1. The First Northern Virginia
Health Summit
Where Are We, and Where Could We Go?
Friday, May 31, 2013

2. Where Are We? Review of Northern
Virginia Health Indicators
Patricia N. Mathews, President & CEO,
Northern Virginia Health Foundation
May 31, 2013

3. County Health Rankings for Northern Virginia
Indicator
Alexandria
City of
Arlington
County
Fairfax
City of
Fairfax County
Estimated
Population
(2012)
144,055 214,681 22,899 1,108,149
Health
Outcomes Rank
8 3 55 1
(Ranking figures indicate rank among 133 Virginia cities and counties, where 1 = best)
May 31, 2013 Northern Virginia Health Summit
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Source: Population estimates: Community Health Solutions analysis of data from Alterzx, Inc. Rankings: Robert Wood Johnson
Foundation and the University of Wisconsin Population Health Institute. www.countyhealthrankings.org.

4. County Health Rankings for Northern Virginia
(cont.)
Indicator
Falls
Church
City of
Loudoun
County
Manassas
City of
Manassas
Park
City of
Prince
William
County
Estimated
Population
(2012)
13,028 331,662 39,372 15,210 424,232
Health
Outcomes
Rank
16 2 7 9 10
(Ranking figures indicate rank among 133 Virginia cities and counties, where 1 = best)
May 31, 2013 Northern Virginia Health Summit
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Source: Population estimates: Community Health Solutions analysis of data from Alterzx, Inc. Rankings: Robert Wood Johnson
Foundation and the University of Wisconsin Population Health Institute. www.countyhealthrankings.org.

5. Prenatal Care
May 31, 2013 Northern Virginia Health Summit
5
Counts (2011) Total Live Births Births w/o Early Prenatal Care
Region Total 33,921 5,189
Alexandria (City of) 2,632 502
Arlington County 3,049 637
Fairfax (City of) 496 72
Fairfax County 15,148 2,110
Falls Church (City of) 148 17
Loudoun County 4,970 443
Manassas (City of) 721 188
Manassas Park (City of) 66 18
Prince William County 6,691 1,202
Virginia 102,525 13,500
Source: Community Health Solutions analysis of Virginia Dept. of Health birth record data (2011).

6. Adult Risk Factors
Rate Estimates (2012) Overweight or Obese At Risk for Binge Drinking
Region Total 58% 20%
Alexandria (City of) 60% 18%
Arlington County 59% 20%
Fairfax (City of) 58% 21%
Fairfax County 59% 19%
Falls Church (City of) 61% 15%
Loudoun County 57% 21%
Manassas (City of) 60% 21%
Manassas Park (City of) 58% 20%
Prince William County 57% 23%
Virginia 62% 18%
May 31, 2013 Northern Virginia Health Summit
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Source: Community Health Solutions analysis of data from Va. Behavioral Risk Factor Surveillance System (2006-2010).

7. Youth Risk Factors
Rate Estimates (2012) Felt Sad or Hopeless for Two or More Weeks in a Row
Region Total 25%
Alexandria (City of) 26%
Arlington County 26%
Fairfax (City of) 25%
Fairfax County 25%
Falls Church (City of) 25%
Loudoun County 25%
Manassas (City of) 26%
Manassas Park (City of) 26%
Prince William County 26%
Virginia 25%
May 31, 2013 Northern Virginia Health Summit
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Source: Community Health Solutions analysis of data from CDC (2011).

8. Oral Health
Rate Estimates (2012)
Children Age 0-17 with No Dental
Visit in Past Year
Adults Age 18+ with
No Dental Visit in Last
Two Years
Region Total 22% 24%
Alexandria (City of) 22% 21%
Arlington County 22% 24%
Fairfax (City of) 22% 24%
Fairfax County 22% 23%
Falls Church (City of) 21% 21%
Loudoun County 21% 25%
Manassas (City of) 24% 22%
Manassas Park (City of) 24% 17%
Prince William County 22% 25%
Virginia 21% 22%
May 31, 2013 Northern Virginia Health Summit
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Source: Community Health Solutions analysis of CDC data.

9. Health Opportunity Index (HOI) for Northern Virginia
May 31, 2013 Northern Virginia Health Summit
9
Virginia Atlas of Community Health (Forthcoming Summer 2013), Geo Health Innovations and Community Health Solutions, Inc.

