Epidemiologists: Public Health’s Smoke-Jumpers

April 10th, 2014 by Will Humble 2 comments »

MeaslesLike a hotshot team, a rapid response by public health is essential to stopping the spread of measles in unvaccinated persons… and disease detectives in Maricopa County are currently working to squash a measles outbreak right now.

Last week a person with measles visited a restaurant, church and airport in Arizona, exposing over a thousand people to measles.  Press releases and health alerts have gone out- and epidemiologists, public health nurses, and healthcare providers have been dispatched by Maricopa County Public Health to identify, isolate and control further cases.  Time will tell if their efforts pay off.  We should know in a couple of weeks (the incubation period for measles is 10 – 18 days).

Measles seeks out the unvaccinated like fire seeks a dry branch – the chance of an unvaccinated contact getting measles is 90% once exposed.   If you’re not vaccinated against measles, you can get it just by being in a room with someone who has measles.  A measles vaccine can prevent infection if given within 72 hours of exposure as an emergency control measure for unvaccinated folks…  but herd immunity is what keeps the community from getting burned.

Let’s Get Screened

April 10th, 2014 by Will Humble No comments »

letsgetscreenedColorectal cancer is the second leading cause of cancer-related deaths in Arizona.  Across men and women, all age groups, races, and ethnicities, about ½ of all colorectal cancer diagnoses in Arizona are late-stage, which are more difficult to treat. Our Fit at Fifty HealthCheck Program screens about 1,500 Arizonans per year by providing Fecal Immunochemical Tests and colonoscopies for individuals who qualify. For more information about the Fit at Fifty program, contact Emily Wozniak or Virginia Warren.

The CDC, the American Cancer Society, National Colorectal Cancer Roundtable, and Health Resources Services Administration have kicked off the “80% by 2018” initiative to prioritize colorectal cancer screenings nationwide. This movement aims to get 80% of Americans screened for colorectal cancer by 2018. This is a result of the facts surrounding the status of colorectal cancer screening nationwide: not enough Americans are up-to-date on their screenings, and too many are being diagnosed with colorectal cancer at late stages. According to the American Cancer Society, the lifetime risk of developing colorectal cancer is about 1 in 20.

Medicare Cost Transparency

April 9th, 2014 by Will Humble No comments »

I’ve always believed that transparency improves the efficiency of any system.  Health care costs are no exception- and health care reimbursement costs are probably at the top of the list of systems that could be improved by applying a healthy dose of cost transparency.

Today the federal government took a giant step forward when they released a public data set called the “Medicare Provider Utilization and Payment Data: Physician and Other Supplier Public Use File”.  It’s a huge database that contains information on utilization, payment, and submitted charges organized by Provider Identifier, Code, and place of service.

Placing this data in the public domain will give researchers around the country access to critical data that can be used to determine where additional system efficiencies can be found and to propose new evidence-based solutions to improve public health outcomes- while making the Medicare and healthcare delivery system more cost effective.

Healthcare Associated Infections Progress Report

April 8th, 2014 by Will Humble 1 comment »

haiprogressreportHealthcare-Associated infections are a major (often preventable) threat to patient safety. Last week the National and State Healthcare Associated Infections Progress Report expanded on previous reports- detailing progress toward the eliminating healthcare-associated infections.  The HAI Progress Report found significant reductions for nearly all infections- including in AZ. Central line-associated bloodstream infections and surgical site infections continued to approach the 5-year goals set in the National Action Plan to Prevent Health Care-Associated Infections.

Arizona’s public health system takes a layered approach to preventing HAI’s in our state.  It starts with our Licensing team- who regulates the healthcare institutions where the care happens.  Our Medical Facilities Licensing team and our HAI Program collaborate to ensure the safety of patients in Arizona by jointly providing technical assistance and guidance to licensed healthcare facilities in response to identified infection control breaches.  The next layer is our network of public health disease detectives.  Our Healthcare-Associated Infections Program and the counties conduct epidemiologic investigations when we get reports of unsafe injection practices affecting multiple patients.

