New Directions in
Public Health Services
and Systems Research
James Hester, John Auerbach, Bechara Choucair, Hilary Heishman,
Paul Kuehnert and Judy Monroe
June 2015
New Directions in Public Health Services and Systems Research
AcademyHealth is the professional society for health services and policy research. Its Public Health Systems Research Interest
Group is its largest, with close to 4,000 researchers, students, and decision makers who work at the Federal, state and local
levels.
AcademyHealth has commissioned this discussion paper to catalyze research to address several new and urgent policymaker
questions raised by the transformation of the U.S. health care system. There is growing emphasis on reducing health care costs,
increasing urgency to address health equity, a continued growth of preventable (and costly) disease, and a resultant need to
promote healthier communities. This paper draws on the experience and perspective of six observers who are immersed in the
changing public health system and offers their shared insights to the PHSSR community.
Introduction
The American healthcare system is in the early stages of what could
be a major transition in focus from clinical care to population
health.1 The widespread adoption of the Triple Aim has created the
prospect of payment models which reward value, including improvements in population health,2 and move away from fee-for-service
models that reward volume. Multiple initiatives mandated by the
Affordable Care Act (ACA), particularly the State Innovation Model
(SIM) program of the Centers for Medicare and Medicaid Services
(CMS), have accelerated the transformation.
This dynamic environment creates significant opportunities and
challenges for public health.3 New community centered infrastructures such as Accountable Communities for Health (ACH) are being
tested.4 Early adaptor healthcare systems are exploring the shift from
a focus on coordinating care for the individual patient, to accepting responsibility for improving the health of populations.5 Major
new players are engaging in the financing and implementation of
improvements in population health, creating the prospect of new
partnerships for traditional public health entities.
What are the consequences of this environment for the emerging
discipline of public health services and systems research (PHSSR)?
Interdisciplinary by nature, PHSSR identifies effective, efficient, and
equitable public health services and systems to support evidencebased decision making and, ultimately, improve the health of the
public. By focusing on the organization, financing, and delivery
of public health services, PHSSR is well positioned to investigate
the move from volume to value. PHSSR’s current body of evidence
includes information about what makes partnerships effective, where
to direct scarce resources, and how governmental public health agencies are evolving as a result of ACA implementation.
In this paper, we suggest expanding the scope of PHSSR to address
the changing demands on the public health system, as well as the
drivers of systems change (e.g. new technologies, evolving community structures). We first describe some key trends that are driving the
rapid evolution of both the players in the public health system and
the way they interact, with a particular focus on the changing role
2
of governmental public health entities. We then discuss the consequences of these changes for the themes of PHSSR and offer observations about some potential barriers to the PHSSR community being
able to take advantage of the new opportunities. Finally, we propose
specific research questions to help accelerate and catalyze thinking
about new ways to expand the PHSSR evidence base.
A. Key trends affecting the public health system
The ACA is the greatest change in U.S. health policy since the Medicare and Medicaid programs were created in 1965. It has not only
accelerated transformation in delivery system and payment reform,
but has created the first National Prevention Strategy, funded new
prevention and public health programs, created new community
health centers, expanded the National Health Service Corps, and
provided health insurance to millions of Americans.6
Even though the public health system is quite broad and includes a
wide variety of players in the public and private sectors, governmental public health entities have traditionally been the locus of accountability for the health of the population. The convergence of a number
of major policy and economic trends including health care reform,
the emergence of new technologies, and the engagement of major
private sector stakeholders is creating significant change in the environment within which governmental public health entities function.
This section highlights and frames some of the key trends affecting
public health systems, including descriptions of some of the new and
emerging players, and ways that traditional interactions are changing. The section provides a foundation for discussion to answer the
question: how should governmental public health evolve?
Delivery system transformation: By creating the new Center for
Medicare and Medicaid Innovation (CMMI), the ACA has accelerated the development of payment and delivery models that are
transforming the health care delivery system at both the community
and primary care practice levels. Halfon has created a helpful framework which describes this transformation in three stages: Healthcare
1.0 which is focused on traditional episodic care, Healthcare 2.0
which coordinates care across time and settings and is more patient
centered and Healthcare 3.0 which addresses the determinants of
health and is focused on the health of the population.7 Most care
systems are engaged in making the transition to coordinated care,
or Healthcare 2.0, at the community level, e.g. accountable care
organizations (ACOs), and at the practice level, e.g. patient centered
medical homes (PCMH). Some early adaptor communities are
beginning to explore Healthcare 3.0, e.g. through the ACH concept.
