Health System Leadership to Address Population Health ......2018/05/15 · Health System Leadership...
Transcript of Health System Leadership to Address Population Health ......2018/05/15 · Health System Leadership...
![Page 1: Health System Leadership to Address Population Health ......2018/05/15 · Health System Leadership to Address Population Health & Reducing Disparities Andrew Shin, JD, MPH Chief](https://reader033.fdocuments.net/reader033/viewer/2022050506/5f97aa8f8a103d2f5657d96f/html5/thumbnails/1.jpg)
Health System Leadership to Address Population Health & Reducing
Disparities
Andrew Shin, JD, MPHChief Operating Officer
Health Research & Educational TrustAmerican Hospital Association
1
![Page 2: Health System Leadership to Address Population Health ......2018/05/15 · Health System Leadership to Address Population Health & Reducing Disparities Andrew Shin, JD, MPH Chief](https://reader033.fdocuments.net/reader033/viewer/2022050506/5f97aa8f8a103d2f5657d96f/html5/thumbnails/2.jpg)
2
Changes in the Health Care Field
![Page 3: Health System Leadership to Address Population Health ......2018/05/15 · Health System Leadership to Address Population Health & Reducing Disparities Andrew Shin, JD, MPH Chief](https://reader033.fdocuments.net/reader033/viewer/2022050506/5f97aa8f8a103d2f5657d96f/html5/thumbnails/3.jpg)
Paradigm Shift
![Page 4: Health System Leadership to Address Population Health ......2018/05/15 · Health System Leadership to Address Population Health & Reducing Disparities Andrew Shin, JD, MPH Chief](https://reader033.fdocuments.net/reader033/viewer/2022050506/5f97aa8f8a103d2f5657d96f/html5/thumbnails/4.jpg)
Improving Health and Well-being
Source: Institute for Clinical Systems Improvement; Going Beyond Clinical Walls: Solving Complex Problems, 2014
20%of health
and well-being is related to
access to care and quality of services
![Page 5: Health System Leadership to Address Population Health ......2018/05/15 · Health System Leadership to Address Population Health & Reducing Disparities Andrew Shin, JD, MPH Chief](https://reader033.fdocuments.net/reader033/viewer/2022050506/5f97aa8f8a103d2f5657d96f/html5/thumbnails/5.jpg)
![Page 6: Health System Leadership to Address Population Health ......2018/05/15 · Health System Leadership to Address Population Health & Reducing Disparities Andrew Shin, JD, MPH Chief](https://reader033.fdocuments.net/reader033/viewer/2022050506/5f97aa8f8a103d2f5657d96f/html5/thumbnails/6.jpg)
Advancing Health and Well-Being by Bridging Care and Community
AHA’s Population Health Approach
![Page 7: Health System Leadership to Address Population Health ......2018/05/15 · Health System Leadership to Address Population Health & Reducing Disparities Andrew Shin, JD, MPH Chief](https://reader033.fdocuments.net/reader033/viewer/2022050506/5f97aa8f8a103d2f5657d96f/html5/thumbnails/7.jpg)
Pathways to Population Health
7 Source: Pathways to Population Health, 2018.
![Page 8: Health System Leadership to Address Population Health ......2018/05/15 · Health System Leadership to Address Population Health & Reducing Disparities Andrew Shin, JD, MPH Chief](https://reader033.fdocuments.net/reader033/viewer/2022050506/5f97aa8f8a103d2f5657d96f/html5/thumbnails/8.jpg)
Achieving Health Equity
There can be no quality without equity —diversity and inclusion practices and community
building approaches are essential strategiestoward that goal.
AHA Vision: A society of healthy communities whereall individuals reach their highest potential for health.
