The much talked about management of population health is an important requirement of the Affordable Care Act. Since the healthcare system today is more and more focused on chronic conditions as opposed to acute care, and since the ability to impact these conditions extends beyond the local hospital and provider community to include public health agencies, payors and others, it is critical that we find ways to build collaborative efforts designed to address population health.
Whose sandbox is it anyway?
It really wasn’t that long ago that population health would not even be on the typical hospital leader’s radar. Our healthcare system was designed (or evolved) to address illness as it arose and to be paid for each service rendered. The built-in incentives rewarded doing more to more people, not trying to keep patients away (i.e. healthy). Of course, the opposite was true for public health departments and other similar agencies, so hospitals and providers have frequently found themselves at best disinterested in and at worst antagonistic to public health agency policy initiatives. In addition, some communities are served by more than one hospital, and the tendency has been to compete for the care of those patients. In this new environment of population health, it may be better for two or more hospitals to work together and collaborate with public health agencies, as well as public and private payors and other community entities on population health issues.
The ACA requires community hospitals to conduct community health needs assessments every three years and to come up with plans to improve community health. While organizations might try to do this independently, there are a number of examples nationally of creative partnerships between hospitals and public health agencies, where a more comprehensive approach has been developed to identify and measure the needs of the community as well as the impacts of the approaches and policies in force. Paul Barr, a senior writer at Hospitals & Health Networks (a publication of the American Hospital Association), cites several examples of these in an article published last week entitled Public Partners in Population Health (click here for the full article).
Common Denominators of Population Health Collaboration
Barr cites a source entitled “Improving Community Health through Hospital-Public Health Collaboration,” by the Commonwealth Center for Governance Studies Inc., November 2014. In this study of 12 successful hospital-public health collaborations, the authors developed the following recommendations:
- Hospitals and public health departments should be at the core, but a broad range of partners should be included.
- When possible, partnerships should be framed around existing, trusting relationships among at least some of the partners.
- A partnership should adopt a mission and goals that focus on clearly defined, high-priority needs that will inspire community engagement and support.
- One or more anchor members are needed to provide financial support.
- A designated body with a clearly defined charter should be created.
- Population health concepts, definitions and principles should be well-defined and mutually understood by those involved.
- Community health measures, objectives, targets, metrics and tools should be selected.
- Develop and disseminate impact statements that measure the effects of the partnership efforts relative to the direct and indirect costs of the partnership.
- A deliberate strategy for broadening sources of financial support should be maintained.
- Boards of participating organizations should establish standing committees with oversight of their participation in the partnership.
- Federal, state and local agencies, hospital associations and public health associations should adopt policy stances that promote cooperation between hospitals and public health departments.
Where have you seen effective population health efforts, even if in the nascent stages and just beginning to show its potential?