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Suggested Citation:"Front Matter." Institute of Medicine. 2014. Population Health Implications of the Affordable Care Act: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/18546.
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POPULATION HEALTH
IMPLICATIONS of the
AFFORDABLE CARE ACT

WORKSHOP SUMMARY

Joe Alper, Rapporteur

Roundtable on Population Health Improvement

Board on Population Health and Public Health Practice

INSTITUTE OF MEDICINE
              OF THE NATIONAL ACADEMIES

THE NATIONAL ACADEMIES PRESS

Washington, D.C.

www.nap.edu

Suggested Citation:"Front Matter." Institute of Medicine. 2014. Population Health Implications of the Affordable Care Act: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/18546.
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THE NATIONAL ACADEMIES PRESS     500 Fifth Street, NW      Washington, DC 20001

NOTICE: The workshop that is the subject of this workshop summary was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine.

This activity was supported by contracts between the National Academy of Sciences and The California Endowment (20112338), the California HealthCare Foundation (17102), HealthPartners, Health Resources and Services Administration (HHSH25034015T), Kaiser East Bay Community Foundation (20131471), Kresge Foundation (101288), the Mayo Clinic, Missouri Foundation for Health (12-0879-SOF-12), the National Association of County and City Health Officials (2013-010204), Nemours, New York State Health Foundation (12-01708), Novo Nordisk, and the Robert Wood Johnson Foundation (70555). The views presented in this publication do not necessarily reflect the views of the organizations or agencies that provided support for the activity.

International Standard Book Number-13: 978-0-309-29434-8

International Standard Book Number-10: 0-309-29434-7

Additional copies of this workshop summary are available for sale from the National Academies Press, 500 Fifth Street, NW, Keck 360, Washington, DC 20001; (800) 624-6242 or (202) 334-3313; http://www.nap.edu.

For more information about the Institute of Medicine, visit the IOM home page at: www.iom.edu.

Copyright 2014 by the National Academy of Sciences. All rights reserved.

Printed in the United States of America

The serpent has been a symbol of long life, healing, and knowledge among almost all cultures and religions since the beginning of recorded history. The serpent adopted as a logotype by the Institute of Medicine is a relief carving from ancient Greece, now held by the Staatliche Museen in Berlin.

Suggested citation: IOM (Institute of Medicine). 2014. Population health implications of the Affordable Care Act: Workshop summary. Washington, DC: The National Academies Press.

Suggested Citation:"Front Matter." Institute of Medicine. 2014. Population Health Implications of the Affordable Care Act: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/18546.
×

Knowing is not enough; we must apply.
Willing is not enough; we must do.
”      

                                                —Goethe

image

INSTITUTE OF MEDICINE
              OF THE NATIONAL ACADEMIES

Advising the Nation. Improving Health.

Suggested Citation:"Front Matter." Institute of Medicine. 2014. Population Health Implications of the Affordable Care Act: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/18546.
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THE NATIONAL ACADEMIES

Advisers to the Nation on Science, Engineering, and Medicine

The National Academy of Sciences is a private, nonprofit, self-perpetuating society of distinguished scholars engaged in scientific and engineering research, dedicated to the furtherance of science and technology and to their use for the general welfare. Upon the authority of the charter granted to it by the Congress in 1863, the Academy has a mandate that requires it to advise the federal government on scientific and technical matters. Dr. Ralph J. Cicerone is president of the National Academy of Sciences.

The National Academy of Engineering was established in 1964, under the charter of the National Academy of Sciences, as a parallel organization of outstanding engineers. It is autonomous in its administration and in the selection of its members, sharing with the National Academy of Sciences the responsibility for advising the federal government. The National Academy of Engineering also sponsors engineering programs aimed at meeting national needs, encourages education and research, and recognizes the superior achievements of engineers. Dr. C. D. Mote, Jr., is president of the National Academy of Engineering.

The Institute of Medicine was established in 1970 by the National Academy of Sciences to secure the services of eminent members of appropriate professions in the examination of policy matters pertaining to the health of the public. The Institute acts under the responsibility given to the National Academy of Sciences by its congressional charter to be an adviser to the federal government and, upon its own initiative, to identify issues of medical care, research, and education. Dr. Harvey V. Fineberg is president of the Institute of Medicine.

