Chicago Department of Public HealthCommissioner Bechara Choucair, M.D.

City of ChicagoMayor Rahm Emanuel

Healthy Chicago and the ACA Creating Opportunities for

Innovation May 16, 2014Bechara Choucair, MD

CommissionerChicago Department of Public Health

@choucair #HealthyChicago

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The Health Information Technology for Economic and Clinical Health Act (HITECH)

• Signed into law on February 17, 2009

• Supports concept of EHRs, led by CMS and ONC for Health IT

• Promoted the adoption and meaningful use of health information technology

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Insurance Reform

Increase access to coverage

More benefits and protection

Lower costs

Health System Reform

More focus on public health and

prevention

Innovation to improve quality and efficiency

Stronger workforce and infrastructure

Breaking Down the ACA

Healthy ChicagoPublic Health Agenda• Released in August 2011

• Identifies priorities for action for next 5 years

• Identifies health status targets for 2020

• Shifts us from one-time programmatic interventions to sustainable system, policy and environmental changes

Chicago Department of Public HealthCommissioner Bechara Choucair, M.D.

City of ChicagoMayor Rahm Emanuel

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Healthy Chicago Targets

IT’S NOT JUST ABOUT INDIVIDUAL BEHAVIOR

IT’S ABOUT HOW WE BEHAVE AS A CITY

Counseling and Education

Clinical Interventions

Long-Lasting Protection Interventions

Changing the Context to Make Individuals’ Default Decisions Healthy

Socioeconomic Factors

Increasing Population Impact

Increasing Individual Effort Needed

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Insurance Reform

Increase access to coverage

More benefits and protection

Lower costs

Health System Reform

More focus on public health and

prevention

Innovation to improve quality and efficiency

Stronger workforce and infrastructure

System Reform

Enroll 15,000 students over 2 years

Grant period: Oct. 2013 – Sept. 2015

LISC - $1,550,000

Four Partners• North River• South West Organizing Project• Logan Square Neighborhood

Assn.• Enlace

The Children’s Initiative

Over 20,000 uninsured children were eligiblefor coverage prior to the passage of the ACA

11 Community Service and Senior Centers

655 enrolled

Family and Support Services & CDPH Sites Uptown and Englewood HIV

Sites

Enrollment at Family Flu Clinics

423 enrolled

• 108 librarians trained • > 100 events at 26 branches

Engaging Libraries

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2013 study of 3,402 artists found:

• 43% did not have insurance

88% said they couldn’t afford it

• 37% of the 1,927 with coverage paid for it themselves

6 times greater than general pop that pays for private, non-group insurance.

• 55% did not understand or were unclear about the ACA

• 3 hour event; 50 navigators

• 1-hour appointments• 125 persons completed

or began enrollment process

• 12,000 licensed public chauffeurs in Chicago

• 300 present daily for license renewal at a single City location with waits of up to 2 hours

• Many self-employed

• Chicago study of cab drivers found:

70% uninsured (v. 20%)

4.6% eat enough produce (v.22%)

6% meet exercise standards

(v. 21%)

~ 50% of drivers in NYC and San Francisco uninsured

Reaching Chicago’s Taxi Drivers

• 3 onsite navigators• Education in waiting area• 7-9 enrollments daily

• Chicago City Colleges

• 7 campuses• ~ 120,000 students• ~6,000 faculty

• Events at 6 campuses

• 206 Enrolled• 472 Educated

The Young Invincibles

Public Housing ResidentsThrough CHA events and partners, 537 residents have either enrolled or started the insurance enrollment process

Operation Warm

Aviation~200 non-City employees work at O’Hare

6-hour education & enrollment event

Focus on small businesses later in year

Illinois ACA Insurance Enrollment 10/1/ 2013 through 4/15/ 2014

~ 504,000 Illinois residents gained coverage

Insurance Reform

Increase access to coverage

More benefits and protection

Lower costs

Health System Reform

More focus on public health and

prevention

Innovation to improve quality and efficiency

Stronger workforce and infrastructure

System Reform

Prevention and Public Health FundThe U.S.’s first mandatory funding for public health

