Promoting Better Health Beyond Health Care

State-level multi-sector actions for addressing the social, economic, and environmental factors that impact health

May 2018

As part of their Better Health Beyond Health Care initiative, the Center for Health Care Strategies (CHCS) conducted a national analysis on innovative ways to promote health. This report discusses the resulting findings and summarizes information from thirty key informant interviews representing programs in 19 states and a small group convening. It explores ways collaboration and cross-sector partnerships can help promote population health and improve outcomes.
Source: Center for Health Care Strategies (CHCS) https://bit.ly/2JizWjj 

National experts and state policymakers increasingly recognize that health outcomes are influenced not only by providing access to health care coverage and services, but also by state level policies in non-health sectors, such as agriculture, education, and transportation, among others. The Center for Health Care Strategies (CHCS), with support from the Robert Wood Johnson Foundation, conducted a national exploration of state-level strategies to promote health beyond the traditional health care levers. Through review of published and gray literature, interviews with state officials and relevant subject matter experts, in-depth site visits, and a small group convening, CHCS aimed to answer key questions, including: 1. What are the levers across state agencies that could be used to improve population health, either through specific policy action or by exerting state influence? 2. What are examples of diverse state agencies working together and with other community partners to improve population health? 3. What are the key factors necessary to promote effective cross-sector collaborations? 4. What types of technical assistance and facilitation would increase states’ capacity to pursue and successfully implement these actions? 5. How might state-level assistance be targeted to support and scale similar innovation? Following is a summary of key takeaways from this exploration, organized according to: (1) precursors, or foundational factors that help to prime the environment for state action; (2) catalysts that initiate and advance coordination among diverse state agencies; and (3) success factors for effective implementation and ongoing collaboration.

Mental Health-related Physician Office Visits by Adults Aged 18 and Over: United States, 2012–2014

Source: Products – Data Briefs – Number 311 – June 2018

Key findings

Data from the National Ambulatory Medical Care Survey

  • Among adults aged 18 and over, the rate of mental health-related physician office visits to psychiatrists (693 per 10,000 adults) was higher compared with the rate to primary care physicians overall (397 per 10,000 adults), and for all age groups except 65 and over.
  • For both men and women, the rate of mental health-related office visits to psychiatrists was higher compared with visits to primary care physicians.
  • The percentage of mental health-related office visits to psychiatrists compared with primary care physicians was lower in rural areas, but higher in large metropolitan areas.
  • For all primary expected sources of payment except Medicare, a higher percentage of mental health-related office visits were to psychiatrists rather than to primary care physicians.

In 2016, mental illness affected about 45 million U.S. adults (1). Although mental health-related office visits are often made to psychiatrists (2), primary care physicians can serve as the main source of treatment for patients with mental health issues (3); however, availability of provider type may vary by geographic region (3,4). This report uses data from the 2012–2014 National Ambulatory Medical Care Survey (NAMCS) to examine adult mental health-related physician office visits by specialty and selected patient characteristics.

Know the Science

Source: National Center for Complementary and Integrative Health (NCCIH) – Know the Science

Why is it important to know the science of health? Simply put, because there is a lot of misinformation out there—from anecdotes disguised as evidence to excessive claims made by supplement manufacturers to TV doctors touting the latest “miracle cure.”

On this page you’ll find tools to help you better understand complex scientific topics that relate to health research so that you can be discerning about what you hear and read and make well-informed decisions about your health. Know the Science features a variety of materials including interactive modules, quizzes, and videos to provide engaging, straightforward content. Learn more about how the Know the Science initiative got started.

So, what are you waiting for? Dive in, and get to know the science.

Interactive Modules

Take our module on making sense of health research

Know the Science: 9 Questions To Help You Make Sense of Health Research

Understanding the basics of scientific studies to help you make better health decisions.

Take our module on understanding health news

Know the Science: The Facts About Health News Stories

Find out how to tell if a news story is reliable or has missing, misleading, or conflicting information.

MLTSS for People for Intellectual and Developmental Disabilities: Strategies for Success

Managed Long-term Services and Supports (MLTSS) 
MLTSS for People for Intellectual and Developmental Disabilities: Strategies for Success
https://bit.ly/2L8obcg 
The National Association of States United for Aging and Disabilities (NASUAD), along with the National Association of State Directors of Developmental Disabilities Services (NASDDDS) and Ari Ne’eman of Mysupport.com are the authors of this important report MLTSS for People for Intellectual and Developmental Disabilities: Strategies for Success. 
Because there are unique challenges in implementing a managed long-term services and supports (MLTSS) program for people with intellectual and developmental disabilities (I/DD), the report provides context on the intersection of program design and participant advocacy and outlines successful strategies for both states and health plans. Promising practices from the few MLTSS programs delivering I/DD services are highlighted throughout.  Check it out if your state is engaged in MLTSS or is thinking about/planning for the transition.  

Opportunities for Improving Programs and Services for Children with Disabilities 

Health Services 
Opportunities for Improving Programs and Services for Children with Disabilities 
Source: https://bit.ly/2k3LxDF 
While a variety of services and programs exist to support the needs of children with disabilities and their families, a focus on achieving specific near- and long-term goals that help prepare for adulthood and coordination of care within and across service sectors are integral to encouraging healthy growth and development, says a new 
report from the National Academies of Sciences, Engineering, and Medicine.  The committee that conducted the study and wrote the report examined federal, state, and local programs and services in a range of areas, such as health care, special education, transition to adulthood, vocational rehabilitation, and social needs care.

