Healthy People 2020: Spotlight On Health: Health-Related Quality Of Life
Healthy People 2020 Spotlight on HealthpresentsPromoting and Measuring Health-RelatedQuality of Life and Well-Being
Carter BlakeyDeputy DirectorDirector, Community Strategies DivisionOffice of Disease Prevention and Health PromotionU.S. Department of Health and Human Services
AgendaI. Healthy People 2020 & Health-Related Quality of Life(HRQOL) & Well-Being (WB)- Carter Blakey, Office of Disease Prevention andHealth Promotion, HHSII. Relevance of HRQOL & WB to Improving the Health ofthe Nation- Ron Manderscheid, National Association ofCounty Behavioral Health and DevelopmentalDisability Directors
AgendaIII. Healthy People 2020’s HRQOL & WB Topic Areaand its Implementation- Rosemarie Kobau, Centers for Disease Control andPrevention, HHSIV. Tracking HRQOL & WB in Communities forpopulation health assessment MATCH County Rankings- Patrick Remington, University of Wisconsin atMadison Oregon Community Care Organization- Kevin Campbell, GOBIV. Question & Answer Session
What Is Healthy People? Provides science-based, 10-year nationalobjectives for improving the health of the Nation A national agenda that communicates a vision forimproving health and achieving health equity Identifies measurable objectives with targets to beachieved by the year 2020 Requires tracking of data-driven outcomes tomonitor progress and to motivate, guide, and focusaction
Uses of Healthy People Data tool for measuring program performance Framework for program planning and development Goal setting and agenda building Teaching public health courses Benchmarks to compare State and local data Way to develop nontraditional partnerships Model for other countries
Healthy People RemainsRelevant
Significance ofHRQOL and Well-Being At the launch of Healthy People 2020, 4 cross-cuttingmeasurement areas were identified as Foundational: General Health Status Health-Related Quality of Life (HRQOL) & WellBeing (WB) Determinants of Health Disparities Evolution 2 new HP2020 Topic Areas created to definekey national objectives in two of these areas: HRQOL &WB and Social Determinants of Health (SDOH)
Pivotal Role of HP2020 HP2020 is playing a significant role in fostering theshift from disease to health The framework for HP2020 addresses:– Social and Physical Health Determinants– Community and Clinical Health Promotion andDisease Prevention– Lifestyle and Health Behavior Change– Health Disparities and Equity Each area relates to lifecycle stage
Questions?Submit your questions using the Q & A feature on the right of your screen.Presenters will respond following all the presentations
Ron Manderscheid, Ph.D.Executive DirectorNational Association of County Behavioral Healthand Developmental Disability Directors
Essential Background Well-being and HRQOL are integral to:– Current transformation underway in Americanhealthcare– Our Health First Era in which good health hasbecome a personal goal
Why Well-being and HRQOL? Well-being and HRQOL are essential healthprocesses, and they are essential measures They are “foundational” because they reflect thedramatic shift in American healthcare from a focusonly on disease and its treatment to a new focus onhealth, disease prevention, and health promotion We simply cannot overstate the importance of thistransition to our Health First Era
Example: Role of HP2020 inReducing Disparities The HP2020 framework can identify and addressdisparities in health and health care Disparities are avoidable differences in health andhealth care in which those who are less advantagedfare worse Equity represents an effort to reduce one or moredisparities HRQOL and WB are excellent measures of disparitiesand can be used to track our efforts to promoteequity
What is Health? The 1948 Preamble to the Constitution of the WorldHealth Organization states:Health is a state of complete physical, mentaland social well-being and not merely the absenceof disease or infirmity Measures of HRQOL and WB reflect the essence ofwhat constitutes good health
HRQOL and Well-Being arePersonal Assessments of Health HRQOL and WB reflect what one thinks ofone’s own health—physical, mental, social They also reflect how one’s health actuallyinfluences what one thinks about one’sparticipation in the family, school orworkplace, and the community
The Affordable Care Act The Affordable Care Act (ACA) of 2010 is designedto improve health insurance coverage, the quality ofhealth care, and population health Measures of population health and health careoutcomes are essential to the success of the ACA HRQOL and WB are excellent measurement tools forthese ACA efforts
