PWAB June 2013 Meeting Minutes

Prevention and Wellness Trust

Ch.224oftheActs of2012

PreventionandWellnessAdvisoryBoard

DPHPublicHealthCouncilRoom

June27,2013

Meeting Minutes

Board Members present:

LoriCavanaugh

RobertBruceCedar CatherineHartman DavidHemenway

PeterHolden StephenieLemon MaryLynnOstrowski HeidiPorter

KarenRegan

SusanServais

Board Members not present:

KeithDenham

TobiasFisher

LisaHolderby-Fox

PaulaJohnson

Guest Speaker:

DavidSeltz–executiveDirectorfortheHealthPolicyCommission

DPH and EOHHS Staff presenting:

CherylBartlett, CommissionerDPH

AnnHwang,EOHHS TomLand,BCHAP

JohnPolanowicz,Secretary

EOHHS

Meetingbeganat 1:05

WelcomeandintroductoryremarksbyCommissionerCherylBartlett

 Discussionofremotephone-inforemergencysituations

 Briefoverviewofthechargeofthe board

 Introductionsofboardmembers

ConductingBusiness—CommissionerBartlett

 Reviewofinformationregardingopenmeetinglaw

 Discussionofremotephonecalls

 Motiontoapprovethe useofremoteattendanceincaseofemergencymadebyMaryLynn

Ostrowski,secondby PeterHolden—unanimousvote

Conflictofinterestdiscussion—boardmembersnotedthat someoftheirorganizationsmaybe interestedinapplyingandagreethat they willlikely needtorecusethemselvesfromreviewof applicationsshouldthatbethe case

 Proposeaddingthis tothe nextagendaforfurtherdiscussion

Preventionand WellnessTrust Fund—Advisory BoardMeeting Minutes—June 27, 2013 1

Objectives—Commissioner Bartlett

 Reviewthe agenda

 Understandingtheresponsibilitiesofthe board

oConsultationwiththe Commissioner

oDevelopingguidelinesforannualreviewofgranteesthat deliversareturnoninvestment

 Overviewofexpenditurepurpose

BackgroundonChapter224—DavidSeltz,HealthPolicyCommission

Pathtoaffordablehealthcareforthe Commonwealth—Chapter224isthenextchapterandphase ofhealthcarereform

Underlyingthreadistobringhealthcarecostsdown3.6%foreachofthenexttwoyears—which maybeadjustedovertime

 This is nota onesizefits allapproach

 Investmentin preventionis a majorcomponent—wellness,worksitewellnesstaxcredit

 DiscussionofHealthPolicyCommission

oWanttotrackandunderstandevidencebaseandcreatesustainablepolicythat willcreate

efficienciesinthe longterm

 Transformationofthehealthcaresystemin termsofcostsandpatientaccess;

buildthe evidencebasearoundimpactoncostandsavings;focusonpolicy recommendationsratherthanquickfixes

 Evaluationofthe changingmarketplaceinMA—cost,qualityandaccess

 Acceleratingpromisingcaredeliverymodels—i.e.patientcenteredcare

homes—considerpopulationhealthas wethinkaboutoutcomes

 Administeronetimeassessmentfromhealth careproviders—thosedollarswill

bedistributedtoPWTF,E-HealthInstitute,communityhealthhospital,those ineligibleforfederalEMRmoney--$135Mover4 yearsinvestingbackintothe community

 Createstabilityandmoreefficientsystem

 Mandatetocoordinatewiththe otherfunds—needalignmentoutcomes,

measures,leveragedollarsto createamultiplier

 Availablefundswillbeskewedhigherin yearonebecausesomedecidedtopayall

inyearoneinsteadofoverfouryears

oGaminglicensesandfundingfromthis sourcewillbealignedwith these otherfunds—

innovationgrantsthe Commissionmayissuein2014

oCommunityhospitalprogramworkingtowardfirst roundofgrants

Howfundsareallocated—Commissioner Bartlett

 $60Moverfouryearsis notrestrictedby fiscalyear

 BillpassedinOctobersothetimetoimplementisfurtherlimited

 Atleast 75%mustbespentonawards

 Nomorethan10%onworksitewellness

 Nomorethan15%onadministration

ReviewingGranteeProgress—Commissioner Bartlett

 Developguidelinesforannualreviewmadeby eachgrantee(Dec 31)

OverviewoftheCommissiononPreventionandWellness—CommissionerBartlett

 OpportunityforoverlapwithPWTFis beingreviewed

 Outcomeswith focusonimpactonprevalence,reductionincosts, whobenefitted

 Recommendationsforcontinuation

ProposedTimeline—CommissionerBartlett

 Meet monthlythroughSeptember,releaseRFRthe endofAugust

 Nomeetingin OctandNov—willholdbiddersconference,reviewandscoreapplications

 Recommendationsforfundingby December

 Therewillbeworkinbetweenmeetingstomovethisprocessalong

QuestionregardingwhocanapplytoRFR—response:this is acollaboration,whichcanbe institutions,municipalities,andcommunity-basedorganizationsprovidedthey demonstrate collaborationandpartnershipslinkingclinicalandcommunityresources

QuestionregardingthetimelinefromRFRreleasetoapplicationdue—response:7-8weeks,have alreadydonesomeoutreach

 Questionregardingthetimingofthe biddersconference—response:goalis toholdit inearly