These models broaden the focus from care of individual patients to
panels of patients and potentially the total population of a community. The coordinated care models used in Healthcare 2.0 are a
catalyst for collaboration across healthcare, public health and community services. Through collaboration, the system as a whole has
the potential to use data to better understand the population and to
link clinical care to non-traditional resources. It is crucial to understand how these changes are impacting the organization, financing
and delivery of public health services and create an imperative for
PHSSR.8
One impact is that all of the models engaged in Healthcare 2.0
coordinated care provide strong incentives for preventive care
services. As the health care system moves toward the provision of
preventive services, the public health system is moving away from
such activity. A second impact involves greater integration with
public health and social services. For example, PCMH, are centered
on the relationship between a patient and his or her primary care
provider. That clinical care provider leads a team committed to
safe, high-quality, accessible care and is likely to suggest preventive services (e.g. immunizations, screening, and counseling) and
to involve social workers, educational counselors, and community
health workers.9 In these settings, a physician may treat a patient
with asthma, arrange for environmental home interventions such
as mattress and pillow dust covers, and coordinate with a public
health agency to target housing quality and code enforcement in
the center’s catchment area.
A healthcare organization that is a PCMH is potentially building a
great foundation for a stronger whole health system, and provides
an opportunity for investigation by PHSSR. This will be reinforced
by the community health models such as ACH which offer significantly broader opportunities for interventions that address the full
range of determinants of health. This calls for research that describes the population health impact of PCMHs’ collaborative, team
approach as well as the effectiveness of the other models that evolve.
Payment reform: One of the major objectives of health care reform
is to realign financial incentives for providers by accelerating the
transition from volume-based payment to value based payment
models. The Triple Aim of reduced total cost, better patient experience of care, and improved population health has become widely
accepted as the framework for value based payment.
CMS has been a major player in payment reform by scaling up the
implementation of new care models such as PCMH and ACOs
that incorporate new payment models. CMMI has initiated a series
of large-scale model tests which now involve tens of thousands of
providers and millions of Medicare and Medicaid beneficiaries.
In addition, CMS has recognized the key role that states play in
payment reform and has awarded two rounds of funding for its SIM
program which has now expanded to 37 states, territories and the
District of Columbia. The Secretary of Health and Human Services
has established the goal for CMS of having 50 percent of all its payments for Medicaid and Medicare services made using value-based
models by 2018.
Private payers such as commercial insurers and self insured employers have been following suit both through their own initiatives,
such as the alternative quality contract of Blue Cross Blue Shield
in Massachusetts, and through collaborations with public payers such as CMMI’s Comprehensive Primary Care Initiative. The
Health Care Transformation Task Force, a coalition of 28 health
care systems and insurers, has committed to having 75 percent of all
payments be value based by 2020.
These new payment models fundamentally change the incentives
for the healthcare system and create the opportunity for savings
in medical care which can be reinvested upstream in population
health initiatives. However, this is unlikely to happen with current
models because the incentives are too weak—we need to increase
the weight given to population health interventions. Also, the measures are too narrow—they need to be broadened beyond clinical
preventive services to include the determinants of health as well
as patient reported quality of life and well being. There is a limited
window but great opportunity to realize savings and invest wisely in
programs and policies that keep communities safe and healthy.
Emergence of innovative financing vehicles: We know that social
determinants, including behavior and environmental exposures,
play a greater role in population health than do clinical services.10
However, the time frames for public health interventions often
stretch over years, if not decades, and thus require different financing vehicles than payment models for clinical services.
One of the more exciting developments in public health is the
emergence of new financing vehicles for population health, such as
the ACA provision that not for profit hospitals must provide community benefit. The ACA strengthened this IRS requirement at the
same time that expanded insurance coverage is expected to reduce
the need for charity care. Therefore, there is great expectation that
healthcare systems will target freed-up funds toward true prevention and wellness efforts—efforts aimed to keep people healthy and
out of the clinical care system.
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New Directions in Public Health Services and Systems Research
Some financial institutions have a similar requirement to reinvest in
their community, per the Community Reinvestment Act. Community Development Financial Institutions (CDFI’s), with the encouragement of the Federal Reserve, have recently expanded their traditional focus on economic development and housing to health.11
Because these CDFI’s are sophisticated financial organizations
managing large, diverse portfolios, they bring advanced modeling
and analytic capabilities. We are already beginning to see innovative
partnerships developing between healthcare systems, public health
entities and these private sector institutions, and to see coordination across those partnerships so that portfolios, investments and
interventions are aligned (for example, the Alignment for Health
Equity and Development initiative, AHEAD).