Key ACA Prevention Measures One of the 10 ACA Essential Health Benefits forinsurance is a mandatory benefit for diseaseprevention and health promotion Measures of HRQOL and WB are key barometers ofpersonal and social health HRQOL and WB are excellent measures for assessingthe progress made in maintaining and promotinggood health under the prevention and promotionbenefit
Key ACA Outcome Measures The ACA seeks to develop healthcare systems thatare person-centered, in which the client is the “truenorth” of care The client’s viewpoint is paramount for assessingcare outcomes HRQOL and WB reflect the client’s point of view andare excellent measures of care outcomes for theACA
The National PreventionStrategy (NPS) With its focus on health determinants, diseaseprevention, and health promotion, HP2020 was aprimary stimulus in the development of a NationalPrevention Strategy in 2011 A majority of the objectives and measures that arepart of the National Prevention Strategy comedirectly from HP2020
Key NPS Measures National Prevention Strategy represents the firsteffort to coordinate all disease prevention and healthpromotion efforts across HHS These efforts will require evaluation to determinetheir effectiveness HRQOL and WB are excellent measures for thesecomparative assessments
Key Points HRQOL and WB reflect our tectonic shift towardhealth and away from an exclusive focus on disease They are essential measures for HP2020, theAffordable Care Act (ACA) and the NationalPrevention Strategy (NPS) They are useful for identifying issues in health andhealth care for counties and communities and fordriving action for positive outcomes
Contact InformationRon Manderscheid, PhDrmanderscheid@nacbhd.org202-942-4296
Questions?Submit your questions using the Q & A feature on the right of your screen.Presenters will respond following all the presentations
Rosemarie Kobau, MPH, MAPPTeam LeadDivision of Population Health Epilepsy ProgramCenters for Disease Control and Prevention
Goals Overview of Health Related Quality of Life & WellBeing (HRQOL & WB) Workgroup Review different measurement approachesapproved for HRQOL & WB topic area28
Overview of Healthy People 2020HRQOL & WB Workgroup Topic approved by HP2020 Federal InteragencyWorkgroup, Winter, 2010 Extends morbidity, mortality, chronic disease statusmeasures to quality of physical, mental and socialdomains of life Multi-dimensional concepts Multidisciplinary perspectives & measurementconsiderations (e.g., Functional status vs.Perception vs. Preferences, Assets vs. Deficits)29
Overview of Healthy People 2020HRQOL & WB Workgroup Workgroup defined 3 complementarymeasurement approaches:i. Self-rated Physical and Mental Healthii. Well-Beingiii. Participation in Society 3 measurement approaches developed fromliterature review, public comments, and opendiscussions Subcommittee for each approach30
3 Measurement ApproachesI. Self-Rated Physical and Mental Health Measures physical and mental health symptoms,including functioning and general healthperceptions Generally deficit-based31
3 Measurement ApproachesII. Well-Being Measures the positive evaluations of people’s dailylives—when they feel very healthy and satisfied orcontent with life, quality of their relationships,positive emotions, realization of potential Presence of positive affect, absence of negativeaffect and life satisfaction Generally asset-based32
3 Measurement ApproachesIII. Participation Measures individuals’ perceptions of the impact oftheir health and functional status on theirparticipation in society Participation includes education, employment, civic,social and leisure activities Assumption: Person with a functional impairment(e.g., vision loss, mobility difficulty) can live a longand productive life and enjoy a good quality of life33
Self-Rated Physical and MentalHealth Subcommittee Measure: NIH PROMIS Global Health Measure (10item measure) Assesses physical and mental health symptoms,including functioning and general healthperceptions Efficient assessment of health status with minimalrespondent burden 2 summary measures of physical and mentalhealth34
Self-Rated Physical and MentalHealth Subcommittee Healthy People 2020 Objectives: Increase the proportion of adults who report goodor better physical health Increase the proportion of adults who report goodor better mental health Approved for inclusion in HP2020 July 2013 Data Sources: NHIS (2010), and other surveys TBD35
PROMIS Physical Health ItemsNHIS 2010 Data (Adults 18 years )1. In general, how would you rate your physicalhealth?2. To what extent are you able to carry out youreveryday physical activities such as walking, carryinggroceries, moving a chair 3. How would you rate your fatigueon average?4. How would you rate your pain on average on scaleof 0 to 10?36