Our HAI Program and Advisory Committee also generate guidance documents for healthcare facilities and provide best practices for infection control and injection safety like materials produced through the CDC’s One and Only Campaign and Arizona’s Stakeholder-driven No Place Like Home initiative- which partners with the national Partnership for Patients: Better Care, Lower Costs project.

And Now, the Rest of the State

April 7th, 2014 by Will Humble 2 comments »

Now that the transition to a new Behavioral Health Authority in Maricopa County is underway- we’re turning our attention to bringing integrated care to the rest of the state.  We’ll be working hard throughout 2014 to set the course for integrating behavioral health and physical health for folks with a serious mental illness as we select behavioral health authorities in the rest of Arizona – it’s called the “Greater Arizona RFP.

We’ve decided that the Greater Arizona RFP will include integration of behavioral and physical health for folks with a serious mental illness- much like the Maricopa County contract.  People in the general mental health or substance abuse categories will get behavioral health services from the RBHA and their physical health care from an AHCCCS acute care health plan.

We’re also planning to consolidate several of the current Geographic Service Areas (GSAs).  We’re likely to have a total of 3 service zones (North, South, & Maricopa)- rather than the current 6.  We’re also going to ensure that tribal land aligns with the GSAs.  Of course- tribes wishing to continue as a Tribal Behavioral Health Authority would continue as-is. Finally, we’re inclined to include a provision in the solicitation that makes it clear awardees will only be able to hold a contract in 1 GSA.  We’ve also made some decisions regarding how we’ll be dealing with Medicare issues.

We plan on issuing the Request for Proposal (RFP) in July, review the proposals from October through December, and award the contracts just before the New Year- with an October 1, 2015 start date.  Stay tuned.  There’s still more work to be done- and some decisions to be made before we put the procurement on the street this Summer.

Opening Day: Mercy Maricopa Integrated Care

April 4th, 2014 by Will Humble No comments »

openingdayThis was a milestone week for our behavioral health program.  Tuesday marked the start of our contract with Mercy Maricopa Integrated Care as the regional behavioral health authority in Maricopa County.  The transition has gone well this week.  Literally 100s of things had to go right in order to have a smooth transition- including Information Technology, eligibility, pharmacy, medical records, claims management, network capacity and a host of other things.  A big thanks go out to the folks at Magellan, MMIC, AHCCCS and our DBHS, IT, and procurement teams for the weeks and weeks of hard work that it took to have a smooth transition for our members.  Well done!

Mercy Maricopa’s core mission is dedicated to providing its members access to care for their behavioral and medical health needs — focusing on the whole person, taking a holistic approach and empowering members to take charge of their health care. A new, secure health information exchange will help physical and behavioral health care providers to share information- leading to better care coordination, improved health outcomes, and reduced costs. Folks interested in learning more about Mercy Maricopa Integrated Care can visit their website, which has a host of resources for members and health care providers.

We’re optimistic that our collective hard work over the last couple of years to develop this new system of care will continue to result in better public health outcomes consistent with our Vision of Health and Wellness for all Arizonans.

Prom Tools for Parents

April 3rd, 2014 by Will Humble No comments »

PromIn the next few weeks many AZ teens will be attending proms.  While proms can have positive memories, the experiences can turn tragic when alcohol is part of the mix.  Alcohol impairs judgment…  potentially leading to sexual assault, unplanned pregnancies, sexually transmitted infections and deadly car crashes.  Car crashes are the leading cause of death among teens… and 1/3 of traffic deaths of 15 to 20 year olds are alcohol-related.

A national survey of more than 1,000 adolescents by the Guttmacher Institute found that 80% of first sexual experiences occurred under the influence of alcohol and about ½  of all nonconsensual sexual experiences involve alcohol use by the perpetrator, the victim or both.  Another recent report called Girls and Drugs found that 1/3 of girls and young women 14 to 21 years old with unplanned pregnancies were drinking when they had sex, and 91% said they hadn’t planned to have sex.

Despite knowing all the reasons why teens shouldn’t drink, it can be challenging for them to stay clear-headed when all  their friends are drinking. No one likes to feel left out, and teenagers especially feel the need for acceptance by their peers. So what can we do as parents?

