Improving Health Outcomes and Assuring Access to High Quality, Affordable Health Care for All Oklaho

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Improving Health Outcomes and Assuring Access to
High Quality, Affordable Health Carefor All
Oklahomans

• Mike Crutcher, MD, MPH
• Commissioner of Health
• Oklahoma State Department of Health

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Improving Health Outcomes and Assuring Access to
High Quality, Affordable Health Carefor All
Oklahomans(includes physical and behavioral
health)

• Prevention and health promotion
• Access to care
• Quality and cost control
• Equity / Health disparities
• Workforce development

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Recent Reports Assessing Health Outcomes and
Health Systems in the U.S.

• United Health Foundation Report, 2007
• Commonwealth Fund Report, 2007
• Robert Wood Johnson Foundation A Checkup on
  Health Care Markets, 2007
• Institute of Medicine Report Crossing the
  Quality Chasm, 2001

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United Health Foundation Report, Oklahoma

• 2007 2006
• Overall Rank 47 44
• Health Outcomes Data Rank Data Rank
• Poor Mental Health Days 4.3 47 3.6 41
• Poor Physical Health Days 4.5 48 4.1
  44
• Infant Mortality (/1,000) 8.0 40 8.2
  43
• Cancer Deaths (/100,000) 215.2 43
  216.5 44
• Premature Death (yrs/100,000) 9,307 43
  9,290 43
• CVD Deaths (/100,000) 412.1 50
  416.4 50

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Total Mortality U.S. 2004(U.S. 801 deaths /
100,000 pop)

• Lowest
• 1. Hawaii 624
• 2. Minnesota 691
• 3. North Dakota 694
• 4. Connecticut 709
• 5. California 717

• Highest
• 45. Oklahoma 946
• 46. Tennessee 953
• 47. W. Virginia 970
• 48. Louisiana 986
• 49. Alabama 991
• 50. Mississippi 992

Centers for Disease Control and Prevention,
National Center for Health Statistics. Compressed
Mortality File 1999-2004.
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(No Transcript)
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Percent of People Below Poverty 2005 Past 12
months
Source U.S. Census Bureau, 2005 American
Community Survey
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Risk Factors for Health(OK Rank)

• Income (lt25,000) (47)
• Education (ltHS, lt Col) (41, 47)
• Health Insurance (44)
• Tobacco use (47)
• Nutrition (50)
• Exercise (47)
• Obesity (44)
• Mental illness (50)
• Prevalence of diabetes (46)
• Prevalence of HBP (45)

Behavioral Risk Factor Surveillance System
2005 BRFSS
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Commonwealth Fund Report, 2007OK Ranking

• Overall rank Tied with MS 50
• Health outcomes 47
• Access to care 49
• Quality 43
• Avoidable hospital use and costs 50
• Equity 50

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7 Attributes of a Highly-Functioning Health Care
MarketRWJF A Checkup of Health Care Markets
Apr 2007

• Community leadership
• Quality improvement
• Performance management
• Public reporting
• Provider financial incentives
• HIT incentives and infrastructure
• Consumer engagement

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The health care system should work to ensure that
all Americans receive care that is

• Safe
• Effective
• Patient centered
• Timely
• Efficient
• Equitable
• Ref Crossing the Quality Chasm, IOM, 2001

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Health care constituencies should work together
to create an environment that fosters and rewards
improvements by

• Creating an infrastructure to support evidenced
  based practice
• Facilitating the use of information technology
• Aligning payment incentives
• Preparing the workforce to better serve patients
  in a world of expanding knowledge and rapid
  change
• Ref Crossing the Quality Chasm, IOM, 2001

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Healthcare constituencies should work together to
redesign healthcare processes in accordance with
the following rules

• Care based on continuous healing relationships
• Customization based on patient needs and values
• The patient as the source of control
• Shared knowledge and the free flow of info.
• Evidenced-based decision making
• Safety as a system priority
• The need for transparency
• Anticipation of needs
• Continuous decrease in waste
• Cooperation among clinicians
• Ref Crossing the Quality Chasm, IOM, 2001

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DHHS Four Cornerstones for Value-Driven Health
Care 2006

• Interoperable health IT
• Transparency of cost
• Transparency of quality
• Promote quality and efficiency of care