PPHF Goals

Clinical Prevention

Community Prevention

Workforce and Infrastructure

Research & Tracking

More information: APHA: Prevention and Public Health Fund

• Original funding: $15B over fiscal years (FYs)10-19, then $2B per year

• P.L. 112-96 (Feb 2012): cut $6.25B over 9 years (FY13-21)

More information: APHA: Prevention and Public Health Fund

PPHF in ChicagoOver $40M in funding to Chicago

PPHF Goals

Clinical Prevention

Community Prevention

Workforce and Infrastructure

Research & Tracking

Immunization & HPV system improvements

Epidemiology and Lab Capacity

Obesity, Tobacco, HIV(focus on systems, policy, and environment)Nursing education, residency expansionPublic Health InfrastructurePCORI – UIC Asthma, CAPriCORN7 other projects

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Tobacco Victories

• Increased Cigarette Tax

• Banned Flavored Tobacco Sales Near Schools

• Regulate E-Cigarettes

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Tobacco Tax Increase

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Ban of Flavored TobaccoSales Near Schools

• 4 Town Hall Meetings following Mayoral request

• Over 200 residents, local and national content experts participated

• Ordinance passed in December 2013

• Chicago is first City to include menthol in flavored tobacco regulations

• Report included over 25 policy recommendations at local, state and federal levels.

• Adopted by Board in October 2013

• Submitted to Mayor in November 2013

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Regulating ElectronicCigarettes

Partners advocated for:

• Keeping e-cigarettes behind counters

• Prohibiting sales to minors

• Requiring tobacco licenses for e-cigarette sales

• Adding electronic smoking devices under the Clean Indoor Air Ordinance.

January 15th passage of ordinance

Aldermen noted they wanted to:

• “stand with public health”

and

• “be on the right side of

history”

Public Awareness Campaigns Reinforce Need for Change

BURNED by Menthol campaign generated

22,775,407 media impressions

Take Pride, Leave Cigarettesgenerated 12,492,530

impressions

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More Smokers SeekingCessation Support

• 24,496 calls in 2013

• 10,000 more calls than 2012

• >73% of callers were African

American or Hispanic

• More than half were uninsured

University of Illinois at Chicagobecame a Tobacco-Free Campusfor total of:

• 5 smoke-free institutions of higher learning

• 6 smoke-free hospital campuses

Chicago Housing Authority designated 2 new 100% smoke-free complexesfor total of:

• 610 smoke-free units in six developments

• 3,250 units of private multi-unit housing

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More Smoke-Free Environments

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Chicago Leads the Nation

Mayor Emanuel receiving African American Tobacco Leadership Council’s Visionary Elected Official Award

The federal government is currently considering:

• Cigarette tax increase• Stronger rules on menthol• Regulating electronic cigarettes

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Adult Smoking is Down

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Youth Smoking is Down…

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… and Taxes are Up

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Obesity Successes

• Increased access to healthy & affordable food

• More opportunities for physical activity

• Focus on CPS students

• Build healthier neighborhoods

• Grow food

• Expand healthy food enterprises

• Strengthen the food safety net

• Serve healthy food and beverages

• Improve eating habits

• Healthy vending machines in all City buildings

• Launched Healthy Vending Challenge

• Follow efforts of Parks and CPS

Increasing Access to Healthy FoodCitywide Food Plan Healthy Vending

• 15 carts in neighborhoods for 2013

• 15 planned for 2014

• ~20 jobs created

• 40 persons trained in retail sales

Farmers for Chicago• Partnership with Growing Power • 5 acres of vacant lots available• Training for local farmers and help installing equipment• 15 acres overall operate as farms or

breaking ground

Produce Carts Urban Farms

Increasing Access to Healthy Food

Increased Opportunities forPhysical Activity

• 2,035 bikes, 300 stations• 12,133 annual memberships• 131,984 24-hour passes• >1M trips, >2million miles

Dearborn St. Complete Street

Divvy Bike Share Program

• 200 miles of on-street protected, buffered and shared bike lanes

• More than 13,000 bike racks, and sheltered parking

• A 645-mile network of biking facilities by 2020 will provide a provide a bicycle accommodation within half-mile of every Chicagoan. 

