Mid-America Coalition on Health Care—Working with Public Health
Summary
The Mid-America Coalition on Health Care (MACHC) has a long relationship with public health, as participants, advisers, and as MACHC members. The Director of the Kansas Health Policy Authority, the Health Director for Kansas City, MO (and former president of NACCHO), and the CEO of the region's safety net hospital have positions on the Board of Directors. Public health concepts and resources underlie virtually all MACHC projects.
About Mid-America Coalition on Health Care
The Mid-America Coalition on Health Care is a 30 year non-profit collaboration of employers and all components of the bi-state Kansas City region's health care delivery system. It has 60 members, representing over 500,000 lives. The MACHC's mission is to improve the health of employees and their families, promote employee and community wellness and illness prevention, develop strategies and initiatives for containing business health care costs, and generate and communicate health care information to the community. The MACHC accomplishes its mission through the collaboration of major employers and all healthcare delivery stakeholders (physicians and medical societies, health plans, hospitals, public health, academic institutions, labor, bi-state governmental units, and pharmaceutical companies).
Mid-America Coalition on Health Care and Public Health
The MACHC has a strong history of partnering with local, state, and national public health organizations. This mutually beneficial relationship is built on the recognition that both partners have overlapping interests in improving population and community health, especially in worksite settings.
In 1998, the MACHC partnered with the Kansas Department of Health & Environment to assess the health risks of a representative sample of 45,000 employees and dependents in eight member companies. The Behavioral Risk Factor Surveillance Survey tool was administered, and the aggregate results were analyzed by Mercer, Inc against the goals of Healthy People 2010. This survey has led employers to participate in a series of different initiatives over the past decade.
Community Initiative on Depression (CID)
In 2000, the Coalition partnered with the American Psychiatric Association on the Community Initiative on Depression, focused on the human and financial costs of depression - both one of the most prevalent and most undiagnosed diseases in the workplace. The CID followed a public health model, working with worksites, clinicians, researchers and the larger community. It engaged 15 employers collaboratively with health plans, clinicians, universities, local health departments, local and national mental health associations, community organizations, the media, national academic researchers, various components of local, county, regional, state and national governments, and pharmaceutical companies.
Although this project concluded in 2005, many efforts continue: A representative of the MACHC co-chairs the APA's Workplace Mental Health Advisory Board and sits on AHRQ's depression-focused Technical Expert Group in the Evidence-Based Practice Centers. The CID has been cited by a wide range of organizations (including the Institute of Medicine, SAMHSA, and the Robert Woods Johnson) as a leading community approach to depression.
Community Initiative on Cardiovascular Health and Disease (CICV)
The second project based on the 1998 BRFSS survey was the Community Initiative on Cardiovascular Health and Disease (CICV), started in 2005 in conjunction with the departments of health of Kansas and Missouri and the Centers for Disease Control and Prevention. Fourteen employers (over 120,000 lives in the Kansas City area) collaborated with providers and public health partners to address ways to reduce CV risk factors across worksite, clinical and community settings. The four-year initiative focuses on hypertension and hyperlipidemia (the CDC's two priorities), as well as smoking, obesity, nutrition, and physical inactivity,
Grounded in the CDC'sHeart-Healthy/Stroke-Free Worksite Toolkit, baseline surveys were taken to assess corporate leadership support, employee attitudes and risk factor knowledge, health plan benefit design, and environmental support for reducing CV risk factors. Key intervention areas include leadership support, environmental improvement, clinical risk rating reduction, benefit design, and data integration. Employer progress from baseline is being reviewed using the comprehensive data sets developed in the MACHC's new Value Based Benefits project (below). For clinical settings, a Web-based Toolkit was developed to educate/activate the healthcare community to address gaps in coordination of care for patients with Acute Coronary Syndrome. In the community sector, a HeartSafe Communities model is being piloted with the Kansas Department of Health and Environment in a large and a small community to increase CPR/AED education and AED placement, and to develop policies to reduce delays in seeking treatment.
The CICV has been designated the CDC's national pilot for itsHeart-Healthy/Stroke-Free Worksites Toolkitand is cited as its "best practice" project. Through the CICV, the MACHC is represented on a wide variety of State panels including the Kansas Governor's Council on Fitness, the Missouri Council on Activity and Nutrition, and the Missouri and Kansas Heart Disease and Stroke Prevention Advisory Boards.
Value Based Benefits / KC2
The employer data shortcomings uncovered in the CICV have spurred a parallel track focused on Value Based Benefits, growing to 17 employers (over 462,000 lives). The MACHC's public health partners are participating as both employers and as health experts. They believe the project tools and learnings could be adapted by State health agencies to deliver health and wellness programming to small and mid-sized companies in communities without an employer-driven coalition. KC2 is the national VBB pilot for the National Business Coalition on Health.
Additional Public-Private Partnership Activities
In addition to these projects the MACHC has conducted two projects focused on the medically indigent and uninsured (through the Robert Wood Johnson Foundation and the Mid-America Regional Council) and one on hospital quality reporting (cited by CMS as its "poster child for quality matters.")
More details about these projects, and other work of the Coalition, are athttp://www.machc.org/.
Lessons Learned and Observations
The Mid America Coalition on Health Care has established an excellent relationship with public health and has benefited from its tools and expertise. The MACHC recognizes and incorporates the strength of public health partners in such areas as community planning, health promotion and education, evidence-based best practices, evaluation, and replication of successful initiatives. Lessons learned and observations for this exceptional example of collaboration by a coalition with public health include the following.
o Use of established tools—e.g., BRFSS (Behavior Risk Factor Surveillance Survey) andBusiness Strategies to Prevent Heart Disease and Stroke Toolkit(www.cdc.gov/DHPSP/library/toolkit/)—developed by public health expedites the assessment and intervention planning processes.
o Public health has access to population and community health data valuable to employers in planning and measuring interventions. Their epidemiologists can be a vital resource.
o Tools and information from public health support the "sell to business" that the MACHC develops to help with employer education, and they support initiatives focusing on the hidden costs of health (e.g. the medically indigent) that business pays for indirectly.
o Mutually beneficial relationships can best be built over a long term series of demonstrated successful relationships, each building on trust and respect and the alignment of common agendas.
o Broad project approaches focus on worksite, community, and health providers. This builds on public health and "health policy" concepts to frame the project in business-related terms and actions.
o State and local public health and the CDC can provide resources, tools, subject matter experts, and funding for projects.
o Coalitions can provide public health with insights into worksite health issues from the perspective of employers and access to laboratories for health improvement initiatives.
o Planning should include detailed work plans, interim and longer term goals and measures, ongoing progress reporting to stakeholders, and defining stages for the evolution of projects.
o Engagement of both parties "demystifies" public health for employers and adds a public health construct to each project and dialogue.
o Public health partners have multiple resources for incorporating evidence-based best practices into coalition projects, many of which are no or low cost.
o Successful coalition projects can be replicated by savvy and "entrepreneurial" public health representatives in small and mid-sized communities which do not have coalitions or sophisticated employers focused on improving employee health status.
o Coalitions provide leadership to expand the dialogue on such important community issues as emergency preparedness to include the business sector.
