leveraging public health capacity to increase health system efficiency
DESCRIPTION
Presenter Sharon Moffatt Chief of Health Promotion and Disease Prevention with the Association of State and Territorial Health Officials, leading on prevention, access to care and health reformTRANSCRIPT
Leveraging Public Health Capacity to Increase Health
System Efficiency
Sharon MoffattAssociation of State and Territorial
Health OfficialsOctober 5, 2010
State Health Agency Structure
Primary Statutory Public Health Authority in State
ID
AZ
UT
MT
WY
NM
CO
AL
FL
SC
TN
KY
INOH
NC
SD
KS
NE
MN
WI
IA
IL
MO
AR
MS
OK
ND
OR
CA NV
WA
TX
AK
PA
ME
VA
NY
CT
WV
DE
NJ
VTNH
MA
RI
MD
HI
LA
GA
MI
Centralized organizationalcontrol
20%
Hybrid organizational control 35%
Decentralized organizationalcontrol
37%
No local health department 8%
State and Local Public Health Relationships
State Health Agency Roles in Health Reform
Previous Roles and New Roles in Response to Affordable Care Act
Health Reform Survey
What issues do your state's current health reform efforts address? (N=45)Expanding health insurance coverage 89%
Electronic health information exchange 78%
Chronic disease management and care 73%
Healthy lifestyles/behaviors 69%
Prevention and wellness 67%
Reducing costs of health care 60%
Quality of care 58%
Barriers to accessing existing medical services 56%
Preventive and primary care 56%
ASTHO Survey 8/09
Health Reform Survey State PartnersWhich other government agencies and non-governmental groups have you
worked with to ensure the integration of health and wellness priorities in health reform efforts?
State Medicaid Program
Clinical Sector/Providers
State Education Agency
Business
Community- and/or Faith- Based Groups
State Insurance Agency
Insurance Industry
Other
Other State Agency
State Agriculture Agency
Other Interest Group
State Transportation Agency
Labor Representatives
State Financial/Banking Agency
0% 20% 40% 60% 80% 100%
87%
80%
53%
51%
51%
49%
44%
42%
36%
29%
20%
18%
16%
4%
N = 45
ASTHO Survey 8/09
California Colorado Connecticut Illinois Maine Maryland Michigan New Mexico
New York Nevada Pennsylvania Vermont Virginia Washington State Wisconsin Wyoming
New State Structures for Implementing Health Reform with Public Health as Identified Member
Public Health and Medicaid
District of Columbia Louisiana Maryland Michigan Missouri
Montana Nebraska New York Utah Wyoming
10 State Health Officials Have Responsibility for Medicaid
Chronic Disease Management (§ 4108)
◦ 2011: HHS grants to states that provide incentives for Medicaid beneficiaries to participate in healthy lifestyle programs.
Immunizations (§ 4106)
◦ 2013: States will receive a 1% increase in FMAP if they offer adult vaccines without cost sharing
Expansion of Family Planning Services (§ 2303)◦ States can expand services without a waiver
Opportunities for Public Health and Medicaid Collaboration
By October 1, 2010 states are required to cover comprehensive tobacco cessation services for pregnant women in Medicaid (§ 4107)
State health departments have experience developing and promoting comprehensive tobacco use prevention and cessation strategies
Public Health and Medicaid Collaboration: Smoking Cessation
Massachusetts 2006 health reform mandated tobacco cessation coverage for Medicaid
Comparison of pre-benefit coverage to post-benefit coverage demonstrated a 26% decline in smoking rates
Example of Public Health and Medicaid Success: Massachusetts
Successful Public Health and Medicaid Collaboration: MA
14
Percent Drop in Smoking PrevalenceMassachusetts, 1998 - 2007
-2.4%
4.3%
1.5%2.0%
3.1%
-1.1%
3.1%
2.2%1.7%
7.9%
-4%
-2%
0%
2%
4%
6%
8%
10%
1998 1999 2000 2001 2002 2003 2004 2005 2006 2007
Patient Protection and Affordable Care Act
Bill shown is 1,990 page House version
Keeping focus on public health and prevention
State Budget Cuts
Huge volume of work for states
Timelines for decisions are short
2010 Election
CHALLENGES
Naples Herald, March 31, 2010
83% of state health agencies cut jobs
76% made cuts in FY09 and FY10
38% expect to lose more staff through layoffs and attrition
Impact of Budget Cuts on States
Asthma programs cut
Immunization outreach reduced
Eligibility for maternal child health programs reduced and waiting lists created
Teen pregnancy programs eliminated
Examples of State Program Budget Cuts
March 2010
“This is an historic, once in a lifetime investment in public health.”
-Paul Halverson, DrPH, ASTHO President
$15B investment in public health over the next 10 years!
Home visiting funding
Section 317 immunization program reauthorized Programs to address several critical health care and public health
workforce shortages authorized
School based Health Centers: 50M
CMS Innovation grants
OPPORTUNITIES
Setting priorities within the state health agency Communication of need to Executive and
Legislative Branch of government Identification of lead for grant applications Assuring quality and alignment of grant
applications given short submission periods
State Health Official Role Funding Opportunities and Challenges
Strong relationship to the state health plan.
Strong relationship to priorities of new administration, legislature.
Expands or improves related initiatives already underway in Maine.
Support, resources and capacity available across stakeholders.
Minimal state funding required (dollars and in-kind funding); recognize the new funding will require new state money to be appropriated.
Enhances state’s ability to meet legal and financial obligations.
Promotes collaboration among providers and consumers and harmonization of delivery systems in communities.
Clear focus on broad populations and overall impact of the specific grant.
Flexibility of application and implementation process: Can the state delegate?
Sustainability after grant funding ends.
Promote interstate cooperation as appropriate
Criteria for Maine State Government to Seek and SupportGrant, Pilot and Demonstration Opportunities in the Federal Health Reform Law
Patient Protection and Affordable Care Act, March 2010. Congressional Research Service (CRS) Healthreform.gov
References and Resources
Sharon Moffatt
Chief of Health Promotion and Disease Prevention Association of State and Territorial Health Officials
2231 Crystal Drive, Suite 450Arlington, VA 20112
www.astho.org