John Auerbach Commissioner Department of Public Health

1
John AuerbachCommissionerDepartment of Public
Health
WorkplanIntegration of Chronic Disease
ProgramsCDCs Negotiated Agreement
2
Chronic Disease Program Integration in
Massachusetts

• Goal To improve health outcomes for
  Massachusetts residents across the life span
  through chronic disease program integration
• Two levels directing activities
• Macro-level operations policy-setting groups
• MASS Goals EHS Goals at the Gubernatorial and
  Secretariat levels
• Health Care Reform
• HealthyMass Compact Initiatives
• Health Care Quality Cost Council
• State Health Department program-specific
  activities
• Public Health Council
• DPH priorities
• DPH program integration and collaboration

3
Context Driving Massachusetts Integration
Demonstration Project
Department Level Program Specific Activities

• Asthma
• BRFSS
• Comprehensive Cancer
• Diabetes
• Heart Disease Stroke Prevention
• Healthy Aging Disability
• Injury and Violence Prevention
• Primary Care
• Oral Health
• Tobacco
• School Health
• Substance Abuse Prevention and Treatment
• Community Wellness
• Nutrition, Physical Activity and Obesity
• WHN/MHP-Care Coordination Pilot
• Worksite Wellness

Macro Level ( system-wide) Operations Policy
Framework
Public Health Council

• HealthCare
• Reform
• Increase access to health insurance
• Strengthen
• public health infrastructure

• Healthcare Quality Cost
• Council
• Improve chronic preventive care
• Mitigate Disease impact

Regulatory Authority
MASS Goals EHS Goals

• DPH Priorities
• Support health care reform
• Eliminate disparities
• Promote wellness
• Manage chronic disease
• Support regionalization
• Maintain core public health functions

• HealthyMass Compact
• Ensure access
• Advance health care quality
• Contain cost
• Promote wellness
• Promote healthy Communities

Chronic Disease Blueprint
Dashboard
Diabetes Task Force Obesity Task Force
External Partnerships
4
Macro Level Health Care Reform
Goal increase access to health insurance and
strengthen public health infrastructure

• Provide health insurance to all residents
• Outcome 439,000 formerly uninsured residents
  are insured
• Increase in coverage provides
• Increased opportunity for prevention, earlier
  detection and treatment
• More data regarding the health of our residents

5
Macro Level Activities Involving Governor,
Legislature and Secretary of HHS
Goal Quality, Affordable Health Care for All

• HealthyMass Compact A Multi-Agency Wellness and
  Quality of Health Care Initiative with 5 Goals
• Ensure access to care
• Advance health care quality
• Contain health care costs
• Promote individual wellness
• Promote healthy communities

6
Macro Level HealthyMass Compact
Goal Establish unified health priorities for the
administration targeting healthcare access,
quality and costs promoting individual wellness
and healthy communities

• Activities include
• Establish five state-wide task forces including
  the Chronic Disease Management and Wellness Task
  Force
• Develop and implement a state-wide Action Plan
  for Preventing and Managing Diabetes
• Create a blueprint for a statewide system of care
  to prevent and control chronic disease

7
Macro Level Health Care Quality Cost Council
Goal Establish a council comprised of state
leaders that reports to the legislature and is
charged with implementing polices that maximize
quality, minimize costs and reduce racial and
ethnic disparities

• Activities include
• Analyze utilization, quality and cost data
• Develop a blueprint for implementing a statewide
  model system of care that improves the health
  status of people with, or at risk for chronic
  conditions (Assigned to HealthyMass Task Force)
• Ensure that all programs include targeted
  strategies to reduce racial and ethnic
  disparities
• Establish policy as needed

8
Macro-Level Other Activities
Goal Strengthen pubic health through data,
programs and policy

• Establish Governor-level and Secretary-level
  quantitative goal-setting Mass Goals and EHS
  Goals respectively resulting in a transparent
  dashboard to measure outcomes
• Strengthen the public health infrastructure using
  new funding for childhood immunizations, tobacco
  control, violence prevention, substance abuse
  family services
• Expand the regulatory authority of the Public
  Health Council

9
Programmatic Departmental Activities
Current Programs focused on integration

• Activity
• ASTHMA
• Inputs
• Asthma program staff
• MA Asthma Advocacy Partnership
• Integrative Aspects
• Chronic Disease Blueprint
• Guidelines for Diagnosis and Management of
  Asthma
• Funding 6 Care Centers to implement
  evidence-based interventions
• Current Outcomes
• Coordination of chronic disease management
• Increase provider adherence to asthma guidelines

• Activity
• BRFSS
• Inputs
• Health Survey Staff
• MDPH programs
• CDC
• Integrative Aspects
• MDPH programs
• Collaborate in publications
• Provide data directly to programs
• Current Outcomes
• Developed a population data base
• Disseminate findings via reports

