Population Health Implications of the Affordable Care Act Workshop Summary (2014) / Chapter Skim
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5 Catalyzing and Sustaining the Adoption and Integration of a Population Health Concept
5 Catalyzing and Sustaining the Adoption and Integration of a Population Health Concept
Pages 25-40
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From page 25... ...
Genoveva Islas-Hooker, Regional Program Director of the Central California Regional Obesity Prevention Program, discussed how grassroots efforts can produce sustainable increases in healthy behaviors. James Hester, former Acting Director of the Population Health Models Group at the Centers for Medicare & Medicaid Services (CMS)
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From page 26... ...
Early on in this effort, the Nemours team developed a set of priority policies that would be needed to support healthy activity and eating by children, including the introduction of new licensing and regulation requirements for the state's Child and Adult Care Food Program in child care facilities and the requirement to increase physical activity in schools. To leverage new policies, Nemours also pursued practice changes that would enable implementation of these policy changes.
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From page 27... ...
In the child care setting, she continued, 100 percent of participants in the first learning collaborative made significant changes in healthful eating or physical activity, and 81 percent made changes in both. Electronic health record data from the primary care setting indicated that lifestyle counseling related to physical activity and healthful eating was provided to 95 percent of Nemours's patients, which she said is nearly double the national average.
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From page 28... ...
In its project aimed at reducing asthma-related emergency department visits among pediatric Medicaid patients, Nemours is using a CMS Health Care Innovation Award to expand a population-based strategy to create an explicit link to the primary care setting. After briefly describing the logic model that Nemours developed, she explained that the most important consideration is to start with the desired outcomes and work backward to identify primary drivers or agents of change.
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From page 29... ...
Perhaps not surprisingly, she said, one in three children is obese and one of every two Latino children is at risk of developing diabetes. With support from the Robert Wood Johnson Foundation, IslasHooker and her colleagues at the Central California Regional Obesity Prevention Program developed a curriculum on leadership development to engage residents as the agents of change in their community.
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From page 30... ...
At the beginning of 2013, 75 percent of Vermont's population was served by Blueprint for Health medical homes that are testing several payment models based on capacity and performance rather than fee-for-service, and a single Medicare ACO covers an additional 50,000 seniors. Although there is a broad diffusion of the language supporting better health for populations and for new payment models that are aligning the interests of multiple payers, the evolution of the delivery system lags
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From page 31... ...
Complicating the transformation is the fact that improving the population's health is complex and requires reinvestment of shared savings from multiple sectors and valuing of long-term impacts. The payment models for population health are still in the early stages of development and the infrastructure and tools for population health improvement are not well developed, Hester added, creating the risk that new payment models will be established with no meaningful population health component.
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From page 32... ...
This obesity prevention grant focused on policy, system, and environmental changes to support healthful eating and increased physical activity across the three broad areas of healthy food, healthy schools, and healthy places. As examples of the activities implemented by the Healthy Works CPPW program, Wooten highlighted the Fresh Fund incentives project that brought fresh produce into areas with limited access to healthy food by offering a one-to-one dollar match that provided up to $20 per month for purchasing fresh fruits and vegetables at neighborhood farmers' markets.
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From page 33... ...
Wooten noted that the County of San Diego also has a National Public Health Improvement Initiative2 grant that supports voluntary public 2 The National Public Health Improvement Initiative provides support to state, tribal, local, and territorial health departments through the Prevention and Public Health Fund established by the ACA. In 2012, 73 health departments at various levels received support from the Fund to "make fundamental changes and enhancements in their organizations
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From page 34... ...
In her closing comments, Wooten noted that Live Well San Diego supports the Triple Aim of improved population health, enhanced individual quality of care, and reduced per capita health care costs. THE MASSACHUSETTS EXPERIENCE WITH INNOVATIONS IN INTEGRATING POPULATION HEALTH In John Auerbach's view, there are two approaches to funding and prioritizing population health.
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From page 35... ...
He added that the committee will explore whether there are better fits with accountable care organization-level or hospital-wide indicators. The state is also looking at whether it could reduce costs and promote population health by standardizing the use of community health workers (CHWs)
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From page 36... ...
has also proposed additional rules that will require that the input to the CHNA must include at least one state, local, tribal, or regional public health department; members of medically underserved, low-income, and minority populations or their representatives; and written comments from previous CHNAs (IRS, 2011)
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From page 37... ...
This program, which also teaches children how to engage and educate their parents about the value of physical activity, has had a significant impact on obesity rates throughout the entire school district. She would also like to see comprehensive wellness programs implemented in schools and daycare facilities.
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From page 38... ...
Other comments concerned the need for a system that can report on the chosen metrics and the difficulty in deciding on how granular to make these measures in terms of balancing the need for useful data with the burden that metrics can place on the provider community. Hester noted that some of the pioneering ACOs have been experimenting with an enhanced health risk appraisal tool that includes information on patient risk factors and self-reported outcomes.
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From page 39... ...
Lawrence Deyton, from the George Washington University School of Medicine and Health Sciences, asked if any thought was being given to the type of training that is needed for the entire health care provider team to become advocates for and partners in population health efforts as opposed to obstacles. He wondered if there was a role for accreditation and licensing boards in terms of setting standards for training, and he asked if successful local community groups are talking to their state boards about adding requirements for training in population health to licensing requirements.
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