Improving Health Through Policy Adam Zolotor, MD, DrPH, President & CEO 12/9/2015 Presented to Care Share Health Alliance: Healthy Carolinians webinar series

North Carolina Institute of Medicine Quasi-state agency chartered in 1983 by the NC General Assembly to: – Be concerned with the health of the people of North Carolina – Monitor and study health matters – Respond authoritatively when found advisable – Respond to requests from outside sources for analysis and advice when this will aid in forming a basis for health policy decisions NCGS §90-470

Two primary vehicles Task Forces North Carolina Medical Journal 3

Secondary vehicles Positioning as experts in state health policy Serve as a resource to members of NCGA, Executive Agencies, local health departments, etc. Serve as a resource and repository for information about health and health policy to advocacy groups, academics, professional groups. Respond to requests for information from media 4

NCIOM Task Force Studies NCIOM studies issues at the request of: ▫North Carolina General Assembly (NCGA) ▫North Carolina state agencies ▫North Carolina foundations ▫Health professional organizations ▫Other nonprofit organizations ▫NCIOM Board Often work in collaboration with other organizations to study health issues 5

Task Force Process NCIOM creates broad-based task forces to study health issues facing the state ▫Task Forces are guided by co-chairs who run the meetings ▫Task Forces generally comprised of between people, who are broadly representative of stakeholder groups and other interested people  Task Force members typically include representatives of state and local policy makers and agency officials, health professionals, insurers, business, faith, and community leaders, consumers and other interested individuals ▫Work often guided by a smaller steering committee ▫Meetings are open to the public 6

Using Research to Inform Policy NCIOM staff and other task force experts identify and synthesize relevant research ▫Studies focus on identifying “evidence-based” and evidence informed or “promising” policies, programs and practices ▫Information used to inform the task force deliberation process Task Force uses the information to shape policy and programmatic recommendations 7

Implementation of Task Force Recommendations Task Force recommendations aimed at: ▫Policy makers (legislature, state and local agencies) ▫Health care professionals ▫Others, including: educational institutions businesses, and the faith community Between 50-90% of task force recommendations are implemented, in whole or in part, within 3-5 years of release of the report 8

Recently Completed Studies Patient and Family Engagement (Done in partnership with the NCQC, NCMS, CCNC, and FNE, funded by the Duke Endowment, published March 2015). Essentials for Childhood: Safe Stable and Nurturing Relationships and Environments to Prevent Maltreat- ment (Done in partnership with DHHS and funded by the CDC, published March, 2015) Rural Health Action Plan (Done in partnership with ORHCC and funded by Kate B. Reynolds Trust, published August 2014). 9

Recently Completed Studies Early Childhood Obesity Prevention (at the request of and funded by the Blue Cross and Blue Shield of North Carolina Foundation. In collaboration with the NC Partnership for Children, released Sept. 2013) Children’s Preventive Oral Health Services (at the request of and funded by Blue Cross and Blue Shield of North Carolina Foundation, the NC Office of Rural Health and Community Care, NC Division of Public Health and in collaboration with the Oral Health Section of the Division of Public Health, released June 2013) Implementing the Affordable Care Act (at the request of the NC Department of Health and Human Services and the NC Department of Insurance, funded by Kate B. Reynolds Charitable Trust, Blue Cross and Blue Shield of North Carolina Foundation, The Duke Endowment, John Rex Endowment, Cone Health Foundation, and the Reidsville Area Foundation, released January 2013) 10

Recently Completed Studies Early Childhood Emotional and Social Wellbeing (at the request of the North Carolina General Assembly, released July 2012) Implementing Evidence Based Strategies in Local Health Departments (In collaboration with the NC Center for Public Health Quality, the Center for Healthy North Carolina, and the NC Division of Public Health. Funded by the Centers for Disease Control and Prevention’s National Public Health Improvement Initiatives. Released Sept. 2012) Developing a Suicide Prevention and Intervention Plan (at the request of the North Carolina Division of Mental Health, Developmental Disabilities and Substance Abuse Services. Funded by the Substance Abuse Prevention and Treatment Block Grant. Released July 2012) 11

Common Themes in Recent Task Force Work Expanding access to health care ▫Expanding coverage to the uninsured ▫Strengthening the health care safety net ▫Improving access for underserved communities Improving quality and efficiency Improving population health ▫Focus on health promotion and primary prevention ▫Strengthening chronic disease management ▫Recognizing the impact of social determinants of health on health outcomes (eg, education, poverty, housing) 12

Common Themes in Recent Task Force Work Developing new delivery systems ▫Work with interdisciplinary teams of professionals, and more active involvement of communities ▫Identifying alternatives to the fee-for-service payment structure ▫Strengthening the mental health, developmental disabilities and substance abuse system of care Implementing evidence-based or evidence- informed strategies ▫Importance of selecting evidence-based strategies and implementing them with fidelity 13