You can help by finding effective ways to say no in a peer pressure situation.  Self-esteem is critically important because it gives kids confidence in themselves and decisions.  Talking to them leading up to the prom and graduation is also important.   Take a look at the website 15 Ways a Teen Can Say No to Alcohol to learn how you can play a role in helping your teen make responsible decisions.  You can also find great tips about talking to teens about alcohol use from the National Institute on Alcohol Abuse and Alcoholism.

 

Farm Bill Provides Public Health Intervention Options

April 1st, 2014 by Will Humble No comments »

farmbillThe passage of the Farm Bill  (the  Agricultural Act of 2014)  includes some changes and reforms to the Supplemental Nutrition Assistance Program (SNAP or food stamps) and the Commodity Supplemental Food Program.  In Arizona, SNAP benefits help put healthy food on the table for more than one million people each month, with more than half of the benefits going to children and teens.

The new Farm Bill promotes healthier options by requiring SNAP retailers to provide healthy choices.  When fully implemented, any store that accepts SNAP must offer at least seven foods in each of the USDA’s four categories of staple foods.  The law also provides grant programs to encourage people that receive SNAP benefits to buy more fruits and vegetables, provide funding for loan programs for healthy food retailers, and create opportunities for schools to add different kinds of vegetables as part of school menus.

In terms of education funding for SNAP… we’ll be able to promote physical activity in addition to nutrition education. This is great news because the combination of healthier foods and physical activity are powerful tools in fighting the obesity epidemic.  And it fits so well with our Winnable Battle to promote nutrition and physical activity to reduce obesity.  Many studies show there’s a link between obesity and low-income families, so adding nutritional criteria to SNAP is a significant improvement on the status quo and a positive springboard for improving health outcomes moving forward.

Ebola

March 31st, 2014 by Will Humble No comments »

ebolaIf you’re like me, your introduction to Ebola virus came in the 1990s with the bestseller nonfiction thriller The Hot Zone and loosely-based film Outbreak.  The descriptions of a deadly hemorrhagic fever that quickly spread through the population were terrifying, as were the life-threatening dangers posed to the intervening infectious disease personnel.

The Guinea Ministry of Health has a total of 103 suspect and confirmed cases with 66 deaths.  They announced today that the disease has spread to the capital, Conakry.  Also, reports of suspected cases in neighboring countries are being investigated: Liberia reported to the WHO 8 suspected cases, including 6 deaths, in individuals with recent travel history to Guinea. Sierra Leone has reported 6 suspected cases, including 5 deaths.

Bats appear to be a reservoir and hosts for the ebolavirus. Initial infections in humans result from contact with an infected bat or other wild animal. Ebola spreads by contact with other patients’ infectious secretions and from consuming the meat of infected animals.  For Guinea’s particular strain, the fatality rate is nearly 90%, and is heralded by fevers and internal bleeding.   Doctors Without Borders and WHO both have teams in Guinea, working with the Health Ministry to contain the spread.

In countries with weak medical infrastructures, an outbreak like this can be devastating.  Historically, countries with poorer infrastructures and health status suffer far worse than more bolstered nations.  So while Arizona is under no threat from Ebola, maintenance of a strong public health and emergency preparedness program remains a top priority.

Case Dismissed: Jason K v. Humble

March 28th, 2014 by Will Humble No comments »

Most of you know that we’ve reached a final agreement with the Plaintiffs in the 32 year-old Arnold vs. Sarn lawsuit.  We expect to have a dismissal hearing later this year- which will officially end the Arnold lawsuit.  We got some other good news on a different behavioral health case last week.

Last Friday marked the end to the 22+ year JK v. Humble lawsuit.  It was a class action lawsuit filed in 1991 by children eligible for or in need of behavioral health services under Medicaid.  We were Defendants in the case along with AHCCCS.  Last week the Plaintiffs asked that the case be dismissed… and the court followed suit by officially dismissing the case right away.  You can learn more about the children’s system of behavioral health services on our website.