Posts Tagged ‘health care’

AZ Healthy Community Design Tools

April 15th, 2013

Improving the health of Arizonans is critical to improving the quality of life as well as reducing health care costs. The most effective strategies are ones that incorporate the principles of population health… which includes health outcomes as well as the determinants that influence those outcomes including the public policy that influences the social and environmental determinants. A city’s General Plan can be a large public health lever to improve those outcomes. 

Designing healthier communities requires a new way of thinking. For example, the way a city zones can affect how easy it is to get physical activity.  The tough part is connecting all of the right people to sit in on the conversation together. The zoning people might not talk to the health people, who may not talk to the transportation folks. But where can community residents start? One place to start is with a recently developed Toolkit put together by ADHS and other members of the Healthy Community Design Collaborative

This toolkit is really designed to help cities, towns and counties strategically think about how to enhance health through changing the built environment, like through adding sidewalks or bike lanes. It’s basically a guide for local residents who want to participate in their community planning process. The Toolkit provides a general overview of the process, explains the purpose of city General Plans, and gives guidance regarding who to talk to in local government- and presents ways to get involved. There’s also a checklist for what policy topics should be addressed in a plan and even some examples of policies for residents to consider for incorporation into their city’s General Plan. It also provides coaching for community residents to build relationships that facilitate implementing policy language. 

Our team recently created the azhealthcommunities.org website, which is another tool that provides information on the influence of community design, accessibility and transportation on health. You can even find some recent examples of how communities in Arizona are working to create healthier environments and learn to create a Health Impact Assessment, which can be used to help city projects improve population health. These are just some examples of how we can work to promote healthy and safe community environments – one of our priority areas of our Strategic Map.

The Health Care/Public Health Continuum

March 13th, 2013

In 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. By the way, reports suggest that behavior accounts for roughly 50% of health outcomes, genetics about 20%, the environmental about 20%, with medical care about 10%… 96% of our national health expenditures are focused on medical care with about 4% dedicated to prevention. Does prevention sound like a good investment?

New Affordable Care Act Proposed Rules Released

November 23rd, 2012

The US Dept. of Health & Human Services released 3 new Affordable Care Act proposed regulations this week…  including: 1) A proposed Rule regarding coverage requirements for pre-existing or chronic conditions; 2) A proposed Rule outlining policies and standards for coverage of essential health benefits; and 3) A proposed Rule implementing and expanding employment-based wellness programs to promote health and help control health care costs.

Did You Get a Health Insurance Refund You Didn’t Expect?

September 13th, 2012

If you did, you can thank the Affordable Care Act.  When you buy health insurance- the percentage of your premium dollars that your insurance company spends on providing you with health care (as opposed to what it spends on administrative, overhead, and marketing) is called a “Medical Loss Ratio”.   The Affordable Care Act limits how much of your premium dollar your insurer can spend on things besides your care.  They’re supposed to give you a rebate on the portion of premium that was over the limit.  The law requires insurers selling policies to individuals or small groups to spend at least 80% of premiums on direct medical care (and efforts to improve the quality of care).  Insurers selling to large groups (usually 50 or more employees) need to spend 85% on care and quality improvement. 

The Medical Loss Ratio part of the Affordable Care Act kicked in this year.  So far, about 400,000 Arizona residents with private insurance coverage received a total of almost $28M in refunds from insurance companies.

 

Platinum, Gold, Silver, and Bronze Health Plans

August 27th, 2012

The Affordable Care Act will establish various tiers of health insurance coverage beginning in 2014.  The baseline “tier” will be a minimum amount of coverage that people need to have to satisfy the federal mandate to have health insurance (or face a tax penalty).  Insurers will be required to offer plans that fit within four levels (tiers) of coverage: bronze, silver, gold, and platinum.  

The levels of coverage aren’t defined using specific deductibles, co-pays, and coinsurance- they’ll use something called  “actuarial value”.  For example, a plan with an actuarial value of 70% (referred to as a “silver” plan) means the plan will pay 70% of a standard population’s health care expenses with the enrollee paying 30% through things like deductibles, co-pays, and/or coinsurance.  The higher the actuarial value the less patient cost-sharing the plan will have on average. 

Bronze plans will have more out-of-pocket costs, and platinum plans will have least.  Bronze plans will cover 60% of enrollee costs, silver 70%, gold 80% and platinum 90%.  Young people (under 30) will be able to buy “catastrophic” plans with an even lower actuarial value.  Each plan (even catastrophic) needs to cover the state’s essential benefit package.   Insurers don’t have to offer plans in all four levels, but within the exchange all insurers must offer at least one silver and one gold plan.  You can read a lot more about actuarial value in this HHS bulletin

There are also benchmarks for premium and cost-sharing subsidies that go to lower and middle income people buying their insurance in the exchange.  I’ll cover that next week.

