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Introduction1

The Institute of Medicine (IOM) Roundtable on Population Health Improvement brings together individuals and organizations that represent different stakeholders (e.g., public and private sector, health and health care) in a dialogue about what is needed to improve population health. The roundtable engages members and outside experts, practitioners, and organizations on three core issues: (1) supporting fruitful interaction between primary care and public health, (2) strengthening governmental public health, and (3) exploring community action in transforming the conditions that influence the public’s health.

The roundtable held a workshop on June 13, 2013, to explore the likely impact on population health improvement of various provisions within the Affordable Care Act (ACA). The workshop was organized by an independent planning committee in accordance with the procedures of the National Academy of Sciences. The planning group was co-chaired by George Flores and David Kindig (also a co-chair of the roundtable), and was composed of Debbie Chang, Dave Chokshi, Jeffrey Levi, Judith Monroe, Kavita Patel, and Andrew Rein. The task of the committee was to plan and conduct a public workshop featuring presentations and discussion of the impact of various provisions in the ACA on population health improvement. The committee was asked to define the specific topics to

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1 The planning committee’s role was limited to planning the workshop. Statements, recommendations, and opinions expressed are those of individual presenters and participants, and are not necessarily endorsed or verified by the Institute of Medicine, and they should not be construed as reflecting any group consensus.



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1 Introduction1 T he Institute of Medicine (IOM) Roundtable on Population Health Improvement brings together individuals and organizations that represent different stakeholders (e.g., public and private sector, health and health care) in a dialogue about what is needed to improve population health. The roundtable engages members and outside experts, practitioners, and organizations on three core issues: (1) supporting fruit- ful interaction between primary care and public health, (2) strengthening governmental public health, and (3) exploring community action in trans- forming the conditions that influence the public’s health. The roundtable held a workshop on June 13, 2013, to explore the likely impact on population health improvement of various provisions within the Affordable Care Act (ACA). The workshop was organized by an independent planning committee in accordance with the procedures of the National Academy of Sciences. The planning group was co-chaired by George Flores and David Kindig (also a co-chair of the roundtable), and was composed of Debbie Chang, Dave Chokshi, Jeffrey Levi, Judith Monroe, Kavita Patel, and Andrew Rein. The task of the committee was to plan and conduct a public workshop featuring presentations and discus- sion of the impact of various provisions in the ACA on population health improvement. The committee was asked to define the specific topics to 1 The planning committee’s role was limited to planning the workshop. Statements, rec- ommendations, and opinions expressed are those of individual presenters and participants, and are not necessarily endorsed or verified by the Institute of Medicine, and they should not be construed as reflecting any group consensus. 1

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2 POPULATION HEALTH IMPLICATIONS OF THE AFFORDABLE CARE ACT be addressed, develop the agenda, select and invite speakers and other participants, and moderate the discussions. Unlike a consensus com- mittee report, a workshop summary may not contain conclusions and recommendations, except as expressed by and attributed to individual presenters and participants. Therefore, the summary has been prepared by the workshop rapporteur as a factual summary of what occurred at the workshop. Several provisions of the ACA offer an unprecedented opportunity to shift the focus of health experts, policy makers, and the public beyond health care delivery to the broader array of factors that play a role in shaping health outcomes. The shift includes a growing recognition that the health care delivery system is responsible for only a modest pro- portion of what makes and keeps Americans healthy and that health care providers and organizations could accept and embrace a richer role in communities, working in partnership with public health agencies, community-based organizations, schools, businesses, and many others to identify and solve the thorny problems that contribute to poor health. The first step requires going beyond narrow interpretations of population, such as the group of patients covered by a health plan. A more expansive understanding of population is necessary, one focused on the distribution of health outcomes (Kindig and Stoddart, 2003) across all individuals liv- ing within a certain set of geopolitical boundaries (Jacobson and Teutsch, 2012). In establishing the National Prevention, Health Promotion, and Public Health Council, creating a fund for prevention and public health, and requiring nonprofit hospitals to transform their understanding of community benefit, the ACA has expanded the arena for interventions to improve health beyond the “doctor’s” office. Improving the health of the population—whether in a community or in the nation as a whole— requires action to transform the places where people live, work, study, and play. The June 13, 2013, workshop on Population Health Implica- tions of the Affordable Care Act examined the population health–oriented efforts of and interactions among public health agencies (state and local), communities, and health care delivery organizations that are beginning to facilitate such action. The workshop was moderated by roundtable co-chairs George Isham and David Kindig, and featured presentations from invited speakers orga- nized into two topical panels and a keynote address. Chapter 2 of the workshop summary offers a synopsis of the morning’s introductory pre- sentation, which provided an overview of the workshop’s focus. Chap- ters 3 through 5 focus on specific topics and include summaries of one or more speaker presentations, followed by a section that synthesizes a group discussion led by moderators and including roundtable members and audience members. Chapter 3 summarizes the first panel’s presenta-

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INTRODUCTION 3 tions on current models for integrating a population health approach into implementation of the ACA. Chapter 4 describes the workshop’s keynote presentation on a proposal to bridge the divide between health and health care. Chapter 5 summarizes the second panel’s presentations on catalyz- ing and sustaining the adoption and integration of a population health concept. The report concludes with Chapter 6, a general discussion of the day’s proceedings.

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