• Activity
• Community Health Worker
• Inputs
• DPH Staff
• CHW -Advisory Council
• CHEC Training
• Integrative Aspects
• Diabetes Program TF
• WHN CHC collaboration
• Current Outcomes
• CHW assigned cohorts w/ CD
• CHW Self Mgmt of CD

• Activity
• Comprehensive Cancer
• Inputs
• Cancer program staff
• Cancer Control Coalition
• Colorectal Cancer QI projects
• Patient Navigation surveys
• Informed decision-making initiative
• Integrative
• Aspects
• WHN/MHP Care Coordination Centers
• Current Outcomes
• Increase access
• Improved outcomes for Black/Hispanic cancer
  patients

• Activity
• Diabetes
• Inputs
• Diabetes program staff
• MA Diabetes Coalition
• Healthy Mass Diabetes Task Force
• MA Health Disparities Collaborative
• Integrative Aspects
• WNH/MHP Care Centers
• Current Outcomes
• Improved care coordination
• Eliminate health disparities
• Improved health outcomes for people at risk for
  or with diabetes

10
Programmatic Departmental Activities
Current Programs Targeting Integration

• Activity
• Heart Disease and Stroke Prevention
• Inputs
• Heart Disease and Stroke program staff
• Relationship with emergency medical dispatchers
  and technicians
• Coverdell licensed stroke centers collaborative
• Guidelines for management of hypertension and
  hyperlipidemia
• Partnership for Heart Healthy, Stroke-Free
  Massachusetts
• Integrative Aspects
• Coverdell hospitals
• WHN/MHP care centers
• Current Outcomes
• Increase adherence to guidelines at WHN/MHP Care
  Centers

• Activity
• Healthy Aging Disability
• Inputs, e.g.
• Healthy Aging and Disability staff
• AHRQ
• National Council on Aging
• Integrative Aspects
• Chronic Disease Self-Management Program at
  WHN/MHP care centers and their communities
• -Executive Office of Elder Affairs
• Disability access at WHNMHP Care Centers
• Current Outcomes
• Documented integration of Chronic Disease Self
  Management into systems of care

• Activity
• Obesity
• Inputs
• DPH Leadership
• Partnerships
• Obesity Grant
• Integrative
• Aspects
• Obesity health risks linked to chronic
  conditions-Broad-based policies
• Data collections
• Current Outcomes
• Coordinate w/ HealthyMass
• Link to MPHW NECON action plans
• Share resources

• Activity
• Oral Health
• Inputs
• -Oral Health Director
• -DPH Staff
• -Educational Resources
• Integrative Aspects
• School Health programs
• Diabetes programs
• Tobacco Use/Cancer
• Cardiovascular Disease
• Nutrition
• Current Outcomes
• Integration of oral health info into chronic
  disease education resources

11
Programmatic Departmental Activities
Current Programs Targeting Integration

• Activity
• WHN/MHP
• Inputs
• WHN/MHP staff
• WHN/MHP Contractors
• Advisory Committee
• UMass Medical School Health Education Network
  (AHEC)
• Integrative Aspects
• Integrative person-centered care coordination
  model
• AHEC training statewide for Community Health
  Workers and Patient Navigators
• MA Tobacco Control Program collaboration
• Current Outcomes
• Increaser access to and use of preventive
  services
• Elimination of health disparities

• Activity
• School Health
• Inputs
• UMass Medical Sch
• MA Academy of Peds
• Blue Cross
• Integrative Aspects
• Asthma Coalition
• PTA
• Boston College School of Nursing
• Collaborating with MDPH
• Current Outcomes
• Increase awareness to 2100 sch nurses re
  substance abuse, asthma
• Implemented CE for school health personnel with
  Northeastern University School Health Initiative

• Activity
• Worksite Wellness
• Inputs
• DPH Leadership
• DPH Staff
• HealthyMass Compact
• Integrative Aspects
• Training
• Evaluation
• Models
• Current Outcomes
• Developed community worksite school
  collaborative
• Innovative model that increases health and
  decreases costs

• Activity
• Women of Reproductive Age
• Inputs
• Bureau Family Health
• Bureau of Substance Abuse
• HealthyMass Compact
• Integrative Aspects
• Work with at risk patients for CD what is this?
• Diabetes Task Force
• Current Outcomes
• Secured medical home for at risk patients
• Improved perinatal outcome

12
Baseline Data

• Outcome Indicators
• CDC Chronic Disease health indicators
• WHN/MHP Care Coordination Pilot intake data
• Statewide surveillance systems (BRFSS, YRBS, YHS)
• Economic impact
• Quality Cost Council and other health care
  reform mechanism yield new data collection
  analysis
• DPH program budget information
• WHN/MHP Care Centers budget information
• Integration process
• STAR Review ( February 2008)
• Care Center process data ( patient satisfaction,
  site satisfaction )