On October 3, AcademyHealth and America’s Essential Hospitals co-hosted an Innovations Summit in Washington, D.C., to highlight initiatives that improve population health or enhance workforce capacity. The blog below, by AcademyHealth Research Assistant Natalie Talis, offers a snapshot from the event. You can also check out the day’s presentations here. It is undeniable that many provisions of the Affordable Care Act (ACA) are making the innovation crowd giddy. Examples of local collaboration and change have been sprouting up across the country. The keys to an innovation’s success are not coded in the original legislative language, but in a community’s interpretation and implementation.  For instance, Accountable Care Organizations (ACOs) are not a novel concept in the health field; but, in the last few years, communities have adapted this idea to fit their needs and resources, resulting in dozens of iterations from Accountable Care Communities in Akron to Coordinated Care Organizations in Oregon. During one of the Summit’s panels, Jennifer DeCubellis presented on Hennepin Health in Minnesota, a unique collaborative effort that expands the ACO model by addressing upstream determinants of health that land high-risk populations in the emergency room over and over again. This pilot program, notably initiated by the Hennepin Department of Health, uses Medicaid funds to pay the county a flat per-member per-month fee to cover the cost of coordinating and providing care for each patient’s healthcare and social service needs. So far, Hennepin Health has already reinvested the $1 million in year one savings back into the program. According to DeCubellis, this investment includes a new “sobering center, initiatives in medical respite, vocational supports, expansion of a complex care clinic, ED in-reach efforts, and psych consults.” Here’s how it works in infographic form. As healthcare systems across the country brace for change, programs like this illustrate that the public health system is poised to be a strong partner, and in many instances, may even provide the leadership needed to institute that change (see Integrator concept). While other initiatives like price transparency may target cost once the patient is ready for treatment, a population health focus addressing the social determinants of health may prevent costly interactions with healthcare altogether. These all sound like good things, so what’s the downside? It’s important to emphasize that efforts like Hennepin Health are pilot projects. We don’t know yet if it is scalable, replicable, or even sustainable. With a new population receiving access to health care coverage, whether through Medicaid or the exchanges, solutions that don’t overburden the health system are necessary. Counties, cities and even states may not have the necessary infrastructure to even track this greater population across systems. So how do we know if Hennepin’s results are generalizable? Do we know if this will work for the entire Medicaid population or is it solely cost-effective for the most indigent? How do cost savings change if Medicaid and public health departments are already merged? While more research is definitely needed to discern the true value and potential downsides to programs like this, leadership and collaboration are essential components to even initiating the project. Hopefully, by hearing stories of successful innovations, other public health departments and care systems will be more likely to cross that bridge.

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