Aging & Public Health: The Case for Working Together Wisconsin Institute for Healthy Aging Learning Forum Karen Timberlake, Director UW Population Health Institute June 13, 2016

Overview What’s the case for collaboration between Public Health and Aging? What makes collaboration difficult? What are some current trends and opportunities? Putting a stake in the ground – vision and leadership

What Is “Health?” Health is a state of complete physical, mental and social well- being and not merely the absence of disease or infirmity. -World Health Organization, 1948

What is “Population Health”? We propose that the definition [of population health] be “the health outcomes of a group of individuals, including the distribution of such outcomes within the group,” and we argue that the field of population health includes health outcomes, patterns of health determinants, and policies and interventions that link these two. What Is Population Health? American Journal of Public Health March 2003: Vol. 93, No. 3, pp doi: /AJPH

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The Case for Collaboration Shared: Goals Populations Communities Resource limitations Desired partners

The Case for Collaboration Shared: Goals Longer, healthier lives for all Better health with less disparity Health as a value and a guiding principle in public and private sector decision making Populations Communities Resource limitations Desired partners

The Case for Collaboration Shared: Goals Populations A life-course perspective Focus on vulnerable populations Communities Resource limitations Desired partners

The Case for Collaboration Shared: Goals Populations Communities Resource limitations Desired partners Federal, state, local government Business Health care

The Barriers to Collaboration

Different theories of change? Resources – perceived scarcity, categorical funds Program-centered rather than person- centered Turf: Expertise, Ownership

Opportunities to Repurpose Silos: What Chronic disease prevention and health promotion Health care transformation Health equity Building healthy places/aging in place Social and economic determinants, especially poverty

Opportunities to Repurpose Silos: Who and How Engaging health care providers and payers Hospital CHNAs and Local Public Health CHIPs Medicaid and Medicare delivery and payment innovations Healthy community development Local government comprehensive plans, Health [and Healthy Aging] in All Policies

Adults, 18-64, with Diabetes and HTN or Depression in WI  Have health insurance  Have a usual source of care  4X as likely to report fair/poor health  More than half are on more than 9 medications  Rates of ED use are 5X higher  Smoke at rates that are more than double the general Wisconsin population 16

Key Findings continued…  Significantly lower rates of physical activity  Nearly double/more than double rates of unemployment  Significant disparities in educational attainment  Selected populations have significantly lower self-reported levels of drinking 17 SHIP Final Report:

Health and Healthcare Transformation Strategic Focus Areas 1.Improve People’s Active Participation in their Health and Healthcare Patient Activation Measure Motivational interviewing Chronic disease self-management classes Chronic disease self-management classes 2.Expand Primary Care and Behavioral Health Integration 18

Health and Healthcare Transformation Strategic Focus Areas 3.Improve Connections For People Between Clinic and Community/Social Resources Comprehensive diabetes prevention strategies should be expanded public health departmentsarea agencies on aging Partnerships between clinical and local community organizations, e.g., public health departments, community action agencies, and area agencies on aging, allow for more comprehensive support to help address social determinants that can contribute to poor health 4.Reduce Disparities Linked to Poor Health and Healthcare Outcomes SHIP Final Report: 19

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CMS, Other Payers Continue Transition to Value 21

CMS, Other Payers Continue Transition to Value ACO Measures With Relevance for Public Health and Healthy Aging Hospitals: All cause readmission SNFs: All cause readmission All cause unplanned admissions (overall, and for various chronic conditions) Ambulatory sensitive admissions Falls screening 22

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SO NOW WHAT?

So Now What? What’s the problem you’re trying to solve? Where are you today? Where do you want to be? What’s keeping you from getting there? Why? Why? Etc. What could you do to address the root causes of barriers to progress? Who else needs to be involved in answering the above questions? Who will convene the process that addresses them? How can Public Health and Aging collaborate and take these steps together, with partners?

A Vision For Your Community?

Can You Be the Leaders Who Move This Work Forward? 1. “Get on the balcony” or “sit a few rows back” 2. Identify the challenge 3. Regulate distress 4. Maintain disciplined attention 5. Give the work back to people Adapted from Heifetz and Laurie, “The Work of Leadership,” Harvard Business Review, December 2001

Channeling Change: Making Collective Impact Work, By Fay Hanleybrown, John Kania, & Mark Kramer Stanford Social Innovation Review, 2012,

Thank You!