AcademyHealth’s 2012 National Health Policy Conference (NHPC) was successful for doing what it does best – bringing together key experts to discuss the most critical health policy issues facing our nation. We are particularly excited that last month's conference included its first-ever plenary panel addressing population health. Yes, that’s right, we said population health.
"Re-Defining Public Health Post-ACA" was a great session with panelists representing the local, state, federal, and carrier perspectives, including:
- Jeff Levi, Executive Director of Trust for America’s Health, as the moderator;
- Bechara Choucair, Commissioner of Health for the city of Chicago;
- Paul Halverson, the Secretary of the Arkansas Department of Public Health;
- Jim Hester, Acting Director of the Population Health Unit in the Center for Medicare and Medicaid Innovation (CMMI);and
- Eduardo Sanchez, Chief Medical Officer for Blue Cross Blue Shield of Texas.
The concept of redefining public health is clearly not a new one—the Affordable Care Act (ACA) included significant provisions to promote prevention (both clinical preventive services and community-based approaches), population health, and disparity reductions. However, the panelists contributed some fresh ideas and perspectives challenging the status quo. As Jeff Levi noted, the ACA suggests that there is increased recognition among policymakers that programs (such as Community Transformation Grants), policy, and systems change can create environments where the healthy choice is the easy choice.
Speaking from the community level, Bechara Choucair said the common goal in the city of Chicago is to improve the health of the population. To do that, Choucair developed Healthy Chicago, an agenda for the city, which Chicago Mayor Rahm Emanuel promised to implement within 100 days. Choucair described the plan as a local tool to translate the national prevention strategy. Among the tasks of identifying priorities and strategies (e.g., policy and systems change), and setting targets, he underscored the importance of including partners—both traditional and non-traditional.
Moving from the local level to the state level, Paul Halverson outlined the major roles for public health: as a provider, particularly in the south, where governmental public health agencies often provide care; as regulator (i.e. emergency preparedness, disease outbreak); and “gap filler.” Halverson suggested that public health can provide leadership to fill the gaps by changing the paradigm to focus on health over sickness, and called upon them to partner with clinical medicine to do so. He cautioned against a perfect storm on the horizon: draconian cuts in budgets, especially in public health (tobacco cessation, teen pregnancy prevention programs); greater reliance by states on the federal budget; simultaneous federal budget cuts, including those that support the public health infrastructure; and major, new public health challenges, such as food safety, obesity, and manmade disasters. Halverson urged policymakers to preserve programs that prevent, prepare, and protect, noting particular concern about underserved populations that public health traditionally serves.
Presenting a federal perspective, Jim Hester, acting director of the Population Health Unit in the Center for Medicare and Medicaid Innovation (CMMI), presented the federal perspective, suggesting that achieving population health cannot be achieved by traditional public health entities alone. “CMS is learning to be a public health agency," he stated. It's encouraging, to hear that this mammoth agency, traditionally solely a payor, is broadening its perspective.
Hester also called for broad stakeholder engagement to mobilize communities, suggesting that CMS—serving as a facilitator—can support community-level infrastructure through its efforts. He noted that CMMI is looking to the National Prevention and National Quality Strategies when considering payment policy. In the implementation of payment reform, Hester suggested that introducing the business model concept (i.e., making the case for population health over time) calls for new discipline and new rigor.
Finally, Eduardo Sanchez from Blue Cross Blue Shield of Texas, a former state health official, admonished policymakers for continually making public health the most invisible, under-resourced, and under-appreciated sector of the health system. Yet, Sanchez suggested that public health’s traditionally slow response to developing new strategies to health improvement may render public health agencies obsolete. He posed several questions—What are the functions of public health? Who should perform them? Who is responsible for public safety? Are public health competencies the same as population health competencies? In response, he suggested that accountable health organizations, “AHOs,” could provide a framework for holding us all accountable for achieving optimal health. Such organizations would redefine public health by integrating community, clinical, governmental, non-governmental, and provider services into a single health system that is inter-dependent and mutually responsible for population health. (Read more of Sanchez's insights in our session preview and on New Public Health.)
Will traditional public health become obsolete? The panelists generally agreed that an evolution in programming, performance, and measurement is occurring in governmental public health, at least, and is essential for enabling it to align with health system transformation.
Who will take on what responsibilities in improving the population’s health remains complicated and murky. Here at AcademyHealth, we’re thinking about how and what we can do to help this essential discussion move from dialogue to action. Feel free to share your ideas with us.
(A video recording of this session is available to NHPC conference attendees on our website.)