Wayne H. Giles, MD, MS joined the Centers for Disease Control and Prevention in July 1992. He is currently the Director of the Division of Population Health within the National Center for Chronic Disease Prevention and Health Promotion at the Centers for Disease Control and Prevention (CDC).
This forum provides an overview of the different levels, drivers and opportunities available to improve population health. It describes the CDC’s and other Federal initiatives designed to support population health. Additionally, this forum presentation identifies opportunities for health care providers to work with Government programs to advance population health.
Presentation: 48 minute

Giles, MD, MS, Wayne H.

Jefferson Digital Commons

Saving Lives. Protecting People.  Centers for Disease Control and Prevention  Division of Population Health  “Population Health Readiness”   Wayne H. Giles, MD, MS  September 9, 2015  Learning Objectives  Describe the many different levels of Population Health   Discuss the drivers & opportunities available to improve Population Health   Identify the CDC’s and other Federal initiatives designed to support Population Health CDC Strategic Directions Improve  health security at home and around the world Better prevent  the leading causes of illness, injury, disability, and death Strengthen public health/ health care collaboration Definition of Population Health  Kindig et al (adapted)  Population health includes factors that influence health outcomes of individuals, including the distribution and equity of such outcomes across various segments of society  (Kindig et a. Am J Public Health. 2003;93:380-383).  What are the Drivers?   Actual Causes of Death† United States, 2000  0 5 10 15 20 Tobacco Poor diet/ Physical inactivity Alcohol consumption Microbial agents Toxic agents Firearms Sexual behavior Motor vehicles Illicit drug use Percentage (of all deaths) * Minino AM, Murphy SL, Xu J, Kochanek KD. Deaths: Final data for 2008. National vital statistics reports; vol 59 no 10. Hyattsville, MD: National Center for Health Statistics. 2011.  † Mokdad AH, Marks JS, Stroup DF, Gerberding JL.  Actual causes of death in the United States, 2000.  JAMA. 2004;291(10):1238-1246. Percentage (of all deaths) Heart Disease Cancer Chronic lower respiratory diseases Unintentional Injuries Diabetes Alzheimer’s disease Pneumonia/influenza Kidney Disease Stroke Leading Causes of Death† United States, 2008  www.cdc.gov/diabetes County-level Estimates of Diagnosed Diabetes among Adults aged ≥ 20 years:                                                       United States 2009  Age-adjusted percent 0 - 6.3 6.4 - 7.5 7.6 - 8.8 8.9 - 10.5 > 10.6 2000 Obesity Trends* Among U.S. Adults BRFSS, 1990, 2000, 2010 (*BMI 30, or about 30 lbs. overweight for 5’4” person) 2010 1990 No Data          <10%           10%–14%     15%–19%           20%–24%          25%–29%           ≥30%   Map: Obesity (Pennsylvania) Graphs are state- and indicator-specific.   State vs. US comparison, and racial/ethnic and education disparities depicted.   Some estimates suppressed due to small sample sizes. Map: Blood Pressure (Pennsylvania) Map: Cholesterol (Pennsylvania) Map: Diabetes (Pennsylvania) Portable  Network Graphics (.PNG) file format.  One graphic file per mapped measure for each state.  Total of 12  or 15 maps per state. Map: Smoking Prevalence (Pennsylvania) The context in which people make decisions about their health often depends on the risks and the resources  in their neighborhoods. PLACE MATTERS Expanded Chronic Care Model Growing Challenges Improving the Health of Attributed/Accountable Populations State Health System Physician  Categorization of Population Health Activities   Bucket #1: Traditional Clinical Approaches  Bucket #2: Innovative Patient-Centered Care  Bucket #3: Community-Wide Health #1: Traditional Clinical Approaches Focused on Preventive care Million Hearts –The Clinical Components  Aspirin People at increased risk of cardiovascular events who are taking aspirin  47% Blood pressure People with hypertension who have adequately controlled blood pressure 46% Cholesterol People with high cholesterol who are effectively managed 33% Smoking People trying to quit smoking who get help 23% MMWR. 2011;60:1248-51  #2: Innovative Patient-Centered Care Focused on Preventive care Community Health Workers  Links health systems and communities   Facilitates access to and improve quality and cultural competence of medical care  Builds individual and community capacity for health by:  Increasing health knowledge and self-sufficiency of the patients  Serving as community health educators  Providing social support   Advocating for the health care needs of patients and communities  #2: Community-Wide Health Focused on Preventive care Million Hearts:  Community-Wide Components  CDC Supports Bucket 3: Partnerships to Improve Community Health (PICH)   PICH (39 Awardees)   • Multi-sectoral community coalitions in: o Large Cities and Urban   o Small Cities and Counties o American-Indian tribes    Examples of Activities:  Boston Public Health Commission - implement citywide strategies  to improve built environment - opportunities for walking & biking    Scenario – Patient with asthma  Bucket 1 – Diagnosis, rx action plan, medications, clinical guidance.   Bucket 2 – Community health worker does home visit; assesses triggers, counsels patient; offers limited remediation.   Bucket 3 – Community standards on housing; limits to indoor and outdoor pollutants; reductions in smoking rates. Emerging Opportunity: Worksite Wellness  A Comprehensive Workplace Health Program to Address Physical Activity, Nutrition, and Tobacco Use in the Workplace established and evaluated comprehensive workplace health programs to improve the health of workers and their families.    