Published on December 4, 2017
By Kurt Waltenbaugh
The Illinois Public Health Institute, with support from sibling organizations in Michigan, Wisconsin, Ohio, and Indiana (Hello, Minnesota? Iowa?), sponsored the first-ever gathering of population health leaders across the upper Midwest to bridge health & health care, including health system leaders, community organizations, government, industry, and other stakeholders.
John Lumpkin from Robert Wood Johnson Foundation kicked things off with a sobering look at the (un)health of the nation. Unhealthy behaviors and living conditions have combined to create an epidemic of obesity and associated chronic illness. Beyond a public health crisis, this is now a national security crisis: a staggering 71% of our 17-24 year olds are not eligible to serve in the military due to health & fitness concerns.
And this crisis is unevenly distributed – babies born a few stops away on the Green Line in Chicago have a 16 year gap in life expectancy. Hence our need for local intervention on a community by community, person by person basis.
With that underpinning the importance of our work, the rest of the conference shifted into: what are we doing about it, and how we can improve it?
1. Amazing things are being accomplished on a small, medium, and large scale across the region. Learning from our peers is a great way to spread the seed of those ideas, and fertilize the ground with shared creativity. Two of many examples:
- Robert Marrs & Jane Pirsig from Aurora Health Care demonstrated a 44% drop in ED charges, and a 46% drop in ED visits with their program. Focusing on intensive care coordination for high risk ED users, they use a combination of techniques including in-person patient encounters in the ED, outpatient clinics, patient home, and in the community as needed for 6-12 months until a patient demonstrates stability.
- Heart of New Ulm – Cindy Winters & Rebecca Lindberg from the Minneapolis Heart Institute Foundation shared an ambitious 10-year project to eliminate heart attacks in Brown County, New Ulm, Minnesota. Amazing gains are possible by aligning funders with stakeholders across the community.
2. Financing: we have far more ideas than ways to fund them. Every session, every conversation carried this theme: how do we access dollars to support & grow our initiatives? The panel, moderated by Doug Jutte, described three methods:
- Pathways HUB model – Jan Ruma from the Northwest Ohio Pathways HUB described contracts with managed Medicaid groups to address social/behavioral determinants of health. Local foundations provide the funding and serve as the “venture capital”. The community health workers find those at risk in the community, build a relationship with them to identify risk factors & barriers, and work to address health-related social needs. The ‘pathway’ is completed when various metrics are met: initial visit to the medical home, positive health outcomes are recorded, and so on. Those metrics trigger payments from the managed care plan to the hub organization providing the services. Data is shared across the hub members to help coordinate the response.
- Pay for Success – Will Snyder from Presence Health explained a creative way to attract outside capital to finance community asthma programs. Bringing an outside investor to assist the provider with initial funding, and a willing payer (in this case government Medicaid), they outlined a unique concept: the investor will fund the provider to implement an asthma intervention. By spending $1,500-5,500 per patient the Presence team will focus on home health, housing stock improvements, asthma education, and other interventions. Over time, those investments save $10,100 per patient, with an expected payback of 3 years. Once success is demonstrated, the Payer reimburses Presence, who splits the return with the investor. Everyone wins: Payer, Provider, Investor, Patient, and Community.
- Investment/Loan Model – Tonya Wells from Trinity Health described Trinity’s approach of taking 1% of their treasury ($75 million) and loaning it to community development financial institutions at a sub-market rate of 2% interest, for periods of 3-5 years. Dignity Health has a similar portfolio of $120 million. This allows the money to reach the community, and recirculate to finance population health programs across a variety of organizations – programs that might not be able to be financed through a traditional bank program. They are also exploring the idea of bypassing the community development financial groups to funds projects directly.
3. Critical success factors:
- Partnerships across silo, outside the four walls of the health system. Hospitals can’t do this alone. Those who have shown success have enlisted powerful partners across their communities to marshal the resources necessary to improve the lives in their care. This suggests a “capability maturity model” to evaluate the status of our organizations:
- Level 1 – Capture & record social/behavioral status that may be determinants of health
- Level 2 – Share the information with case managers, socials workers, and others to use the data: address the problems and refer patients to services to help improve their conditions
- Level 3 – Participate as one of the many stakeholders in the community, demonstrate the improve power of collective impact outside the health system
- It’s all about the data. None of this work is possible without a more complete understanding of the individual. We each have 525,000 minutes to spend each year. The typical person spends less than 60 minutes in a clinic setting. Where the rest of those minutes are spent count the most for our health. Capturing this social/behavioral data, sharing it with appropriate stakeholders, measuring the improvement are mandatory to effect gains.
- Art Jones from Medical Home Network Accountable Care Organization in Cook County, Illinois showed us that rising risk cases CAN be identified based on social risk factors before they become high utilizers. He cautions – focusing solely on high utilizers does not prevent them from happening in the first place!
- Friday morning, at the roundtable for capturing & using social/behavioral data, we learned that traditional healthcare data is insufficient for understanding, predicting, and meeting the healthcare needs of most Americans. Current healthcare data often excludes environmental, behavioral, economic, and demographic characteristics that play an influential role in an individual’s current and future health condition. Using individually identified consumer behavior data provides a baseline to identify risk and measure improvement. Applying this information to our unique communities and patients allows us to predict future health outcomes, identify rising risk before it happens.
What passion in our community! The great strides taken to address inequity and insure everyone lives their life to the fullest are encouraging. What a unique opportunity to applaud our successes, and strive for greater gains! I eagerly look forward to next year.
What did you see at the Midwest Forum on Population Health? Do have additional thoughts & insights to share, to keep the conversation going?