10. Where Innovation Is Tradition
Health Reform:
Where is the Commonwealth
NOW?
Len M. Nichols, Ph.D.
Center for Health Policy Research and Ethics
The First Northern Virginia Health Summit
Springfield, VA
May 31, 2013

11. Review reform climate
• Virginia voted for Obama, twice
(and Sens. Webb and Kaine, respectively)
• McDonnell elected Governor in 2009, Rs
gained Senate split 20-20 after 2011 elections
• AG Cuccinelli first to file suit against ACA
• 26 person VHRI appointed by Gov, led by Sec.
Hazel, recommended, in December 2010:
State-run exchange
Prepare for Medicaid expansion, delivery reform
11

12. Where Innovation Is Tradition
Post-Supreme Court decision on ACA
• Created opportunity to oppose Obamacare in
the name of fiscal prudence for state
• Argument undercut by 3 facts:
Feds would pay 100% of expansion population
costs for 3 years, 90% thereafter
State would save money for 5-6 years, low cost
thereafter compared to economic benefit to state
Chamber of Commerce of VA came to support
Medicaid expansion
12

13. Where Innovation Is Tradition
De Facto Partnership on Exchange
• McDonnell decided, after SCOTUS, to NOT
apply for establishment grant for exchange
• Governor also did not want to use the word
“partnership” in deal with Feds
• Feds have signaled willingness to let Virginia
BOI do “plan management,” one key function
of partnership exchanges
13

14. Where Innovation Is Tradition
Medicaid possibilities
• Created by Senate split and Gov.’s desire for
transportation signature achievement
• Budget created Medicaid Innovation and Reform
Commission (MIRC)
• MIRC has 12 members, 3/5 from each house
must vote YES to judgment that:
ADEQUATE Medicaid reform progress is being
made to justify expansion in July of 2014
14

15. Where Innovation Is Tradition
Delegate Appointees to MIRC
• Steve Landes-R (Albemarle, Augusta,
Rockingham)
• Jimmie Massie-R (Henrico)
• John O’Bannon-R (Henrico, city of Richmond)
• Beverly Sherwood-R (Frederick, Warren, city of
Winchester)
• Johnny Joannou-D (cities of Chesepeake,
Norfolk, Portsmouth, Suffolk)
15

16. Where Innovation Is Tradition
Senate Appointees to MIRC
• Walter Stosch-R (Henrico, city of Richmond
• Emmet Hanger-R (Augusta, Greene, Madison,
Rockingham, cities of Staunton and Waynesboro)
• John Watkins-R (Powhatan, Chesterfield, city of
Richmond)
• Janet Howell-D (Fairfax, Arlington)
• Louise Lucas-D (Portsmouth).
16

17. Where Innovation Is Tradition
Medicaid Reforms DMAS is pursuing
• Statewide managed care, including for ABD and
foster children
• PACE expansion
• Enhanced program integrity
• Assessment requirements for CBHS
• Dual eligibles financial alignment demonstration
17

18. Where Innovation Is Tradition
Medicaid reforms DMAS is planning
• Comprehensive 1115 waiver to allow more
coordination, streamline with private insurance
features emerging in state employee, FAMIS,
exchange, etc.
• Use payment reform to leverage tight, high
quality networks
• Coordinate purchasing/delivery reforms in
public-private partnership
18

19. Virginia Health Innovation Center
• Created in 2012 on 2010 recommendation of
Virginia Health Reform Initiative Advisory
Council
• 501c3, housed at state Chamber of Commerce
• Seed money from stakeholder associations
• Surveyed providers, found 400 “examples,” now
has 6 task forces creating proposals for CMMI
PCMH, integrating behavioral and acute, medication
management, care transitions, consumer engagement,
bundles for babies
19

20. Where Innovation Is Tradition
Summary
• Medicaid expansion depends on 2013 elections
• Delivery reforms and some coverage expansion
through federal exchange will proceed
• Can collaboration replace individualism in
time?
20

21. 21

22. Beyond Health Care
Northern Virginia Health Summit
Fairfax, Virginia
May 31, 2013
Steven H. Woolf, MD, MPH
VCU Center on Human Needs
Department of Family Medicine and Population Health
Virginia Commonwealth University

23. Higher Mortality Rates and Lower Life
Expectancy
Mortality Rates by Cause of Death Life Expectancy

24. Beyond the Clinical Setting

25. WHO Conceptual Model
From: A Conceptual Model for Taking Action on the Social Determinants of Health.
Geneva: World Health Organization, 2010

26. Role of Personal Health Behaviors
Cause Estimated deaths
Tobacco 400,000
Diet/activity patterns 300,000
Alcohol 100,000
Microbial agents 90,000
Toxic agents 60,000
Firearms 35,000
Sexual behavior 30,000
Motor vehicles 25,000
Illicit use of drugs 20,000
Source: McGinnis and Foege. JAMA 1993;270:2207-12.

