1. Social Determinants of Health
Presented by
Anne-Marie FitzGerald, Evaluation Manager

2. Definition of Health Disparity/Health Inequality (choose one)
Differences in the burden of disease among population groups.
Differences in health that are avoidable, unjust, and unfair.
Systematic differences in access, quality and utilization of health care among population groups.
I am not sure.
3 / 3
Cross-tab label

3. Definition of Health Equity (choose one)
All persons have fair opportunities to attain their full health potential.
People’s needs guide the distribution of opportunities for well-being.
Equal utilization, equal access, equal outcomes.
I am not sure
3 / 3
Cross-tab label

4. Does it matter for Equity how we organize and pay for health care?
Yes No
I am not sure
3 / 3
Cross-tab label

5. Social Determinate of Health
Focus on Disparities
Social Determinate of Health
It is generally considered that Genes & Biology determine about 5% of our health status

6. Disparities - % Population with a Disability

7. Percent with less than high school education
Population with Associate Degree or higher
The region struggles to both produce and maintain an educated workforce. Relatively few students who go onto success fully complete a 4 year college degree return to the region, post graduation, to work & raise families.
Percent with less than high school education
County
Clinton
15.7%
Essex
12.0%
Franklin
15.6%
Hamilton
10.9%
Warren
9.4%
Washington
13.3%
Upstate NY
11.1%
NYS
15.1%

8. Median Household Income
Unemployed
County
Clinton
7.9%
Essex
8.2%
Franklin
9.3%
Hamilton
4.9%
Warren
7.2%
Washington
9.8%
Upstate NY
7.7%
NYS
8.7%
Median Household Income
County
Clinton
50,522
Essex
47,400
Franklin
45,702
Hamilton
51,595
Warren
54,909
Washington
50,864
Upstate NY
54,125
NYS
57,683
Key Factors in the Economic Distress of the Region:
Loss of jobs in manufacturing and the collapse of the family farm industry.
Growth in unstable-low paying service industry jobs.

9. Housing as Health
Percentage of Households with Rent Above the Affordability Threshold (2012)

10. Drivers of Health System’s Change
SHIP
DSRIP
PHIP

11. How does PHIP fit? DSRIP PHIP
Population Health Improvement Program (PHIP)
Delivery System Reform Incentive Payment Program (DSRIP)
Support the Triple Aim of higher quality, improved patient satisfaction, and reduced cost
Support health care transformation efforts: Medical Home, Health Home, DSRIP, State Health Innovation Plan (SHIP), and the State Innovation Model (SIM)
Work in conjunction with health care transformation efforts: Medical Home, Health Home, PHIP, State Health Innovation Plan (SHIP), and the State Innovation Model (SIM)
6 county region: Clinton, Essex, Franklin, Hamilton, Warren, Washington
9 county region: PHIP six counties plus Fulton, Saratoga & St. Lawrence
Broad based, benefiting all community members
Focused on Medicaid beneficiaries with the potential to benefit broader population
Support health care transformation by building sustainable infrastructure: fostering diverse collaboration, improving access to data, promoting evidence-based strategies, and focusing on health care disparities (population-specific differences in the presence of disease, health outcomes, or access to healthcare)
Working toward health care transformation specifically through 11 projects to change the way care is delivered and improve health outcomes
How does PHIP fit?
PHIP
DSRIP

12. TRIPLE AIM PHIP DSRIP SHIP Improve Health
Better health care and consumer experience
Lower Costs
TRIPLE AIM

13. How is this going to work ?

14. Convening neutral forums
Establish an ad hoc committee [the Health Advisory Council] from the 14 stakeholder groups that will designate a liaison to report to the AHI Board of Directors
Convene the Council at least quarterly [public and media invited]; coordinate with other meetings including DSRIP committees/project teams, Medical Home, Health Home, ARHN
Ensure cascading of information bi-directionally from stakeholder groups and subcommittees [policy, workforce, data]

15. Data infrastructure
AHI has engaged John Snow, Inc. to conduct a needs assessment
a. Inventory current assets
b. Conduct stakeholder interviews
c. Research and compile potential data
resources
Develop long term plan for data infrastructure to support regional needs assessments and project planning

16. PHIP can help ……….. Let’s talk about ……
Required assessments, data needs, surveys
a. Community Service Boards/Regional Planning Councils
b. Disability providers
c. Public Health and Hospital
d. Long Term Care
e. Others
2. Other community health data needs
3. Evaluation needs

17. Now what ????

18. Lottie Jameson ljameson@ahihealth.org
Megan Murphy
Anne-Marie FitzGerald
Dillon Horgan |