Before After

• 61 events• 13,173 participants• Twice the number from

2012

.

Focus on CPS Students New PE policy requires

• 30 minutes of daily PE (or 150 minutes weekly) at elementary schools

• Daily PE for high schools

$2.25M grant will support implementation

Estimates of obesity prevalence for CPS students in kindergarten, 2003-12

Insurance Reform

Increase access to coverage

More benefits and protection

Lower costs

Health System Reform

More focus on public health and

prevention

Innovation to improve quality and efficiency

Stronger workforce and infrastructure

System Reform

Public Health

Clinical Medicine

Health Outcome

s

Public Health & Medicine

The Center for Medicare and Medicaid Innovation• Established in 2010 to test innovative payment and

delivery models that reduce expenditures for Medicare, Medicaid and the Children’s Health Insurance Program, while improving or maintaining care quality

• Focus on improving population health by financing new models that encourage collaborative efforts between medical providers and community-based organizations and services.

• Necessitates collaboration between public health and medicine

Payment and Care Delivery Models

• Models mandated or promoted by policy experts

• Models that demonstrate compelling approaches

• Other models include:– Accountable Care Organizations– Initiatives for dual-eligible beneficiaries– Bundled payments

Innovation Grants

University of Chicago• $6.1M for Comprehensive Care Physician model• $5.9M for CommunityRx; connect patients to resources

$4M State Innovation Plan “Alliance for Health”• Integrated delivery

systems• Supports for high-

needs people• Enhanced public

health supports

• Adequate workforce

• State leadership in CQI for public health and health care systems

• Funds research to obtain evidence for clinical and preventive care

• $4M to UI Health and eight local medical centers to test interventions to decrease pediatric asthma emergency department visits

Patient-Centered Outcomes Research Institute (PCORI)

ACA Accelerating Technology Innovation• Telemedicine/Remote Patient

Monitoring

• Big Data

• mHealth

• Electronic Medical Record Integration

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AdvancingHealthy ChicagoThrough Technology

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Innovations in TechnologyProjects

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Innovations in TechnologyStrategy

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Open Data PortalsSpur Innovation

Recent Releases:• Medicare

Provider Utilization and Payment Data

• Chronic Conditions Data

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Our Open Data PortalSpurs Innovation too…

Chicago Health Atlas is aDatabase

• De-identified electronic health record data for ~1 million Chicagoans

• In-patient and out-patient visits spanning 2006-2011

• Individual patient records matched across institutions

Chicago Health Atlas is aCollaboration• Informatics researchers from multiple

healthcare institutions

• Chicago Health Information Technology Regional Extension Center (CHITREC)

• Chicago Community Trust

• Chicago Department of Public Health

Chicago Health Atlas is aWebsite

ChicagoHealthAtlas.org

Digital Therapeutics

Social Network AnalysisTwitter

Current Applications

FoodBorne Chicago

FoodBorne ChicagoCompleting the Service Circle

CLICKS & REPORT

RESIDENT TWEETS

ONLINE RESULTS

Predictive AnalyticsFood Inspections

Currently• 32 Inspectors• 623 Inspections/Inspector• 15,176 Food Establishments• 2,715,000 Chicagoans

Centers for Disease Control and Prevention• Many food borne illnesses go unreported• 1 in 6 Americans (48 million people) get sick• 128,000 are hospitalized• 3,000 die of foodborne diseases

To Meet Requirements of Inspections• Do we increase productivity?• Do we increase workforce?

Predictive AnalyticsFood Inspections

While Data Mining for the Analytics Project…• While the number of

food inspections is trending up, the number of fails is down, as is the rate of fails.

• Nine months of 2013 had fewer fails than any of the same months in the previous 3 years.

• Every month of 2013 had a lower rate of fails than any of the same months in the previous 3 years.

Why Healthy Chicagois Making a Difference

Partnerships Policies

Technology and

Innovation

Public Awareness

City Participation is Growing

Healthy Chicago Partnerships

@ChiPublicHealth

312.747.9884

facebook.com/ChicagoPublicHealth

HealthyChicago@CityofChicago.org

www.CityofChicago.org/Health