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Archive for the ‘Social Determinants of Health’ Category

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In the past, I’ve written quite a few blog posts about the importance of health systems partnering with community and public health organizations to positively impact community and population health. Here are a few examples:

Engaging Public and Community Organizations to address Social Determinants of Health, December 13, 2016

Public Health 3.0, October 5, 2016

Organizations Collaborating to Advance Population Health (Video), July 13, 2016

Replicate This: A Hospital Sponsored Community Blog, May 5, 2016

Population Health Management Is Our Future, March 15, 2016

Population Health: An Informal Conversation with National Leaders, April 21, 2015

One Year of Public Health & Primary Care Working Together, March 5, 2015

Clearly, this is an area in which I have a strong interest; so when I find a person or organization who shares my passion, I get excited; I see hope!

To that end, earlier this week I found the following passage on Renown Health’s website, and I was elated. They get it! This statement clearly articulates a vision of community health that I share and often promote within this blog (as you can see from the list of blog posts above).

Together, We’re Better

“As the healthcare landscape continues to evolve, we will broaden our approach, and think not only about healthcare, but also about health. And, we will think beyond the walls of the hospital and take our services and winning spirit out into our communities.

We recognize that we all must come together if we are to really move the needle on our community health statistics and improve the overall health of our community. To accomplish these lofty goals, we are forging new partnerships with doctors, nonprofits, other hospitals, and those who are educating tomorrow’s workforce — just to name a few. We will leave no stone unturned in our quest to think differently and focus on what’s really important. And, we won’t forget our most significant partnerships — the one we share with our 6,000+ employees. The good work we do would not be possible without them.” (Renown Health Website)

It was wonderful to discover a healthcare organization that is embracing this perspective. I believe much of this philosophy comes from Dr. Tony Slonim, Renown’s CEO. He is an amazing guy and a model physician leader. If you’re not familiar with Dr. Slonim, I’ll give you some highlights. Dr. Slonim is a Clinical Professor of Medicine and Pediatrics at the University of Nevada School of Medicine (UNSOM). He is a board certified physician in Internal Medicine, Pediatrics, and Critical Care, and a Doctor of Public Health. Dr. Slonim is a nationally recognized expert in patient safety, accountable care, healthcare quality, and innovative care delivery models focused on improving health in the community. He is an academic leader with more than 100 publications, 15 textbooks and more than $2 million in National Institutes of Health funding to his name. Dr. Slonim serves on the boards of the American College of Physician Executives, the Stevens Institute of Technology, and is the Chairman of the Certified Medical Representatives (CMR) Institute Boards.

I first met Dr. Slonim through an article in the The American Journal of Managed Care (AJMC) where he was interviewed about Physician Leadership. As I read that interview, I was engaged by his perspective on the health system’s role in addressing community health.

“We’re on a quest toward a healthy community, and that means we’re looking outside of our walls not only to healthcare and the healthcare we provide, but also ensuring the community’s health. How are we there not only when they’re sick or injured, but when they have questions about what vitamins or herbals to take? When they need support on how to reduce their stress or how to lose weight or stop smoking? Those are the ways that we need to engage the community with prevention and wellness. And we’re doing that a lot more aggressively than we ever have.” (AJMC, March 14, 2016)

After doing a little digging, I found Dr. Slonim’s TEDx Talk where he continues to address the theme of creating healthier communities. I’ve embedded that video below.

In short, Dr. Slonim and I share a common belief that community health needs to be addressed in the community – and that this is best done through partnerships between the health system and community/public health organization. For me, it was so gratifying to discuss a physician leader and health system that is embracing that philosophy!

Here’s the backstory: This week one of my colleagues and I spent a couple of days in Reno, Nevada visiting the marketing team at Renown Health. During my time at Renown, I was fortunate to spend time with their CEO, Dr. Tony Slonim.

For those of you who haven’t heard of Renown, it is a not-for-profit integrated healthcare network serving a 17-county region comprised of northern Nevada, Lake Tahoe and northeast California. It is one of the region’s largest private employers with a workforce of more than 5,700. Renown’s network includes three acute care hospitals, a rehabilitation hospital, skilled nursing, and the area’s most comprehensive medical group and urgent care network. Of the 5,627 hospitals in the United States, Renown is one of only 281 physician-led organizations.

We left Renown with a great appreciation for the organization and its commitment to addressing community health. The health of our communities is dependent upon hospitals and health systems moving beyond their walls, and partnering with community organizations. It was wonderful to learn that the team at Renown embraces this perspective.

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It is clear to me that healthcare marketers are going to have to shift much of their focus to promoting health and wellness, whereas, in the past we’ve largely promoted healthcare transactions related to brief episodes of poor health or prolonged interactions due to chronic disease. Recognizing the need for that shift in focus, I’m always intrigued when I run into individuals who are starting new enterprises designed to encourage healthy behaviors.

