http://nwhf.org/conversation/ en info@communityhealthpriorities.org Copyright 2012 2012-05-09T19:28:43+00:00 http://nwhf.org/conversation/comments/curry/ http://nwhf.org/conversation/comments/curry/ As Jan Kaplan, director of Curry County health department, explains how the county got into its financial mess and what it means for the future of public health, it dawns on me that perhaps the timing couldn’t be better.  With health care transformation under way in Oregon, new opportunities for collaboration between medical providers, insurers, and public health are emerging. This could mean that local health departments struggling to fund essential services under the current model may find innovative ways to strengthen the infrastructure necessary to support healthy communities. Curry County is, in many ways, at the forefront in this effort.  Earlier this year, as the Board of Commissioners considered the alternative ways to provide services and this last May 1, the Board gave the official go-ahead for the health department to become a non-profit. Other options being explored are a potential merger of the health department with another organization or a formal contractual partnership. Whatever the model, Curry County health department is positioning itself to be an active partner in the development of a Coordinated Care Organization in the area.  The Department’s Healthy Communities team is leading visioning councils in each of the coastal communities in the county that will help develop a Community Health Assessment and a Health Improvement Plan, both of which will be required of CCOs.  And the department has received some financial support from Mid-Rogue IPA to implement a maternal care home demonstration project that would expand the department’s capacity for home visits, improve care coordination and provide nutritional guidance for pregnant mothers, and until the child reaches age 5.  Not only would this program address a key issue in the fight against obesity and related chronic diseases like diabetes; it would also demonstrate how a performance-based payment system could work. So, despite its fiscal challenges, Curry County has some bright spots in its future and it could certainly be an example for other counties in the state seeking to have healthier communities. Economic Issues, Public Health, Rural Health 2012-05-09T19:28:43+00:00 http://nwhf.org/conversation/comments/exit/ http://nwhf.org/conversation/comments/exit/ I’ve been thinking about transitions, retirement and leadership lately with Northwest Health Foundation’s founding president, Thomas Aschenbrener retiring at the end of June. Over the past fifteen years, Thomas has encouraged the Foundation to explore new ways to create positive change in the community. He has promoted true partnerships with community organizations, funders and civic leaders. The nursing collaboration with the Robert Wood Johnson Foundation would not be here without Thomas’s support and encouragement; with him we leveraged our small, regional Foundation’s vision into a national model of philanthropic partnership. I applaud Thomas for recognizing that the time to leave an organization is when it is doing well. “I am leaving when Northwest Health Foundation has never been stronger,” he said. The staff is extremely capable and the board is well poised to succeed with its individual skills, diversity of background, and experience in working collaboratively.” His words brought me to think about the need for investment, not just in nursing leadership development, but also in nursing leadership succession. There are now several nurse leadership and management academies, faculty development programs, discussion groups, books and online modules sprouting up everywhere. Clearly, we know how to make good nurse leaders. Succession management for nurse leadership, however, is less well understood. Peter Buerhaus, at Vanderbilt University Medical Center, predicts that as the economy recovers, nurses who previously delayed retirement will spend more time and energy on their exit strategies from the workforce. I think the nursing profession should start considering what those strategies should look like. We need to help the current leaders get ready to leave by creating programs that encourage them to expand their thinking beyond their current positions. We need to help them to move on from this meaningful work to the next level of their lives. Can we create other supportive roles for the near-retirement nurse, or structure work so that retirement can be redefined? How do we make sure our retiring nurses continue to be leaders in their communities? What role should leadership development programs have in assisting current nursing leaders to strategize their exits? Some may disagree with me, but I believe that helping current leaders get ready for their own next phase could be just as important as training the next generation of nurse leaders. — Judith is NWHF’s Director of Workforce Development, and director of the Partnerships Investing in Nursing’s Future (PIN) program, a collaboration with Robert Wood Johnson Foundation. This piece was excerpted from her column in the “PIN Point” newsletter, which can be viewed here. Economic Issues, Education, Public Health 2012-05-06T20:28:32+00:00 http://nwhf.org/conversation/comments/aq_accreditation/ http://nwhf.org/conversation/comments/aq_accreditation/ In March 2012, Northwest Health Foundation announced a grant opportunity to support public health accreditation efforts at county and tribal health departments.  