Prevention: A Great Investment

February 26th, 2015 by Will Humble No comments »

Healthcare ProfessionalsIn the world of health care – the clinician works with patients individually.  They examine various indicators of health for their patient including direct observations and laboratory or other diagnostic tests and implement interventions to help their patient improve their health.  Providers also encourage their patients to live healthy lifestyles and take safety precautions – and help patients with preventative care by providing vaccinations and the like.  Over time, the health care provider follows the patient and measures how they’re doing with patient centered criteria.

In the world of public health, the practitioner works with communities…in other words the community is the patient.  Public health folks look at outcome indicators to determine the health of the community so they can take action and implement interventions at the wholesale level to improve population health.  In other words – public health uses community indicators like infant mortality, communicable disease rates, obesity and diabetes to assess the patient (the community).

Of course, public health relies on health care providers in the health care world to carry out public health objectives and interventions.  So you can see that there is a strong interface between health care and public health – but the distinction is that in health care the patient is the patient while in public health the community is the patient – the interventions are community based, and community indicators are the primary assessment tool.

Reports suggest that behavior accounts for roughly 50% of health outcomes, genetics about 20%, the environmental about 20%, with medical care about 10%.  However, 96% of our national health expenditures are focused on medical care with about 4% dedicated to prevention.

New Ambulance Company Approved to Operate in Maricopa County

February 25th, 2015 by Will Humble No comments »

Emergency VehiclesA few weeks ago I approved American Medical Response’s (AMR Maricopa) application to operate ambulances in Maricopa County, called a Certificate of Necessity or CON.  While I approved the CON (after reviewing a host of evidence presented to an Administrative Law Judge and her Order) I didn’t actually issue the Certificate because of the administrative and due process statutes involved.  A.R.S. § 12-901(2) says that decisions in administrative adjudications aren’t “final” until after a request for rehearing or review is denied, or the decision on a request for rehearing or review is rendered.  Rural Metro (pursuant to A.R.S. § 41-1092.09) filed a request for rehearing or review of my decision.

Today I denied Rural Metro’s request for a rehearing and issued the Certificate to AMR.


Tai Chi Prevents Injury

February 25th, 2015 by Will Humble No comments »

tai chiBefore I started working here in ’92 I spent a year backpacking in southern Asia with my now wife (then my girlfriend).  Wherever we went in China we’d see seniors in the parks or village squares doing Tai Chi in the morning.  In a village it might be a group of a dozen folks, and in the cities you might seem over 100 people practicing together.  Little did I know that we were observing an evidence-based practice that reduces injuries – a strategy that would one day be part of Arizona’s Health Improvement Plan.

Falls are consistently the leading cause of injury-related deaths, hospitalizations and emergency department visits among Arizona residents 65 and older, at a cost of more than $825M each year in Arizona.  But, how can we prevent falls?  One best practice is Tai Chi – or moving meditation.  Medical studies show the health benefits of Tai Chi.  Worldwide, many people practice Tai Chi as a safe exercise to improve their overall health including:

  • Lowering stress and blood pressure
  • Improving strength and better balance
  • Reduce pain and stiffness
  • Improving immune system
  • Overall sense of wellness

In a recent study published by the National Council on Aging, comparing Tai Chi: Moving for Better Balance with other evidence-based exercise programs delivered to persons aged 65 and over, Tai Chi showed a net return on investment (ROI) of 509%, which was nearly five times greater than the other programs.

These results show how health care funders and providers can implement effective falls prevention programs that address both the health and cost burdens of unintentional falls.  The results were further bolstered by a recent UCLA study which demonstrated that a “westernized” version of Tai Chi renders significant sleep benefits, improving chronic health conditions and prevent falls among older adults. Tai Chi incorporates a more holistic approach than physical exercise and balance programs, as it addresses issues of the mind, body, and spirit.

As part of our Health Aging Plan, which consists of a three-pronged approach including falls prevention, Alzheimer’s Disease awareness, and chronic disease self-management among older adults, our Bureau of Tobacco & Chronic Disease has received a high level of interest in developing a Tai Chi initiative across the state.  With only a handful of trainers in the state who can teach and certify others to become Tai Chi instructors, our initial effort will begin this Spring by launching a pilot program of training and certifying Tai Chi instructors in partnership with the Western Area Council of Governments – Area Agency on Aging, and our partners in Yuma, La Paz, and Mohave Counties.   Of course – we’ll also be including this best practice in our upcoming Arizona Health Improvement Plan.

