Priority 4: Nebraska has improved integration among public health, behavioral health and healthcare services.

There are several factors that contribute to the health and quality of life for individuals, families and communities such as preventive services, safe and healthy environments, access to affordable physical and behavioral healthcare. Unfortunately these services are usually not well integrated or provided within a collaborative framework. However, changes in the healthcare systems are creating new opportunities to build a framework for integration. Moving the concept of integration forward is a complicated task that will involve several activities. The SHIP Integration Priority is developed to achieve several goals towards this effort.

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Nebraska SHIP Priority 4: Nebraska has improved integration among public health, behavioral health and healthcare services.

For this SHIP goal, several activities were planned for implementation:

  • Analyze health data from clinics with healthcare home models, and recommend best practices.
  • Implement health education and promotion programs to compliment clinic services.
What Works

Several clinics are already operating healthcare home clinics and tracking various health indicators such as Hemoglobin A1c and cholesterol levels. These clinics receive additional funding from BlueCross BlueShield of Nebraska, Medicaid, and Federally Qualified Health Centers (FQHCs). By developing a pilot project and collecting comparable data among selected clinics, it will be possible to identify best practices and to identify the roles of local and state health departments in tracking the data and connecting patients with appropriate community health promotion programs.

How We Impact

The Health Care Home Model has some very unique characteristics and places patients at the center of the health care system and includes the following:

  •  A physician-led, team-based coordination of care process that focuses on the patient and his/her family.
  •  A care model that is holistic – including the patient’s physical, mental, and socioeconomic health status.
  •  A care model where each patient is assigned a provider and care team that oversees and implements continuity of care that is delivered through access to a spectrum of health care delivery services, including home health, hospital inpatient care, specialists, rehabilitation facilities, and long-term care facilities.
  •  A focus on providing high-quality care, especially to patients with chronic disease/conditions, including a documented monitoring process using patient registries.
  •  24/7 access to care.

There are several elements of the health care home model. These elements include 1) patient tracking and registry, 2) access to care, 3) care management, 4) patient self-management support, 5) test tracking, 6) referral tracking, 7) performance reporting improvement, and 8) advanced electronic communication.

Why Is This Important?

The health care home model (also referred to as the medical home model) has the potential to improve health care delivery at the patient level by redesigning and improving the linkage between primary care clinics and public health agencies. The Health Care Home Model (HCHM) was first implemented in the 1960s, but it has gained considerable momentum in the 2000s. Although not all HCHMs are successful, several research studies have found that these models can improve the quality of health care services, reduce costs, and improve the health of the population.

In Nebraska, the model is rapidly spreading across the state. In 2011, Blue Cross Blue Shield of Nebraska initiated a medical home model in nine cities by focusing on management of diabetes, using test results for the patient’s blood sugar, blood pressure, and cholesterol levels. In 2012, this model was expanded to 33 clinics and about 42,000 Blue Cross subscribers.

In 2010, the State Legislature appropriated funds for two medical home pilot projects for Medicaid patients. In 2011, two pilot projects were launched in clinics located in Lexington and Kearney. Also, as part of the Medicaid managed care contract, Coventry and Arbor Health are expected to develop medical home models in twelve new communities over a three-year period. Blue Cross Blue Shield of Nebraska has experienced early success with this model and the Medicaid program is rigorously evaluating the results of the pilot projects.

The HCHM has the potential to improve the health of the population by improving access to care (e.g., after hours care and electronic communication), and reducing health disparities. For example, racial and ethnic minority populations tend to have a higher incidence of chronic conditions, which could be treated more effectively through more timely clinical preventive services (e.g., culturally and linguistically relevant diabetes health education). Other disparities can be prevented through cancer screening programs and immunizations.

Public health agencies can provide direct support to HCHMs and they can improve the health of the population by working collaboratively with employers, schools, the faith community, and nonprofit agencies. They also provide a variety of programs and activities that are designed to reach the entire population.

Definition

This scorecard is created to track performance, therefore the demonstration of data (numerical and narrative) describes what we define as success. In some instances, a trend may be moving in the wrong direction, but still may be within our 'Target for Success' area. The use of Color Arrows (and sometimes also Color Bands) help to define the Target for Success and Current Progress.

Green, Black and Red color arrows are used to reflect our 'Current Progress' status.

  • GREEN Arrow = We're getting better!
  • BLACK Arrow = We're maintaining our position.
  • RED Arrow = We're going in the wrong direction.

Green, Yellow or Red color bands are used to reflect our 'Target for Success' zones.

  • GREEN Color Band = We've reached our Target for Success!
  • YELLOW Color Band = We're making progress, but not quite there yet.
  • RED Color Band = We're below our Target for Success.

Data is described with the Time Period, Actual Value, Target Value, Current Trend and Baseline Change %. These mean:

  • Time Period - The most current time period for which the data were available.
  • Actual Value - The actual level of achievement, the most current data point for the indicator; also shown in a Color Band to reflect if that value is or is not within our Target for Success zone.
  • Target Value - The desired level of achievement for the data indicator.
  • Current Trend - The direction of progress is shown by a Color Arrow to reflect our Current Progress status, and also noting for how many data points the direction been occurring.
  • Baseline Change % - The percentage of change between the baseline data point and the current data point (actual value); also shown with a Color Arrow to describe Current Progress status.
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Story Behind the Curve

Nebraska SHIP Priority 4: Nebraska has improved integration among public health, behavioral health and healthcare services.

