Public Health & Healthcare Transformation

13
Patrick F. Luedtke, MD, MPH Senior Public Health Officer Medical Director, Community & Behavioral Health clinics Lane County Health & Human Services Public Health & Healthcare Transformation

description

Public Health & Healthcare Transformation. Patrick F. Luedtke , MD, MPH Senior Public Health Officer Medical Director, Community & Behavioral Health clinics Lane County Health & Human Services. Lane County Health & Human Services. - PowerPoint PPT Presentation

Transcript of Public Health & Healthcare Transformation

Page 1: Public Health & Healthcare Transformation

Patrick F. Luedtke, MD, MPH

Senior Public Health Officer Medical Director, Community & Behavioral Health clinics Lane County Health & Human Services

Public Health & Healthcare Transformation

Page 2: 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

Page 3: Public Health & Healthcare Transformation

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)

Page 4: Public Health & Healthcare Transformation

• 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

Page 5: Public Health & Healthcare Transformation

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

Page 6: Public Health & Healthcare Transformation

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)

Page 7: Public Health & Healthcare Transformation

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

Page 8: Public Health & Healthcare Transformation

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

Page 9: Public Health & Healthcare Transformation

• 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

Page 10: Public Health & Healthcare Transformation

• 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)

Page 11: Public Health & Healthcare Transformation

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

Page 12: Public Health & Healthcare Transformation

• Program goal: Tobacco cessation in 30% of program participants

• Participation goal: 80% of pregnant Medicaid patients

Tobacco Cessation Incentive Program

Page 13: Public Health & Healthcare Transformation

Questions?