Recently, after giving a talk to a group of business leaders who were interested in learning about social media, a woman named Kim Saffran came up and introduced herself. She has started a business that gets adults and families to integrate “play” into their lives. The fledgling business is called Return2Recess. Perhaps not surprisingly, Kim’s business has found early success with individuals living in retirement and 55+ communities.

I asked Kim if I could interview her for my blog, and she agreed. The 14-minute video (below) introduces Kim and her business. It’s going to take a lot of entrepreneurs like Kim to get Americans moving – but this is a great start. At the most basic level, Return2Recess is addressing one of the social determinants of health. There are similar efforts around the country helping people access healthy food options and safe, healthy housing – initiatives designed to address the conditions in the environments in which people are born, live, learn, work and play that affect their health and well-being.

 

 

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Innovative partnerships among hospitals, public  health departments, and community organizations are addressing root causes of local health problems, according to a new report from Advisory Board that outlines best practices from 18 communities that have begun forming effective coalitions under the BUILD Health Challenge.

By 2019, Medicare and Medicaid reforms will affect physician payments based on resource use and total costs of care, prompting hospitals and health systems to focus more strongly than ever on community health as a whole. According to research published in The New England Journal of Medicine, up to 80-90% of health status is attributable to factors other than clinical care. The vast majority of physicians cite socioeconomic conditions such as lower income or education, environmental hazards, and lack of access to healthy food, safe housing, and transportation as leading directly to poorer health outcomes, but only 20% of physicians are confident in their ability to address these problems, according to a study conducted on behalf of the Robert Wood Johnson Foundation.

Hospitals and health systems have struggled to build partnerships that would improve health outcomes and generate significant savings. The new report – Building the Business Case for Community Partnership: Lessons from the BUILD Health Challenge – identifies four critical steps to promote population health management and collaboration across the continuum of care: strongly engage hospital or health system leadership; prioritize initial focus on a subset of initiatives that will be iterated; strengthen partnerships to build on the skillsets, relationships, data, or tools each partner brings; and design seamless screening and referral protocols.

The BUILD initiative, cofounded by Advisory Board to promote partnerships that are Bold, Upstream, Integrated, Local, and Data-Driven, started with grants to 18 communities in 2015. This analysis of the 18 funded communities reinforced the belief that transforming health outcomes requires a carefully coordinated effort to eliminate silos.

The report found that engaging hospital or health system leadership helps garner the executive buy-in and secure the resources needed for success. Since many health care organizations have multiple initiatives occurring at once, the report suggests that hospital and health system leaders recognize that the process is an iterative one and begin by focusing on a few prioritized services.

The research also found that successful initiatives leveraged the unique strengths of community organizations to extend the reach of the health care team. The recommended final step – design seamless screening and referral protocols – helps health care providers ensure timely follow-through, which also improves patient and provider satisfaction.

Data demonstrate the need for such coordinated efforts to address “upstream” health factors. For example, while people are 2.9 times as likely to have poor overall health if they are members of a food-insecure household, evidence shows that programmatic approaches can help.  Research from the Center for Effective Government showed that every $1 spent on Meals on Wheels produced $50 in Medicaid savings. Similarly, offering housing and supportive services to high-cost homeless individuals produces an annual per-person health care savings of $8,000, according to a study in Health Affairs.

BUILD Health Challenge Open for New Grant Applications
The BUILD Health Challenge will fund additional grants for at least 17 more communities in 2017. The Round 1 application period for funding closes on February 21. Interested hospitals and health systems can attend informational webinars on December 12 or 15 or January 31.

 

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Early this week, my colleague, Kate Gillmer, and I were invited by the Centers for Disease Control and Prevention (CDC) to sit in on a webinar where they formally launched their new initiative – Health Impact in 5 Years (HI-5). The HI-5 or “High-Five” initiative highlights a list of non-clinical, community-wide approaches with a proven track record. Each intervention listed is associated with improved health within five years and is reported to be cost-effective or cost-saving over the lifetime of the population or even earlier. Public and private organizations can use this list to quickly assess the scientific evidence for short-term health outcomes and overall cost impacts of community-wide approaches.

With its emphasis on community-wide approaches, HI-5 complements CDC’s 6|18 Initiative, which focuses on 18 traditional and innovative clinical interventions for six high-burden conditions. Together, HI-5 and 6|18 provide public health, health care, and a diverse array of other sectors with evidence across the continuum of prevention and care.

As you can see in the graphic below, HI-5 is focused on non-clinical, community-wide public health interventions for population health improvement – those interventions that have the greatest potential for impact on health because they reach entire populations of people at once and require less individual effort than clinical interventions.

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HI-5 highlights two types of public health interventions: 1) Those that help to change the context by making the healthy choice easier, and 2) interventions addressing the social determinants of health.

Interventions Changing the Context:

School-Based Programs to Increase Physical Activity
School-Based Violence Prevention
Safe Routes to School
Motorcycle Injury Prevention
Tobacco Control Interventions
Access to Clean Syringes
Pricing Strategies for Alcohol Products
Multi-Component Worksite Obesity Prevention

Interventions Addressing the Social Determinants of Health:

Early Childhood Education
Clean Diesel Bus Fleets
Public Transportation: System Introduction or Expansion
Home Improvement Loans and Grants
Earned Income Tax Credits
Water Fluoridation

For more information on the HI-5 initiative, go to http://www.cdc.gov/HI5.

