Health Reform: Is Colorado Ready?

Dennis Lenaway, PhD, MPHOffice of the Chief of Public Health Practice

U.S. Centers for Disease Control and Prevention

June 9, 2009

Health Care Crisis + Public Health Crisis

Aging Population

Re-emerging Diseases

Emerging Diseases

Obesity

Health Disparities

Access to Quality Health Care

Health Insurance Costs

Uninsured and Underinsured

Per Capita Health Care Spending in International Dollars

Lif

e E

xpec

tan

cy

30

40

50

60

70

80

90

0 500

1000 2000 3000 4000 50001500 2500 3500 4500

Sierra Leone

United States

Japan

Cuba Switzerland

Life expectancy vs. health care spending

2006 U.S. National Health Expenditures

31%

31%

8%

13%

7%

7%3%

Hospital Care

Physician/ProfessionalServicesNursing Home andhome healthPrescription drugs andmedical productsAdministration

Research andInvestmentGovernment publichealth (prevention)

Health Reform and Public Health

“Simply put, in the absence of a radical shift towards prevention and public health, we will not be successful in containing medical costs or improving the health of the American people”

President Barak Obama

Health Reform and Public Health

“Public health is also essential to health reform. As the nation’s lead prevention agency, CDC will play a role to establish a health care system that is more accessible, more cost-effective, and more accountable”

Dr. Thomas Frieden

CDC Director

“The public health infrastructure has suffered from neglect…”Institute of Medicine 2003

“Currently, serious gaps exist in the nation’s ability to safeguard health…The country does not devote the resources needed to adequately help prevent disease and protect the health of Americans” TFAH “Shortchanging America’s Health” 2008

“Public health is chronically underfunded in the US. There is currently a shortfall of $20 billion per year in spending on public health” TFAH “Blueprint for a Healthier America” 2008

Question: Can Public Health fully deliver on the “Promise of Prevention”?

Health Reform and CDC’s Strategies

Setting Agency Standards Public Health Accreditation Board

Setting System Standards National Public Health Performance Standards Program

Engaging with Communities MAPP

Managing our Resource Portfolio Senior Management Officials Strategic Management Agreements

Workforce Development

Workforce Development

Resource Management(SMO & SMA)

Community Engagement(MAPP)

Public Health System(NPHPSP)

Public Health Agency(PHAB)

Comprehensive Infrastructure for State and Local Public Health Agencies

“The establishment of a voluntary national accreditation program is desirable for many salient reasons. Chief among them is the opportunity to advance the quality, accountability and credibility of governmental public health departments”

Exploring Accreditation Project Steering Committee (2007)

“If you’re not keeping score, you’re just practicing"

Why Accreditation?

Strong Recommendations from the Institute of Medicine (2003)

• “Accreditation mechanisms may help to ensure the robustness and efficiency of the governmental public health infrastructure, assure the quality of public health services, and transparently provide information to the public about the quality of the services delivered.”

• “The performance standards (NPHPSP) effort is seen as one way to help move the state and local components of the nation’s public health system closer to the system envisioned in the Future of Public Health IOM report (1988).”

And Strong Recommendations fromthe Trust For America’s Health (2008)

“Today our public health system is not held as accountable as it should be for health outcomes, or for how taxpayers’ public health dollars are spent.”

“CDC should develop incentives and provide support for states and localities to pursue accreditation.”

“CDC would require a significant increase in resources both to manage its federal leadership role on accreditation and to fund PHAB and health department activities directly related to achieving accreditation…A special infrastructure grant…would require its own dedicated resources.”

American Recovery and Reinvestment Act of 2009

Public Law 111-5

Prevention and Wellness Provisions

• Section 317 immunization program - $300 million to CDC

• Healthcare-associated infections - $50 million to HHS

• Evidence-based clinical and community-based prevention and wellness strategies that deliver specific, measurable health outcomes that address chronic disease - $650 million to HHS

Is Colorado Prepared for Health Reform?

New 2008 Public Health Act Calls for standards and improvements

New Public Health Alliance of Colorado Collaborative of 10 public health organizations

New Colorado School of Public Health Combining the resources of CU, CSU, UNC

New CDPHE Office of Planning and Partnerships Actively engaged in statewide planning with partners

Comprehensive Health Reform

Health in all policies

Population/Community-based disease prevention and health promotion

Health care service and delivery improvement

“OK Fellas, we shoot first…. then Q and A”

Building Public Health Infrastructure for a Healthier America