Integrating Public Health and Safety Net Care Healthcare Safety Net Initiatives: Policy and Performance Eduardo Sanchez, M.D., M.P.H. Director, Institute for Health Policy UT School of Public Health February 9, 2007

National Health Spending $6,697 per person per year National Health Spending In 2005: The Slowdown Continues Aaron Catlin, Cathy Cowan, Stephen Heffler, Benjamin Washington the National Health Expenditure Accounts Team In 2005, U.S. health care spending increased 6.9 percent to almost $2.0 trillion, or $6,697 per person. The health care portion of gross domestic product (GDP) was 16.0 percent, slightly higher than the 15.9 percent share in This third consecutive year of slower health spending growth was largely driven by prescription drug expenditures. Spending for hospital and physician and clinical services grew at similar rates as they did in Health Affairs, 26, no. 1 (2007): Health Affairs

The Price is Not Right U.S. Ranking: Health Care Spending1st Life Expectancy28 th In comparison of 6 similar countries* the U.S. ranked last in: Patient safety, efficiency, equity, and patient centeredness Source: The World Health Report 2003, Total Population at Birth. Commonwealth Fund studies, 2004, 2005 *Australia, Canada, Germany, New Zealand, U. Kingdom

Texas Perspectives #1 An aging population with increasing medical care costs An increasing Hispanic population An epidemic of obesity An explosion of type 2 diabetes

Texas Perspectives #2 A shortage of healthcare providers Wide, and in some cases, growing health disparities The challenge of improving health literacy The highest % of residents without health insurance

POPULATION HEALTH (Kindig and Stoddart, 2003) “the health outcomes of a group of individuals, including the distribution of such outcomes within the group” “the field of population health includes health outcomes, patterns of health determinants and interventions that link these two”

The role of government Public Health Medical Care Safety Net A shared responsibility – the notion of systems

PUBLIC HEALTH (Institute of Medicine, 1988) “What we, as a society, do collectively to assure the conditions in which people can be healthy” The means by which we achieve population health?

Spiral of Health Cost Increases with High Numbers of Uninsured Uninsured utilize higher than necessary levels of care More uninsured More employers drop coverage because of high premiums Insurance companies Raise premiums for insured Increased charges to paying customers Higher uncompensated costs

How can the spiral be interrupted? Reduce the number of uninsured –Increase numbers of eligible and enrolled in Medicaid/CHIP/state or local government programs –Make insurance more accessible/affordable Individually purchased Employer provided –Necessary but not sufficient

The Healthcare Equation is Out of Balance Demand Older Heavier More Sedentary Un & Underinsured Health Illiterate Supply Increasing Access Increasing Workforce System Redesign Improving Quality of Care Improving Technology Improving Meds Demand Reduction Is Imperative

How can the healthcare equation be balanced (the spiral be interrupted)? Improve population health –Traditional and chronic disease-focused public health –School-based health education and management –Worker health promotion (worksite wellness)

Supply Increasing Access Increasing Workforce System Redesign Improving Quality of Care Improving Technology Improving Meds Demand Reduction Is Imperative Health Promotion Health literacy initiativesHealth literacy initiatives Healthier lifestylesHealthier lifestyles Access to care (clinical preventive services)Access to care (clinical preventive services) The Healthcare Equation is Out of Balance

How can the healthcare equation be balanced ? Improve the health care delivery system –Invest in and connect to public health –Primary-care centered health system

Patient Centered Medical Home (mental/dental/medical) 1.Easy access 2.Continuity of care 3.Comprehensive care 4.Coordination of all care (Includes disease management ) Tobacco Prevention And Cessation Comprehensive School Heath Education Worker and Worksite Wellness Specialty Care Diagnostic Testing Hospital Based Care Inpatient Care Emergency and trauma care Primary-care Centered Health System Public Health Primary Care Specialty/Tertiary Care Medical Care Concept = Optimal Communication (Integrated Virtual System) Including best use of health informational technology

Conclusion: Policy and Performance Policy – a healthcare delivery system that integrates public health and medical care Performance measures –Population health status –Individual health status