Population Health Implications of the Affordable Care Act Workshop Summary (2014) / Chapter Skim
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3 Current Models for Integrating a Population Health Approach into Implementation of the Affordable Care Act
3 Current Models for Integrating a Population Health Approach into Implementation of the Affordable Care Act
Pages 9-20
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From page 9... ...
presented a nonprofit perspective. Joshua Sharfstein, Secretary of the Maryland Department of Health and Mental Hygiene and Chair of the Maryland Health Benefit Exchange, and Lillian Shirley, Director of the Multnomah County (Oregon)
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From page 10... ...
Key components of the ACC include integrated, collaborative medical and public health models; interprofessional medical teams; a robust health information technology infrastructure that standardizes data across the multiple electronic health records (EHRs) ; a community health surveillance and data warehouse; and a dissemination infrastructure to share best practices.
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From page 11... ...
In addition, said Janosky, the accountable care community involves cost avoidance and cost recovery models that will help reinvest savings in the coalition's work. As an example of a desired outcome, Janosky described the ACC's diabetes program, which aims to reduce the incidence of disease from its current level of approximately 8 percent of the population of Akron.
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From page 12... ...
Overall, the average cost per month of care of individuals with diabetes fell by 10 percent, and after 1 year of involvement there was a consistent reduction in costs. Using national figures for cost savings associated with improved blood sugar control and weight loss, Janosky estimated that this program saved more than $3,700 per person per year.
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From page 13... ...
In one case, the local hospital has taken over the school health program because it learned that it was seeing too many children with uncontrolled asthma coming into its emergency department. Maryland has also organized local health improvement coalitions, involving public health agencies and other partners across the state, and the local hospitals have helped to support these.
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From page 14... ...
"If we can get health care payment aligned to better patient experience and better outcomes, we will see a better coordinated experience for patients, and ultimately we will have improved health outcomes. When we do that, we get more financial incentives back into the health care system and we get a virtuous cycle." STATE-WIDE HEALTH SYSTEM TRANSFORMATION Although the state was once advised to start small, Lillian Shirley said, Oregon is tackling a statewide effort to change the way health care is delivered and paid for by using its 15 coordinated care organizations (CCOs)
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From page 15... ...
In each of these efforts, local advisory groups are looking at a wide range of factors, such as public safety and education, that are normally not part of the health care spending discussion, but that negatively impact health. The work that public health agencies do in partnership with other sectors in prevention efforts can help decrease the medical costs associated with these outcomes.
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From page 16... ...
NorthPoint, she explained, was established in 1968 as a community health center and operates as a federally qualified health center in partnership with Hennepin County. It offers integrated health and social services that include medical, dental, and behavioral health services as well as food and housing services, chemical dependency treatment, and even a public art gallery.
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From page 17... ...
As part of this effort, staff participate in training to become more culturally appropriate and to learn how to tap into cultural practices as a means of encouraging patients to change harmful behaviors and seek routine health care and screening. One of NorthPoint's most promising ventures, said Whitney-West, is as a partner member of Hennepin Health, an integrated health care network functioning as an ACA demonstration accountable care organization.
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From page 18... ...
could help public health agencies' efforts as ONC develops the third phase of the meaningful use requirements for health information technology, Shirley said it would be highly informative to funding decisions if EHRs could be mined for race and ethnicity data, but she acknowledged the cost and challenges implicit in adding lines of code to EHR. Flores said that ONC could help facilitate the deployment of telemedicine for population health purposes in a way that uses the nation's communications infrastructure so that data from remote parts of the country could be analyzed using analytic systems that
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From page 19... ...
Janosky and Whitney-West both said their programs are taking the same approach of integrating behavioral health into larger health programs. At NorthPoint, a psychologist is now "embedded" in the primary care clinic.
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From page 20... ...
Often, he said, public health departments are restricted in terms of how involved they can get beyond the core focus. Another roundtable member, Marthe Gold, who is a visiting scholar at the New York Academy of Medicine, asked about the opportunity under the ACA to ensure a robust public health infrastructure.
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