These new financing vehicles offer the promise of major sources of
capital to fund programs and infrastructure targeted at upstream
determinants of health, but they also impose new requirements for
better evidence on financial impacts and better tools for projecting
long term consequences. Much of the traditional evidence for public health interventions stops at risk factors and does not go the next
step to document savings and costs. The development of convincing
business cases which tap new sources of capital will require new
types of evidence.
Engagement of sophisticated, well-funded new players, particularly the private sector: Businesses are important participants in
local, multi-stakeholder collaborations for population health improvement. An employer committed to improving the health of its
employees is dependent upon the existence of community resources
which address upstream determinants of health (e.g. sidewalks,
bike paths, access to healthy foods) and will often support those
resources. Employers have also been key players in, and funders
of, community integrator coalitions, e.g., several large employers pay a per employee annual assessment to the Upper CT River
Valley Rethink Health coalition. Businesses have real incentives
for improved health, including improving employee productivity,
controlling employee health care costs and improving recruitment
and retention of the workforce; this aligned self interest is a strong
motivator. Self-insured employers, who now account for a majority
of the commercially insured population, have a unique opportunity
to capture cost savings and reinvest them upstream. Some of these
employers are explicitly adopting triple aims objectives–they have
recognized the multiple benefits of having a healthier workforce
and are becoming much more proactive in designing their benefits
and interventions to explicitly target improvements in health. Many
of these companies are more nimble than public payers and provide
laboratories for innovation.
4
Channeling corporate philanthropy can also serve multiple roles,
such as contributing to healthier communities and improving community relations, overall goodwill, and branding. The resultant public/private partnerships can become the foundation for cooperation
and community-based problem solving for many other issues.
A promising trend is the social impact, or pay-for-success, model,
where private sector funding provides upfront investment for
evidence based interventions. For example, Chicago has expanded
early childhood education for vulnerable kids with social impact
bonds from Goldman Sachs.
Introduction of balanced portfolio concepts: As hospitals and
public health agencies increasingly work together to conduct health
needs assessments and develop community health improvement
plans, they are increasingly grappling with developing complementary sets of population health interventions.12,13 Conceptual
frameworks such as the County Health Rankings Model or Evans
and Stoddard’s determinants of health can provide a common
understanding of how health is influenced and guide selection
of interventions. Each community needs to create a portfolio of
interventions which addresses its prioritized needs, builds on its
resources and assets and matches each intervention to an appropriate financing vehicle. Just as a financial portfolio needs to be balanced among the options available, a community health portfolio
should also be balanced in multiple dimensions. These include time
horizons for expected outcomes, the level of risk or evidence for
interventions, and the scale of both health and financial return.14
Building and managing such a portfolio will require the development of community integrator or backbone organizations that can
manage the process from needs assessment to implementation.
Partial models of such organizations exist, but understanding how
to build more complete community integrators and how they will
interact with the other components of the public health system is a
major potential research theme discussed below.
Expansion of health data: Our access to and ability to share data
about individuals, clinical populations and communities continues
to grow with the rapid proliferation of health-related applications,
electronic health records (EHRs), and health information exchanges.15 Likewise, accessible data and information about communities from sources outside of public health or healthcare, such
as community development organizations, school systems, land
use and transportation departments and housing organizations, is
proliferating.
This rich data environment is the source of a wide array of opportunities for multi-sector collaboration to improve health as well as
new sources and measures of population health.16
B. Implications for governmental public health at
the national, state and local level
The changes in the public health system created by the drivers discussed above are having a profound impact on governmental public
health agencies. They are creating new ways of adding value and
challenging traditional roles, which in turn raise questions about
the core capabilities of governmental public health.
As a result, public health agencies are facing fundamental questions
about what roles to assume, how best to collaborate and whether to
strategically withdraw from traditional activities.17 Agency leaders
will need to be more nimble than ever to keep up with the pace of
change, despite a lack of flexible resources. This will require forming
close and mutually reinforcing relationships with clinical providers
and health insurers. Indeed, public health leaders must get a seat
at the table with health care system leaders. There is concern that
governmental public health is just a bystander in some states and
jurisdictions—that traditional public health services will erode or
that the promise of building a robust, comprehensive and synergistic health system will not be realized.
