Col­lab­o­rat­ing on health­ier com­mu­ni­ties

Modern Healthcare - - COMMENT - By Larry Co­hen

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.

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