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Indiana Lags in Health. Can the Tide Be Turned?

First Person is an Indiana-based benefits and talent advisory firm. As such, we keep a close finger on the pulse of regional healthcare systems and the trends in well-being amongst the state of Indiana’s population. Along the way, we get access to an amazing group of healthcare professionals in our public, university and private systems. One goal of First Person is to share the connections and information that becomes available to us when it is relevant to the needs of the employers and employee populations we serve.

We recently had the opportunity to hear Nir Menachemi, PhD, MPH, the Fairbanks Endowed Chair Professor and Department Chair Health Policy and Management at the Indiana University (IUPUI) School of Public Health. His presentation focused on a January 2020 team report, entitled, Addressing Factors that Affect Health Care Costs: Recommendations for Indiana Stakeholders. The report takes a deep dive into root causes for the escalating cost curve for healthcare in Indiana.

Here’s the bottom line: We have a public health crisis in Indiana.

It’s not a problem without visibility or data. It’s not the worst in the United States. But it’s too far from the best. It is something that can be overcome. To do that we have to understand the baseline, then get started and collaborate.

Here are some quick takeaways from Dr. Menachemi’s report:

  • The average Hoosier is sicker and suffers from more health conditions than the average American, especially with respect to high smoking rates, mental health conditions and cardiovascular disease. Diabetes in Indiana is also elevated relative to the national rate.
  • People in Indiana have higher age-adjusted mortality from accidents, suicides and drug overdoses.
  • Infant mortality and maternal mortality are particularly high in Indiana.
  • Public health investments in Indiana are consistently well below US averages and frequently below neighboring states.
  • Indiana performs in the bottom tier with respect to public health preparedness.
  • Given Indiana’s low investments in public health, our state ranks below the bottom quartile in the US for overall health, mental health, infant mortality, overall mortality, obesity and smoking. These health rankings are consistently worse than neighboring states.
  • Rural hospitals in Indiana are at higher risk of closure due to financial issues than rural hospitals in the US overall.

For further context, see the chart below:  

Source – Addressing Factors that Affect Health Care Costs: Recommendations for Indiana Stakeholders

As you can see, the statistics paint a bleak picture for the state of Indiana. As the report goes on to note, however, we know there is strong “evidence (that) links investments in public health to a reduction in health care spending and improvements in population health. Moreover, community-based multisector partnerships can convincingly improve health outcomes.”

Our own Senior Director of Health Strategy, Ryan Bojrab, DPT, has seen this firsthand. Ryan spent close to ten years in the Eskenazi Health system in Indianapolis as both a clinician and clinical administrator focusing on health and well-being efforts across employees and patients in federally qualified health centers. Ryan brings his experience to bear in developing First Person strategies for employee population health.

A key takeaway from Ryan’s experience at Eskenazi is: to move the needle, it takes a systems approach to population health. Community health improvement involves more than just standalone disease prevention and treatment programs. The systems approach to addressing population health measures health based on a variety of interrelated factors including social, racial, economic and physical.

Let’s take one example: social determinants of health (i.e., geographical location or socioeconomic status). These social determinants can be assessed more fully by using the systems approach. For example, the source of one community’s health problems might be due to a lack of healthcare clinics in their region, or even lack of public transportation to clinics. A source of another community’s health problems could be sprawl and an overdependence on automobiles. When we understand what some of these determining factors are, we can become better problem solvers in creating health improvement programs.

What can be done right now?

There is not a single answer. As the IUPUI report outlines, recommendations span from market activity, clinical adjustments and payment considerations, to regulatory updates and consumer approaches. Encompassing all these recommendations is the need for collaboration. There’s not one hero here – it will take an army of diverse stakeholders to make the population in this state healthier.

Here are some of the report recommendations:

  • Implement an all-payer claims database, including self-insured employers, to enable insurers, employers, providers, policymakers and researchers to have improved transparency.
  • Leverage technology like telemedicine to increase competition among providers, especially in markets with a scarcity of physicians.
  • To the extent feasible, encourage the use of narrow or tiered provider networks.
  • Increase investments in public health services and encourage the use of community-based multisector partnerships that address, mitigate or otherwise focus upon socioeconomic conditions that drive preventable healthcare utilization and exacerbate disease.
  • Move toward greater use of value-based payment models among commercial payers, including bundled payment models.
  • Examine ways to effectively increase competition in Indiana for payers and providers through more research. Insufficient evidence exists on policies that can increase competition.
  • Partner to pursue rigorous research to determine if physician-facing price transparency tools, particularly focused on laboratory tests, could reduce costs of care.
  • Launch a concerted effort to reduce low-value care by raising awareness among physicians, patients and others, and implementing payer-initiated incentives that target a reduction of low-value services.
  • Work to swiftly address the issue of low preventive service utilization for patients with high deductible health plans.

Piece of cake, right? Well, remember, there’s a role for everyone to play. Collaboration is key. To those in the healthcare community, the idea that Indiana is not leading the nation in Public Health is not surprising. However – what can be appreciated in Dr. Menachemi’s report is that the data is clear, there are recommendations for a wide array of stakeholders, and it succinctly illustrates why collaboration and investment from industry and community leaders is the only way this gets done.

We can change the trajectory of Public Health for our state. I’m excited for it. Everybody can do their part. Let’s get started.

To learn more about how you can address and enhance the health and well-being strategy in your workplace community, get in touch with Brandon Collins – Advisor at First Person and Ryan Bojrab, DPT – Sr. Director of Health Strategy at First Person. Send us an email if you like. Or drop us a line on LinkedIn or via tweet. We love this stuff and are glad to help!

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