Health Equity
![Page 9: Health System Leadership to Address Population Health ......2018/05/15 · Health System Leadership to Address Population Health & Reducing Disparities Andrew Shin, JD, MPH Chief](https://reader033.fdocuments.net/reader033/viewer/2022050506/5f97aa8f8a103d2f5657d96f/html5/thumbnails/9.jpg)
EQUITY IMPERATIVE
Source: https://www.theodysseyonline.com/dont-see-color-poem
![Page 10: Health System Leadership to Address Population Health ......2018/05/15 · Health System Leadership to Address Population Health & Reducing Disparities Andrew Shin, JD, MPH Chief](https://reader033.fdocuments.net/reader033/viewer/2022050506/5f97aa8f8a103d2f5657d96f/html5/thumbnails/10.jpg)
Institute for Diversity and Health Equity
![Page 11: Health System Leadership to Address Population Health ......2018/05/15 · Health System Leadership to Address Population Health & Reducing Disparities Andrew Shin, JD, MPH Chief](https://reader033.fdocuments.net/reader033/viewer/2022050506/5f97aa8f8a103d2f5657d96f/html5/thumbnails/11.jpg)
11
How does the Pathways to Population Health framework resonate with you? What is missing?
What else would help you accelerate your journey to health and well-being using population health as the vehicle?
What is your organization doing to promote population health and address social determinants of health?
Regional Policy Boards
![Page 12: Health System Leadership to Address Population Health ......2018/05/15 · Health System Leadership to Address Population Health & Reducing Disparities Andrew Shin, JD, MPH Chief](https://reader033.fdocuments.net/reader033/viewer/2022050506/5f97aa8f8a103d2f5657d96f/html5/thumbnails/12.jpg)
What We Heard
“Given slim margins for most non-for profit hospitals, limited dollars for investing in population health strategies”
12
“…frustrated that after years of effort we’re not making more progress toward health improvement goals.”
“Health disparities and equity must be prominent in any discussion of population health or social determinants”
“Addressing social determinants is all about relationships and networks with patients and community stakeholders”
“Need to link social determinants strategies with clinical outcomes to provide value proposition to leadership.”
“Hospitals can’t be at the center or have primary responsibility – we should be a convener or connector in the process.”
![Page 13: Health System Leadership to Address Population Health ......2018/05/15 · Health System Leadership to Address Population Health & Reducing Disparities Andrew Shin, JD, MPH Chief](https://reader033.fdocuments.net/reader033/viewer/2022050506/5f97aa8f8a103d2f5657d96f/html5/thumbnails/13.jpg)
Population Health Alignment
13
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Population health aligned with mission
Strong collaborations with community organizations
Population health aligned with clinical integration strategy
Focus on a broad range of population health issues
Priorities aligned with public health department's priorities
Financial resources available for population health initiatives
Programs address socioeconomic determinants of health
Strongly disagree Disagree Neutral Agree Strongly agree
Source: Health Research & Educational Trust, 2015.
![Page 14: Health System Leadership to Address Population Health ......2018/05/15 · Health System Leadership to Address Population Health & Reducing Disparities Andrew Shin, JD, MPH Chief](https://reader033.fdocuments.net/reader033/viewer/2022050506/5f97aa8f8a103d2f5657d96f/html5/thumbnails/14.jpg)
Bridging the Gap
14
Source: Health Research and Educational Trust, 2014
![Page 15: Health System Leadership to Address Population Health ......2018/05/15 · Health System Leadership to Address Population Health & Reducing Disparities Andrew Shin, JD, MPH Chief](https://reader033.fdocuments.net/reader033/viewer/2022050506/5f97aa8f8a103d2f5657d96f/html5/thumbnails/15.jpg)
15
![Page 16: Health System Leadership to Address Population Health ......2018/05/15 · Health System Leadership to Address Population Health & Reducing Disparities Andrew Shin, JD, MPH Chief](https://reader033.fdocuments.net/reader033/viewer/2022050506/5f97aa8f8a103d2f5657d96f/html5/thumbnails/16.jpg)