PROMIS Mental Health ItemsNHIS 2010 Data (Adults 18 years )1. In general, would you say your quality of life is .2. In general, how would you rate your mental health,including mood and ability to think?3. In general, how would you rate your satisfactionwith social activities / relationships?4. How often have you been bothered by emotionalproblems?37
Adults who Report Good or BetterPhysical Health, 201038
Adults who Report Good or BetterPhysical Health, 201039
Adults who Report Good or BetterMental Health, 201040
Adults who Report Good or BetterMental Health, 201041
Health-Related Qualityof Life & Well-BeingNew Topic AreaVisit 202042
Next Steps for the 3Subcommittees Continue to review the literature Consult with other subject matter experts outsideof Subcommittees Analyze relevant data sources Identify evidence-based resource material43
Opportunities for PartnerInvolvement Ensure strong data sources exist and continue toadvance the field Provide feedback through the public comment processeach Fall Use Healthy People 2020 measures as benchmarks forwork at the state and local levels Implement evidence-based programs to improve HRQOL& WB in the population Access HP2020 tools and data online athealthypeople.gov44
Questions?Submit your questions using the Q & A feature on the right of your screen.Presenters will respond following all the presentations
Patrick Remington, M.D.Associate Dean for Public HealthProfessor of Population Health SciencesSchool of Medicine and Public HealthUniversity of Wisconsin-Madison
Health-Related Quality of Life andthe County Health RankingsHealthy People 2020Spotlight on Health WebinarSeptember 25 , 2014
OVERVIEW OF TODAY’S TALK Describe variation in healthrelated quality of life in the U.S. Review the County HealthRankings model—visit:www.countyhealthrankings.org Discuss potential uses of healthrelated quality data in your owncommunity
HOW DOES CDC MEASURE POPULATIONHEALTH-RELATED QUALITY OF LIFE?The County Health Rankings uses 3 ofthese 4 questions
County Health Rankings “Action Model”www.countyhealthrankings.org
COUNTY HEALTH RANKINGS: 2 RANKINGS52
Finding your own local “Snapshot”
How do we help?-Use ranking to callattention to healthdisparities-Provides a modelof communityhealth (includesQoL)66
COUNTY HEALTH RANKINGS APPROACH67
How do we help?-Use ranking to callattention to healthdisparities-Provides a modelof communityhealth (includesQoL)68
CONCLUSION Health-related quality of life in the U.S. variesdramatically across the U.S., and within each state The County Health Rankings can be used in a HP2020effort by providing information on physical, mental, andoverall self-reported health Explore: http://www.countyhealthrankings.org to seehow health-related quality of life varies in your state anduse this information in your work with HP2020 planningand promotion71
Questions?Submit your questions using the Q & A feature on the right of your screen.Presenters will respond following all the presentations
Kevin M. CampbellChief Executive OfficerGreater Oregon Behavioral Health, Inc
Oregon Community Care OrganizationDevelopmentOne State’s efforts to transform thehealthcare delivery system
Oregon’s Health Care Reform:The Triple AimI. Better healthII. Better careIII. Lower costsCan only happen if we are assessingwell-being and health-related quality of lifeas primary outcome measures
The U.S. has a Sick Care System,not a Health Care System 45% of Americans have 1 chronic condition 50% of these receive care from 3 physicians Treatment accounts for 75% of direct medical care inthe U.S
Most of the cost is concentratedin a small number of enrollees In Eastern Oregon, 5% of enrollees are responsible for55% of all Medicaid costs, each averaging 25,000 in2013 Within that number, 2.4% of enrollees were responsiblefor 42% of costs each averaging 68,000 for that sametime period
What we will cover today How Oregon’s Coordinated Care Organizations (CCO’s)are organized, operated, and the services they deliver How our Mental Health Organization built a CCO How the work of the CCO relates to HRQoL and WB
What we will cover today How we use HRQoL and WB as primary qualitymeasures How we are developing an upstream agenda of betterpersonal health, prevention, and promotion
Oregon’s Concept (ORS 414.625) Person-centered care Fits well with well-being and health-related quality oflife Comprehensive, coordinated care management Assistance with navigating the health care system Accessible (geographically, financially, diverse &underserved)
Oregon’s Concept (ORS 414.625) Emphasis on prevention, healthy lifestyle, evidencebased practices Focused on measurable and meaningful healthoutcomes Community-Based Community Advisory Councils Community Health Improvement Plans as a guide tolocally achieving the Triple Aim
