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ACA funding also has the potential to
improve population health through initiatives
such as Community Transformation Grants
(community-level efforts to prevent chronic
disease) and workplace wellness program
incentives. On January 5, 2016, HHS
announced funding of $157 million through
the Accountable Health Communities Model.
The funds will support “up to 44 bridge
organizations, which will deploy a common,
comprehensive screening assessment
for health-related social needs among
all Medicare and Medicaid beneficiaries
accessing care at participating clinical
delivery sites.”
5
Healthcare providers are
also incented, as with the Internal Revenue
Service requirements for tax-exempt
hospitals, to develop Community Health
Needs Assessments. In addition, there are
Community Health Assessment requirements
for health departments seeking accreditation
through the Public Health Accreditation
Board.
2
These last two mechanisms include
performance measures requiring the
“identification of entities accountable for
specific activities that contribute to overall
community and population health.”
2
Although seemingly a daunting task,
integrated service delivery that addresses
social determinants and population health
is possible – and already being done
successfully by multiple organizations.
The State of California
California’s Frequent Users of Health
Services Initiative “promotes the
development and implementation of
innovative, integrated approaches to
addressing the comprehensive health
and social service needs of frequent users
of emergency departments (EDs).”
6
The
Initiative funds a program office within the
Corporation for Supportive Housing along
with six programs. Forty-five percent
of the enrolled frequent users were
homeless; more than a third were placed in
permanent housing and 54 percent were
placed in shelters, board and care homes
or similar placements.
The programs concentrated on connecting
the participants to housing and
understanding the impact of this connection
for homeless clients and ED and inpatient
outcomes. According to the Final Evaluation
Report, “clients connected to permanent
housing showed greater reductions in both
ED use and charges compared to those who
remained homeless or in less stable housing
arrangements” (34 percent versus 12 percent
reduction in ED visits and 32 percent versus
2 percent reduction in ED charges). Positive
results in the number of inpatient days and
charges were also reported.
Floyd Memorial Hospital
Floyd County, Indiana (population 75,000),
has low levels of poverty compared with the
rest of the United States. However, it ranks
83 out of 92 Indiana counties in tobacco use
and has significant areas for improvement in
all areas of lung health. Additionally, obesity
rates are high (30 percent of the population
are obese; 60 percent are overweight or
obese). These issues have contributed to a
high incidence of heart disease and high
healthcare costs.
7
To fight the problem, Floyd Memorial
Hospital and Health Services focused on
heart disease, obesity and cancer (lung,
colon, breast). They implemented three
community coalitions (Physical Activity,
Nutrition, Tobacco) to tackle each priority.
Over two years, the hospital’s community
benefit platform has undergone a huge shift
to align with these priorities. It completed
a community health needs assessment,
an action plan, focused priority areas
and launched three engaged community
coalitions (Physical Activity, Improving
Nutrition and Tobacco Prevention and
Cessation) and a grant-giving program.
The Floyd Memorial team reported several
achievements, including funding mini-grants
for physical activity programs, staging Fitness
Days, a project that encouraged eating
home-grown vegetables and creating an
online student health magazine.
