Collaborating on healthier communities
The U.S. healthcare system is in the midst of a transformation— some would say a revolution— that I’ve waited my whole career to see.
Prodded by the Affordable Care Act and the realization that business as usual is unsustainable, health systems are developing innovative new models focused on outcomes.
We’re changing incentives that previously rewarded treatment volumes over results; cures for individuals over the health of populations; and tests and procedures over health measures that go upstream to improve community environments, keep people healthier and reduce the need for treatment.
I’ve worked in public health for 30 years—the past 16 as founder of the Prevention Institute—and I have never seen a time with greater change potential. I’m heartened by the growing interest in population health and a model we call community-centered health homes. In this model, clinics and hospitals recognize that factors outside their walls are the biggest forces shaping health.
They collaborate with the community to improve conditions while focusing on care coordination.
In the past, few health systems invested in prevention because, in a fee- for- service environment, there was little incentive. Insurers refrained too, because they had little ability to reap benefits—improved community health was as likely to benefit their competitors’ members as their own.
Incentives are shifting. The CMS has embraced the “triple aim” of improved population health, greater patient satisfaction and lowered costs and is rewarding providers based on outcomes.
In Akron, Ohio, health institutions convened by the Austen Bioinnovation Institute are collaborating to turn the idea of an accountable care organization into an “accountable care community” that will be accountable not just to patients, but to everyone in the community. Its first goal: to reduce diabetes rates by improving access to healthy food and activity and promoting medication management. In the first 18 months of these efforts, diabetes incidence, hospitalization and amputation rates have each dropped 9% or more.
Another initiative, Live Well San Diego, brought together hospitals, schools and businesses to promote community health. Its “3-4-50” focus aims to change three factors (poor diet, physical inactivity and smoking) that contribute to four chronic conditions (cancer, cardiovascular disease, diabetes and respiratory disease) that cause 50% of deaths.
The logic of the marketplace is changing and health systems that don’t adapt will risk being left behind.
Larry Cohen is the founder and executive director of the Prevention Institute, Oakland, Calif.