National Perspective on Changes Impacting the Public Health System Judith A. Monroe, MD Director, Office for State, Tribal, Local and Territorial Support Deputy Director, Centers for Disease Control and Prevention 2014 North Carolina State Health Director’s Conference Raleigh, NC January 23, 2014

CDC Strategic Directions Improve health security at home and around the world Better prevent the leading causes of illness, injury, disability, and death Strengthen public health/ health care collaboration

Key Features of Affordable Care Act

“Simply put, in the absence of a radical shift towards prevention and public health, we will not be successful in containing medical costs or improving the health of the American people.” - President Obama

“…health strategies, interventions, and policies applied at the population level can advance current approaches to our nation’s most pressing health concerns more efficiently and effectively than can isolated, intensive individual-level actions within the clinical care sector.” -Institute of Medicine

IOM Activities with Implications for Population Health in the ACA Primary Care and Public Health: Exploring Integration to Improve Population Health Valuing Community-based, Non-clinical Prevention Policies and Wellness Strategies For the Public’s Health: The Role of Measurement in Action and Accountability The Best Care at Lower Cost: The Path to Continuous Learning Health Care in America Roundtable on Health Literacy

IOM Activities with Implications for Population Health in the ACA (cont’d) Quality Measures for the Healthy People Leading Health Indicators Living Well with Chronic Disease: Public Health Action to Reduce Disability and Improve Functioning and Quality of Life Roundtable on the Promotion of Health Equity and the Elimination of Health Disparities

Expanded Insurance Coverage Prevention Services Innovation Models Health Equity Health Workforce Incentives Health Homes Resources to Prevent Illness & Keep People Healthy

Resources to Prevent Illness & Keep People Healthy (cont’d) Community benefits accountability Community Transformation Grants National Prevention Strategy

More Spending, Less Health Genetics: 20% Medical Care: 10% Behaviors & Environment: 70% Prevention: 3% Health Care Services: 97% Factors Influencing Health National Health Expenditures References: Bipartisan Policy Center. “Lots to Lose: How America’s Health and Obesity Crisis Threatens our Economic Future.” June 2012

Overview of Heath System Transformation Health Delivery System Transformation Critical Path Episodic Non-Integrated Care Acute Care System 1.0  Episodic health care  Lack integrated care networks  Lack quality and cost performance transparency  Poorly coordinate chronic care management Outcome Accountable Care Coordinated Seamless Healthcare System 2.0  Patient/person centered  Transparent cost and quality performance  Accountable provider networks designed around the patient  Shared financial risk  HIT integrated  Focus on care management and preventive care Community Integrated Healthcare Community Integrated Healthcare System 3.0  Healthy population centered  Population health focused strategies  Integrated networks linked to community resources capable of addressing psycho social/ economic needs  Population-based reimbursement  Learning organization capable of rapid deployment of best practices  Community health integrated  E-health and telehealth capable Source: Neal Halfon, UCLA Center for Healthier Children, Families & Communities

Integrate population health into the healthcare system Elevate the priority for primary prevention and health equity Empower consumers & communities to improve health outcomes Improve quality and access via language and cultural competence Opportunities to Improve Population Health Through ACA Implementation

Bridge clinical care and community health in health homes Strengthen the safety net to also serve the remaining uncovered Increase capacity and fix mal-distribution of workforce Incentivize workplace wellness Opportunities to Improve Population Health Through ACA Implementation (cont’d)

Replicate Community Transformation Grants and Innovation Models Community benefits for population health programs Opportunities to Improve Population Health Through ACA Implementation (cont’d)

The Center for Medicare & Medicaid Innovation (the Innovation Center) with CMS supports the development and testing of innovative health care payment and service delivery models.

2013

A Practical Playbook: Public Health and Primary Care Together

National Public Health Improvement Initiative The National Public Health Improvement Initiative (NPHII) provides support to health departments or their bona fide agents for Accelerating public health accreditation readiness activities Implementing performance and improvement management practices and systems Implementing and sharing practice-based evidence

“Health Departments in a Brave New World” -Christopher Maylahn, David Fleming, Guthrie Birkhead (Prev Chronic Dis 2013) “Health Departments in a Brave New World” -Christopher Maylahn, David Fleming, Guthrie Birkhead (Prev Chronic Dis 2013)

Centers for Disease Control and Prevention 1600 Clifton Road NE, Atlanta, GA Phone: CDC-INFO ( )/TTY: Web: