Nov 5 2013
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APHA 2013: Public Health System Transformation Under the Affordable Care Act

The changing environment for health departments under the Affordable Care Act (ACA) was the focus of a very well attended early morning session at the American Public Health Association (APHA) annual meeting in Boston today, moderated by APHA public health policy analyst Vanessa Forsberg, MPP.

Hospitals and private health care providers will soon be competing with health departments for clinical services such as immunizations for a newly insured population, according to Forsberg. However collaboration may help departments keep and grow clinical services, as well as collaborate with new partners under other new ACA rules, such as community benefit requirements for hospitals to improve population and individual health.

“There’s a lot of innovation, a lot of people moving into that space and this is a clarion call to say public health had a head start and don’t let the space be taken from you, learn the finance side,” said James Corbett, M.Div, JD, an ethics fellow at the Harvard Medical School and vice president of charity care and ethics at the Steward Health Care System in Boston.

Opportunities for health departments, says Corbett, include focusing on addressing disparities, preventive health, innovative programs and partnerships that improve care and reduce costs.

A key example Corbett shared was a decision by Steward to hire community health workers whose services can be billed for under the ACA beginning January 1. Corbett says he looked at the hospital’s bad debt documentation by language and found trends, then convinced the hospital’s CEO to allow him to hire community workers who got iPads and then went out into the community to visit patients who hadn’t paid bills. They were able to use the devices to record identification and other information, then help the patients sign up for Medicaid and other assistance that allowed them to be covered and the health system to be paid.

That model might work for health departments as well, and contrasted interestingly with a presentation by a Utah health department which detailed the high rate of uncompensated services the department delivers. Corbett says the community workers were able to capture $3 million in previously unpaid billings for the health system. The population health benefit, of course, is that by having benefits the health system can also then refer them to primary care providers ongoing preventive care and other health services.

“We’ll enroll them [in the ACA] and make sure they actually show up to the PCP practices,” said Corbett.

Amanda Parsons, MD, MBA, deputy commissioner of the New York City Department of Health and Mental Hygiene, spoke about the department’s primary care information project, which began as a mayoral initiative in 2005. Its mission is to improve the quality of care in medically underserved areas through health information technology. The project has aggregated data that can be used to improve individual and population health throughout the city. More than 6,000 providers were given electronic health record systems, which have enabled the city to collect meaningful, aggregated data on such things as body mass index and the number of patients getting screened for high blood pressure.

Parsons says they currently get de-identified data by practice and will soon be able to get that by provider, which will allow them to do—among other things—population surveillance, replacing in some cases “painful surveying” in order to get data for the city on such critical measures as obesity. Providers in the program are given dashboards (“they liked that term much better than report cards”) that show the aggregate data for their practices. “Most providers don’t know how their doing,” and find getting the information valuable, Parsons said.

The program has recently seen improvements in rates of all clinical preventive services measured. “everything is moving upward over time… [we’re] most excited about blood pressure control which moved five percent,” said Parsons, who said she encourages “all local health departments to find the regional health information organization” in their areas. RHIO, also known as Health Information Exchange Organization, are multi-stakeholder organizations created to help support health information exchanges which transfer health information electronically across organizations.

>>NewPublicHealth will be on the ground throughout the APHA conference speaking to public health leaders and presenters, hearing from attendees on the ground and providing updates from sessions, with a focus on how we can build a culture of health. Follow the coverage here.

Tags: APHA, Community Benefit, Community Health, Community benefit, Health insurance