Leadership Prioritization & Alignment
16 Source: Athena Health, 2017.
![Page 17: Health System Leadership to Address Population Health ......2018/05/15 · Health System Leadership to Address Population Health & Reducing Disparities Andrew Shin, JD, MPH Chief](https://reader033.fdocuments.net/reader033/viewer/2022050506/5f97aa8f8a103d2f5657d96f/html5/thumbnails/17.jpg)
TrusteesPhysicians
Administrators
Leadership Engagement
![Page 18: Health System Leadership to Address Population Health ......2018/05/15 · Health System Leadership to Address Population Health & Reducing Disparities Andrew Shin, JD, MPH Chief](https://reader033.fdocuments.net/reader033/viewer/2022050506/5f97aa8f8a103d2f5657d96f/html5/thumbnails/18.jpg)
Trustee Engagement
![Page 19: Health System Leadership to Address Population Health ......2018/05/15 · Health System Leadership to Address Population Health & Reducing Disparities Andrew Shin, JD, MPH Chief](https://reader033.fdocuments.net/reader033/viewer/2022050506/5f97aa8f8a103d2f5657d96f/html5/thumbnails/19.jpg)
Transitioning Payment Models
19
Source: Health Catalyst, 2017Source: Innosight, 2017
![Page 20: Health System Leadership to Address Population Health ......2018/05/15 · Health System Leadership to Address Population Health & Reducing Disparities Andrew Shin, JD, MPH Chief](https://reader033.fdocuments.net/reader033/viewer/2022050506/5f97aa8f8a103d2f5657d96f/html5/thumbnails/20.jpg)
Workforce Capacity
20
63.2%
32.4%18.2%
18.0%
29.0%
22.3%
3.7%
9.9%
14.2%
15.1%28.7%
45.3%
Small (<100 beds) Medium (100-299 beds) Large (300+ beds)
FTEs DEVOTED TO POPULATION HEALTH0-1.99 FTEs 2-5.99 FTEs 6-9.99 FTEs 10+ FTES
Source: Health Research & Educational Trust, 2015.
![Page 21: Health System Leadership to Address Population Health ......2018/05/15 · Health System Leadership to Address Population Health & Reducing Disparities Andrew Shin, JD, MPH Chief](https://reader033.fdocuments.net/reader033/viewer/2022050506/5f97aa8f8a103d2f5657d96f/html5/thumbnails/21.jpg)
Workforce Competencies
• Community Health Assessment• Community Health Improvement Planning and Action• Community Engagement and Cultural Awareness• Systems Thinking• Organizational Planning and Management
21
![Page 22: Health System Leadership to Address Population Health ......2018/05/15 · Health System Leadership to Address Population Health & Reducing Disparities Andrew Shin, JD, MPH Chief](https://reader033.fdocuments.net/reader033/viewer/2022050506/5f97aa8f8a103d2f5657d96f/html5/thumbnails/22.jpg)
Workforce Capacity
![Page 23: Health System Leadership to Address Population Health ......2018/05/15 · Health System Leadership to Address Population Health & Reducing Disparities Andrew Shin, JD, MPH Chief](https://reader033.fdocuments.net/reader033/viewer/2022050506/5f97aa8f8a103d2f5657d96f/html5/thumbnails/23.jpg)
Policy Levers to Advance Population Health
• Payment– APMs, MACRA, State-based initiatives (e.g. Medicaid 1115 Waivers),
Accountable Communities for Health
• Data/Measurement– Outcomes, health services, community health (housing, healthy food
access, opportunities for physical activity)– Data-sharing infrastructure
• Community Benefit/Community Health Needs Assessments
23
![Page 24: Health System Leadership to Address Population Health ......2018/05/15 · Health System Leadership to Address Population Health & Reducing Disparities Andrew Shin, JD, MPH Chief](https://reader033.fdocuments.net/reader033/viewer/2022050506/5f97aa8f8a103d2f5657d96f/html5/thumbnails/24.jpg)
Accountable Health Communities
24
![Page 25: Health System Leadership to Address Population Health ......2018/05/15 · Health System Leadership to Address Population Health & Reducing Disparities Andrew Shin, JD, MPH Chief](https://reader033.fdocuments.net/reader033/viewer/2022050506/5f97aa8f8a103d2f5657d96f/html5/thumbnails/25.jpg)
Payment Models
Payment Taxonomy Framework
Category 1:Fee for Service – No Link
to Quality
Category 2:Fee for Service – Link to
Quality
Category 3:Alternative Payment Models Built on FFS