27. Economic & Social
Opportunities and Resources
Living & Working Conditions
in Homes and Communities
Personal
Behavior
Medical
Care
HEALTH
The importance of behavioral and social factors
Policies to promote
healthier homes,
neighborhoods,
schools and
workplaces
Policies to promote child
and youth development
and education,
infancy through college
Policies to promote economic
development and reduce poverty
Robert Wood Johnson Foundation Commission to Build a Healthier America
www.commissiononhealth.org

28. “Downstream” determinants
• Access to healthy foods
• Physical activity
• Tobacco and alcohol
• Healthy housing
• Safe neighborhoods
• Clean air and water
• Safe working conditions

29. “Upstream determinants”
• Inadequate education
• Unemployment
• Declining income and net worth

30. 1996
1997
1998
1999
2000
2001
2002
-50,000
0
50,000
100,000
150,000
200,000
250,000
Deaths(peryear)potentially
avertedintheUnitedStates
Year
Deaths potentially averted by medical advances (see footnotes)
Deaths potentially averted by eliminating education-associated excess mortality (see footnotes)
Am J Public Health. 2007;97:679–683

31. Proportion of Deaths in Virginia Associated With
Reduced Household Income
0
5
10
15
20
25
30
Proportion of
deaths that
would be
averted (%)
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
Am J Public Health. 2010;100:750-5

32. “Health in All” Policies
• Transportation
• Land use
• Built environment
• Taxes
• Housing
• Agriculture
• Environmental justice
• Etc.
Health and
illness

34. Annual Costs (Health Care And Program Spending), Three Layered Intervention Scenarios,
Year 0 To Year 25.
Milstein B et al. Health Aff 2011;30:823-832
©2011 by Project HOPE - The People-to-People Health Foundation, Inc.

35. The House Bill would “save” approximately $1.516 billion per year between
2013 - 2017 and $1.78 billion per year between 2018 - 2022.
Increase in U.S. Poverty Rate
0.25%
increase
0.50%
increase
1.00%
increase
Costs for
diabetes care
$0.723 billion $1.473 billion $2.946 billion

37. Page County, Virginia

38. www.countyhealthcalculator.org

39. Contact Information
• Steven H. Woolf, MD, MPH
Center on Human Needs
Department of Family Medicine
Virginia Commonwealth University
804-828-9625
• swoolf@vcu.edu

40. MOBILIZING COMMUNITY
PARTNERSHIPS TO IMPROVE
PUBLIC HEALTH
The First Northern Virginia Health Summit
Gloria Addo-Ayensu, MD, MPH
Director of Health, Fairfax County
May 31, 2013

41. 41
Human
Services
Agencies
Parks
Economic
Development
Mass Transit
Employers
Nursing
Homes
Mental
Health
Drug
Treatment
Civic
GroupsCHCs
Laboratory
Facilities
Hospitals
EMS
Health Care
Providers
Health
Department
Churches
Philanthropist
Elected
Officials
Media
Schools
Police
Fire
Corrections
Environmental
Health
Community
Centers MCOs
Local Public Health System

42. Social Determinants of Health
and other root causes of poor
health
Changing the Context
to make individuals’ default
decisions healthy
Long-lasting
Protective Interventions
Clinical
Interventions
Counseling
& Education
Examples
Poverty, education,
housing, inequality
Immunizations, brief
intervention, cessation
treatment, colonoscopy
Smoke-free laws,
water fluoridation,
restrictions on trans
fats and sodium
Rx for high blood
pressure, high
cholesterol, diabetes
Eat healthy, be
physically active
Adapted from Frieden TR, Am J Public Health. 2010;100:590-595.
Smallest
Impact
Largest
Impact
42

43. 43
Human
Services
Agencies
Parks
Economic
Development
Mass Transit
Employers
Nursing
Homes
Mental
Health
Drug
Treatment
Civic
GroupsCHCs
Laboratory
Facilities
Hospitals
EMS
Health Care
Providers
Health
Department
Churches
Philanthropist
Elected
Officials
Media
Schools
Police
Fire
Corrections
Environmental
Health
Community
Centers MCOs
Local Public Health System