EMTALA & Ebola

February 24th, 2015 by Will Humble No comments »

clinicianThe Emergency Medical Treatment and Active Labor Act (EMTALA) is a federal law that requires hospitals that accept Medicare payments to provide emergency healthcare to anybody regardless of citizenship or immigration status or their ability to pay.  Under the law, hospitals that accept Medicare payments can’t transfer or discharge patients that need emergency treatment unless there’s informed consent on the part of the patient or after the patient is stabilized.  An exception is when the patient’s condition requires the patient’s transfer to a hospital that’s better equipped to administer treatment.

Because patient care for Ebola patients is so unique, we (and most other states) have been struggling to interpret EMTALA requirements when building our protocol for assessment and treatment of Ebola (or potential Ebola) patients.  Last Fall the Centers for Medicare and Medicaid Services sent out a survey and certification letter to provide guidance to hospitals regarding meeting EMTALA requirements if a patient presents who was potentially exposed to Ebola.

Last week they followed up their earlier memo with a Q & A for clarification.  The short story is that all Medicare-certified hospitals with an emergency department are expected (at a minimum) to screen, isolate and begin stabilizing treatment for any patient with possible Ebola symptoms.  Medicare-participating hospitals with specialized capabilities (our designated hospitals) are required (within the limits of their capability and capacity) to accept appropriate transfers of individuals protected under EMTALA from other hospitals, without regard to insurance or ability to pay.  CMS hasn’t published the Q & A publically yet – but we’ll make sure it gets into our Ebola website when it’s ready for broad distribution.

We’ll be taking a close look at the new clarification as we continue to build our protocols for treating Ebola and other emerging infectious diseases.


ADHS Community Profiles Dashboard Gets International Recognition

February 23rd, 2015 by Will Humble No comments »

StatisticsOur Community Profiles Dashboard is featured this month in the ESRI News, for State & Local Government newsletter as an example of the benefits from making health date more accessible.  I’ve blogged about our Dashboard, which is a leap forward for public health professionals, city planners, non-profit organizations, medical providers and anyone who needs public health data to improve their performance.

What makes the Dashboard revolutionary is the way you can access, sort, and analyze the information.  The Dashboard provides several options for looking at the state, county, or small community level data among the more than 100 Primary Care Areas in Arizona.

In addition to the news feature in ESRI, our Dashboard has received worldwide recognition this year.  The Geowise Company, which built our Dashboard using Instant Atlas (IA) Software analyzed dashboards from around the world to determine what works and what doesn’t in IA dashboard creation.  Based on this analysis, our Community Profiles Dashboard was voted number three in the world.  This will be featured in the next Instant Atlas Newsletter.

I encourage public health professionals, city planners, and medical providers to use the Community Profiles Dashboard to look at health indicators in their communities.  This information is vital in developing healthy communities and targeting resources where they’re needed most.  To help you learn how to use the Dashboard, we’ve created a four part online video tutorial.

AzPHA Spring Conference

February 20th, 2015 by Will Humble No comments »

AZPHA_Logo_Clr-1pngRegistration is now open for the Arizona Public Health Association (AzPHA) 2015 Spring Conference.  The conference titled: “It Starts Upstream:  A Public Health Approach to Building a Healthy Future” will be held on Thursday, April 9, at the Phoenix Zoo.

This year’s conference will feature panel discussions on the Social Determinants of Health and Nutrition through a Cultural Lens, a presentation on preconception health and a keynote presentation on epigenetics.  The afternoon will feature a World Café, which will include four 20 minutes presentations at several tables.  There will be a wide variety of public health topics, including healthy aging, developing sustainable public health policies, comprehensive medical and dental program for children in foster care, and many more topics.  The conference is a great opportunity to learn about emerging public health issues and network with your fellow public health professionals.

AzPHA is a key stakeholder in Arizona’s public health network of community partners that includes government agencies, medical professionals, community groups, advocates, private industry, and individual citizens – all working together to make our communities healthier.  They’re a non-profit organization that’s been around since 1928.