September

InitialConsensus—GuidingPrinciples—CommissionerBartlett

 Evidence-basedapproaches

oLiterature,DPHcampaignssuchasMassinMotion(33%reach),Community

TransformationGrants

 Community-basedapproach

Questionregardingwhichcommunitiescanbetargeted—response:the datawillguideand neighborhood-leveltargetingisappropriateifsupportedbydataandburdenhigher

DavidHemenway—commentregardingdiscrepancybetweenevidence-basedandinnovation/new ideas

oAgainstthe notionthat wealwaysuseevidence-basedasit inherentlystiflesinnovation

oIf focusonjustevidence-base,don’tget innovativeideas

oGoodtouseevidencebase, butalsowantapplicantsdoinginnovativethings

oShouldsayevidencebaseORinnovativeideas

oMustbemorethanonlychronicdisease—injuriesshouldbeincluded

oCommenttouseadditionallanguagetoincludeinjuries

CommentfromStephanieLemon—the intersectionofinnovationandevidence-baseis howyou implement;roomonthe localleveltohaveorganizationscreativelyimplementprogramsthatdo have a solidevidence-basebehindit—thatshouldbekeptinmind

ProposedVision—CommissionerBartlett

 Wecanadjustlanguagetoincludeinjuries

 Proposeditemstodiscuss:

oNumberofcommunitiestofund

oInternaldiscussionis toaward6-12grants$1Meach

 KarenRegancomment:willthe biddingprocessonlybeonce—TomLandrespondsthat the goalis toonlygoouttobidonce

 StephenieLemoncomment:agreeswiththeapproachtofundasmallernumberofgrants

 SusanServaiscomment:onceweseewhat the proposalsareshoulddictatethe numberorproposals weaccept—TomLandresponds:the numberofcommunitieswillbegreaterthanthe numberof grantsawarded,andweneedtoguidethe scopeoftheirapplications

oSusanServaiscomment:Proceedwithcautionwhenputtingoutanumberofanticipated

awardssothat peopledonotunnecessarilybuilduptheirproposalstoreachacertain dollaramount

 RobertBruceCedarcomment:arecommunitiespreparedforthis—responsesfromotherboard membersagreethatcommunitieshavealreadybeentalkingaboutthis andareready

 Partofthe workofthe boardistolookat diseasesandinjuriesanddeterminewhichdiseasesand interventionstotarget

 Peter Holdencomment:If youaregiventheaward,doyouhave flexibilityonceyougetthe award?

oIf it is toodirective,itcanbea pointlessexercisebecausecriteriaaresospecificthat

nothinggets done

oBesuretodefineallthestrategies, butdonotholdtheminstoneoverthe4years

oWithoutflexibilitysomeofthesegrantsaregoingtofail

Preparingfor theJuly29thMeeting—TomLand

 Overviewofthe notebook

 Reviewnextstepsand‘homework’neededbeforethe nextmeeting

oIf consensusisapparentwhenreviewing‘homework,”DPHwillbeginwritingthatinto

the RFRandimmediatelydraftwhat wecan

oWilldiscussareasofdivergenceatJuly29thmeeting

 MonthlymeetingsthroughSeptember,noneinOctandNov

 Section60is highlightedforgoals

 Section276highlightsthe measuresforsuccess

 Outlineofthe lawitself

 RFRdevelopment

 Listeningsessionson7/177/18acrossthestate

 JulyandAugustmeetingswillleadtofinalversionofthe RFR

 GoaltocompleteRFRanddoit well

 BiddersconferencetentativelyscheduledforSept9th

Wanttohave letters ofintent(LOI)asarequirementsowe canestablishreviewteams;workingto determineifthat is possible

 Wouldlikesomeboardmemberstoparticipateinthe reviewprocess

 HopetofinalizeprocessinDecemberandmakerecommendationsofawards

 ContactTomLandorCommissionerBartlett ifthereareanyquestions,commentsorconcerns

 Proposefundingasmallernumbersofgrantees

 Clinical/communitylinkagesareessential

 Datagroups—requiresgreatest amountofattention

oHealthcarecostsoverall

oNeedtohavegeographicsensitivitytomakethis effective

oLookedat annualhealthcarecosts

oFinalgraphshowsthe maximumreturnoninvestment

 Summaryofgeographicdistribution—pocketsofneedandthey arenotthesameacrossthe map

 Databriefswithdisease-specificinformationat thestate level

 Lookat evidence-basedinterventionsasa startingpointtogauge3,5,10yearcostsavings

HOMEWORK:whatyouthinkthe focusshouldbeandbriefnarrativeas tothe rationaleforyour selections

Questionstoguidedecisionsonpriorities—TomLand

 PositiveROIin2-3yearsasa strongconsideration

 Healthconditionthatis uniquethatmayhave efficiency

 Provideadditionalinformationonthe evidence-base

 Lookat disparitiesandwhichinterventionsmaybemosteffective

 TomLandwillsendelectronicformwiththequestions

Introductionandremarks—SecretaryPolanowicz

 Needexamplesthatfundingforpreventionhasimpactonoverallmedicalexpenditures

Interestinkeepingthegrantnumberssmallsothatwewillhave a markedimprovementonthose measuresanddemonstratea realROI

 This is anopportunitytoreinforceandprovethe fact thatpreventioncanmakeadifference

 This needstobedoneina timelywaythatwillmovethe needleintheshortterm

 Stateethicswilljoinustodiscussrecusalprocess

Closingcomment

Questionsregardingconsultationamonggroupmembers—cannothaveaquorumorsequential quoruminpersonorviaphonetocomplywith openmeetinglaw.

The meetingadjournedat 2:30p.m. Respectfullysubmitted,

JennaRoberts

SusanSvencer