Sharpening the Axe

December 19th, 2011 by admin No comments »

There’s a well-known quote attributed to Abe Lincoln that goes something like this: “Give me 6 hours to chop down a tree and I will spend the first 4 sharpening the axe.”  Maybe somebody will someday quote me as saying:  “Give us 20 months to transform the delivery of behavioral health and primary care services to address the health disparities among folks with a serious mental illness and we’ll spend the first half partnering with stakeholders“.  OK, we’ll probably never be quoted like that- but you get the idea.  The more up front work we do with our partners during our behavioral health system transformation- the more likely we’ll be successful in the end.

Community Based Research:  The last few months have been very busy as we’ve gathered Stakeholder input on the various moving pieces that fit into our overall behavioral health integration project.  We’ve had several meetings, focus groups, and forums lately on the concept of integrated primary and psychiatric care.  The first series of the focus groups were in the Fall of 2010 and were designed to gather input from peer and family members (the Raise Your Voice effort).  This Fall we and AHCCCS coordinated an RFI and had in-person meetings with companies the get input about the feasibility of the integration effort.  Throughout December, we pressed ahead with a series of stakeholder meetings from the behavioral health provider community.  Our Behavioral Health shop, AHCCCS and St. Luke’s Health Initiative sponsored and coordinated a series of focus groups over the last couple of weeks to gather input regarding integrating behavioral health and physical healthcare- and St. Luke’s Health Initiative will be busy over the next couple of weeks putting together the data- which we’ll use as we design and implement Health Homes for folks with a serious mental illness.  

Licensing Efforts:  Our Licensing and Rules teams also just finished a series of forums with behavioral health providers to gather input about how we should put together a rulemaking package that will put a regulatory structure regarding the quality of care that’ll set the stage for integrating behavioral health and primary acute care from a licensing standpoint. We’re excited about this rulemaking because it supports our efforts to establish coordination and collaboration between all behavioral health and physical health providers.

We’ve developed a preliminary plan to facilitate integration of behavioral and physical health services and the just completed forums included a presentation that included highlights about the statutory framework; preliminary integration plans for health care institutions and behavioral health services; and a brief outline of the rulemaking process including formation of workgroups. During the forums we received constructive feedback and lots of questions- and more than 200 folks attended.  The feedback received was encouraging. Questions from the audience included:  What is the timeline for completing the rulemaking? In a rural setting, is integration and co-location the same? What about respite care? Can I be in a workgroup? If we don’t integrate, will we lose our license? What about CSAs? If we are integrated, will we have two surveyors- one for BH and one for PH? What about DUI screening? Now that the licensing forums are completed, we’ll proceed with putting together a “straw man” set of rules- followed by some roll-up-the-sleeves work groups (including licensees) to help us assemble a draft rule package.

Summary: We’re committed to strengthening the recovery based foundation that characterizes Arizona’s behavioral health system using this evidence-based practice called Community Based Participatory Research- which is used in public health research to engage the community in designing programs that are responsive to the public’s needs.

Our Unwelcome Winter Visitor Returns

December 16th, 2011 by admin 3 comments »

Just in time for the holidays, we’re got our first lab confirmed case of influenza – actually two cases.  Influenza has probably been in the state for a while now, but we don’t officially start counting the cases until there is a case confirmed at our lab.  The vaccine was approved this summer and fights 3 different types of flu.  If you’re out holiday shopping, you might want to think about giving yourself a gift… a flu vaccine could help you have a flu-free holiday!  For information about where to find a flu shot, visit

Another key to prevent the spread of influenza and other diseases is washing your hands with soap – or if you can’t do that, use hand sanitizer.  Covering your cough and sneeze will also help keep germs from spreading.  When you are sick, stay home and keep your kids home from school when they are sick.  There’s more specific information for schools, parents and healthcare professionals on our flu website.