CEOs of health systems are not waiting for governmental public
health. They are recognizing the value of public health leadership
within their own organizations and creating new C-suite roles such
as Vice President of Population Health and Chief Transformation
Officer. In many cases they are hiring former health officers for
these positions, building out their teams by hiring experienced public health staff from governmental roles. The time for public health
innovation and collaboration is now. As is the time for investigation
of this dramatic shift.18
C. New themes for PHSSR
The changes in the public health system generated by the trends
highlighted above are unprecedented in both their rate and their
scope. They touch every segment of the system and challenge traditional assumptions about roles, core capabilities and structure.
When the last national agenda for PHSSR was published, the
authors noted that “to be successful in mobilizing the production of
more rigorous and relevant evidence, the national PHSSR research
agenda should function as a work in progress subject to continual
review, revision, and monitoring. New questions should be added
as the information needs and uncertainties of new stakeholders are
identifıed, as population needs and risks evolve, and as ongoing
research studies answer existing questions and raise new ones.”19
Understanding that both the key trends driving the changes and
the consequences for governmental public health entities are robust
topics for PHSSR in themselves, the following are some potential
new themes created by the transformation of the health system. Additional, specific questions are listed in the appendix.
The impact of state driven health reform on governmental public
health: State government plays a key role in designing and accelerating health care reform through the integration of tools available at
the state level. The SIMs program has engaged 37 states, territories
and the District of Columbia in a formal, structured process to
create and implement a state transformation plan which includes a
population health improvement plan.20
Resultant research questions include:
• How have governmental public health entities engaged in this
process and what barriers have they encountered?
• What strategies have they employed?
• What has been the impact on the role of governmental public
health, its partnerships and its core competencies? For example,
Oregon is leveraging health system transformation to improve
population health with governmental public health through
legislation requiring its Medicaid coordinated care organizations
(CCOs) to develop agreements with local public health authorities. How effective is mandating a role versus a more voluntary
approach?
Testing of strong community integrators: As mentioned above,
public health departments are increasingly collaborating with other
organizations that work with or serve the same local population—
from other sectors (e.g. community development, social services,
criminal justice, housing) to private business, behavioral health, and
health care.
Collaborating entities need organizational structures in order
to guide, grow and sustain their joint efforts over time. Often an
organization, either one of the participants or one newly formed
for the purpose, coordinates those involved and serves as backbone
or “quarterback” for the collaborative effort, in a role commonly
called “integrator.”21 An example of an integrator is the Atlanta
Regional Collaborative for Health Improvement (ARCHI) which
is a partnership of “organizations and experts who have a stake in a
comprehensive assessment of health priorities and a commitment
to ensuring local investments in health are crafted in a way that
improves health in Metro Atlanta.”22
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New Directions in Public Health Services and Systems Research
While many public health agencies have begun to learn and share
lessons about successful governance of collaborations with integrator organizations, we need a better understanding of how different
sizes and types of communities can successfully build and sustain
effective integrators to support collaboration for health improvement. Furthermore, the nature of integrator organizations often
makes sustainable financing a challenge for both their internal operations and their support projects, which, as discussed elsewhere
in this paper, makes research into financing and payment reform
relevant to strong community integrators.
The transition of healthcare systems to healthcare 3.0 and the
development of their public health capacities: While the path for
a healthcare system to evolve from a coordinated care to a community health centered system will vary with size and location, making
the transition will require holistically addressing patient’s needs in
their communities. Certainly this is the time to partner with governmental public health and to tap community resources.
What are the common barriers faced in this process and are there
strategies which increase the likelihood of success? How can governmental public health entities facilitate the transition and partner
with healthcare systems? What new skill sets will be required for
each of the participants?
The evolution of foundational capabilities for governmental public health entities: The well-documented variability in the availability and quality of public health services across the United States led
the Institute of Medicine to call for “…a minimum package of public health services, which includes the foundational capabilities and
an array of basic programs no health department can be without.”23
The Public Health Leadership Forum engaged federal, state and
local leaders to create a consensus set of foundational capabilities
and services described as “… cross-cutting skills so fundamental
that they need to be present in state and local health departments
everywhere for the health system to work anywhere.”24
A cost study of these capabilities and services is now being conducted in 12 states. It is hoped that this foundational capabilities
framework will be operationalized across the country and—in combination with accreditation and continuous quality improvement,
cross-jurisdictional sharing of services, increased collaboration with
health care systems and payers, more standardized and transparent financial accounting, and development of a multi-disciplinary,
boundary-spanning leadership for health—that public health agencies will be transformed and ready to meet the challenges of the
21st century.25 Given the variation in context and starting points,
how will the role and capabilities vary across communities?
6
The engagement of the private, for-profit sector in financing and
implementation of population health initiatives: The private forprofit sector is becoming more active in funding population health
initiatives and in providing a diverse set of services for improving
population health. These services include improving access to preventive care and behavior change support, collecting and analyzing
data on population health, and sophisticated financial analysis.
How is the private sector partnering with other stakeholders in
selecting its interventions? One concern is fragmentation of efforts.
Philanthropic investment, corporate social responsibility funds, or
direct investment in community health improvement need to be
coordinated so that a multi-stakeholder collaboration can apportion spending on the community’s highest priority health concerns.
Another area to explore is the potential for collaboration with
public health when capabilities overlap, e.g. metrics, data collection
and analytic models.
The development and implementation of population health metrics for monitoring and payment to provider systems and community integrators: The development of health metrics is essential
if population health is to be incorporated into value based contracts
and other systemic mechanics to reward best practices.
In a value based reimbursement arrangement, payments are often
tied to performance on a set of metrics. Including population health
metrics in those sets will incentivize greater attention to preventive, community health-oriented interventions and will incentivize
sustained engagement in local collaborative health improvement efforts.26 This includes enhanced measures as well as the data systems
to provide timelier and more granular data at the community and
health care system levels.
Such metrics are not difficult to identify if the type of population
health activities under consideration are traditional clinical services
(e.g. immunization, screening). Attention to prioritizing such metrics is necessary given the disappointingly low number of patients
who are counseled about and/or provided with evidence based
preventive services (e.g. smoking cessation, hypertension screening and control). More challenging are less conventional services
provided outside of a traditional clinical setting, such as homebased education and risk reduction performed by community
health workers, the provision of chronic disease self-management
or the use of home-based self-monitoring blood pressure devices.
The traditional mechanisms for identifying and establishing such
metrics–such as submitting proposals for review by the NQF, just
don’t work as well for such activities.
Even less easy to identify are those metrics which capture possible
actions by ACOs or large clinical providers and systems that might
reduce morbidity and mortality at the community level. A stronger
body of evidence is needed for innovative clinical and total community metrics. In addition, a systematic mechanism for capturing
such information must be developed and supported if population
health metrics are to be embedded consistently.
Conclusion
Generating timely and relevant research is difficult under the best
of circumstances, but the rapidly changing health policy environment makes it even more challenging. Early trends need to be
discerned in a chaotic setting. New data sources and analytic tools
need to be invented and tested. While we acknowledge that traditional academic incentives hinder the translation and dissemination
of research on a rapid-cycle, just-in-time basis, the time frame is
now for producing needed results.
Just as PHSSR has new realms to explore, new connections to make
between sectors and new questions and sources of data, it also will
have new audiences who will be interested in the kinds of evidence,
guidance and insights the research can provide. For example, the
increasingly common multi-stakeholder collaborations that are
developing in order to conduct community health improvement
processes will provide opportunities for exploring appropriate nontraditional metrics of success or exploring ways to track community
resilience.
CDFIs and other groups looking at new ways to strengthen communities are an important audience for new kinds of PHSSR
because of the specificity of their needs, including evidence of
return on investment for interventions. The purchasers, payers, and
providers who engage in alternate payment models (APMs) that
support higher value care and connections to other services such
as behavioral health tend to have more accountability for clinical population health. Providers in such arrangements could use
research methods and output with shorter timelines, to allow for
monitoring care and patient and community outcomes in more real
time and rapid cycle improvement.
Other new audiences for PHSSR include housing and urban
development, state Medicaid offices, urban or regional planning offices and community organizations such as YMCA or United Way.
Overall these new audiences call for practical PHSSR that explores
new and different models for the kind of whole health system transformation happening in communities across the country.
Local health departments should consider partnerships with
researchers and evaluators to ensure that research is more responsive and relevant to public health needs and policy making. Placing
researchers on a full time or part-time basis at local health departments also provides health departments an easier path to translating research into policy to improve public health. It is hoped that
new funding (i.e. opportunities for states and communities through
CMMI and PCORI) will be adapted to make it possible for health
departments to successfully compete for these dollars.
