文章基本信息

标题：Population Health, Public Health, and Accountable Care: Emerging Roles and Relationships
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作者：Julia F. Costich ; F. Douglas Scutchfield ; Richard C. Ingram 等
期刊名称：American journal of public health
印刷版ISSN：0090-0036
出版年度：2015
卷号：105
期号：5
页码：846-850
DOI：10.2105/AJPH.2014.302484
语种：English
出版社：American Public Health Association
摘要：To identify roles for public health agencies (PHAs) in accountable care organizations (ACOs), along with their obstacles and facilitators, we interviewed individuals from 9 ACOs, including Medicare, Medicaid, and commercial payers. We learned that PHAs participate in ACO-like partnerships with state Medicaid agencies, but interviewees identified barriers to collaboration with Medicare and commercial ACOs, including Medicare participation requirements, membership cost, risk-bearing restrictions, data-sharing constraints, differences between medicine and public health, and ACOs’ investment yield needs. Collaboration was more likely when organizations had common objectives, ACO sponsors had substantial market share, PHA representatives served on ACO advisory boards, and there were preexisting contractual relationships. ACO–PHA relationships are not as straightforward as their shared use of the term “population health” would suggest, but some ACO partnerships could give PHAs access to new revenue streams. Accountable care organizations (ACOs) have proliferated across the United States to serve patients covered by Medicare, commercial insurers, and Medicaid. An ACO is an association of providers and third-party payers that assumes a defined range of responsibilities for a specific population and is held accountable, financially as well as through specific quality indicators, for its members’ health. 1 Because of ACOs’ population health orientation and need for related expertise, there may be roles or market niches for state or local public health agencies (PHAs) with ACOs. For example, the surveillance function of PHAs could identify persons at risk for having costly health problems, particularly communicable conditions such as tuberculosis and sexually transmitted infections. PHAs often maintain registries of groups or serve hard-to-reach populations that could incur disproportionate costs as ACO members, such as persons with cancer or stroke, infants with birth anomalies, and vulnerable populations needing attention during emergencies. However, although public health competencies are used to address the health of all those residing in a PHA’s jurisdiction, the attributed population in an ACO includes only individuals who receive primary care from ACO member providers and is thus a small subset of the population served by a PHA. 1 Considering this distinction between the populations served by PHAs and ACOs, why would ACO collaborations be of interest to PHAs? One answer is that government public health programs have undergone repeated funding cuts at all levels since 2008 and are thus under some pressure to identify alternative revenue sources, including ACOs. 2,3 PHAs could also be interested in ACO collaboration because their core mission is to improve the health of the populations they serve. When a PHA helps an ACO improve its members’ health, it raises the health status of its own population.