Patrick F. Luedtke, MD, MPH Senior Public Health Officer Medical Director, Community & Behavioral...
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Transcript of Patrick F. Luedtke, MD, MPH Senior Public Health Officer Medical Director, Community & Behavioral...
Patrick F. Luedtke, MD, MPH
Senior Public Health Officer Medical Director, Community & Behavioral Health clinics Lane County Health & Human Services
Public Health & Healthcare Transformation
1) Includes 4 FQHC clinics, Public Health, the County Mental
Health clinic, & the Behavioral health system payer
2) I serve as the County Public Health Officer (50%) and the
Medical Director of the FQHC clinics (50%)
3) I also serve on the CCO Board, the CAP, and on two CCO
subcommittees (PCMH & Quality)
4.) Other H&HS employees serve on CCO Board & committees
Lane County Health & Human Services
Lane County: The View From Space
1. CCO: ~74,000 lives, Board of 21, Prevention funding of $1.33 per member per month
2. Public Health
• Clinical: MCH, WIC, Prevention, Communicable Dz• Non-clinical: Environmental Health, Vital Records,
Preparedness• Other: PH/MH authority, “soft power” convening
authority (e.g., STD Summit)
• Community Health Needs Assessments
• Community Health Improvement Plans
• Health equity & Public Health equity initiatives
• Tracking health and process outcomes (e.g., patient safety, patient experience, care coordination, CHWs)
• Create & implement community-based prevention guidelines (e.g., tobacco, obesity, vaccination rates)
• Community initiatives based on claims data (e.g., tobacco use in pregnant women)
PH-PC: Integration and Reverse Integration
1.) Tobacco use in pregnant women
2.) Falling immunization rates (AFIX program)
3.) The Good Behavior Game (lower drug/alcohol
use disorders, smoking, antisocial PD, suicidal
ideation, delinquency, incarceration)
Specific Lane County Projects
Tobacco Cessation Incentive Program
Nicotine testing & incentive $$ for pregnant smokers
“All my pregnant patients smoke!”
Primary Care Physicians (PCP)
“We have too many preemies and pre-term labor cases.”
Obstetrics/Gynecology (OB/GYN)
• Vital statistics birth data review. • Federally qualified health centers
pregnant patient chart review.Public Health (PH)
PH-PCP-OB/GYN steering committee
Claims data review for preemie/pre-term labor costs. (CCO)
1st Trimester 2nd Trimester 3rd Trimester0
5
10
15
20
25
Prenatal Smoking By Trimester, Oregon vs. Lane County, 2009
Pre
nata
l Sm
okin
g (%
)
Lane County
Oregon
Smoking in Pregnancy
Data Source: Oregon Health Authority
Age Smoking Rate Patient Number<20 27% 294
20–24 25% 860
25–29 16% 1,147
30–34 11% 843
35–39 9% 348
>/= 40 11% 81
NOTE: Survey of current use rates: FQHC, PeaceHealth hospitals/clinics, Douglas county.Data Source: Lane County Vital Statistics: 2009
Lane County: Smoking in Pregnancy
• Prenatal smoking is associated with:
• 30% of small for gestational age (SGA) infants
• 10% of preterm infants
• 5% of infant deaths*
• Expected quit rate, without incentives is ~37%**
• Decreased ear infections and asthma attacks in child
Clinical Expectations
*MMWR 58(ss04);1-29 May 26, 2009 ** PRAMS 2005
• Preventing 1 SGA birth = $45,000 savings
• $1 spent on cessation = $3.50 in neonatal savings
Medicaid Savings
Data Source: CDC, Smoking-Attributable Mortality, Morbidity, and Economic Costs (SAMMEC)
Fiscal Data
Monetary goal: 10% cost reduction/yr (ROI = 7.6)
Lane County Medicaid Neonatology Costs (2012)Line item cost $7,643,967
# of Episodes 1,773
Cost/Episode $4,311
Unique members 1,715
• Program goal: Tobacco cessation in 30% of program participants
• Participation goal: 80% of pregnant Medicaid patients
Tobacco Cessation Incentive Program
Questions?