2. Community-Clinical Partnerships to Solve the Problems that Kill Us
Live Long and Prosper
Community-Clinical Partnerships to Solve the Problems that Kill Us
Rebecca Rapport
Ashlie Brown
Hot Issues in Health
December 6, 2018

4. Our Resolutions for this Presentation
Boldly go outside the clinic to address the factors that determine our health Seek out lessons learned from early pioneers who have proven that community-clinical linkages work Voyage around Colorado to find partnerships creating innovative solutions today

5. The parts of our lives that determine our health
#HIHC18

6. Leading causes of death: Leading causes of death:
Eighty is the New Forty
Leading causes of death:
Chronic diseases
Leading causes of death:
Infectious diseases
1918 Influenza Pandemic
Source: National Center for Health Statistics – Death rates and life expectancy at birth

7. What is Holding us Back? Three landmark papers
1984: Higher job status associated with lower mortality rates
1993: Premature mortality caused by tobacco, alcohol, diet and activity
1995: “Fundamental Causes of Disease” are income, social ties and education
#HIHC18
#HIHC18

8. What Goes Into Your Health
Source: Institute for Clinical Systems Improvement, Going Beyond Clinical Walls: Solving Complex Problems (October 2014)
Adapted from the Bridgespan Group

10. #HIHC18

11. #HIHC18

12. For decorative purposes only
Me!
#HIHC18

13. Also me!
#HIHC18

14.              Race and Ethnicity (White)
Income (Childhood)  
Family/Social Supports (strong family ties)
Education (8th Grade) 
Safety
(Combat experience) 
Employment
(John Deere) 
Smoking status
(1.5 packs/day) 
Income (Adult) 
Diet and activity
(Red meat and carbs) 
Safety (Small town)  
Access to Care
(Non-compliant)
Access to Care 
Quality of Care
#HIHC18

15. Effective Solutions Link the Determinants of Our Health
Socioeconomic Factors
Physical Environment
Health Behaviors
Health Care

16. Lessons Learned from Early Pioneers
#HIHC18

17. Early Pioneers Are Paving the Way for Linkages
Health Behaviors
Health Care
#HIHC18

18. Step 2: Linking Step 3: Supporting
Screening
I’m a doctor,
not a lifestyle coach!
$429
Step 3: Supporting

19. Lifestyle Change is More Effective Than Medicine
Reduction in the incidence of Type 2 Diabetes
Metformin
Lifestyle Change
31%
58%

20. The Diabetes Prevention Program Wasn’t Built in a Day
2009
Diabetes Prevention Act
DPP Research Study
2002-present
DPP Outcomes Study
2016
Medicare announces DPP reimbursement
Lesson Learned!

21. Reimbursement is lagging for qualified providers

22. New Medicare Perk for Diabetes Prevention Stumbles at Rollout
Lesson Learned!

23. Reimbursement is also lagging costs
Avoided health care expenditures per participant over first three years
Cost per participant
Expected average Medicare reimbursement per participant
$3,171
$800
$139

24. Employers Are Buying In
Lesson Learned!
Employers Are Buying In

25. What Have We Learned? 1
Plan on long timeframes to prove the impact of innovative programs
Explore innovative payment mechanisms to support proven programs – and recognize when they aren’t working
Engage stakeholders across sectors who may benefit from the results 2 3
#HIHC18

26. Community-Clinical Partnerships Across the State
#HIHC18

27. Screening: Five Needs With Big Impacts on Care
Accountable Health Communities Model
Food insecurity
Transportation problems
Interpersonal violence
Housing instability
Utility help needs

28. Linking: Getting a Lyft to Address Transportation Barriers

29. Supporting: Connecting the Systems That Keep Us Healthy

30. How to Help the Next Generation Live Long and Prosper1
Plan on long timeframes to prove the impact of innovative programs
Explore innovative payment mechanisms to support proven programs – and recognize when they aren’t working
Engage stakeholders across sectors who may benefit from the results 2 3
#HIHC18

31. More Examples Are All Around Us
Socioeconomic Factors
Physical Environment
Health Behaviors
Health Care

32. Three Takeaways
Boldly go outside the clinic to address the factors that determine our health Seek out lessons learned from early pioneers who have proven that community-clinical linkages work Voyage around Colorado to find partnerships creating innovative solutions today