PowerPoint Presentation

AAFP 2016 State Legislative Conference

Integration of Primary Care and Public Health

Health of the Public and Science DivisionBellinda K. Schoof, MHA,CPHQ

No DisclosuresI have no disclosures or financial conflicts of interest.2

Changing LandscapeFocus on Population Health ManagementAffordable Care Act (ACA)New Care Models ACOsPatient Centered Medical Home MACRA New Payment Models

Changing LandscapeDelivering on the Triple AimImproving population healthImproving patient experienceReducing CostImproving physicians experience

Why Now?Dramatic rise in health care costs has led many stakeholders to embrace innovative ideas

Health research continues to clarify the importance of social and environmental determinants of health and the impact of primary prevention

Why Now?Unprecedented wealth of health data is providing new opportunities to understand and address community-level health concerns

The ACA and MACRA presents an overarching opportunity to change the way health is approached in the United States

Estimated Deaths Attributable to Social Factors in the U.S. - 2000Low education: 245,000Racial segregation: 176,000 Low social support: 162,000Individual level poverty: 133,000Income inequality: 119,000 Area level poverty: 39,000

In comparison: Acute MI: 192,898Cerebrovascular disease 167,661Lung cancer: 155,521

Estimated Deaths Attributable to Social Factors in the US. Galea S et.al. AJPH:June 16,2011;eprint.

7(meta-analysis epidemiologists at U Michigan and Columbia)

Integration of Primary Care and Public HealthPosition PaperKey MessagesCommunity-oriented primary care supports population health.Roles of primary care and public health overlap and reinforce one anothers work.Become informed about the integration movement.Family medicine, public health, and other relevant organizations should collaborate to improve delivery systems and conditions in which people live.

Overlapping Roles of Primary Care and Public Health

AAFPs Call to ActionPhysician LevelUnderstand the role of public health Awareness of integration efforts between primary care and public healthPractice LevelRedefine population based on a community levelRecognition and incorporation of the public health infrastructure into the medical neighborhoodCollaboration and communication with public health infrastructure to operate as a continuous unit with a common goal

AAFPs Call to Action contdLeadership LevelFacilitate collaboration and communication amongst health systems and public health orgsDrive change within health systems to partner with public health orgsEducational LevelDrive change within undergraduate and graduate medical education to ensure FPs of tomorrow are prepared for a more integrated system

Poverty and Health The Family Medicine Perspective Position PaperKey MessagesMove toward prevention and away from crisis care.Enhance communication and trust through cultural proficiency, coaching, and peer-to-peer support.Address socioeconomic challenges and work with patients to develop achievable treatment plans.Make a community health resource folder and help patients access material support.Participate in research that develops evidence for how to address poverty.Advocate on behalf of low-income communities.

Reprinted with permission from Glass TA, McAtee MJ. Behavioral science at the crossroads in public health: extending horizons, envisioning the future. Soc Sci Med. 2006;62(7):1650-1671.

Practical Playbook Roadmap for IntegrationPairs the public health organizational structure with the patient-centered medical home wherein a team of health care professionals provides preventive and medical care in the context of family and community and an unstoppable health care force is created. 12

Practical Playbook(www.practicalplaybook.org)AAFP has been integral in promoting the initiative spearheaded by the CDC; the Department of Community and Family Medicine at Duke University in Durham, N.C.; and the de Beaumont Foundation.

The initiative offers an interactive Web-based resource designed to help primary care and public health professionals collaborate to achieve population health improvement and reduce health care costs through preventive care.13

AAFPs Community Health Resource NavigatorSmoking Bans in the U.S. Farmers Markets and Parks in the Phoenix Metropolitan Area

Brings information about communities to the family physicians fingertips. Topics include:Community resources such as food pantries, farmers markets, parks and recreational facilities, etc. Build and share your virtual resource folder.Evidence-based public health laws, such as smoking bans, land use policies, vaccination exemptions, etc. Learn how to support patients health by advocating for healthy public policy in their communities.

Mini-Grants for Tobacco and Nicotine Prevention and ControlAims to reduce the harm inflicted on Americans by tobacco and nicotine products by promoting prevention and cessation, and eliminating secondhand smoke exposure. Systems Thinking: Applicants are asked to consider what other organizations are doing and to integrate their activities as appropriate to develop synergy in their community. Innovation: Applicants are asked to help their organization do something new, but creating or adopting a new intervention.

A community-based education program designed to teach kids to live tobacco-free.Has reached more than 10 million children worldwide since being created in 1988.Effective in increasing students knowledge of and attitudes towards tobacco use.Anecdotally, Tar Wars has resulted in family physicians working alongside a variety of community partners, including public health.

Identifying Benefits, Barriers, and Facilitators to Integration of AFP Chapters and Public Health Organizations Applied ResearchCollaborative project with The Practical PlaybookAim is to understand the motivation behind why AFP chapters do or do not collaborate with public health organizations. Findings will inform future work to promote collaboration between AFP chapters and public health organizations to further the integration of primary care and public health movement.Qualitative design based on interviews with 7 AFP chapter executives and 7 AFP chapter staff members.

Additional Resources

Integration of Primary Care and Public Health from a Family Medicine Perspective http://www.aafp.org/about/policies/all/integprimarycareandpublichealth.html

Cultural Proficiency - Quality of Care for Diverse Populations Videos http://www.aafp.org/patient-care/social-determinants-of-health/cultural-proficiency.html

Help Your Patients Manage Racism-Related Health Risks http://www.aafp.org/patient-care/social-determinants-of-health/cultural-proficiency/minority-health.html

Early Childhood Literacy - Reach Out and Read Program http://www.aafp.org/patient-care/social-determinants-of-health/child-literacy.html

Community Health Resource Navigator (CHRN) - an interactive mapping tool http://www.aafp.org/patient-care/social-determinants-of-health/chrn.html

Poverty and Health - Family Medicine Perspective http://www.aafp.org/about/policies/all/policy-povertyhealth.html

Social Determinants of Health http://www.aafp.org/about/policies/all/social-determinants.html

Health Literacy http://www.aafp.org/about/policies/all/health-literacy.html

Population Health http://www.aafp.org/about/policies/all/population-health.html

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Bellinda Schoof - bschoof@aafp.org 19