44. Engaging LPHS Partners – Phase One
 Emergency Preparedness
 911 and anthrax crisis
 Smallpox & CRI planning
 Pandemic preparedness
 H1N1
44

45. Fairfax County Pandemic Flu Planning
Pandemic Flu Planning Initiative Structure
•Vaccine and anti-viral distribution
•Community disease prevention
•Surge Capacity
•Laboratory and Surveillance
•First Responders and mass casualty
•Legal Considerations
•Communications and Notification
•Essential Needs
1 The Emergency Management Coordinating Committee will serve as the Leadership Team for this effort
2 Steering Committee: Dr. Gloria Addo-Ayensu, Dr. Raja’a Satouri, Barbara Antley, Holly Clifton, Kimberly Cordero, Zandra Duprey, Marilyn McHugh, Michelle Milgrim, John Niemiec
3 Steering Committee: John Burke, Carol Lamborn, Amanda McGill, Becky McKinney, Larry Moser
Updated August, 2006
•Policy Support
•Operational Support
•Public Safety
•County Infrastructure
•Private Sector Planning
Executive Team
(provides oversight, sets direction and insures appropriate internal and external communication)
Co-Chairs: Verdia Haywood, Rob Stalzer
Leadership Team (EMCC)1
(ensures coordination and integration of coordinating committees)
Chairperson: Rob Stalzer
Public Health Coordination
(responsible for planning, response and recovery for
public health efforts)
Co-Chairs: Dr. Gloria Addo-Ayensu, Dr. Raja’a Satouri
Critical Infrastructure and Resource Management
Coordination
(responsible for planning, response and recovery for infrastructure
and resource management efforts and private sector planning)
Co-Chairs: Doug Bass, Merni Fitzgerald
Public Health Work Groups2 Critical Infrastructure and Resource Management
Work Groups 3
Fairfax County
Pandemic Flu
Plan Coordinators
John Burke
(Deputy Fire Chief)
Amanda McGill
(Program Manager)
Laura Suzuki, R.N. MPH
(Public Health Nurse)

46. Engaging LPHS Partners – Phase Two
 Community health
challenges
 Individual and family
preparedness
 Cultural competency
 HIV
 Vaccine/health literacy
 TB
 Health promotion
 Workforce
development
46

47. Rationale for Engaging LPHS Partners
47
 Builds capacity for addressing public health
challenges
 Promotes cultural competency
 Provides opportunity to address gaps and root
causes of poor health
 Empowers the community to participate in
improving their own health
 Strengthens local public health system
 Improves community health

48. Engaging LPHS Partners – Phase Three
 Expectation of LHDs
 Essential Public Health
Services
 Community assessment and
planning (MAPP)
 Healthy People 2020
 National Prevention Strategy
 Accreditation
 County Health Rankings
 Shift in drivers of morbidity
and mortality
 Transition to population-
based service delivery
48

49. Principles for Successful Partnerships
49

50. Maintaining Effective Partnerships
50
 Build on what already exists and leverage existing
resources to minimize the need for additional
costs initially.
 Look for opportunities for early successes and set
realistic goals.
 Listen to partners and be flexible.
 Find ways to collaborate on priorities that further
each other’s mission.
 Allow sufficient time for partnership to develop
and scale up gradually.
 Make capacity building and sustainability a core
strategy of the partnership.
 Partnership building is work, but rewarding!

51. Crude Death Rate for Infectious Diseases in the United States
Good Sanitation
= Good Hygiene
Transforming Public Health
Together

52. Investing in Effective Partnerships is
ROI
 2001 Anthrax
 Health Department response
 2009 H1N1
 Entire LPHS participation
 Activation of County EOC
 ICS & COOP
 75,000 vaccinated
 287 clinics
 1018 MRC volunteers
 19,548 Hours
 $516,000
52

53. Health in All Policies (HiAP) – A Better
Way
53

54. Thank You54

55. DISCUSSION QUESTIONS
1. Where are there opportunities for
collaboration across specific silos that
might yield improved health for Northern
Virginians?
2. What can I do -- in my work and where I
live -- to improve the public’s health?
3. Complete the sheet on your table by
listing groups you know that are working
on health and health-related solutions in
the region.
July 17, 2013 Event Name
55

56. The First Northern Virginia
Health Summit
Where Are We, and Where Could We Go?
Friday, May 31, 2013