Responsive Practice | Institute on Disability/UCED

“Responsive Practice builds on knowledge that providers already have and identifies opportunities to maximize wellness for individuals with disabilities,” explains Kimberly Phillips, DPH Principal Investigator and co-author of the training.” 

Source: Responsive Practice | Institute on Disability/UCED

Responsive Practice 
Responsive Practice: Providing Health Care & Screenings to Individuals with Disabilities 
https://bit.ly/2ryQ30t
The New Hampshire Disability and Public Health (DPH) project’s Responsive Practice training is now available online, on-demand, and is free for a limited time. Responsive Practice enhances health care providers’ ability to deliver disability-competent care that is accessible to people with intellectual, mobility, and other disabilities.

Health conditions, functional status and health care utilization in adults with cerebral palsy

Family Practice, 2018, 1–10
doi:10.1093/fampra/cmy027

Robert J Fortuna1,*, Ashley Holub2, Margaret A Turk3, Jon Meccarello4 and Philip W Davidson4

1 Departments of Internal Medicine and Pediatrics and
2 Department of Public Health Sciences, University of Rochester, Rochester, NY, USA,
3 Department of Pediatrics and Physical Medicine and Rehabilitation, State University of New York Upstate Medical University, Syracuse, NY, USA and
4 Department of Pediatrics, Neurodevelopmental and Behavioral Pediatrics, University of Rochester, Rochester, NY, USA

*Correspondence to Robert J. Fortuna, Departments of Internal Medicine and Pediatrics, School of Medicine and Dentistry, University of Rochester, Rochester, NY, USA; E-mail: robert_fortuna@urmc.rochester.edu

Abstract

Aim. Health conditions in children with cerebral palsy (CP) are well described, yet health is less defined with advancing age. We examined health conditions, functional status and health care utilization in adults with CP across age groups.

Methods. We collected cross-sectional data on health conditions, functional status and utilization from the medical records of adults with CP across a large university-affiliated primary care network using the Rochester Health Status Survey IV (RHSS-IV), a 58-item validated survey. Data from the National Health and Nutrition Examination Survey and National Health Interview Survey provided prevalence estimates for the general population as comparison.

Results. Compared to the general population, adults with CP had higher rates of seizure disorder, obesity and asthma across all ages. Adults with CP under 30 years of age had higher rates of hypertension (16.7 versus 5.6%; P = 0.04), urinary incontinence (41.7 versus 10.5%; P < 0.001) and depression (16.7 versus 6.9%; P = 0.07). Conversely, there were lower rates of alcohol misuse, tobacco/nicotine and sexually transmitted illnesses. Independence with all activities of daily living decreased from 37.5% at 18–29 years of age to 22.5% in those 60 and over. Seizure disorders, urinary incontinence and gastroesophageal reflux disease were all independently associated with lower functional status. As expected, health care utilization increased with advancing age.

Conclusions: Adults with CP should be monitored for conditions occurring at higher prevalence in CP, as well as common conditions occurring with advancing age. Age-related functional decline should be anticipated, especially with coexisting seizure disorders and urinary incontinence.

Health services use and costs for Americans with intellectual and developmental disabilities: A national analysis

Fujiura, G. T.,Li, H., & Magana, S. (2018) Health services use and costs for Americans with intellectual and developmental disabilities: A national analysis. Intellectual and Developmental Disabilities. 56, (2) p. 101–118. DOI: 10.1352/1934-9556-56.2.101

Abstract

Health services and associated costs for adults with intellectual and developmental disabilities (IDD) were nationally profiled and the predictors of high expense users statistically modeled. Using linked data from the National Health Interview Survey and Medical Expenditure Panel Survey for the years 2002 through 2011, the study found a mixed pattern of differences in rates of service use and costs when compared to the general population depending upon personal characteristics, health status, and type of health care service. Prescription medication costs were the primary driver of total health care expenditures for Americans with IDD. The presence of secondary chronic health conditions and poor mental health status were the consistent predictors of high expense users across types of health care. Study results are discussed in terms of implications for more nuanced evaluations of health care costs and need for recurring surveillance of health care for Americans with IDD in the years following passage of the Patient Protection and Affordable Care Act.

Impact of Medicaid Managed Care on Illinois’s acute health services expenditures for adults with intellectual and developmental disabilities

Yamaki, K., Wing, C., Mitchell, D., Owen, R. & Heller, T. (2018) Impact of Medicaid Managed Care on Illinois’s acute health services expenditures for adults with intellectual and developmental disabilities, Intellectual and Developmental Disabilities, 56 (2), p. 133–146. DOI: 10.1352/1934-9556-56.2.133

Abstract

States have increasingly transitioned Medicaid enrollees with disabilities from fee-for-service (FFS)to Medicaid Managed Care (MMC), intending to reduce state Medicaid spending and to provide better access to health services. Yet, previous studies on the impact of MMC are limited and findings are inconsistent. We analyzed the impact of MMC on costs by tracking Illinois’s Medicaid acute health services expenditures for adults with intellectual and developmental disabilities (IDD) living in the community (n ¼ 1,216) before and after their transition to MMC. Results of the difference-in-differences (DID) regression analysis using an inverse propensity score weight (IPW) matched comparison group (n¼1,134) design suggest that there were no significant state Medicaid cost savings in transitioning people with IDD from FFS to MMC.

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