1. Public Health and Primary Care:
The Best of Both Worlds
Ted Wymyslo, MD
Director, Ohio Department of Health
Terry Allan, Health Commissioner
Cuyahoga County Board of Health
Annual Practice-Based Research Festival
Dec. 7, 2013

2. Source: Image from Institute of Medicine video, “Primary Care + Public Health in the Community,”
2012, http://www.iom.edu/Reports/2012/Primary-Care-and-Public-Health/Video.aspx
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3. Where We Are
Fragmentation
Where We Need to be
vs.
Coordination

Multiple separate providers

Accountable medical home

Provider-centered care

Patient-centered care

Reimbursement rewards volume

Reimbursement rewards value

Lack of comparison data

Price and quality transparency

Outdated information technology

Electronic information exchange

No accountability

Performance measures

Institutional bias

Continuum of care

Separate government systems

Medicare/Medicaid/Exchanges

Complicated categorical eligibility

Streamlined income eligibility

Rapid cost growth

Sustainable growth over time
SOURCE: Adapted from Melanie Bella, State Innovative Programs for
Dual Eligibles, NASMD (November 2009)
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4. Principles of Successful Integration
• Community engagement
• Strong leadership
o Involve both clinical medicine and public health
• Common goal of improving population health
• Collaborative use of data and analysis
• Sustainability
o
Funding, quality measures, payment reform
Source: “Primary Care and Public Health Exploring Integration to Improve Population Health” Report Brief,
http://www.iom.edu/~/media/Files/Report%20Files/2012/Primary-Care-and-PublicHealth/Primary%20Care%20and%20Public%20Health_Revised%20RB_FINAL.pdf

5. IOM—Integration of Public Health and Primary Care
Goal: Optimize population health.
IOM Continuum of Integration
Source: “Primary Care and Public Health Exploring Integration to Improve Population Health” Report Brief,
http://www.iom.edu/~/media/Files/Report%20Files/2012/Primary-Care-and-PublicHealth/Primary%20Care%20and%20Public%20Health_Revised%20RB_FINAL.pdf
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6. ODH Priorities and Cross-Cutting Strategies
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7. Aligning Priorities through Integration
Initiative
Opioid Emergency Dept.
& Prescriber Guidelines
Public Health Issue
Injury Prevention
ODH & WebMD
Public Health Communication
OPQC 39-Week Project
Decrease Infant Mortality*
Ohio Quit Line/Ohio Tobacco
Collaborative
Curb Tobacco Use*
Creating Healthy Communities
Reduce Obesity*
OPCPCC
Expand PCMH across Ohio*
* An ODH Strategic Priority
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8. Reduce Prematurity
Ohio Perinatal Quality Collaborative
39-Week Project: Sept 2008 - March 2013
• Successful QI project improved birth outcomes by
reducing the number of non-medically scheduled
deliveries prior to 39 weeks as well as improving birth certificate
accuracy.
• Received ASTHO’s 2012 Vision Award for innovative
and effective approach to improving maternal and
infant health.
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9. Help People Quit Smoking
• Increase the number of Ohioans who have access
to cessation services at no cost.
• Promote 5 A’s - Ask, Advise, Assess, Assist, Arrange.
www.healthyohioprogram.org
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10. Creating Healthy Communities (CHC)
The CHC Program currently
serves high-need
communities in 16 counties,
for a collective population of
5,797,335.