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We Can Do Better Improving the Health of the
American People

• Addressing unhealthy behavior
• Tobacco
• Obesity
• Addressing health disparities
• Ref Schroeder, N Engl J Med, Sept 20, 2007

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Obama Health Plan

• Provide affordable, accessible health coverage
  for all
• Promote prevention and strengthen public health
• Lower costs and improve the quality of our health
  system
• Invest in health IT systems
• Support disease management programs
• Require full transparency of quality and costs
• Align incentives for excellence
• Address disparities in health outcomes and access
  to care
• Reform medical malpractice

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Improving Health Outcomes and Assuring Access to
High Quality, Affordable Health Carefor All
Oklahomans(includes physical and behavioral
health)

• Prevention and health promotion
• Access to care
• Quality and Cost control
• Equity / Health disparities
• Workforce development

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1 Improving health outcomes through prevention
and health promotion

• Efforts to decrease poor health due to heart
  disease, cancer, stroke, chronic lung disease,
  diabetes, obesity and other chronic diseases
• Tobacco use prevention
• Nutrition and fitness promotion
• Chronic Disease Management
• Clinical preventive services

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Oklahoma Health Improvement Plan

• Vision Oklahomans will achieve optimal
  physical, mental, and social health, and the
  state health status will be in the top quartile
  of the states by 2013
• Mission Working together to lead a process to
  improve and sustain the physical, social, and
  mental well being of all people in Oklahoma
• Initial focus areas Tobacco, Obesity, Child
  Health

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Tobacco Use Prevention and Cessation

• OSDH Tobacco Use Prevention Service
• Oklahoma Alliance on Tobacco or Health
• Tobacco Use Prevention and Cessation Advisory
  Committee
• Tobacco Settlement Endowment Trust
• Cherokee and Muscogee Creek Nations Tobacco
  Tribal Support Centers
• Turning Point
• OSMA Physicians Campaign for a Healthier Oklahoma

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Promotion of Improved Fitness and Nutrition

• Strong and Healthy Oklahoma Initiative
• Fit Kids Coalition
• Schools for Healthy Lifestyles / Its All About
  Kids
• Tribal REACH Projects
• Turning Point
• OSMA Physicians Campaign for a Healthier Oklahoma

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2 Increase Availability and Accessibility of
Health Services

• Expand/improve utilization of existing publicly
  funded programs
• Develop new public/private systems to expand
  access
• Increase number of Community Health Centers
  (FQHCs)
• Improve coordination of existing health services
• IHS and tribal services
• Expand volunteered health services
• Telemedicine

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3 Improve the Quality of the Health Care System
and Control Costs

• Community leadership
• Health Information Technology
• Quality Improvement / Performance Management
• Transparency of cost and quality (Public
  reporting)
• Provider incentives for quality care (Pay for
  Performance)
• Consumer engagement
• Medical liability reform
• Medical home

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Health Information Technology

• Electronic Medical Records (EMR)
• Electronic Health Record (EHR)
• Personal Health Record (PHR)
• E-prescribing
• Information exchanges (RHIOs)
• Electronic credentialing for health care
  providers
• Collection, analysis and accessibility of health
  information

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Oklahoma Health Care Quality Improvement Advisory
Committee

• Hospitals and Home Health
• Long Term Care
• Outpatient Care (Prevention)

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Proposed Activities to Improve Quality Indicators

• Provider education
• Accountability measures
• Consumer engagement
• Incentives

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4 Equity

• Addressing disparities in health outcomes and
  access to care based upon race/ ethnicity,
  income, education, gender, disability or place of
  residence

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5 Workforce Development Assure Adequate Supply
of Well Trained Health Professionals

• Assessment and coordination of health care
  workforce needs
• Emphasis on primary care training and placement
  in rural areas
• Pay alignment for primary care
• Scope of practice issues for Physician Assistants
  and Advanced Practice Nurses

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Recommendations to Improve Health Outcomes and
Quality

• Remove current exemptions on smoking in public
  places, including stand-alone bars
• Publish an annual report on quality indicators
  for medical facilities, nursing homes and home
  health agencies
• Require coverage by payers for annual
  examinations, at low or no charge, to detect
  preventable diseases