The unprecedented rate of change in the public health system
creates new challenges for PHSSR. If research is to be relevant, it
must be able to keep pace with the rapid evolution of the system
it is studying. This is not easy for a research community rooted in
academic standards of research design and peer review. Staying informed about the changes in environment and contexts may require
greater attention to works in progress and stronger relationships
with change agents in communities.
We hope this paper will serve as a catalyst and will help navigate the
chaos. PHSSR has an important role in shaping the design of the
new public health system, easing the transition from the old and
ensuring that the intended Triple Aim objectives are achieved. Fulfilling this role will involve many challenges, but we are confident
that the PHSSR community is up to the task.
Appendix: Research Questions
1. What organizational characteristics (ranging from size and
financial condition, to community setting characteristics, to
culture and leadership) are required for successful collaboration
between non-profit hospitals and governmental public health
agencies? What are the barriers for hospitals or health systems
to work with state and local public health in new health care
financing models?
2. How does assessment impact population health? What types
and under what circumstances are community assessments
most effective?
3. How does collaborative community health improvement planning impact population health? What types and under what
circumstances are community health improvement plans most
effective?
4. To what extent are financial and/or human resources aligned
across or shared between hospitals, health departments and
other community organizations as a result of collaborative community health assessments/community health improvement
plans? Does that alignment improve the community’s health?
5. How can we most effectively categorize and build evidence for
population-level interventions along multiple dimensions of a
balanced portfolio, including life course phases for which an
intervention is appropriate, outcome timelines, intervention
reliability, and return on investment?
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New Directions in Public Health Services and Systems Research
6. How can we most effectively extract appropriate data from
individual electronic health records as well as other new sources
of data, and aggregate it in ways that create reliable and valid
measures of population health (while protecting the privacy of
individuals)?
7. What organizational, fiscal, political, and other characteristics
lead a state public health system to undertake a process to
reorganize and transform public health structures and practices
utilizing the foundational public health services framework?
What are the population health impacts of such transformations? What hinders such change?
8. What are the roles of state and local health departments in new
and emerging health care financing models?
9. How are business models for public health changing as a result
of the ACA?
10. What are the gaps in the healthcare system that can be filled
by the public health system? In what roles or performing what
functions do governmental public health departments add the
most value to the health status of the community?
11. What policies are needed to strengthen public health service
delivery in the changing health system?
12. How are Medicaid and health insurance expansions impacting
public health infrastructure at the state and local level?
13. Are there better population health outcomes where there is
interoperability and bidirectional flow of public health and
clinical data systems?
14. Are there better population health outcomes when local health
departments are part of the local ACOs? Are there savings?
15. Does collaboration with local health departments lead to improved measured outcomes in PCMHs and ACOs?
Acknowledgements
The paper is intended to help inform and stimulate discussion.
The authors would like to acknowledge the helpful editorial
review by Katherine Froeb Papa and Dr. Margo Edmunds of
AcademyHealth. The views expressed in this discussion paper
are those of the authors and not necessarily of the authors’
organizations, the Centers for Disease Control and Prevention,
the Robert Wood Johnson Foundation or AcademyHealth.
Suggested Citation
Hester J, Auerbach J, Choucair B, Heishman H, Kuehnert P,
Monroe J. “New Directions in Public Health Services and Systems
Research,” AcademyHealth, June 2015.
8
Endnotes
1 For the purpose of this paper, population health is defined as “the health
outcomes of a group of individuals, including the distribution of such outcomes
within the group” from Kindig D, Stoddart G. What is population health?
American Journal of Public Health. 2003 Mar;93(3):380–3. The focus is total
population health—or the abbreviated “population health”—not population
management or population medicine, as defined by Kindig here: http://healthaffairs.org/blog/2015/04/06/what-are-we-talking-about-when-we-talk-aboutpopulation-health/.
2 Berwick D, Nolan T, Whittington J. The Triple Aim: Care, Health, and Cost.
Health Affairs. 2008 May; 27(3): 759-69.
3 Hester J, Auerbach J, Chang D, Magnan S, Monroe J. “Opportunity Knocks
Again for Population Health: Round Two in State Innovation Models,” Institute
of Medicine, April 2015. http://www.iom.edu/Global/Perspectives/2015/StateInnovation-Models-2.aspx.