The National Research Council was organized by the National Academy of Sciences in 1916 to associate the broad community of science and technology with the Academy’s purposes of furthering knowledge and advising the federal government. Functioning in accordance with general policies determined by the Academy, the Council has become the principal operating agency of both the National Academy of Sciences and the National Academy of Engineering in providing services to the government, the public, and the scientific and engineering communities. The Council is administered jointly by both Academies and the Institute of Medicine. Dr. Ralph J. Cicerone and Dr. C. D. Mote, Jr., are chair and vice chair, respectively, of the National Research Council.

www.national-academies.org

Suggested Citation:"Front Matter." Institute of Medicine. 2014. Population Health Implications of the Affordable Care Act: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/18546.
×

PLANNING COMMITTEE ON POPULATION HEALTH IMPLICATIONS OF THE AFFORDABLE CARE ACT1

GEORGE R. FLORES (Co-Chair), Program Manager, The California Endowment

DAVID KINDIG (Co-Chair), Professor Emeritus, University of Wisconsin School of Medicine and Public Health

DEBBIE I. CHANG, Vice President, Policy and Prevention, Nemours

DAVE CHOKSHI, White House Fellow, Department of Veterans Affairs

JEFFREY LEVI, Executive Director, Trust for America’s Health, and Assistant Professor, Department of Health Policy, George Washington University

JUDITH A. MONROE, Director, Office for State, Tribal, Local and Territorial Support, Centers for Disease Control and Prevention

KAVITA PATEL, Fellow and Managing Director, Engelberg Center for Health Care Reform, The Brookings Institute

ANDREW S. REIN, Associate Director for Policy, Centers for Disease Control and Prevention

Consultant

JOE ALPER, Consulting Writer

IOM Staff

ALINA B. BACIU, Study Director

COLIN F. FINK, Senior Program Assistant

LYLA HERNANDEZ, Senior Program Officer

ANDREW LEMERISE, Research Associate

CAROL MASON SPICER, Associate Program Officer

ROSE MARIE MARTINEZ, Director, Board on Population Health and Public Health Practice

______________

1 Institute of Medicine planning committees are solely responsible for organizing the workshop, identifying topics, and choosing speakers. The responsibility for the published workshop summary rests with the workshop rapporteur and the institution.

Suggested Citation:"Front Matter." Institute of Medicine. 2014. Population Health Implications of the Affordable Care Act: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/18546.
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Suggested Citation:"Front Matter." Institute of Medicine. 2014. Population Health Implications of the Affordable Care Act: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/18546.
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ROUNDTABLE ON POPULATION HEALTH IMPROVEMENT1

GEORGE ISHAM (Co-Chair), Senior Advisor, HealthPartners, and Senior Fellow, HealthPartners Institute for Education and Research

DAVID KINDIG (Co-Chair), Professor Emeritus, University of Wisconsin School of Medicine and Public Health

TERRY ALLAN, President, National Association of County and City Health Officials, and Health Commissioner, Cuyahoga County (Ohio) Board of Health

RAYMOND J. BAXTER, Senior Vice President, Community Benefit, Research and Health Policy, Kaiser Permanente, and President, Kaiser Foundation International

DEBBIE I. CHANG, Vice President, Policy and Prevention, Nemours

GEORGE R. FLORES, Program Manager, The California Endowment

MARY LOU GOEKE, Executive Director, United Way of Santa Cruz County, California

MARTHE R. GOLD, Visiting Scholar, New York Academy of Medicine, and Professor, Sophie Davis School of Biomedical Education, City College of New York

PEGGY A. HONORÉ, Director, Public Health System, Finance and Quality Program, Office of the Assistant Secretary for Health, Department of Health and Human Services

ROBERT HUGHES, President and Chief Executive Officer, Missouri Foundation for Health

ROBERT M. KAPLAN, Director, Office of Behavioral and Social Sciences Research, National Institutes of Health

JAMES KNICKMAN, President and Chief Executive Officer, New York State Health Foundation

PAULA LANTZ, Professor and Chair, Department of Health Policy, The George Washington University School of Public Health and Health Services

MICHELLE LARKIN, Assistant Vice President, Health Group, Robert Wood Johnson Foundation

THOMAS A. LAVEIST, Professor and Director, Hopkins for Health Disparities Solutions, Johns Hopkins Bloomberg School of Public Health

JEFFREY LEVI, Executive Director, Trust for America’s Health

SARAH R. LINDE, Rear Admiral, U.S. Public Health Service, Chief Public Health Officer, Health Resources and Services Administration

______________

1 Institute of Medicine forums and roundtables do not issue, review, or approve individual documents. The responsibility for the published workshop summary rests with the workshop rapporteur and the institution.

