The Affordable Care Act takes two U.S. health systems — public health and health care — and brings them into each other’s world like never before. As the ACA envisions, more collaboration between the overall health workforce will save lives and money.
In a webinar hosted Tuesday by APHA, experts spoke on what public health practitioners can expect as ACA health care delivery reforms continue to take effect.
At the heart of this collaboration are Accountable Care Organizations, or ACOs, which bring together doctors, hospitals, businesses and other health workers to give “coordinated high quality care.” From a public health perspective, this notably includes patient-centered care, electronic health records and a rigorous accreditation process to ensure quality health facilities.
Effective medical care must include social determinants because “four behaviors are responsible for 50 percent of all health outcomes,” according to Abt Associates Vice President and Senior Fellow, and former APHA president, Deborah Klein Walker.
“If you are going to change behaviors, that usually doesn’t happen within the medical system — there is no one single intervention at work,” Klein Walker said. “Most of all you really need a shared accountability approach where you have people in the community coming together to share the strategic plans to eliminate a particular behavior. And you put all this together, and think about the cost drivers and where we need to go, there is no question that if you want to improve the health of the population, you’ve got to bring the health delivery system and the public health system together.”
Systems already in place indicate that ACOs can work when collaboration is high.
The Cambridge Health Alliance in Massachusetts integrates academic programs, clinical services and community health functions, but also includes a commitment to culture and underserved populations — including bilingual medical providers and a volunteer health advisor program. Among its accomplishments, noted Karen Hacker, now the Director of the Allegheny County Health Department (Penn.), the alliance developed programs that significantly reduced asthma-related admissions to emergency rooms and lowered rates of childhood obesity.
The “whole system has changed” in Oregon, said Lillian Shirley, director of the Multnomah County (Ore.) Health Department. In 2012, Oregon developed 16 Coordinated Care Organizations — their approach to ACOs — that plan to cover the state’s whole population of Oregon Health Plan (Medicaid) members, and to particularly focus on managing care for the 20 percent of that population that drives 80 percent of health costs.
Diane Rydrych, director of the Division of Health Policy at the Minnesota Department of Health, also described her state’s efforts to develop new relationships and engage all sectors in their State Innovation Model grant work to test Accountable Communities for Health.