1. CLINICAL PREVENTIVE SERVICES – OCTOBER 2014 NEAL LUSTIG, POMPERAUG HEALTH DISTRICT, DOH

2. POMPERAUG HEALTH DISTRICT TAKING THE PREVENTIVE COMPONENT TO YOUR COMMUNITY– OCTOBER 2015 CPHA – October 23, 2015 Major Focus of Pomperaug Health District Especially Since 2008 Wide Variety of Activities Chronic Disease Modification and Education Efforts Hypertension, Diabetes, Fall Prevention, Vaccination, Chronic Disease Self Management Initiatives Affordable Care Act – ACA – Prevention Initiatives State Innovative Model – Status CT Medicaid - 2015

3. CHRONIC DISEASE SELF-MANAGEMENT PROGRAM Led by people with chronic health conditions Very structured Highly interactive classes Mutual support Build confidence Goal setting Problem solving Helps people regain control Why it Works

4. PREVENTIVE SERVICES – POMPERAUG HEALTH DISTRICT CDSM – Evidence Based Program – Stanford University Why Reinvent the Wheel? Promoted by SDPH and WCAAA 6 Weeks – Chronic Disease Management Program – Diabetes 4 day Main Course Two Day Module for Diabetes Techniques – Dealing with Symptoms – Exercise – Healthy Eating – Use of Medication – Interaction With Physicians Action Plans – Sharing – Helping – Participative Does Not Conflict With Existing Programs Handouts

5. PREVENTIVE SERVICES POMPERAUG HEALTH DISTRICT DSMT – CDSM – Diabetes – SDPH - Kozak Type 2 Diabetes Focus Trained Leaders Community Benefits – Reduction in Disease Severity, Cost Benefits Reduced Health Distress – Reduced A1C – Fewer Symptoms Local Health Department Benefits – Community Purpose – 9.6% of CT Population has Diabetes Community Relevancy – Included in ACA List of Covered Preventive Service Can We Bill – Maybe? Handouts

6. A MATTER OF BALANCE (MOB): MANAGING CONCERNS ABOUT FALLS EVIDENCE-BASED PROGRAM Research by the Roybal Center for Enhancement of Late-Life Function at Boston University.* Designed to reduce the fear of falling and increase the activity levels of older adults who have concerns about falls.

7. FALLS: A GROWING PUBLIC HEALTH CRISIS In the US in 2009: 19.700 seniors died from falls 2.2 million treated in Emergency Departments Falls account for 61% traumatic brain injuries for adults >65 Economic Impact (total annual costs) Fatal falls: $0.2 billion Nonfatal injuries: $19 billion www.cdc.gov/ncipc/factsheets/fallcost.htm 1/3 to 1/2 of older adults acknowledge fear of falls Fear of falling is associated with:  depression  decreased mobility and social activity  increased frailty  increased risk for falls as a result of deconditioning Preventive Services - PDDH

8. PREVENTIVE SERVICES – IMMUNIZATION SERVICES Childhood Vaccination – Connecticut Vaccine Program – Relationship Seasonal Flu Vaccine – CT Vaccine Coalition Vaccinators of the First Resort? – Last Resort? Where are Your thoughts? Needed Services – Well Proven is Disease Prevention Access – Affordability Some States 50-60% Vaccines by Local Health Department CT is 1%, 2%,3% Who Decided This?

9. CONNECTICUT MEDICAID – NOW 753,000

10. PREVENTIVE SERVICES STATE INNOVATIVE MODEL - SIM $45,000,000 Grant from CMS – Center Medicare and Medicaid Services Multi Year Grant to State of CT TO Reform the Health Care System Designated Prevention Service Centers Purpose to Provide Single Source of Evidenced Based Preventive Services Integrate Best Practices of Primary Care and Public Health So Where is Prevention in the Affordable Care Act?? So Where is Prevention Services in CT – SIM – Medicaid – Insured?? Appears to be multi Year with “Prevention” off to second year!