Healthy Montgomery. Our Meaningful Community Partnership Effort to Drive Population Health. Thursday May 17, 2018

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1 Healthy Montgomery Our Meaningful Community Partnership Effort to Drive Population Health. Thursday May 17, 2018

1.04m Residents 55% Racial or Ethnic Minority 36% Growth in the Senior Population by 2025 159,010 Children in

projection is 196,000 individuals 35% currently receiving FARMS Residents living <200% Federal Poverty Level

2 service areas in FY17 A Staff of Over 1600 More than 130 Programs Over 600 Provider Contracts Caseload Changes

2 1.04m Residents 55% Racial or Ethnic Minority 36% Growth in the Senior Population by ,010 Children in the Public School System 6 Zip Codes of Extreme Need 33% Foreign Born 41% non-english Spoken at home 2015 projection is 196,000 individuals 35% currently receiving FARMS Residents living <200% Federal Poverty Level 99,000 clients served in FY17 Average client accessed 1.8 services/benefits in 1.2 service areas in FY17 A Staff of Over 1600 More than 130 Programs Over 600 Provider Contracts Caseload Changes for FY16 - FY17 TCA 5% Decrease SNAP 8% Decrease MA 3% Increase Serving 31,000 Uninsured Adults, Children, and Pregnant Women Montgomery County At-a-Glance. 2

3 County s First Status of Health Report 3

4 Covers all major health topics Comprehensive and centralized health statistics in one location Targets various levels of audiences Comparison with Maryland and U.S., and benchmarking with Healthy People 2020 Disparities among population subgroups and geographic areas Population health surveillance, program effectiveness evaluation, and planning and resource allocation 4

5 Healthy Montgomery Our collective impact effort to improve health for all residents.

Government agencies and offices County hospital

Partners Health insurance companies Elected

6 Government agencies and offices County hospital systems Minority health initiatives and programs Advocacy groups Schools, colleges, and universities Community-based service providers Partners Health insurance companies Elected officials of Healthy Montgomery Source: 6

7 History of community benefit in Montgomery County over the past decade. Hospital economic wars IRS regulations on community benefit Hospital Cost Review Commission on community benefit reporting for non-profit hospitals Medicare Waiver Payment and Service Delivery Reform ACA Healthy Montgomery as a Collective Impact Initiative Small tests of change leading to Nexus Montgomery 7

8 Community Health Improvement Process (CHIP) The HM Community Health Improvement Process includes five phases: Phase 1: Environmental Scan to compile and review available data and resources Phase 2: Comprehensive community health needs assessment Phase 3: Setting of health priorities and development of action plans Phase 4: Implementing, monitoring and evaluation Phase 5: Pre-planning for next iteration Planning for Action Implementation and Evaluation Plan Needs Assessment Data Systems/ Infrastructure Priority Setting Environmental Scan 8

9 6 Priority Areas and Supporting Strategies. Apply strategies that address: Lack of Access, Health Inequities, and Unhealthy Behaviors To Improve Outcomes In: Behavioral Health Cardiovascular Disease Obesity Cancers Diabetes Maternal and Infant Health 9

10 Community Health Needs Assessment Healthy Montgomery Summary of Progress, Are we making progress? Are we achieving equity? Progress by Healthy Montgomery priority areas Integrating Data into key findings 10

Community Health Improvement Plan 2017-2019 Collective Impact Criteria Addresses demonstrated inequities among specific groups Data/trends can be monitored over time using a shared measurement

11 Community Health Improvement Plan Collective Impact Criteria Addresses demonstrated inequities among specific groups Data/trends can be monitored over time using a shared measurement approach Includes multiple sectors Involves program and system changes (not an individual program/single organization) Demonstrates an alignment with a Healthy Montgomery health outcome Priority Strategies Implement a Health in All Policies Model Develop integrated care programs to address behavioral health needs within primary care services Combined diet and physical activity promotion programs 11

12 Robert Wood Johnson Foundation, University of Wisconsin Health Outcomes Length of Life, Quality of Life Health Factors Health Behaviors, Socioeconomic Factors, Physical Environment Montgomery County has been ranked #1 since 2014 Sub-County Variations in progress County Health Ranking (CHR). 12

13 A Sampling of Our Population Health Findings.

14 Behavioral Health (CHR Indicators). Poor Mental Health Days % Excessive Drinking % Alcohol Impaired Driving Deaths % Mental Health Providers Ratio % Frequent Mental Distress Drug Overdose Mortality Rate 14

15 Behavioral Health (HM Indicators). Mental Health Related ER Visit Age- Adjusted Rates, Montgomery County and Maryland, Mental Health Related ER Visit Age- Adjusted Rates by Sex and Race/Ethnicity, Montgomery County,

16 Cardiovascular Health (CHR Indicators). Poor Physical Health Days % Adults Smoking % Physical Inactive % With Access to Exercise Opportunities 16

17 Cardiovascular Health (HM Indicators). Age-Adjusted Mortality Rates, Heart Disease, Montgomery County, Maryland, and U.S Age-Adjusted Mortality Rates by Sex and Race/Ethnicity, Heart Disease, Montgomery County,

18 Diabetes (CHR Indicators). % Adult Obesity % Physical Activity % Receiving HbA1c % Diabetic 18

Montgomery County and Maryland, 2008-2016 Diabetes

19 Diabetes (HM Indicators). Diabetes Related ER Visit Age-Adjusted Rates, Montgomery County and Maryland, Diabetes Related ER Visit Age-Adjusted Rates by Sex and Race/Ethnicity, Montgomery County,

20 Improving Population Health A collective effort of all partners. Several factors in play The Affordable Care Act; The Medicare Waiver, Payment and Service Delivery Reform Strengthened Collaboration and Partnership through publicprivate investments in the healthcare delivery continuum A need to address disparities in outcomes to improve population health and well-being Addressing Social Determinants of Health as critical to improving population health and wellbeing Leads us into a discussion of the purpose and infrastructure around Nexus Montgomery.. 20

21 Thank You Uma S. Ahluwalia Director Montgomery County Department of Health and Human Services 401 Hungerford Drive Suite 500 Rockville, Maryland o e. 21

COMMUNITY PARTNERS MEETING

PUBLIC HEALTH & SYSTEMS IN ACTION COMMUNITY PARTNERS MEETING Presenter: Amy Fagan, Assistant Director of Health Date: February 23, 2017 HEALTH DISTRICT VISION HEALTHY PEOPLE, HEALTHY COMMUNITY HEALTH COALITION