Progress Implementing Past Recommendations Primary Care and Specialty Supply Task Force (Update 2013, Report 2007) ▫Progress made on 76% of recommendations 1 New Medical School, 70 new slots at UNC and ECU (including campuses in Ashville, Charlotte, and Wilmington) 7 new PA programs, 6 new NP programs Adolescent Health (Update 2012, Report 2009) ▫Progress made on 72% of recommendations  Variety of activities around increasing HS graduation rates. (70.3% 2008 to 80.2% 2012)---13 million recurring funding for dropout prevention, more early school and HS to CC partnerships aligned with local economic needs. Chronic Kidney Disease (Update 2012, Report 2008) ▫Progress made on 73% of recommendations  Increase education around management and referral  Universal lab measurement of GFR

Progress Implementing Past Recommendations Just What Did the Doctor Order? Health Literacy Task Force (Update 2010, Report 2007) ▫Progress made on 79% of the recommendations  Standardized process for review of health information from NC DHHS. Nursing Report (Update 2007, Report 2004) ▫Progress made on 89% of recommendations  Nursing Faculty Fellows Program (1.2 million appropriations x 2 years)  Expand Nursing Doctorate programs (2 new programs)  Increase funding for Community College nursing programs (recommend designation as high cost program, in stead, weighted funded with additional $1 million appropriations)  Funding restored to UNC system nursing programs  Establish matriculation agreement, RN to BSN 15

Progress Implementing Past Recommendations Uninsured and Safety Net Reports (Update 2008, Reports 2006, 2005) ▫Progress made on 75% of the safety net recommendations and 62% of the covering the uninsured recommendations  helped lead to legislative funding to expand and strengthen the existing safety net system (community health grants) and to coordinated systems of care for the uninsured (HealthNet funding). Child Abuse Prevention (Update 2008, Report 2005) ▫Progress made on 75% of the recommendations  Several recommendations around evidence-based program funding. Significant increases in both state and private (and later federal) funding for EPBs.

Reflections on NCIOM Success Bring wide range of stakeholders and other interested parties to study the issue in neutral territory Work on issues when groups want to make a difference ▫Do not work on issues where there is no room for compromise Use research and evidence to inform policy options Help involve stakeholder groups in supporting and implementing recommendations 17

NCIOM challenges Difficult fiscal and political climate for new spending and priorities last 5 years. ▫Prevention Action plan Change in executive and legislative branches. Newly appointed board of directors. Variable engagement with legislators. As a quasi-state agency, we respect the distinction between informing and lobbying. 18

NCMJ Contributors The Duke Endowment is a co-publisher of the NCMJ largest supporter Health professional associations have supported the NCMJ including: ▫NC Medical Society ▫NC Dental Society Advertising 19

Issues July/Aug Cancer Care in North Carolina. Wheeler SB, Basch E. Sept/Oct Long-term Care in North Carolina. White HK. Nov/Dec Improving Population Health in North Carolina. Slade-Sawyer, P.

21 76 (1) Rural Health in North Carolina. Collins, C. 76 (2) Traumatic Brain Injury in North Carolina. Hooper, SR. 76(3). Patient and Family Engagement. Blanton, K. 76 (4): Evidence-Based Practice, Morris, P Issues

22 Current and Upcoming Issues Nov/Dec 2015: Military Health (Williams, JL; Jackson GL) 2016 Upcoming Issues Jan/Feb: Research (Morris, P) March/Apr: Workforce (Fraher, E and Ricketts, T). May/June: Gastroenterology July/August: Pay for Value

How a bill becomes a law Well place stories with effective legislative advocacy (congenital heart disease and diabetes screening) Effectively backed by good data---especially ROI data. (CFTF interested in WSIPP Results First) Right now, legislation is more palatable when funds are not requested, or if funds required, a shift in priorities will help carry an agenda. Developing a legislative champion. Partners that can lobby. Partners with strong interests. ▫Unlikely partners. Who else might be interested in your issue. Coalition of partners. 23

Pay it back, pay it forward Vote Contribute Support with information Support with a venue to speak during election seasons Who are your representatives? Call, visit, write. They need a pulse of constituents. Can you provide one. Local papers. Get to know legislative aids. 24

Our strategy Develop new and old relationships with legislators and executives. Fewer recommendations directed at NCGA, and fewer still with recommendations for appropriations---back by clear ROI argument when possible. Legislative champions (hopefully from TF). Coalition of lobbying partners. 25

For more information Websites: Key contacts: ▫Adam Zolotor, MD, DrPH, President and CEO, NCIOM ext. 24 or 26