Alejandro Queral, NWHF program officer, sat down with public health consultant Craig Mosbaek to talk about public health accreditation and this grant opportunity. Craig Mosbaek: What’s the benefit of accreditation for public health departments? Alejandro Queral:  One of the main benefits is quality assurance – the ability to tell public officials and the community you serve that the health department is meeting high standards for improving population health, and that it is doing so in a more efficient way.  Accreditation ensures that health departments are tailoring their efforts to the needs and values of the community and using promising and evidence-based practices to promote health.  The standards ensure that a health department is addressing community-wide health and therefor embracing health equity.  CM:  This is the second round of funding NWHF has made available to health departments around accreditation.  Why is accreditation important to NWHF? AQ:  We all want a first class public health system.  Accreditation helps assure communities that their local health department is functioning at a high level.  A practical factor – and I think the writing is on the wall – is that accreditation will likely be a requirement for certain funding opportunities from national organizations.  The Foundation also sees this as an opportunity to have better integration between the health care delivery system and public health.  For example, health departments applying for accreditation and non-profit hospitals seeking to keep their non-profit status are both required to conduct Community Health Assessments and Community Health Improvement Plans.  We hope to encourage collaboration on these and other community projects that will ultimately result in better health for everyone. CM: Why does this grant opportunity refer to Coordinated Care Organizations (CCOs)? AQ:  The only way to realize the goal of a healthier population is to have a robust healthcare delivery system along with effective population-based approaches to improving health. CCOs are the new organizational unit for the healthcare delivery system in Oregon.  The CCOs are starting now by serving the Oregon Health Plan [Medicaid] population, but this will expand to include public employees and, at some point in the future, a majority of Oregonians.  In some areas around the state, health departments are taking an active role in the formation of CCOs.  Healthcare systems are very familiar with the concept of accreditation, so an accredited health department will be seen as one that can deliver high quality services. We recognize that health departments are working at capacity and are strained for resources.  Working with CCOs can be an opportunity to think of different ways to deliver services and explore innovative financing models. CM: Tribal health departments can apply for this NWHF grant. What are the benefits of accreditation for tribal health departments in Oregon? AQ:  The main benefits are the same for local and tribal health departments — quality assurance and access to funding resources.  The Public Health Accreditation Board (PHAB) worked with tribal groups to make sure that the accreditation standards were appropriate for tribal health departments.  The Northwest Portland Area Indian Health Board (NWPAIHB) has an accreditation manager to help tribal health departments with the process.  And, Joe Finkbonner, Executive Director of the NWPAIHB, is on the Board of Directors for PHAB. CM: NWHF is also offering a Learning Collaborative, consisting of the health departments that receive these new grants.  What do you think the health departments can learn from each other in this process? AQ:  Public health accreditation and CCOs are both new processes, so everyone seems to be in learning mode.  Health departments can learn from each other about planning and prioritization strategies and tools that will help them develop and implement more robust quality improvement processes. The process of accreditation is full of technical details around reports and documentation and NWHF will provide some technical assistance to our grantees, but a Learning Collaborative will help with that.  We are thinking of opening up the Learning Collaborative to all health departments, not just our grantees. CM: Closing thoughts for people working in a health department on the fence about applying for this grant? AQ:  One of the benefits of this grant opportunity is that health departments will have some flexibility on how the money can be spent.  Our hope is that this opportunity will help local health departments move forward with accreditation while also playing an active role in the health care transformation process in Oregon. “Accreditation helps assure communities that their local health department is functioning at a high level.  A practical factor – and I think the writing is on the wall – is that accreditation will likely be a requirement for certain funding opportunities from national organizations.” -Alejandro Queral   Interviews, Economic Issues, Policies & Laws, Public Health, Rural Health 2012-05-02T23:43:30+00:00 http://nwhf.org/conversation/comments/ssb/ http://nwhf.org/conversation/comments/ssb/ In an April 2012 survey, 62% of California voters supported a “special fee” on soda and soft drinks to fight obesity among children. The survey was conducted by Field Research Corporation on behalf of the California Endowment. Meanwhile, the Center for Consumer Freedom, an industry-funded group, recently cited a nationwide Harris Interactive poll that showed 62% of Americans opposing a soda tax.  