The main program goals included: – Reducing the risk of chronic disease among employees through science-based workplace health interventions and promising practices. – Promoting sustainable and replicable workplace health activities such as establishing a worksite health committee, having senior leadership support, and forming community partnerships and health coalitions. – Promoting peer-to-peer business mentoring.   National Healthy Worksite Program (NHWP) – 2011-2015  What is The CDC Worksite Health ScoreCard? A tool designed to help employers  assess evidence-based health promotion  interventions in their worksites to prevent  heart disease, stroke, and related chronic  conditions.  Available at:  http://www.cdc.gov/workplacehealthpromotion http://www.cdc.gov/healthscorecard/index.html  http://www.cdc.gov/hsc   How  is the HSC Organized?  Organizational supports   Tobacco control  Nutrition  Physical activity  Lactation Support  Weight management  Stress management  Depression  High blood pressure  125 Yes/No questions assesses best practice health promotion interventions (policies, programs, environmental supports) in 16 topic areas  High cholesterol   Diabetes   Signs and symptoms of heart attack and stroke   Emergency response to heart attack and stroke  Occupational Health & Safety  Vaccine-Preventable Diseases  Community Resources   Program Strategies and Interventions  •Leadership support •Culture •Work climate • Facilities that support health • Access and opportunities • Relationship with management / coworkers • Social support • Health behaviors • Risk factors • Current health status Individual Interpersonal Organization Environment Somerset County, ME Pierce County, WA Kern County, CA Shelby County, TN Harris County, TX Marion County, IN Buchanan County, MO Philadelphia County, PA NHWP Communities Employer Site Employer Size Employer Sector 2013 Overall Score 2015 Overall Score Employer A Large Finance, Insurance & Real Estate 128 201 Employer B Large Finance, Insurance & Real Estate 128 201 Employer C Large Finance, Insurance & Real Estate 131 201 Employer D Large Finance, Insurance & Real Estate 126 200 Employer E Mid-Size Manufacturing 48 181 Employer F Small Professional, Scientific & Technical Services 42 185 Employer G Mid-Size Professional, Scientific & Technical Services 66 183 Employer H Large Public Administration 71 146 Changes in Health ScoreCard  Score of Active in Philadelphia Employers Changes in Health for Philadelphia Employees Who Participated in Both Assessments  (2013 & 2015)  Health Issues and Lifestyle Risks 2013 2015 Self-Reported Health Assessment Survey Current Smoker 10.0% 7.9% No/low exercise 55.7% 45.0% Fruit and Vegetable consumption (5+ per day) 7.9% 10.7% Biometric Screening BMI: % overweight (BMI between 25.0 – 29.9) 37.1% 33.6% Culture & Climate Survey Overall, how safe do you think your workplace is (1 - extremely unsafe to 10 - extremely safe) 7.70 8.11 Overall, how supportive is your company of your personal health, (from 1 - extremely unsupportive to 10 - extremely supportive)? 6.84 7.45 N=140 FEDERAL RESOURCES  What is State Innovation Model (SIM)?  Testing the ability of state government to use their regulatory and policy levers to accelerate health transformation  Improve population health  Transform healthcare payment & delivery systems  Decrease total per capita health care spending  Public and private collaboration with multi-payer and multi-stakeholder engagement  Cooperative agreement between awardee and the Innovation Center  Provides technical and financial assistance to provide better care and better health at lower cost through quality improvement to the state population |40 SIM Round 2 Awardees Note: The following R2 Model Design Awardees are NOT captured in this graphic: Puerto Rico, American Samoa, the Commonwealth of the Northern Mariana Islands and the District of Columbia OR AR MN ME MA VT CA UT IA IL MI OH TN PA NH RI MD DE CT HI ID MT WA NV AZ NM CO OK WI NY VA KY WV NJ Round 1 Model Test States Round 2 Model Test Awardees Round 2 Model Design Awardees Priority Areas:  High Value Targets of Change   Hypertension and Cardiovascular Disease,  Diabetes, COPD, Asthma, HIV/AIDS  Fall prevention in older adults  Behaviors that reduce the risk for chronic disease  Adherence and self management skills  Broader models that link clinical care with community-based interventions  Health Care Innovation Award  (HCIA)   Health Care Innovation Award HCIA  PA SIM Model Design:  Population Health Priorities   There are a number of programs in place focused on CMMI – identified priorities.     Examples include focusing on improving population health and outcomes with regard to childhood obesity, tobacco use, diabetes, behavioral health, oral health, and drug use.     Chronic Disease Self-Management Program  Low-cost,  community-based class for people with chronic diseases developed at Stanford University  A CDC meta-analysis of CDSMP showed improvements in fatigue, depression, health distress, etc.   CDC’s Arthritis Program funds 12 state arthritis programs that can offer CDSMP as a proven  intervention  Health Resources and Services Administration Community Health Workers Evidence-based Model Toolbox CDC Tools and Resources  CDC Fellowship Opportunities Things CAN Be Different!    Saving Lives. Protecting People.  Office of the Director Division of Population Health  Contact Information:  Wayne H. Giles, MD, MS 770 488 5269 hgiles@cdc.gov  

Population Health Readiness

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Population Health Readiness

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