Community Health Diagnostics

December 15th, 2011 by admin No comments »

Last week I wrote about the Health Care/Public Health Continuum…  in which I described how in the public health world the community is the patient.  In order to assess and better help the patient we need to have indicators and surveillance data to help us construct and implement interventions.  One of our primary goals over the last couple of years has been to shift the focus of our community based public health performance measures toward actual outcomes.  In other words, we don’t want to measure our success on simple activities like whether we did an intervention, placed an ad, or whether someone’s paperwork is right- but on whether our interventions and services actually make a difference.  

That’s where our data Dashboard resources come in.  Last year we rolled out our Arizona Health Matters website- to help the public health system to access data and information about community health- and to measure community outcomes.  It helps the public health system, planners, policy makers, and community members learn about issues and identify improvements.  On the site you can compare Arizona’s health with other communities and the nation, using more than 100 health and quality of life indicators; search and compare data by County and zip code within Arizona; learn about evidence-based promising practices or use the Report Assistant to create quick reports and summaries.

Medicare Physician Bonus Program

December 14th, 2011 by admin 1 comment »

The Fed’s operate a Medicare Physician Bonus Program to encourage doctors to work in underserved areas and improve access to care for folks on Medicare.  Certain physicians (including MDs, DOs, dentists, podiatrists, and chiropractors) are eligible to receive a 10% bonus if they’re providing services to Medicare beneficiaries in a geographic primary care Health Professional Shortage Area (Psychiatrists practicing in a mental health shortage areas are also eligible).  It’s the provider’s responsibility to ensure they’re in an eligible area- which can be confirmed here.  For any questions, please contact Tracy Lenartz.

Medicare Moves Upstream

December 13th, 2011 by admin No comments »

Keeping off the pounds is tough at any age. Now seniors are getting a helping hand from Medicare.  Last month Medicare announced that it’s adding coverage for nutritional and behavioral counseling for those who are obese as measured by body mass index or BMI.  BMI is a tool which measures weight status for adults- and it’s broken into several categories: Underweight (Below 18.5), Normal (18.5 – 24.9), Overweight (25.0 – 29.9) and Obese (30.0 and above).  This new program for Medicare beneficiaries is for folks with a BMI of 30 or more.    You can use this BMI calculator to see where you stand.  

The objective of this new preventive coverage is to reduce the impact of obesity and chronic disease among the 30% of folks men and women within Medicare are obese.  For Medicare beneficiaries with a BMI over 30, counseling coverage includes: 1) One face-to-face visit every week for the first month; One face-to-face visit every other week for months 2 – 6; and One face-to-face visit every month for months 7 – 12 if the individual meets their weight-loss goals.  Additional information on this exciting new preventive coverage can be found on the Medicare website

Why is this new benefit important? Because most states now have adult obesity rates over 25%- resulting in higher risks for stroke, heart disease, diabetes, cancer, respiratory diseases and arthritis.  In other words- obesity results in all kinds of bad health outcomes and cause a host of expensive down-stream treatment costs.

Acing the Readiness Test

December 12th, 2011 by admin No comments »

Disease detection and swift and effective public health interventions are essential to saving lives in a public health emergency.  According to a new report from the CDC on Public Health Preparedness, Arizona’s public health system is ready and well-prepared. The CDC report outlines the Department’s ability to detect and respond to a wide range of public health threats including our ability to request, receive, and distribute emergency supplies through the Strategic National Stockpile.  This year, we scored 97 out of 100 on the review.  The evaluation for the Phoenix metropolitan area rose to 95.  You can see the complete report on the CDC’s website.

By the way, the CDC has developed a new National Strategic Plan for Public Health Preparedness and Response- which is a guide for the nation’s public health system.  The plan identifies eight core objectives which need to be achieved to reach the vision.

Leveraging Community Partners for Change

December 9th, 2011 by admin No comments »

A few months ago our tobacco & chronic disease prevention team was awarded a CDC grant to increase coordination and collaboration on evidence-based interventions addressing the leading causes of chronic diseases in Arizona (heart disease, cancer, pulmonary disease, stroke, diabetes, and arthritis).  The Chronic Disease Prevention and Health Promotion grant will look for ways we can leverage community partners to improve the health of all Arizonans through health policy, school-based initiatives, community health impact assessments, increased preventive health screenings, chronic disease self-management and worksite wellness.  