Both Field and Harris are respected polling companies. So, who’s right? Depends on who you ask. Or, more precisely, how you ask. The California survey:  “Do you support or oppose having the state put a special fee on the sale of soda and soft drinks and use the money to fight obesity among children?”  In the Harris poll, respondents were asked if they support or oppose “Putting a new tax on soft drinks with high sugar content.” One obvious difference: the term “special fee” in the California poll and “new tax” in the Harris poll.  Another is that the California poll proposes revenue to be used to fight childhood obesity. While the Center for Consumer Freedom admits that addressing childhood obesity increases support for a soda tax, they argue the government can’t be trusted to follow through on this, citing that only 2% of tobacco settlement monies have been used to fund tobacco cessation. Other results from the Field poll in California show that 94% of respondents said obesity among children and teens is a very or somewhat serious problem.  When asked what poses the greatest health risk to kids, almost half said either unhealthy eating habits (28%) or lack of physical activity (20%). Note to advocates, or anyone interested in passing soda tax legislation: 1. Seemingly minor details in wording can make a difference. 2. People want their excise taxes to address the issue at hand. In the case of Oregon, connecting a soda tax to Farm to School programs, or school-based physical education programs can make for solid, and popular, public health policy. Combine solid wording with sound policy and a misguided poll can be turned upside-down, making the difference between real policy and policy merely considered. Disparities, Economic Issues, Policies & Laws, Food & Nutrition, Public Health 2012-04-10T20:34:04+00:00 http://nwhf.org/conversation/comments/photo2012/ http://nwhf.org/conversation/comments/photo2012/ Once again, NWHF is pleased to partner with the Oregon Public Health Division to launch 2012 Oregon Youth Photo Contest. The deadline for entries was April 15, 2012. Winners will be selected on May 10, 2012, and announced soon after. Stay tuned here to the NWHF Conversation blog for the announcement of winning entries. Each year, the directive for the photo contest is to show “what health means to you” through the lens of the camera, and include a caption.  Entrants must be between 12 and 18, and live in Oregon. Complete rules, as well as the submission form, can all be found here. Commucations, Food & Nutrition, Public Health, Rural Health, Transportation, Urban Issues 2012-03-16T19:41:01+00:00 http://nwhf.org/conversation/comments/SB_1580/ http://nwhf.org/conversation/comments/SB_1580/ Oregon has just taken a bold step forward toward transforming its health care system. The legislature’s passage of SB 1580 will now allow communities to create “coordinated care organizations” (CCOs) — teams of nurses, doctors, mental health therapists, community health workers, dentists, and other specialists organized around a single geographic area. The CCO model is expected to better coordinate the treatment of our 600,000 Oregon Health Plan members with a focus on reducing costs and improving quality. The idea is that coordinating care around teams of providers will better ensure that people stay healthy. If the CCOs are successful for the Oregon Health Plan members, it is expected that an ever-increasing number of Oregonians will eventually receive their health care from CCOs. This will help bring healthcare delivery, in Oregon at least, into the 21st century. There are many reasons to celebrate the passage of this bill. One is the legislative process that generated it. While there were other competing CCO bills, legislators wisely chose the bill that reflected the multi-year, public process directed by the Governor-appointed Oregon Health Policy Board (OHPB). Thousands of Oregonians provided input over the years into a process that resulted in the Oregon Health Policy Board’s “CCO Implementation Proposal,” the guiding document for SB 1580. Another reason to celebrate is the way legislators worked together to improve the bill along the way. They added a requirement that each CCO have a “community advisory council” to ensure that the needs of the community are being addressed. They also required that the CCO governance structure include at least two members from the community at large, so the organization’s decision-making remains “consistent with the values of the members and the community.” And they mandated that each CCO have an “innovator agent” who will coordinate information among CCOs, and encourage best practices and lessons learned. Ultimately, the major reason to celebrate is that—with federal government approval—Oregon can create innovative models of health care delivery that save costs, increase quality, and incorporate incentives to keep people healthy. Now the real work to improve our current dysfunctional health care system will begin. These new CCOs will have an opportunity to approach the people they serve not as individual patients with diseases that need treatment, but as community members whose health they can enhance. Through integrating physical health, mental health, and oral health care, CCOs can promote both well-being among the people they serve and hold down the escalation of health care costs. We at the Northwest Health Foundation hope CCOs