Collaboration Between Health Care and Public Health Workshop Summary (2016) / Chapter Skim
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3 Million Hearts: A National Public Health and Health Care Collaborative
3 Million Hearts: A National Public Health and Health Care Collaborative
Pages 19-34
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From page 19... ...
in 2011 with the goal of preventing 1 million heart attacks and strokes by 2017.1 Moderator Paul Jarris of ASTHO opened the panel discussion with brief comments about the infrastructure necessary to support a national collaborative. Guthrie Birkhead, deputy commissioner for New York State Department of Health, described the New York State experience with the Million Hearts collaborative.
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rapidly improving hypertension, Jarris said. The goals of the ASTHO learning collaborative are to • improve hypertension control and to achieve the national Million Hearts goal; • identify and build networks and cross-sector partnerships to control hypertension; • test models of collaboration between public health and health care; • reintroduce a quality improvement (QI)
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A significant barrier, Jarris said, was the broad notion that electronic health records (EHRs) are sufficient for population health management.
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Across the 10 states there were more than 150 partners and stakeholders involved, including payers, hospital systems, quality improvement organizations, Federally Qualified Health Centers (FQHCs) , local public health departments, community partners, state public health departments, health informatics, paramedics, and nontraditional partners.
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The ASTHO learning collaborative is unique in that it is a multistate collaborative, with ASTHO bringing states together and providing coordination and technical assistance. Birkhead shared the New York State experience with the Million Hearts collaborative as a case example of the successful collaboration between public health and health care.
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Patients received automated blood pressure monitors and education materials developed by the AmeriCorps collaborators and the county health departments. Data collection was a major component of the project, and Birkhead highlighted several innovations that came out of the Million Hearts project.
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Lessons Learned Birkhead offered a list of lessons learned from the New York State experience with the Million Hearts collaborative: • Cross-sector collaboration with various partners was key to success. • Senior leadership involvement at all levels in all systems was essential.
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At the local level, a key factor was the engagement of the county health departments as members of the FQHC quality improvement teams. The local health departments were integral partners in implementing the home blood pressure monitoring strategy, providing education to patients around blood pressure monitoring techniques and following up to measure the increase in knowledge and skills around self-monitoring of blood pressure and uptake and satisfaction with the program.
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. These initiatives include, for example, the New York State Prevention Agenda–State Health Improvement Plan; the State Health Innovation Plan–SIM grant; the Medicaid Delivery System Reform Incentive Payment Waiver Program; and the Population Health Improvement Program.
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Program Program (PHIP) Key Themes: PHIP Deliverables: - Integrate Delivery – Performing Provider Systems - Identify, share, and assist with implementation of best - Performance-based payments practices/strategies to promote population health - Statewide performance matters - Support and advance the NYS Prevention Agenda - Regulatory relief and capital funding - Support and advance the SHIP - Long-term transformation and sustainability - Serve as resource to DSRIP Performing Provider Systems FIGURE 3-1 Alignment of the New York State Million Hearts Collaborative with ongoing New York State Department of Health initiatives to improve health and transform health systems.
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The majority of the plan's members are in rural communities, and participation in Million Hearts supports the development of quality incentive programs (e.g., referrals to and graduation from Heartland OK; improved blood pressure control and/or medication adherence)
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Each of the three community health centers in New York engaged with patients in a different way. The home blood pressure measurement, for example, presented an opportunity for a community health worker to engage patients personally about their own needs.
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The biggest problem, whether in the clinic, the fire department, or the church, was people not sitting for the required period before their blood pressure was taken. Marthe Gold from the City College of New York raised the potential issue of overdiagnosis and overtreatment, given the heterogeneous approach to diagnosing hypertension, from clinical office to home visits to borrowing blood pressure cuffs from the library.
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Data Sanne Magnan from the Institute for Clinical Systems Improvement noted that the Office of the National Coordinator for Health Information Technology has released a 10-year vision to build interoperable health information technology and asked what advice Million Hearts might offer them. Birkhead said that the vision does involve public health more so than in the past, and is building the population health view into EHR systems.
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The current business case for EHRs is essentially capture of claims and improved billing, not for the registry function or their ability to improve population health. He expressed hope that SIM grants will create a demand for tools in EHR that will support population health or that it will be mandated in a certified EHR.
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