AZ Leads the Way to Reducing Teen Pregnancies

April 10th, 2012

Teen pregnancy is a key public health indicator because of the profound negative health outcomes related to a lack of education and economic opportunity.   For example, only about 50% of teen mothers receive a high school diploma versus approximately 90% of their peers.  The disadvantages caused by a teen pregnancy can last a lifetime- and even spill over to the next generation.  Teen pregnancy is expensive too- costing about $11B per year in increased health care, foster care, incarceration, and lost tax revenue.  That’s why we’ve made reducing teen pregnancy in AZ a key element in our strategic map. 

Today’s good news is that teen pregnancy made a historic drop over the last 3 years in AZ.  In fact, teen pregnancy dropped by almost 30% in AZ over the last 3 years- the steepest decline in the nation.  

How did we get here?  As is the case with most things in public health- our success is tied to a host of interventions and circumstances.  No doubt our community-based contracts under the Personal Responsibility Education Program is a factor along with our federal Abstinence Education contracts.  The study that was published today shows that teens are becoming more educated about how to effectively prevent teen pregnancies and are using that info.  Another factor is probably the economy.  There’s a well known link between lower pregnancy rates in general and challenging economic times. 

The bottom line is that the trend toward lower teen pregnancy rates in AZ and the US is encouraging- but we need to do even better by using tried and true evidence-based practices to keep up the pressure on this important health indicator. 

 

Medical Marijuana Presentation for Physicians

March 23rd, 2012

Cara Christ, MD and her team put together a dynamite new PowerPoint presentation on the role of AZ physicians under AZ’s Medical Marijuana Act.  The goal of the presentation is to provide a resource for physicians to be better informed about their role under the Act- and to learn about the checks and balances that we included in the system to ensure that the program keeps its “medical” character.

Step Right Up: Get your Masters in Public Health in Phoenix!

March 14th, 2012

When I got into public health 25 years ago, it was kind of a boutique profession. Since then, it’s really gone mainstream- and public health is increasingly being recognized as a key element in driving down our country’s increasing health care costs.  So if you’re a beginning or mid-career professional- get in on the ground floor and snap up your MPH right here in Phoenix. 

Lucky for you, the U of A’s Mel & Enid Zuckerman College of Public Health is offering a Master of Public Health (MPH) (with a concentration in Public Health Practice) in Phoenix at the Biomedical Campus.  The next bolus of students will start this Fall.  There’s still time to apply for the fall classes- but the May 1st application deadline is rapidly approaching. 

The Phoenix program offers the Master of Public Health in Public Health Practice which prepares students to develop the public health skills needed to work in a variety of governmental and non-governmental settings including the local, county and state departments of health, the Indian Health Service, Medicaid and Medicare programs, hospitals, and community health centers.  Students work as part of multidisciplinary teams and develop skills to manage and evaluate real-life public health programs. 

Here’s a link about admissions criteria and how to apply.  You can also contact Kim Barnes at kim.barnes@arizona.edu or 602-827-2070 for more info.

Recovery Through Whole Health RFI

February 9th, 2012

We’ll be having a “Request For Information” session regarding our “ Recovery Through Whole Health, the Regional Behavioral Health Authority with Health Homes” project (a.k.a. the upcoming Request for Proposal for behavioral health services in Maricopa County) on March 21 from 1- 5 pm at the Radisson City Center at 3600 N. 2nd Ave. in Phoenix.

We’ll have more details about the event in March through an official notice from ADHS via the State of Arizona e‐procurement system, ProcureAZ and on our Integration Website.   Folks can also register at https://procure.az.gov/bso/ under commodity code 952‐08 to receive the “official” notice of the RFI.

This will be a relatively informal event where we’ll provide some information about the project and our expectations…  and it’ll provide an opportunity for potential bidders, other behavioral health providers and consumers, peers and family members to ask questions about the project.  We don’t expect to be asking for written responses – again, this will be a relatively informal affair.

The Health Care/Public Health Continuum

November 29th, 2011

In 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 various 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.  By the way, studies and reports suggest that behavior accounts for roughly 50% of health outcomes, genetics about 20%, the environmental about 20%, with medical care about 10%… 96% of our national health expenditures are focused on medical care with about 4% dedicated to prevention.