The Role of LHDs in Improving Population Health

LaQuandra S. Nesbitt, MD, MPHDirector, LMPHW

KHDA RetreatOctober 9, 2013

Agenda

• Improving “health”• Work of “public health”• Improving “population health”• Role of LHDs• How to transition• Discussion

IMPROVING HEALTH

What is Health?

“Health is a state of complete physical, mental, and social well-being and not merely the absence

of disease or infirmity.”

World Health Organization

What Determines the Population Health Status?

Policies &Programs

50% =

How Do We Improve Health?

THE “WORK” OF PUBLIC HEALTH

What is Public Health

“Public health is the science and art of preventing disease, prolonging life and

promoting health through the organized efforts and informed choices of society, organizations,

public and private, communities and individuals”

World Health Organization

Core Functions of Public Health

Food Hygiene, Public Facilities, Wastewater, Pools,Onsite Sewage,Smoke Free Ordinance

LMPHW Clinics (Family Planning, Immunization, STD, Tuberculosis)Obstetrical UltrasoundsBreast, Colorectal & Cervical Cancer ScreeningFamily Health CenterQuality Charitable Care Trust

Student Practicum OpportunitiesTraining (CEUs) for staffEvolving Partnership with U of L

Annual Performance PlanningResults Framework

Vital Statistics AnalysisBehavioral Risk Factor Surveillance System (BRFSS)EPSDT

Communicable Disease Investigation Epidemiology Site Assessments & EducationPublic Health Laboratory

Diabetes, Heart DiseaseNutrition (incl. WIC) & Physical ActivityMedicare FraudMaternal & Infant Home VisitationCenter for Health Equity

Center for Health EquityMayor’s Healthy Hometown Movement(Community Transformation Grant)

Mayor’s Healthy Hometown Movement Leadership TeamHealth Impact Assessments

Where Does the Money Come From?

All Funding Sources Combined

IMPROVING POPULATION HEALTH

What is Population Health?

“Population health is the health outcomes of a group of individuals, including the distribution

of such outcomes within the group”

Kindig D, Stoddart G. What is population health? American Journal of Public Health 2003 Mar;93(3):380-3

Improving Population Health

• Health care goal– The improvement of

individual patient outcomes through the provision of medical services

• Public health goal– Improving health

outcomes in the population as a whole through health promotion and disease prevention

Hardcastle et al. “Improving the Population’s Health: The Affordable Care Act and the Importance of Integration” Journal of Law, Medicine and Ethics Fall 2011

Improving Population Health

• Recognize the impact of the social determinants of health

• Collect population level data and use it to make program and policy decisions

• Close the chasm between public health and clinical medicine

Why Integration?

• Policy decisions may have unintended consequences

• Improves quality of care for patients• Avoids duplication and the resulting

unnecessary costs• Public health and individual health care

complement, but cannot replace, each other

Hardcastle et al. “Improving the Population’s Health: The Affordable Care Act and the Importance of Integration” Journal of Law, Medicine and Ethics Fall 2011

LHD’S AND POPULATION HEALTH

Role of Local Health Department

• Convener• Data collection and analysis• Establish priorities• Subject matter expert(s) for community• Research/review best practices• Advocate for local and state policy

Louisville Metro Example

• Issue: Current safety net funding levels are unsustainable– Convene “safety net” organization leaders– Identify high utilizer/cost patterns– What worked in Cincinnati, OH and Camden, NJ– Participate in policy discussions regarding system

reform

Louisville Metro Example

• Issue: Local hospital needs to decrease readmissions– Identify which patients are being readmitted more

frequently– Draw on strengths of hospital (nurse case

management/discharge planning) and local health department (community health worker/home visitation)

– Collect data and determine effectiveness of intervention

– Disseminate findings

HOW TO TRANSITION

Introspection

• Do I have the right staff?• Are we allocating resources appropriately?• Does our board of health have the right

composition?• Do members of my community recognize me

as a leader?• Am I prepared to get out of the business of

healthcare?

Introspection

• Does my team realize the field of public health is evolving?

• Is maintaining the current FTE levels in my organization a priority?

• Do I have a plan to teach my staff new skills?

Contact Info

LaQuandra S. Nesbitt, Director, LMPHWlaquandra.nesbitt@louisvilleky.gov

@DrLNesbitt