with interests of coalition members
2. Identify skills and resources of members of the coalition
3. Find an organizational home
4. Pay attention to management of the coalition
Implementation-
Use a strategic planning process
2. Expect some ebb & flow
3. Diversify activities
Start small and ramp up
Don’t reinvent the wheel
Change is incremental
Maintaining and sustaining-
Train the trainer
Develop a sustainability plan
Show value for coalition members to maintain interest