AzPHA provides a way for members to network with other public health and medical professionals from around the state, enhance their skills by attending professional development trainings, and advocate for a better public health system in Arizona.  Take a look at their website to learn about all the benefits of joining and the discounted memberships.

Southern AZ RBHA Procurement Protest

February 19th, 2015 by Will Humble No comments »

arnold-sarn1In mid-December (2014) we awarded contracts for the Northern and Southern regions of the state to Health Choice Integrated Care (Northern AZ) and Cenpatico Integrated Care (in Southern AZ).  On January 2nd United Healthcare filed a Protest with the ADHS for the award in Southern AZ, requesting an Emergency Stay and Administrative Hearing.  Last month (January 21) we denied the Protest.

United HealthCare has until tomorrow (February 20th) to file a Notice of Appeal to the ADOA Director.  If United Healthcare appeals our Decision, then we would have 21 days from the date of the appeal to file an Agency Report to the ADOA Director and interested parties.  After review of our Agency Report, the ADOA Director can issue a Stay, dismiss the appeal in whole or part, terminate the award, or schedule an Administrative Hearing.

The contracts for the Northern and Southern regions are scheduled to begin on October 1, 2015 and are three-year contracts with the option for two additional two-year extensions.

Coping with Stress

February 18th, 2015 by Will Humble No comments »

WStress can have a profound impact on health and affects your body, thoughts, feelings, and behavior.  Symptoms like chronic headaches, insomnia, and lower productivity can be a direct result of stress.  Being able to recognize common stress symptoms can give you a jump on managing them.  Stress management is important, because, left unchecked, it can cause high blood pressure, heart disease, obesity, and diabetes.  It can also lead to behavioral health conditions like anxiety or depression.

Each year since 2007, the American Psychological Association publishes a study called the Stress in AmericaPaying With Our Health.  This year’s report came out last week.  It’s only 23 pages long- so it’s digestible.  The survey measures stress among Americans including the leading sources of stress, things people do to manage stress, and the impact that stress has on our lives.

The Association’s annual awareness campaign educates folks about the connection between stress and physical health and how you can change your lifestyle and behaviors to better manage stress.  They also have a Psychology Help Center, which is an online consumer resource featuring articles and information like Stress management: How to strengthen your social support network; Face the numbers: Moving beyond financial denial; Money and family: Creating good financial habits; and Happy couples: How to avoid money arguments.

Helping our team manage stress is one key to helping employees achieve wellness.  Benefits Options are available for employees, retirees, and their spouses and dependents.  In addition to an Employee Assistance Program, Benefit Options offers resources like Fact Sheet: Mental Well-Being and Learn How to Stop the Cycle of Stress.

Ebola Interventions Working

February 17th, 2015 by Will Humble No comments »

ebolaThere has been tremendous progress in controlling Ebola Virus Disease in West Africa in the last month.  New Ebola cases have fallen sharply in the last few weeks to fewer than 100 per week.   For the week ending January 25, there were 4 new cases in Liberia, 30 in Guinea and 65 in Sierra Leone.  At this point in the epidemic, the focus will shift toward more aggressive case finding, case management, safe burials, and community engagement is used as effectively as possible.

As of late January, 50% of new confirmed cases in Liberia came from known contacts.  Once 100% of new cases come from known contacts, epidemiologists will be able to track every chain of transmission, which is the key to tracking down the final cases and stopping transmission once and for all.  The World Health Organization has the late January report posted on their website.

AMR Certificate of Necessity

February 17th, 2015 by Will Humble No comments »

rural-metro webYou might recall that a few weeks ago I approved American Medical Response’s (AMR Maricopa) application to operate ambulances in Maricopa County (called a Certificate of Necessity or CON). I approved the Certificate of Necessity after reviewing a host of evidence presented to an Administrative Law Judge and her Order recommending approval.  Approval of the application doesn’t mean that AMR Maricopa actually possesses the CON.

According to the administrative and due process statutes involved, we wait 30 days before physically issuing the Certificate of Necessity.  A.R.S. § 12-901(2) says that decisions in administrative adjudications are not “final” until after a request for rehearing or review is denied, or the decision on a request for rehearing or review is rendered.

Rural Metro (pursuant to A.R.S. § 41-1092.09) has filed a request for rehearing or review of my prior decision.  We received AMR Maricopa’s response to Rural Metro’s request.  I now have until February 26 to make a final decision on this matter.