Page viii Cite
Suggested Citation:"Front Matter." Institute of Medicine. 2014. Population Health Implications of the Affordable Care Act: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/18546.
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SANNE MAGNAN, President and CEO, Institute for Clinical Systems Improvement

PHYLLIS D. MEADOWS, Senior Fellow, Health Program, Kresge Foundation, and Associate Dean for Practice, Office of Public Health Practice, School of Public Health, University of Michigan

JUDITH A. MONROE, Director, Office for State, Tribal, Local and Territorial Support, Centers for Disease Control and Prevention

JOSÉ MONTERO, President, Association of State and Territorial Health Officials, and Director, New Hampshire Division of Public Health Services

MARY PITTMAN, President and Chief Executive Officer, Public Health Institute

PAMELA RUSSO, Senior Program Officer, Robert Wood Johnson Foundation

LILA J. FINNEY RUTTEN, Associate Scientific Director, Population Health Science Program, Department of Health Sciences Research, Mayo Clinic

BRIAN SAKURADA, Senior Director, Managed Markets and Integrated Health Systems, Novo Nordisk

MARTIN JOSÉ SEPÚLVEDA, IBM Fellow and Vice President, Health Systems Policy Research, IBM Corporation

ANDREW WEBBER, Chief Executive Officer, Maine Health Management Coalition

IOM Staff

ALINA B. BACIU, Study Director

COLIN F. FINK, Senior Program Assistant

LYLA HERNANDEZ, Senior Program Officer

ANDREW LEMERISE, Research Associate

CAROL MASON SPICER, Associate Program Officer

ROSE MARIE MARTINEZ, Director, Board on Population Health and Public Health Practice

Suggested Citation:"Front Matter." Institute of Medicine. 2014. Population Health Implications of the Affordable Care Act: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/18546.
×

Reviewers

This workshop summary has been reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise, in accordance with procedures approved by the National Research Council’s Report Review Committee. The purpose of this independent review is to provide candid and critical comments that will assist the institution in making its published workshop summary as sound as possible and to ensure that the workshop summary meets institutional standards for objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the process. We wish to thank the following individuals for their review of this workshop summary:

Georges Benjamin, American Public Health Association

Lawrence Deyton, George Washington University

David Kindig, University of Wisconsin–Madison

Kate Papa, AcademyHealth

Although the reviewers listed above have provided many constructive comments and suggestions, they did not see the final draft of the workshop summary before its release. The review of this workshop summary was overseen by Susan J. Curry, University of Iowa. Appointed by the Institute of Medicine, she was responsible for making certain that an independent examination of this workshop summary was carried out in accordance with institutional procedures and that all review comments were carefully considered. Responsibility for the final content of this workshop summary rests entirely with the rapporteur and the institution.

Suggested Citation:"Front Matter." Institute of Medicine. 2014. Population Health Implications of the Affordable Care Act: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/18546.
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Suggested Citation:"Front Matter." Institute of Medicine. 2014. Population Health Implications of the Affordable Care Act: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/18546.
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Acronyms

ABIA Austen BioInnovation Institute in Akron
ACA Affordable Care Act
ACC accountable care community
ACO accountable care organization

CCO coordinated care organization
CCROPP Central California Regional Obesity Program
CDC Centers for Disease Control and Prevention
CHA Catholic Health Association
CHNA community health needs assessment
CHW community health worker
CMS Centers for Medicare & Medicaid Services
CPPW Communities Putting Prevention to Work

EHR electronic health record

HHSA Health and Human Services Agency

IOM Institute of Medicine
IRS Internal Revenue Service

NACCHO National Association of County and City Health Officials

Suggested Citation:"Front Matter." Institute of Medicine. 2014. Population Health Implications of the Affordable Care Act: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/18546.
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ONC Office of the National Coordinator for Health Information Technology

SCHIP State Children’s Health Insurance Program

TCE The California Endowment
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Population Health Implications of the Affordable Care Act: Workshop Summary Get This Book
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Population Health Implications of the Affordable Care Act is the summary of a workshop convened in June 2013 by the Institute of Medicine Roundtable on Population Health Improvement to explore the likely impact on population health improvement of various provisions within the Affordable Care Act (ACA). This public workshop featured presentations and discussion of the impact of various provisions in the ACA on population health improvement.

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 proportion 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.

Population Health Implications of the Affordable Care Act looks beyond narrow interpretations of population as the group of patients covered by a health plan to consider a more expansive understanding of population, one focused on the distribution of health outcomes across all individuals living within a certain set of geopolitical boundaries. 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 concept 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 acting to transform the places where people live, work, study, and play. This report examines 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.

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