Jim Hester, former Acting Director of the Population Health Models Group at the Innovation Center in CMS

In May of this year, the U.S. Department of Health and Human Services unveiled a new opportunity for organizations nationwide to fundamentally improve the quality and delivery of health care. This round of Health Care Innovation Awards, made possible by the Affordable Care Act, builds on the past success of awards distributed last year that funded projects applying innovative solutions to improve outcomes and rein in health expenditures. Jim Hester, PhD, has been active in health reform and population health for almost four decades.  His most recent position was the Acting Director of the Population Health Models Group at the Innovation Center in the Centers for Medicare and Medicaid Services assisting in the development of delivery system transformation and payment reform initiatives such as Pioneer Accountable Care Organizations, medical homes and population health models. Read more now from Hester on what the grants hope to achieve and why he thinks innovation holds tremendous promise for solving the nation’s greatest challenges in population health.

What are some of the critical issues in population-based health you hope the innovator grants will address?

The grants could enable communities to create a sustainable local integrator structure at the community level, which would integrate clinical services, public health programs and community-based initiatives directed at upstream determinants of health. They could also address how to engage new models of care such as medical homes and ACO’s in improving the health of the entire population of a community, not just the patients they serve. Lastly, they could also help create sustainable payment models that enhance the accountability and financial rewards for improving population health.

What are some innovations that some communities might find valuable to improving health?

The grants, and the innovations they inspire, hold great potential for community health.  For example, population-based data sets can identify and target concentrations of patients with a given problem. Integrating non-profit hospital community health needs assessments with other community initiatives and the prospect of linking to community development financing institutions can provide a huge boon to a community’s fiscal and physical health.  The grants will help create new, innovative models for financing population health, which could happen through social impact bonds, hospital community benefit funds, wellness trusts, etc.

And some of these innovations are already reaching local communities. The Accountable Communities for Health model, for example, that Minnesota is using as a core element in its State Innovation Model.  Community-based enhancements to the medical home model are being implemented statewide in the Vermont Blueprint for Health and in Maryland’s Community Centered Health Home model. Additionally, In Pueblo, Colo., and Atlanta, Ga., communities are using the Rethink Health simulation model to develop a local population health infrastructure and intervention plan.

One of the categories for grants that CMS is seeking focuses squarely on improving the health of populations. Is the public health community seizing opportunities to become more innovative?

The public health community is extremely diverse with a wide range of capabilities and attitudes towards change. The Affordable Care Act is driving a rapid pace of delivery system reform and new payment models based on the “Triple Aims.” The public health community is having to learn how to collaborate with a broader range of stakeholders, how to present a stronger business case for its population health initiatives and how to modify its programs and core services to adapt to a new environment. I believe that a broad cross-section of the public health community recognizes that the Health Care Innovation Awards, together with the State Innovation Models, provide a unique opportunity to develop key new relationships and skills.

How can the broader public health community support these innovation grants?

Communities that are not participating in the Awards can still actively seek out grantees and understand how their local public health programs and core capabilities can support the objectives of their grants. CMS is looking for short-term results from proven programs that can be implemented quickly. Those not necessarily involved in the innovations need to make a business case to these and other grant recipients by offering their support and demonstrating how they can help grantees achieve results and save money.

They can also invest time in understanding the new value-based payment models, the financial analyses that support them, and the potential consequences for public health. This is like learning a new language and a different culture. It’s also important to stay aware of the objectives and innovations of grants in other regions, including the State Innovation Models, and try to learn from the broader innovation community. That’s the overall goal.

Learn more about these models.