This SHIP goal includes several activities that were planned for implementation:

  • Local health departments complete community health needs assessments in collaboration with local hospitals.
  • Local health departments implement community health improvement plans in collaboration with local hospitals.
What Works

Over the past thirteen years, all eighteen local public health departments have conducted a comprehensive community health assessment and have repeated the process at least once every five years. A majority of the departments use the Mobilizing for Action through Planning and Partnerships (MAPP) approach to update their local public health improvement plans approximately every five years. This process involves a thorough review of health needs, community health risks (e.g., tobacco use, obesity levels, and environmental quality), and the ease of access to health services (e.g., insurance coverage status, transportation). This process also involves input from a diverse group of community members and the development of local health priorities. Above to the left is a statewide breakdown of the local health departments in Nebraska. Below is a graphic depicting the MAPP process by which the state and some local health departments identify health priorities and formulate health goals.

Click here to learn more about the MAPP process: http://www.naccho.org/topics/infrastructure/MAPP/i...




What We Do

While many local health departments collaborate to make Nebraska healthier, here is an example from the Northeast Nebraska Public Health Department:

The Northeast Nebraska Public Health Department (NNPHD) built community partnerships through the Mobilizing for Action through Planning and Partnerships (MAPP) process in 2007 and again in 2011-2013. This process includes data collection from every known data set for public health, hospitals, community action agencies, educational institutions, local and regional governmental entities and other non-governmental organizations. The NNPHD and the two Critical Access Hospitals located within the health district, Pender Community Health Center and Providence Medical Center, combined resources, time and efforts to coordinate these work products for the betterment of the community. Other collaborations between local health departments and area hospitals in Nebraska help to improve the quality and comprehensiveness of care for a variety of health priorities. These partnerships aim to create healthier communities and subsequently aid in creating a healthier state.

Who We Serve

To learn more about how local health departments contribute to the public health system, please explore the Annual Report on the Public Health Portion of the Nebraska Health Care Funding Act (LB 692): http://dhhs.ne.gov/publichealth/Pages/puh_oph_lhd....

How We Impact

The activities and programs of the local public health departments are summarized under the associated ten essential services of public health. The ten essential services of public health provide a working definition of the public health system and a guiding framework for the responsibilities of local public health partners.

1. Monitor Health Status to Identify and Solve Community Health Problems

2. Diagnose and Investigate Health Problems and Health Hazards in the Community

3. Inform, Educate, and Empower People about Health Issues

4. Mobilize Community Partnerships to Identify and Solve Health Problems

5. Develop Policies and Plans that Support Individual and Statewide Health Efforts

6. Enforce Laws and Regulations that Protect Health and Ensure Safety

7. Link People to Needed Medical and Mental Health Services and Assure the Provision of Health Care when Otherwise not Available

8. Assure a Competent Public Health and Personal Health Care Workforce

9. Evaluate Effectiveness, Accessibility, and Quality of Services within the Health Care Industry and Public Health Departments

10. Research and Gain New Insights and Innovative Solutions to Health Problems



Why Is This Important?

The Affordable Care Act requires all nonprofit hospitals to complete a population-based community health needs assessment and an implementation plan based on the priorities in the Community Health Needs Assessments (CHNA). Currently, many hospitals are working with local health departments to develop the CHNA and the implementation plan. Since these plans must be developed every three years beginning in 2013, it is a great opportunity to expand the resources for population health activities.

The activities and programs of the local public health departments are organized under the three core functions of public health: assessment, policy development, and assurance. The assessment function involves the collection and analysis of information to identify important health problems. Policy development focuses on building coalitions that can develop and advocate for local and state health policies to address the high priority health issues. The assurance function makes state and local health agencies as well as health professionals responsible for ensuring that programs and services are available to meet the identified priority needs of the population.

Definition

This scorecard is created to track performance, therefore the demonstration of data (numerical and narrative) describes what we define as success. In some instances, a trend may be moving in the wrong direction, but still may be within our 'Target for Success' area. The use of Color Arrows (and sometimes also Color Bands) help to define the Target for Success and Current Progress.

Green, Black and Red color arrows are used to reflect our 'Current Progress' status.

  • GREEN Arrow = We're getting better!
  • BLACK Arrow = We're maintaining our position.
  • RED Arrow = We're going in the wrong direction.

Green, Yellow or Red color bands are used to reflect our 'Target for Success' zones.

  • GREEN Color Band = We've reached our Target for Success!
  • YELLOW Color Band = We're making progress, but not quite there yet.
  • RED Color Band = We're below our Target for Success.

Data is described with the Time Period, Actual Value, Target Value, Current Trend and Baseline Change %. These mean:

  • Time Period - The most current time period for which the data were available.
  • Actual Value - The actual level of achievement, the most current data point for the indicator; also shown in a Color Band to reflect if that value is or is not within our Target for Success zone.
  • Target Value - The desired level of achievement for the data indicator.
  • Current Trend - The direction of progress is shown by a Color Arrow to reflect our Current Progress status, and also noting for how many data points the direction been occurring.
  • Baseline Change % - The percentage of change between the baseline data point and the current data point (actual value); also shown with a Color Arrow to describe Current Progress status.
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