Core elements of aCoordinated Care Organization (CCO) Network of all types of health care providerswho have agreed to work together in their localcommunities Flexibility to support new models of care thatare patient-centered team-focused reduce health disparities
Core elements of a Coordinated CareOrganization Coordinate services Patient-centered focus on prevention andchronic illness management Flexibility within a predictable global budget toprovide community-based services in additionto the traditional Medicaid benefits
100% Integrated Care CCO’s will be required to have 100% of their membersenrolled in person-centered medical homes with fullyintegrated behavioral health services
100% Integrated Care CCO’s will be responsible for tracking andassisting with elements of a person’s healthrelated quality of life and well-being including: TransportationHousingEmployment & Financial SecurityNutritionEducation
Mental Health Organization CCO GOBHI provided Medicaid mental health benefitin 17 counties of Oregon 7 different health plans 6 dental plans Responsible for physical heath anddental benefits in those same counties
Mental Health Organization CCOOwners of the Eastern Oregon CCO are: GOBHI (29%) Moda Health (29%) 4 hospitals (10% each) Federally Qualified Health Center (1%) Independent PhysiciansAssociation(1%)
Mental Health Organization CCO Board of Directors includes not only owners butCounty Commissioners, Mental Health, PublicHealth, Juvenile, Senior Services, and Physicians Each County has a Community Advisory Council(CAC) with a majority of its members beingconsumers of health care to provide oversightof the CCO
Oregon CCO’s
70% of the cost of healthcare isdriven by HRQoL and WBDeterminantsof HealthWorld Health Organization 2009
Leading Causes ofDeathVSActual Causes ofDeathMcGinnis JM, Foege W H, 1994
This is the model we usedto create CCOs
Most health problems have physicaland psycho-social components Physicians and their patients look for purelyphysical causes for the patient’s problems The behavioral specialists job is to reframe theissue to include psychosocial stressors thatimpact the patient’s health
Behavioral health diagnoses are veryprevalent in the CCO Of the super-utilizers of services in EasternOregon 2013, over 65% had one or morebehavioral health diagnoses This population also has significant problemswith transportation, housing, jobs, nutrition,and educational opportunity
Strength-based Approaches in CCO All persons involved in CCO’s are being trainedto approach their job as a community healthworker or peer supporter Strategy: build on small successes rather thaninventorying overwhelming needs
Core Elements of Community HealthImprovement Plan Improve health outcomes for children ages 0–5 throughintegrated services To improve the skill sets of residents of EOCCO torecognize and seek treatment for mental health issues To implement a standardized approach to the use ofcommunity health workers
Core Elements of Community HealthImprovement Plan Improve oral health for children under 10 years old Better align public health services with primary care forpopulation health management Improve the skill set of all local community advisorycouncil (LCAC) members Allow LCACs to use their local knowledge to testinnovations in science in partnership with universitybased researchers
Key PointsPeople throughout Oregon believe we are on theright track to achieve the Triple Aim because: Coordinated Care Organizations are moving frommedical care to healthcare in the services we deliverand through redesign of the delivery system We recognize the importance of foundationalinvolvement of behavioral health in CCO developmentand operation
Key Points What the CCO does relate toHRQoL and WB We are developing upstreamagenda of better personalhealth, prevention, and healthpromotion by understanding theimpact of social determinants ofhealth
Kevin M. Campbell, .org/
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The Affordable Care Act The rdable Care Act (ACA) Affoof 2010 is designed to improve health insurance coverage, the quality of health care, and population health Measuresof population health and health care outcomesare essential to the success of the ACA HRQOL and WB are excellent measurement tools for these ACA efforts
Week 3: Spotlight 21 Week 4 : Worksheet 22 Week 4: Spotlight 23 Week 5 : Worksheet 24 Week 5: Spotlight 25 Week 6 : Worksheet 26 Week 6: Spotlight 27 Week 7 : Worksheet 28 Week 7: Spotlight 29 Week 8 : Worksheet 30 Week 8: Spotlight 31 Week 9 : Worksheet 32 Week 9: Spotlight 33 Week 10 : Worksheet 34 Week 10: Spotlight 35 Week 11 : Worksheet 36 .
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