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Screen Shot 2016-07-07 at 12.20.49 PMI’ve written about the BUILD Health Challenge in the past. You can see my prior post by clicking here. The BUILD Health Challenge is an initiative designed to foster and expand meaningful partnerships among health systems, community-based organizations, local health departments, and other organizations that impact health in the community.

The Advisory Board Company, the de Beaumont Foundation, the Colorado Health Foundation, The Kresge Foundation, and the Robert Wood Johnson Foundation have teamed up to improve community health and promote health equity through this effort. Overall, they seek to catalyze meaningful progress toward total population health. An important aspect of this effort is addressing the upstream factors that impact health. Often referred to as the social determinants of health, they include factors as diverse as early childhood development, economic opportunity, regulation and policy, the built environment, transportation and infrastructure, educational attainment, public safety, and housing.

While attending the Practical Playbook’s National Meeting in May, several participants in the BUILD Health Challenge (grantees) were recorded on video, speaking about their local initiatives. These videos do an amazing job capturing the essence of the BUILD Health Challenge. The examples of collaboration to improve the health of populations within these communities are outstanding. It is also great to hear how these organizations are directly addressing the social determinants of health! The first time I viewed these videos I knew that I would want to share a few of them on my blog. So, here you go.

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Earlier this week I wrote a post about Duke University School of Medicine’s new Center for Population Health Sciences. My premise was that, as healthcare marketers, we are all going to be in the population health promotion business sooner or later. So we need to start paying attention!

Screen Shot 2016-03-15 at 3.01.18 PMTo that end, my team and I have front row seats on the population health management express. We’ve spent the last year working with The Practical Playbook, a collaboration of the De Beaumont Foundation, the CDC, and Duke’s Department of Community and Family Medicine. The Practical Playbook exists to encourage, inform and facilitate collaboration between public health organizations and healthcare organizations (hospitals, health systems, primary care providers) with the ultimate goal of positively impacting population health. This spring the Practical Playbook is holding its first ever National Meeting, May 22 – 24, at the Hyatt Regency, Bethesda, MD.

“The Practical Playbook National Meeting will be a milestone event towards advancing robust collaborations that improve population health. By bringing together key stakeholders from across sectors – representing professional associations, community organizations, government agencies and academic institutions – the National Meeting will help to catalyze a national movement, accelerate collaborations by fostering skill development, and connect like-minded individuals and organizations to facilitate the exchange of ideas to drive population health improvement.” (National Meeting Website)

My belief is that this conference will spend more time on the “how” of population health management through collaboration, rather than the “why.”  Attendees should leave the meeting with knowledge, case studies, contacts and resources that help organizations develop collaborations and programs that address the social determinants of health – within the community. For more information, go to http://nationalmeeting.practicalplaybook.org/.

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Screen Shot 2016-03-14 at 3.18.40 PMIf you’re not actively involved in promoting and supporting population health management programs today, you most likely will be in the near future. The day will soon come when healthcare marketers work to develop communication programs that help keep patients out of the hospital while connecting them to ongoing care resources. Trust me, it is coming. For many of you, that day has already arrived.

As evidence of this movement (as if you needed evidence), Duke University School of Medicine has announced the launch of its new Center for Population Health Sciences in the School of Medicine. The center will be led by Lesley Curtis, PhD, professor in the Department of Medicine and director of the Center for Pragmatic Health Services Research in the Duke Clinical Research Institute (DCRI).

According to the announcement, posted on the Duke School of Medicine Blog:

“The goal of the Center for Population Health Sciences is to identify determinants of health and the most effective means for improving health. This multi-disciplinary center will comprise faculty members from a variety of disciplines including epidemiology, health services research and policy, health economics, health measurement and behavior, and implementation science who share an interest in answering complex questions about the drivers of health in populations. The center will foster active collaborations with the Duke Margolis Center for Health Policy, the Duke Global Health Institute, the Center for Community and Population Health Improvement, the Duke Clinical Research Institute, the Duke University Health System, and other entities engaged in the science of population health. “

Along with the Center’s research initiatives, there are plans for the development of new educational programs including a post-graduate certificate program in Population Health Sciences and Master and PhD programs in Population Health Sciences. From my perspective, these educational programs are absolutely necessary if we are going to adapt successfully to the new reality within healthcare. The next generation of clinicians need to understand that successfully addressing population health involves taking on the social determinants of health – and that can’t be done entirely within the walls of the hospital or medical office. As I’ve mentioned in past blog posts, to improve the health of various populations, health systems are going to have to partner effectively with public health and community organizations. Health systems will be challenged address food deserts, safe housing, violence and lack of transportation – all factors that impact health. By collaborating with community organizations, we can help to identify and address those upstream determinants of health.

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