will be bold and creative with the care they provide, making connections with community-based, public-health focused organizations that can promote health through upstream approaches—through, for example, fostering access to healthy food, providing opportunities for physical activity,  delivering culturally sensitive care to communities of color, connecting with early childhood education programs, and perhaps even connecting people to health-promoting supports such as housing, transportation or jobs. The possibilities are endless, and if Oregon takes advantage of these possibilities, our state can be a model for positive health reform across the nation. Disparities, Policies & Laws, Public Health, Rural Health 2012-02-23T22:57:59+00:00 http://nwhf.org/conversation/comments/story_event/ http://nwhf.org/conversation/comments/story_event/ Earlier this year, NWHF held a workshop featuring two national presenters sharing their perspectives about storytelling frameworks and techniques. The purpose of the session was to help our nonprofit community engage stakeholders, develop resources, and boost the perception of their organization and the work they do every day. The event featured Emilio Pardo, chief brand officer at AARP, and Michael Margolis, the founder of Get Storied, a storytelling training firm. Around 200 people attended, representing more than 50 organizations including Albertina Kerr, Black Parent Initiative, Bob and Charlee Moore Institute for Nutrition, Boys & Girls Aid Society, Bridge Meadows, Causa Oregon, Central City Concern, Clackamas Community Land Trust, Clark County Public Health, Family Building Blocks, Friends of Zenger Farm, Growing Gardens, Healthy Beginnings, and Innovative Changes. At the event, we asked some of the attendees how their organization contributed to the health of their community and we got a variety of answers. See the video for more. If you’d like to be invited to events such as this in the future, be sure to subscribe to our e-news. Do you work for a nonprofit? Please feel free to leave a comment below and share how your organization contributes to the health of your community… Commucations, Policies & Laws, Rural Health 2012-02-21T19:01:58+00:00 http://nwhf.org/conversation/comments/hunger-obesity/ http://nwhf.org/conversation/comments/hunger-obesity/ “People are fed by the food industry, which pays no attention to health, and are treated by the health industry, which pays no attention to food.” - Wendell Berry This January, Laurie Trieger, executive director of the Lane Coalition for Healthy Active Youth (LCHAY) and I hosted a session at the 2012 Food Security Summit in Corvallis exploring the root causes of hunger and obesity. Obesity and hunger are very much linked and we hope to eventually be able to identify key policy priorities that could begin to address these root causes. I believe this discussion needs to start with the acknowledgement that, like hunger, obesity is a symptom of a deeply flawed economic structure that favors profits over health. The industrialized food production and food distribution system is responsive to economic goals and completely ignores the health or environmental needs of the community. This is why we have concentrated animal feeding operations where thousands of pigs and chickens can live in crammed conditions and are pumped with antibiotics to avoid mass infections.  The drive to make money is also the reason the food industry has spent billions of dollars in advertising fast foods, sugary drinks, salty and greasy snacks, and thousands of other edible products.  And by the way, advertising dollars has moved well beyond traditional media; the food industry is investing larger portions of their budgets in digital marketing to kids using Facebook, Twitter, and web-based video games that require the user to give personal information and buy their products.  These techniques are based on brain research intended to understand the causes such mental health problems as ADD/ADHD, depression and schizophrenia. They are exploiting children’s underdeveloped brains to sell their products. The food industry has made plenty of calories available because the price of food industrially processed food is economically efficient to produce.  Unfortunately, those calories lack any real nutritional value.  While there’s protein and other nutrients in a Big Mac, there’s also so much fat and sodium that, on balance, the nutritional benefit is less than the harm from eating it. Scientists like Kent Thornburg at OHSU are finding that in fact our society is experiencing “high calorie malnutrition.”  The result is a dual crisis of obesity and malnutrition. Hunger in America indeed looks very different from hunger in places like Ethiopia. Hunger in America is not necessarily about not having enough to eat (though that also takes place, particularly in these hard economic times, with many parents skipping meals to feed their children).  But hunger in America is more about quality than quantity.  So my question for policy makers and advocates is this: What is the single, most important thing we can do to tackle the dual crisis of hunger and obesity? Disparities, Economic Issues, Food & Nutrition, Public Health 2012-02-21T18:55:31+00:00 http://nwhf.org/conversation/comments/cco/ http://nwhf.org/conversation/comments/cco/ Next month (February 2012), the Oregon version of health care reform, the coordinated care organization (CCO), will be acted on by our Legislature.  