by Jill Rosenthal and Manel Kappagoda of ChangeLab Solutions
The United States ranked 15th among affluent countries in life expectancy in 1980. By 2009, it had dropped to 27th place. Our fragmented health care delivery and public health systems, and the lack of coordination between the two, has resulted in an imbalance of high health spending and poor health outcomes.
A recent report by the Robert Wood Johnson Foundation’s Commission to Build a Healthier America, confirms what we already know: dramatically changing these statistics requires a combined approach that comprises investment in health care delivery and expanding “our focus to address how to stay healthy in the first place.”
The ACA places special emphasis on prevention through both the public health and healthcare delivery systems. Many of the ACA’s opportunities and investments are directed at states, reaffirming each state’s critical role in reforming the country’s health and health care systems.
Encouraging New Models to Bridge Health and Health Care
The federal government is encouraging states to build and test new models of bridging health and health care. For example, the Centers for Disease Control and Prevention’s (CDC) Coordinated Chronic Disease Program, created by the ACA, gives grants to state public health departments to develop overarching chronic disease strategies, requiring states to include “engagement with health care systems” and “enhancement of clinic-community linkages.” Meanwhile the Centers for Medicare and Medicaid Services’ (CMS) State Innovation Models (SIM) program, also created with ACA funding, encourages state delivery system planners to “integrate community health and community prevention activities in their multi-payer models” for payment reform efforts. These new models require the creation of new partnerships across state and local government agencies, communities, and private sector stakeholders.
A new report developed by the National Academy for State Health Policy and ChangeLab Solutions looks at how eight leading states- California, Maryland, Massachusetts, Minnesota, North Carolina, Oregon, Texas, and Vermont– have combined many of the new policy levers and resources offered through the ACA with existing state authority to create a new balance between the health care delivery and public health systems with the ultimate goal of the Triple Aim: improving care and health outcomes, and reducing costs.
States have the opportunity to create a new balance in how community-based interventions are financed by capitalizing on healthcare delivery system mechanisms. This report lays out the issues related to those opportunities, shows how they’re relevant for state policymakers and other interested stakeholders, and shares innovative state examples. It focuses specifically on state health policy and the unique role that state governments can play in building bridges between the public health and health care sectors.
How States Are Making a Strategic Difference
Here are some of the state strategies highlighted in the report. They fall into three categories:
Existing federal authority and grants
- All the states profiled use or have used Medicaid waivers to support community-based interventions as part of their delivery system and payment innovations.
- Massachusetts, Minnesota, Oregon and Vermont each received a State Innovation Model (SIM) Testing award, which supports multi-payer health system transformation efforts and encourages states to integrate community health and prevention activities in their models.
Delivery system reform models
- Most of the states profiled have multi-payer Patient-Centered Medical Home initiatives underway, which can provide incentives for health promotion activities.
- Oregon, Minnesota, and Vermont are requiring organizations participating in an accountable care arrangement, which holds providers accountable for patient outcomes, to enter into community partnerships.
- Massachusetts assesses a percentage of insurance and hospital revenue into its Prevention and Wellness Trust Fund to support community-based population health improvement.
New federal requirements for non-profit hospitals
- Several states, such as Maryland and Oregon, are taking steps to link hospitals required by the ACA to conduct a community health needs assessment with existing state requirements and with community health improvement expertise and initiatives already underway in their communities.
Although some of these strategies have been implemented before, new incentives and motivations make optimizing the nation’s health more attainable. We are now better positioned to realize the promise of ensuring as many of us as possible “stay healthy in the first place.”