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.

Contents

• THE NATIONAL ACADEMIES
• PLANNING COMMITTEE ON POPULATION HEALTH IMPLICATIONS OF THE AFFORDABLE CARE ACT
• ROUNDTABLE ON POPULATION HEALTH IMPROVEMENT
• Reviewers
• Acronyms
• 1. Introduction
• 2. Overview
• 3. Current Models for Integrating a Population Health Approach into Implementation of the Affordable Care Act
  • A NONPROFIT MODEL OF INTEGRATION
  • ALL-PAYER HOSPITAL PAYMENT REFORM
  • STATE-WIDE HEALTH SYSTEM TRANSFORMATION
  • THE COMMUNITY HEALTH CENTER PERSPECTIVE
  • DISCUSSION
• 4. A Proposal to Bridge the Divide Between Health and Health Care
  • DISCUSSION
• 5. Catalyzing and Sustaining the Adoption and Integration of a Population Health Concept
  • PERSPECTIVES FROM AN INTEGRATED CHILD HEALTH SYSTEM
  • THE ROLE OF GRASSROOTS LEADERS IN IMPROVING COMMUNITY HEALTH
  • CREATING A FUNDING STREAM TO REWARD IMPROVEMENTS IN POPULATION HEALTH
  • BUILDING BETTER HEALTH AT THE COUNTY LEVEL
  • THE MASSACHUSETTS EXPERIENCE WITH INNOVATIONS IN INTEGRATING POPULATION HEALTH
  • MOVING HOSPITALS TOWARD POPULATION HEALTH
  • DISCUSSION
• 6. Final Thoughts
• APPENDIXES
  • Appendix A References
  • Appendix B Biographies of Speakers
  • Appendix C Workshop Agenda

Rapporteur: Joe Alper.

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.

Suggested citation:

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

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.