B5 Working Together for Health_Deborah Cohen

WORKING TOGETHER FOR HEALTH Integrating a Population Health Approach into Health System Planning and Decision Making

Prevent More to Treat Less Conference June 4, 2014

Deborah Cohen Canadian Population Health Initiative Canadian Institute for Health Information dcohen@cihi.ca

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The Expanding Role of the Population Health Approach Context • Despite Canada’s historical contribution to the genesis of the population health approach, Canada’s healthcare system has been slow to move away from the traditional medical model • In recent years there has been increasing support for a population health approach into all aspects of the health system

Study • CPHI conducted a research study to examine how senior health leaders in Canada are integrating a population health approach into health system planning and decision making 2

The Research Project Partnered project between CIHI, University of Toronto, and the University of Saskatchewan Phase 1 • Engage health system leaders to gain insight into best practices, enablers and barriers to using population health information in health system planning and decision-making – Semi-structured interviews with senior health system leaders using purposive sampling

Phase 2 • Examine Phase 1 findings and identify strategies for improving the use of population health information in health system planning and decision-making – “Lead user” workshops in Toronto and Vancouver, March 2013 3

The Study Sample: Leaders in the Industry (n=21) (response rate 21/28 (75%)) – Phase 1 Geographical coverage

Roles

Organization Types

British Columbia Alberta Saskatchewan Manitoba Ontario Quebec Nova Scotia Northwest Territories Canada/National

Deputy Minister Assistant Deputy Minister Chief Executive Officer Executive Director Chief of Staff/Vice President Dean of Medicine Chief Medical Officer of Health

 Regional /District Health Authorities Local Health Integration Networks (LHINs) Provincial Ministries of Health Teaching Hospitals Community Health Centers

* urban and rural viewpoints were represented

Phase 2 participants represented additional provinces and skill sets including epidemiologists, public health, researchers and managers within the system 4

The Concept of Population Health • Most leaders had a strong understanding of the population health approach concept • Inter-sectoral action/partnerships/collaboration • Social determinants of health • Population versus individual level focus • Equity/disparity/vulnerable groups • Community engagement and healthy communities

• However population health approaches were quite diverse operationally • Health of people across a continuum - at the individual level and population level, moving away from a service based focus • Social justice drivers and cost reduction drivers 5

We asked senior level health system leaders the following question:

Is the health care system doing enough to improve population health?

The overwhelming response – ‘No’

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The Realities…

Barriers Contextual realities – Time lags and 4 year political cycles and the ‘tyranny of the acute’ Ownership and resources – Who ‘owns’ population health and what funding models support it?

Institutionalization – Lack of permanent programming – champion-driven versus institutionalized programs

Enablers Leaders and leadership – The role of champions (at multiple levels), personal passion and social justice Strong Business Case – Economic/quality/outcome evaluations that demonstrate viability and cost savings Processes and Resources – Partnerships and inter-sectoral action & whole of gov’t /enterprise-wide approaches 7

The Population Health Approach is Gaining Momentum The population health approach in healthcare was typically applied in the following three areas: – In the design of health services delivery and programs – As a conceptual framework to guide inter-sectoral action – To shift workforce capacity and culture

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Three Key Messages •

While health care leaders saw value in the population health approach they were unclear how to apply it

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Public health and healthcare often operate as two solitudes

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The population health approach could apply in these key areas: –

Chronic disease prevention and management

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Vulnerable populations/equity in health

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Health system costs and demand reduction

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Healthy communities

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A Case Study: The Population Health Approach ‘in-action’ Ottawa Inner City Health…

Ottawa Hospital partners with resources in the community to improve care and social services for the chronically homeless

video

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Next Steps for CIHI • Develop a case study research series “Working Together for Health’ that explores pockets of innovation across Canada and shares lessons learned with others who want to apply the approach • Future networking and collaborative opportunities being explored • Pursue future qualitative and quantitative research and analytical products that bring the population health lens to key health system priority issues

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To access CIHI’s program of work on Population Health and Canada’s Health System visit www.cihi.ca/cphi For more information contact Deborah Cohen, Senior Researcher, CIHI dcohen@cihi.ca

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