Architecture
Category 4:Population-Based
Payment
Desc
riptio
n
Payment based on volume of services and not linked to quality of
efficiency
At least a portion of payments vary based on the quality or efficiency of health care delivery
Some payment is linked to the effective
management of a population or episode of care. Payment still
triggered by delivery of service, but
opportunities for savings or 2-sided risk
Payment is not directly triggered by service
delivery so volume is not linked to payment. Clinicians and orgs are
paid and responsible for care of a beneficiary over a long period
(e.g., ≥ 1 year)
Source: Centers for Medicare and Medicaid Services, 2015. Better Care. Smarter Spending. Healthier People: Paying Providers for Value, Not Volume. Available at: https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2015-Fact-sheets-items/2015-01-26-3.html
![Page 26: Health System Leadership to Address Population Health ......2018/05/15 · Health System Leadership to Address Population Health & Reducing Disparities Andrew Shin, JD, MPH Chief](https://reader033.fdocuments.net/reader033/viewer/2022050506/5f97aa8f8a103d2f5657d96f/html5/thumbnails/26.jpg)
Community Health Needs Assessments
![Page 27: Health System Leadership to Address Population Health ......2018/05/15 · Health System Leadership to Address Population Health & Reducing Disparities Andrew Shin, JD, MPH Chief](https://reader033.fdocuments.net/reader033/viewer/2022050506/5f97aa8f8a103d2f5657d96f/html5/thumbnails/27.jpg)
Beyond Community Benefit Requirements
![Page 28: Health System Leadership to Address Population Health ......2018/05/15 · Health System Leadership to Address Population Health & Reducing Disparities Andrew Shin, JD, MPH Chief](https://reader033.fdocuments.net/reader033/viewer/2022050506/5f97aa8f8a103d2f5657d96f/html5/thumbnails/28.jpg)
3.6 million people in the U.S. can’t access medical care due to transportation issues.
1.48 million individuals are homeless in the U.S. every year.
The Need to Address Social Determinants of Health
12.7% of U.S. households are food insecure.42 million Americans face hunger.
![Page 29: Health System Leadership to Address Population Health ......2018/05/15 · Health System Leadership to Address Population Health & Reducing Disparities Andrew Shin, JD, MPH Chief](https://reader033.fdocuments.net/reader033/viewer/2022050506/5f97aa8f8a103d2f5657d96f/html5/thumbnails/29.jpg)
Addressing the Social Determinants
Innovative Clinical Prevention Traditional Clinical Prevention
Increase the use of clinical
preventive services
Provide services that extend care outside the clinical setting
Community-Wide Prevention
Implement interventions that
reach whole populations
1 2 3
![Page 30: Health System Leadership to Address Population Health ......2018/05/15 · Health System Leadership to Address Population Health & Reducing Disparities Andrew Shin, JD, MPH Chief](https://reader033.fdocuments.net/reader033/viewer/2022050506/5f97aa8f8a103d2f5657d96f/html5/thumbnails/30.jpg)
Setting the Goalposts
30
![Page 31: Health System Leadership to Address Population Health ......2018/05/15 · Health System Leadership to Address Population Health & Reducing Disparities Andrew Shin, JD, MPH Chief](https://reader033.fdocuments.net/reader033/viewer/2022050506/5f97aa8f8a103d2f5657d96f/html5/thumbnails/31.jpg)
![Page 32: Health System Leadership to Address Population Health ......2018/05/15 · Health System Leadership to Address Population Health & Reducing Disparities Andrew Shin, JD, MPH Chief](https://reader033.fdocuments.net/reader033/viewer/2022050506/5f97aa8f8a103d2f5657d96f/html5/thumbnails/32.jpg)
Quality Improvement ApproachPatient-Level Health Care Organization
Population-LevelGeneral Population-Level
Primary Prevention Financial literacy, support, & nutrition programs for low-income families with strong family history of DM
Provide on-site Farmers’ Market, gym, walking trails or financial counseling for families at risk for DM
