In Spring 2013, we are on the precipice of dramatic, disruptive change in the health field that offers an unprecedented opportunity and challenge to transform health care and population health.
We know that traditional public health approaches along with more and better health care are not enough to improve health outcomes, equity, and cost. We must also:
- implement sustainable, fundamental "upstream" changes that address the root causes of disease and disability; and
- transform the way we deliver health care to ensure access to quality, affordable health care for all.
Enjoy this keynote panel presentation from Larry Cohen of the Prevention Institute, which was presented at the 2013 Annual Leadership Conference, co-sponsored by the Center for Health Leadership (CHL) and the California Pacific Public Health Training Center (CALPACT) at UC Berkeley's School of Public Health.
To learn more about this event, please visit:
http://calpact.org/index.php/en/events/leadership-conference
Learn more about CALPACT:
http://calpact.org/
Learn more about the CHL:
http://chl.berkeley.edu/
Health 3.0 Leadership Conference: Community Centered Health Systems with Larry Cohen
1. Larry Cohen
Executive Director
Prevention Institute
Community Centered Health Systems:
Transforming Community Health and
Care Delivery Through Upstream
Innovations
@preventioninst
http://www.facebook.com/PreventionInstitute.org
UC Berkeley School of Public Health Leadership Conference
Transforming Community Health and Care Delivery
May 30, 2013
www.preventioninstitute.org
2. “Simply put, in the absence of a radical shift towards
prevention and public health, we will not be successful in
containing medical costs or improving the health of the
American people.” - President Obama
3. u Prevention and Public Health Fund
u Community Transformation Grants
u National Prevention Strategy
u National Prevention, Health Promotion, and
Public Health Council
u Center for Medicare and Medicaid Innovation
u Funding for Community Clinic Expansion
Opportunities for
Prevention in Health Reform
4.
5. It is unreasonable to expect
that people will change their
behavior easily when so many
forces in the social, cultural,
and physical environment
conspire against such change.
“
”
Institute of Medicine
Source: Institute of Medicine. (2000). Promoting health: Intervention strategies from social and
behavioral research (B. D. Smedley & L. S. Syme, Eds.). Washington, DC: National Academies Press.
17. 355 Diseases
15 Diseases
44%56%
Citation: Kenneth Thorpe et al.. “Which Medical Conditions Account For The Rise In Health Care Spending?”
Health Affairs, 10.1377, web exclusive.
A Majority of
Costly Conditions are Preventable
u Medical spending increased by $199 billion (1987-2000)
u 15 diseases account for 56% of this increase
18. Current Health Care Spending
Factors Influencing
Health
National
Health
Expenditures
References: Bipartisan Policy Center. “Lots to Lose: How America’s Health and
Obesity Crisis Threatens our Economic Future.” June 2012
70%
10%
20%
$2.2 Trillion
Behaviors
Environment
Genetics
Medical Care
19. Behaviors
Environment
70%
Medical Care, 10%
Genetics
20%
$2.2 Trillion
Current Health Care Spending
Factors Influencing
Health
National
Health
Expenditures
References: Bipartisan Policy Center. “Lots to Lose: How America’s Health and
Obesity Crisis Threatens our Economic Future.” June 2012
20. Behaviors
Environment
70%
Medical Care, 10%
Genetics
20%
Prevention, 3%
Health Care
Services
97%
$2.2 Trillion
Current Health Care Spending
Factors Influencing
Health
National
Health
Expenditures
References: Bipartisan Policy Center. “Lots to Lose: How America’s Health and
Obesity Crisis Threatens our Economic Future.” June 2012
21. $1 Investment
$5.60
Return on
Investment
Savings at
5 years
$16 Billion
Annual Savings
In 5 Years
Return on Investment with Prevention
Reference: Prevention for A Healthy America: Investments in Disease Prevention Yield Significant Savings, Stronger Communities,
Trust for America’s Health, July 2008
22. Prevention for
a Healthier America
u $5.6:$1 ROI
u $16 billion savings
in 5 years
http://preventioninstitute.org/component/jlibrary/article/id-75/127.html
31. INQUIRY! ASSESSMENT! ACTION!
ENVIRONMENTAL
POLICY
CHANGE!
COORDINATED
CLINICAL
COMMUNITY
PREVENTION
ACTIVITY!
IDENTIFY
PRIORITY
HEALTH ISSUES!
COMPREHENSIVE
STRATEGY
DEVELOPMENT!
PARTNERSHIP
FORMATION!
• Health Care!
• Public Health!
• Community
Organizations!
DATA
COLLECTION!
CLINICAL/COMMUNITY
POPULATION HEALTH INTERVENTION MODEL
OUTCOMES!
IMPROVED
HEALTH!
!
COST SAVINGS!
!
EVIDENCE-BASE
FOR EFFECTIVE
PRACTICE!
Existing Clinician Skills
PATIENT INTAKE DIAGNOSIS TREATMENT
32. Emerging Opportunities
Ø Payment mechanisms incentives
n maximize healthcare quality, minimize costs, incentivize prevention and an
integrated health system
Ø Population health data innovation
n track population health trends
n reveal the links between determinants and health outcomes
n uncover the best interventions for improving health
Ø Metrics to promote health in the first place
n incentivize prevention and move away from individual-based assessment
n capture the leading indicators of successful community prevention
n assess the impact of community-level change
Ø Workforce innovations
n advance the roles of community health workers, promotoras, integrators,
navigators
Ø Intersectoral community partnerships and advocacy
n support true engagement and partnerships for sustainable community change
33. How Can We Pay for a Healthy
Population?
♦ Wellness Trusts
♦ Social Impact Bonds and Health
Impact Bonds
♦ Community Benefits from Non-
Profit Hospitals
♦ Accountable Care Organizations
34. Connecting Clinical Population
Perspectives Through Data
u Collecting
community
driven data
u Creating
interoperable
data sets
u Tracking
population
health trends
36. “We are bringing together the health and
human rights voices in south LA and
beyond to discuss the healthcare crisis and
how we build a movement for the right to
health.”
-Jim Mangia, CEO St. John’s
37. National:
Health System that Integrates
Prevention/Public Health/ Healthcare
Statewide:
Community-Centered
Health System
Accountable
Care Community
Local:
Community
Centered
Health Home
Accountable
Care Community
Local:
Community
Centered
Health Home
59. “You can do more than
bail out these medical
disasters after they have
occurred, and
go upstream from medical
care to forge instruments
of social change that will
prevent such disasters
from occurring in the first
place.”
—Jack Geiger, MD
Photo Credit: Daniel Bernstein
68. Developing Effective Coalitions:
The 8-Step Process
1.Analyze program objectives, determine whether
to form a coalition
2. Recruit the right people
3. Devise preliminary objectives and activities
4. Convene the coalition
5. Anticipate necessary resources
6. Develop a successful structure
7. Maintain coalition vitality
8. Improve through evaluation
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