11. Ensuring every Ohioan has an established
relationship with a personal healthcare
provider, in a system focused on making
health decisions that promote wellness and
achieve high value.
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12. Patient-Centered Medical Homes (PCMH)
•
•
•
•
•
•
•
Personal Primary Care Provider
Primary Care Provider-Directed Medical Practice
Whole Person Orientation
Coordinated and Integrated Care
Care is Safe and High-Quality
Enhanced Access
Payment Reform
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13. The Medical Neighborhood
Local
Health
Department
School
Adult Son’s House
Hospice
Patient’s House
PCMH
Nursing Home
Academic
Institution
Pharmacy
Rural Access
Center
Dietitian
Critical Access
Hospital
Counseling Center
Urgent Care
Dentist
Office
Laboratory
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14. Strengthen PCMH Capacity in Ohio
• Facilitate statewide expansion of the PCMH model of
care.
Ohio recently surpassed the 300th PCMH Practice Milestone!
• Align statewide expansion activities with existing
regional and other PCMH initiatives.
• Support efforts to utilize PCMHs as workforce training
sites.
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15. PCMH Expansion: Ohio is just getting started
340 PCMH Practices
in Ohio
Population Density
in Ohio (11.5 million)
Source: Patient-Centered Medical Home, www.odh.ohio.gov, Nov., 2013.
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16. Coming Together to Transform Health in Ohio
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17. o
More about Health Integration in Ohio
www.odh.ohio.gov & www.astho.org
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18. Acting Locally
Working with ODH and Community
Partners in Greater Cleveland to
Advance Public Health Practice

19. Avg. Dist.
(Miles)
Grocery > 25,000 S.F.
Distance to Grocery (Miles)
Unweighted
0.03 to 1
1
to 1.5
1.5 or Greater
(No Population)
Cuyahoga
1.4
Suburbs
1.3
Cleveland
1.6

20. Food
Balance
Score
Grocery > 25,000 S.F.
Fast Food
Food Balance Ratio
Weighted by Population Share
0 to 1
1 to 2.5
2.5 or More
(No Population)
Cuyahoga
2.5
Suburbs
2.0
Cleveland
4.5

21. Avg. Dist.
(Miles)
Fast Food
Distance to Fast Food (Miles)
Unweighted
0 to 1
1 to 1.5
1.5 to 3.3
(No Population)
Cuyahoga
0.5
Suburbs
0.7
Cleveland
0.4

22. Households Without Vehicles
Grocery > 25,000 S.F.
Fast Food
Food Balance Ratio
Weighted by Population Share
0 to 1
1 to 2.5
2.5 or More
(No Population)

26. Place Matters: Health, Wealth, & Life
Expectancy

27. Family &
Culture
Health
Health
Inequities Disparities

28. www.hipcuyahoga.org

31. Strategic Issues
Create safe &
supportive
environments
Vision
Create access
to quality &
equitable
care
Key Priorities
Eliminate race
as a Social
Determinant of
Health
Improved
nutrition &
physical activity
Improve
chronic disease
management
Improve
coordination
between
clinical care &
public health

32. Cuyahoga County Infant Mortality
3 Year Avg. (2008 – 2010)
18%
15.5%
16%
14%
12%
9.3%
10%
8%
5.2%
6%
4%
2%
0%
2008 - 2010
Overall
White_N/H
Black_N/H

33. Burden of Infant Deaths
(2008-2010)

34. Ohio Equity Institute
 One of 9 communities across the state involved in
a collaborative supported by ODH with CityMatCH
to improve overall birth outcomes and reduce
racial and ethnic disparities in infant mortality
across the state by addressing inequities.
 Will assess local capacity and data to develop
plans, tools, and strategies for reducing inequities
in birth outcomes.

35. Clinical-Public Health
Collaboration
CWRU School of Medicine and
the Cuyahoga County Board of
Health

36. Examples of Collaboration
• Heidi Gullett, board certified in preventive
medicine (2 year commitment)
– Co-Chair Clinical and Public Health Subcommittee of
HIP Cuyahoga
– Assist with field practicum coordination for University
Hospitals Preventive Medicine Residency
– Linkage with FQHC’s and hospitals systems
– Identify opportunities in ACA
– Identify academic/public health research opportunities
– Assist with accreditation preparation
– Participant in ASTHO PHC/PH Collaboration

40. Questions?
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41. Working Together to Protect and Improve
the Health of all Ohioans.
Ted Wymyslo, M.D.
Director, Ohio Department of Health
(614) 466-2253
Terry Allan, Health Commissioner
Cuyahoga County Board of Health
tallan@ccbh.net
www.odh.ohio.gov
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