Advocate for local increase in minimum wage and supports for low-income families, particularly those at risk of DM
SecondaryPrevention
Poverty screening & financial assistance for DM patients at-risk of end-of-month hypoglycemia
Subsidize vouchers to local Farmer’s Market or hire a financial counselor for low-income DM patients
Change timing and content WIC & school food programs to avoid food insecurity among DM
Tertiary Prevention Reduce ED use among high-utilizer severe diabetics using food and income support referrals
Coordinate with local banks, collectors, lenders, to reduce debt burden for utilizer diabetics
Support legislation/ regulations to provide financial and “hotspotter” services to severe diabetics
![Page 33: Health System Leadership to Address Population Health ......2018/05/15 · Health System Leadership to Address Population Health & Reducing Disparities Andrew Shin, JD, MPH Chief](https://reader033.fdocuments.net/reader033/viewer/2022050506/5f97aa8f8a103d2f5657d96f/html5/thumbnails/33.jpg)
Collecting and Using Data
![Page 34: Health System Leadership to Address Population Health ......2018/05/15 · Health System Leadership to Address Population Health & Reducing Disparities Andrew Shin, JD, MPH Chief](https://reader033.fdocuments.net/reader033/viewer/2022050506/5f97aa8f8a103d2f5657d96f/html5/thumbnails/34.jpg)
Changing Environments
34
South Asian Cardiovascular Center at Advocate Lutheran General Hospital Chicago, Illinois
![Page 35: Health System Leadership to Address Population Health ......2018/05/15 · Health System Leadership to Address Population Health & Reducing Disparities Andrew Shin, JD, MPH Chief](https://reader033.fdocuments.net/reader033/viewer/2022050506/5f97aa8f8a103d2f5657d96f/html5/thumbnails/35.jpg)
Partnerships
35
![Page 36: Health System Leadership to Address Population Health ......2018/05/15 · Health System Leadership to Address Population Health & Reducing Disparities Andrew Shin, JD, MPH Chief](https://reader033.fdocuments.net/reader033/viewer/2022050506/5f97aa8f8a103d2f5657d96f/html5/thumbnails/36.jpg)
Partners
36
Sour
ce: H
RET,
201
7. A
cces
sed
at: w
ww
.hpo
e.or
g/pa
rtne
rshi
ppla
yboo
k.
![Page 37: Health System Leadership to Address Population Health ......2018/05/15 · Health System Leadership to Address Population Health & Reducing Disparities Andrew Shin, JD, MPH Chief](https://reader033.fdocuments.net/reader033/viewer/2022050506/5f97aa8f8a103d2f5657d96f/html5/thumbnails/37.jpg)
Creating Strategic Alliances…
![Page 38: Health System Leadership to Address Population Health ......2018/05/15 · Health System Leadership to Address Population Health & Reducing Disparities Andrew Shin, JD, MPH Chief](https://reader033.fdocuments.net/reader033/viewer/2022050506/5f97aa8f8a103d2f5657d96f/html5/thumbnails/38.jpg)
ACHI Insights
38
![Page 39: Health System Leadership to Address Population Health ......2018/05/15 · Health System Leadership to Address Population Health & Reducing Disparities Andrew Shin, JD, MPH Chief](https://reader033.fdocuments.net/reader033/viewer/2022050506/5f97aa8f8a103d2f5657d96f/html5/thumbnails/39.jpg)
PUTTING ASIDE DIFFERENCES
Atrium Health and Novant HealthCharlotte, North Carolina
![Page 40: Health System Leadership to Address Population Health ......2018/05/15 · Health System Leadership to Address Population Health & Reducing Disparities Andrew Shin, JD, MPH Chief](https://reader033.fdocuments.net/reader033/viewer/2022050506/5f97aa8f8a103d2f5657d96f/html5/thumbnails/40.jpg)
THE ROAD AHEAD
![Page 41: Health System Leadership to Address Population Health ......2018/05/15 · Health System Leadership to Address Population Health & Reducing Disparities Andrew Shin, JD, MPH Chief](https://reader033.fdocuments.net/reader033/viewer/2022050506/5f97aa8f8a103d2f5657d96f/html5/thumbnails/41.jpg)
The Path Forward
• Getting to a Shared Framework• Community and Government Partnerships• Board Engagement and Education• Strengthening linkages between quality with equity and
disparities • Contextual Approaches to Advancing Population Health
41