4 Magnan S, Fisher E, Kindig D, Isham G, Wood D, Eustis M, Backstrom C, Leitz
S. “Achieving Accountability for Health and Health Care,” Institute for Clinical
Systems Improvement, 2012. https://www.icsi.org/_asset/qj7tk6/Commentary--Magnan.pdf.
5 Halfon N, Long P, Chang D, Hester J, Inkelas M, Rodgers A. Applying A 3.0
Transformation Framework to Guide Large-Scale Health System Reform. Health
Affairs. 2014 Nov; 33(11): 2003-11.
6 Stoto M. “Population Health in the Affordable Care Act Era,” AcademyHealth,
2013. http://www.academyhealth.org/files/AH2013pophealth.pdf.
7 Halfon N, Long P, Chang D, Hester J, Inkelas M, Rodgers A. Applying A 3.0
Transformation Framework to Guide Large-Scale Health System Reform. Health
Affairs. 2014 Nov; 33(11): 2003-11.
8 Shaw F, Asomugha C, Conway P, Rein A. The Patient Protection and Affordable
Care Act: Opportunities for Prevention and Public Health. The Lancet. 2014;
384(9937): 75-82.
9 See Practical Playbook: https://practicalplaybook.org/.
10 Booske B, Athens J, Kindig D, Park H, Remington P. “Different Perspectives
for Assigning Weights to Determinants of Health,” University of Wisconsin,
February 2010. https://uwphi.pophealth.wisc.edu/publications/other/differentperspectives-for-assigning-weights-to-determinants-of-health.pdf.
11 Erickson D, Andrews N. Partnerships Among Community Development, Public
Health, and Health Care Could Improve the Well-Being of Low-Income People.
Health Affairs. 2008 Nov; 30(11): 2056-63.
12 Health Research & Educational Trust. “Hospital-based Strategies for Creating a
Culture of Health,” October 2014. http://www.hpoe.org/resources/hpoehretahaguides/1687.
13 Laymon B, Shah G, Leep C, Elligers J J, Kumar V. The Proof ’s in the Partnerships:
Are Affordable Care Act and Local Health Department Accreditation Practices
Influencing Collaborative Partnerships in Community Health Assessment and
Improvement Planning? Journal of Public Health Management and Practice. Jan/
Feb; 21(1): 12-17.
14 Hester J, Stange P. “A Sustainable Financial Model for Community Health
Systems,” Institute of Medicine, 2014. https://www.iom.edu/~/media/Files/
Perspectives-Files/2014/Discussion-Papers/BPH-SustainableFinancialModel.pdf.
15 Holve E, Mays G. Filling the Gaps in Data and Methods for Public Health Services and Systems Research. eGEMS. April 2015; 2(4).
16 For a good example, see the New York City Macroscope project: http://www.nyc.
gov/html/doh/html/data/nycmacroscope.shtml.
17 The Public Health Leadership Forum suggests, in “The High Achieving Governmental Health Department in 2020 as the Community Health Strategist,” that the
key practices of the Chief Health Strategist include building a more integrated,
effective health system through collaboration between clinical care and public
health. See http://www.resolv.org/site-healthleadershipforum/.
18 For more on the study of “natural experiments” by PHSSR, see http://www.
publichealthsystems.org/dissemination/news/2012-10-13/researchers-examineimpact-system-changes-public-health and http://www.academyhealth.org/
Training/ResourceDetail.cfm?ItemNumber=7869.
22 See http://www.archicollaborative.org/.
19 See http://www.publichealthsystems.org/research/research-agenda.
24 See http://www.resolv.org/site-foundational-ph-services/.
20 Hester J, Auerbach J, Chang D, Magnan S, Monroe J. “Opportunity Knocks
Again for Population Health: Round Two in State Innovation Models,” Institute
of Medicine, April 2015. http://www.iom.edu/~/media/Files/PerspectivesFiles/2015/SIMsRound2.pdf.
25 Kuehnert P, Palacio H. Transforming Public Health in the United States. Perspectives in Public Health. 134 (51), 251-252.
21 See http://www.improvingpopulationhealth.org/blog/2012/05/what-does-apopulation-health-integrator-do.html.
23 “For the Public’s Health: Investing in a Healthier Future,” Institute of Medicine,
2012.
26 Auerbach J. Creating Incentives to Move Upstream: Developing a Diversified
Portfolio of Population Health Measures Within Payment and Health Care
Reform. American Journal of Public Health. March 2015, 105 (3): 427-31.
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