They are now waiting for the report and recommendations from the Health Policy Board in response to the direction SB 3650.  I have attended the conversations about CCO’s for the past several months and here are my thoughts: First, the idea of creating a health care system is remarkable in its vision.  I say BRAVO to the forward thinking legislators. Right now we do not have an American health care system, but rather a collection of independent fiefdoms.  It’s important to understand that our first efforts will not get it right, but the efforts are critical first steps. If we acknowledge that, and do not think that the effort is a failure when we uncover the inevitable problems, we will be successful in the longer term. If we are committed to the “triple aim” of cost, access, quality, and committed to work with patients and providers, we will evolve into a system that actually can improve our world ranking of a healthy population and be cost effective. Second, the health policy board received a great deal of good information from providers and consumers about what the new CCO’s should include.  The important test is whether the legislature has the ability to work with these recommendations to advance the interests of all people or default to rewarding the few power players.  Can the legislature support the work of the Health Policy Board and really listen to and act on their recommendations? Third, there is some question whether we should have one CCO in a region or several to promote competition.  It seems to me that the fewer CCOs the better. We know that shifting from one insurance carrier to another, by insureds or practitioners, produces redundant administration that can run up the cost of health care by as much as 30% without providing any additional direct services. Fourth, governance is the most critical factor in the success of CCOs. While some feel that only providers should be part of the governance board, these boards must be made up of providers, local public health, local elected officials and consumers. I recommended a 40-20-20-20 percent allocation. Fifth, there is a risk that CCOs will get contracts to provide coverage, but fail to provide timely access.  It should not be acceptable for patients to wait 6 weeks for appointments or to drive 60 miles to see a provider in another city.  Monitoring timely and meaningful access should be part of the legislative requirements. Sixth, culturally adequate care cannot be compromised.  CCO’s need to have the expectations laid out for equity, and systems in place for helping them achieve culturally adequate care as well as documenting equity from the patient’s perspective. Seventh, the selection process of CCOs should be spelled out.  The Oregon Health Authority should create a review group with the same make-up as the recommended governance board to select the CCOs for certification. Eighth, we need to see the allocation to CCOs as a fixed pot of money and that the providers in this system should be paid fairly for their services, but be paid by salary rather than fee for service. Within this salary structure, primary care providers should be recognized as the important role of keeping people healthy and if there is to be cost savings in this system, it will be because of their effectiveness.  It is important to reduce the competitiveness for dollars we see in the fee for service system. Finally, one issue that has been largely avoided thus far is the need for the full range of health services to include women’s health.  While the issue was raised at the CCO workgroup meetings, there was no further acknowledgment of it. Women’s health services, especially reproductive health, should not be systematically denied by providers.  It is essential that we have create an explicit understanding of the women’s health services that our CCOs are expected to provide.  We are on the brink of a remarkable opportunity to affect the health of our generation and those that follow us.  If we are willing to keep our focus on that which brings health to all Oregonians, we will have made a great achievement.  I hope the legislators will step up to do their part. ————————- Thomas Aschenbrener, NWHF President, serves on Oregon’s Governor-appointed CCO Criteria Work Group. Disparities, Economic Issues, Policies & Laws, Public Health 2012-02-18T18:32:17+00:00 http://nwhf.org/conversation/comments/EHRs/ http://nwhf.org/conversation/comments/EHRs/ Are public health departments ready for the deluge of data to come from electronic health records (EHRs)?  Maybe not, according to a recent article in the American Journal of Public Health, entitled “Public Health Surveillance and Meaningful Use Regulations: A Crisis of Opportunity.” With financial incentives from the federal government, EHRs are being implemented by more and more hospitals, clinics, and individual doctors, who are required to show they’re making meaningful use of the EHR data. This includes sending data to health departments for programs such as immunization registries and disease reporting.  Findings from a public opinion survey on EHRs, “Making IT Meaningful: How Consumers Value and Trust Health IT”,  show a generally positive attitude towards EHRs.  Patients see EHRs as a way to improve on quality of care, and they would like on-line access to their health records. Use of EHRs will continue to expand, and public health departments need to prepare for the increasing quantities of data and find innovative ways to use these data to improve population health. Policies & Laws, Public Health 2012-02-18T00:26:53+00:00