From now through December 12th our team will be meeting with stakeholders throughout Arizona in a series of partner meetings to gather input on the development of a chronic disease strategic plan surrounding these issues and interventions.  Hundreds of community partners have been invited to participate in sessions taking place in Yuma, Tucson, Flagstaff and Phoenix.  Simply visit our Chronic Disease Blog for details.

Patient Confidentiality: A Cornerstone of Public Health Practice

December 8th, 2011 by admin No comments »

When we think about holding things in confidence- several relationships come to mind that have a long history built on trust and the sharing of deeply private information.  Most of us can name these relationships with ease… husband and wife… lawyer and client… health care providers, public health officials and patients.  These relationships exist for a reason.  To share one’s deepest thoughts, emotions, challenges, fears or medical conditions with another person requires a sacred trust.  That expectation of trust allows us to navigate through life’s challenges… confident that we can overcome whatever may be in our path… certain that we can heal from our wounds… willing to make peace with what may face us along the way. 

Patient confidentiality is a cornerstone of public health practice- not just because of patient information protection laws like HIPAA- but because it’s the right thing to do.   The effectiveness of the entire public health system rests on a foundation of trust.  A covenant within the entire Health Care/Public Health Continuum that gives patients the assurance that their private information will remain private.  Without that trust- the critical public health information that we rely on to implement effective public health interventions and save lives would erode. 

Violating that sacred trust would also cause irreparable harm to the very people we’re trying to help.  Would you be comfortable telling your physician or the public health system private information if you knew it would be shared with your friends, neighbors or complete strangers?  Would it instill confidence that the provider and the public health system had your best interest as a priority?   The answer to these questions for most people is clearly “No”.    

Those are just some of the reasons why we take patient confidentiality so seriously- whether it’s communicable disease information, data from our cancer, birth defects, trauma registries, patient information within the public behavioral health system, or information about the folks that we help at the Arizona State Hospital.  As the agency that has the privilege of promoting health and wellness for all Arizonans- it’s important that we also hold the trust and confidence of Arizonans that comes with that privilege.

Forging a New Trauma Tool

December 7th, 2011 by admin No comments »

Kudos to our EMS and Trauma System team for forging some new tools to improve trauma care in AZ.  Our Data and Quality Assurance team  developed an innovative benchmarking tool that’s shared with each of AZ’s trauma centers.  The tool shows each facility their injury specific survival rates and compares those rates to the (blinded) other centers. The report provides a balanced approach that gives good information in a non-threatening manner, yet kindles the competitive spirit of the healthcare field to improve care for Arizonans.  Here is a copy of the aggregate report

Our Trauma team has also been busy adding a technical assistance focus to their website.  Over the past couple of years they’ve been working with rural hospitals across the State to bring them into our trauma system, including migrating the documentation required for trauma center designation and site reviews into an electronic format.  This will assist the trauma surgeons and trauma managers that are on the site review teams that visit these rural hospitals.

Home Birth Protest

December 6th, 2011 by admin 40 comments »

Those of you that were working at our downtown campus last Wednesday afternoon may have seen the 100 or so folks carrying placards in front of our 150 Building.  They were asking us to make it easier to have a home-birth in AZ.  How can we do that, you ask? 

Many of you probably didn’t know that we license the 50 or so Midwives that practice in Arizona.  Our licensing rules for Midwives were last revised in the mid 1990’s, our rules are out of date, and the application is too complicated.  I met with 4 of the community folks upstairs during the demonstration- and we had a productive discussion.  Basically- they asked us to consider revising our Midwife licensing rules to simplify the application process and consider revising their scope of practice.  We talked during our meeting about the rulemaking process (both exempt and regular), gave them a realistic forecast of how quickly we could revise the rules using each approach, and set up a dialog so we could come up with a solution together. 

Coincidently- there was a study published in the British Medical Journal this week regarding the safety etc. of home births. The study basically suggests that there’s little difference in complications among the babies of women with low-risk pregnancies who delivered in hospitals vs. those who gave birth at home with a midwife.  Of course- the article is more complicated than that- so visit the journal article for more info…