With the implementation of the Affordable Care Act and the push toward the Triple Aim of patient-focused care, lower costs, and improved health of populations — “population health” has become a buzzword, often coming to mean improving medical care or simply delivering healthcare to larger groups of people. While providing high-quality healthcare is critical, improving the health of a population is a much bigger endeavor.
Improving population health ultimately means creating healthy communities. It involves a myriad of interrelated factors that contribute to an individual’s health – such as safety in the home, appropriate housing, education, access to healthy food, clean air, time and space for recreation, social connections, and mental health services.
In a large, diverse, and inclusive state willing to invest in its people—with many funders pledging support for new approaches, California has become a proving ground for innovative programs to improve population health and serve as models that can be replicated elsewhere. Successful models have some things in common: They use data to precisely identify which factors are impacting health: establish shared goals and benchmarks; and track progress over time.
Programs that are scalable and effectively improve community health encourage cross-sector collaboration—so that it’s not just hospitals, physicians, or community health centers working to keep people healthy. Schools, social organizations, housing agencies, and other government departments are all striving to move the needle.
Sonoma County, Stockton, and Ventura County are among many bright spots in California, providing examples of successful efforts to create healthier communities using data and cross-sector collaboration to target specific needs — bringing schools, governments, non-profits, and health centers together to address them.
Picturing Health in Sonoma County
Sonoma County commissioned a study that gathered and analyzed information from an array of publicly available data sources to create A Portrait of Sonoma County, a snapshot of factors that affect the health of residents, with many measures focused down to a granular neighborhood level. More than 75 organizations and individuals pledged to use the report to improve factors that are impacting the health of Sonoma County communities. Since the report was broken down by issues affected health, education, and income at a neighborhood level, it led to specific, targeted actions.
Among those actions, a community health collective identified specific neighborhoods to receive additional health screenings and attract healthy food markets. The county supervisors, noting the major impact smoking had on health countywide, expanded policies providing secondhand smoke protections to include e-cigarettes. A community health program created resource guides in Spanish and English to address this gap in the safety net.
Identifying Trauma Victims Earlier
In Stockton, data from a community needs assessment showed trauma was significantly impacting health in South Stockton. The California Accountable Communities for Health Initiative, established by a group of health funders including Blue Shield of California Foundation, funded their efforts to develop and expand trauma prevention recovery programs in the South Stockton Promise Zone. Young people exposed to abuse or violence in the home and the community are at risk for poor mental health and even for heart disease, depression, and alcoholism as adults. The grant creates a system of care providers, mentors, and school personnel trained to identify victims of trauma as early as possible and match them with social support and recovery services.
Customizing support for probation
Ventura County is testing a program to reduce recidivism by providing evidence-based services to men and women on probation. The goal is to help each client get access to the services they need most to help them lead healthy and productive lives when returning to their families and communities. Success will be measured by an independent evaluator, using administrative data in a randomized controlled trial conducted by the University of California, Los Angeles. The project uses a “Pay for Success” funding model where investors will recoup their investments if the rate at which participants commit new crimes is at least 5 percent lower than similar people who are not getting the customized services.
These examples of healthier communities are made possible when data infrastructure and support for cross-sector collaboration are in place. Improvements in community health will become visible when we bring models like these to a national scale — where communities, including the healthcare system, are focused first on creating environments that keep people healthy and, when necessary, providing services in a way that supports healthy populations.
The Biggest Barrier to Improving Population Health
While cross-sector models demonstrate that it is possible to make communities healthier, we can’t ignore one of the biggest barriers — our fee-for-service system for paying for healthcare — which encourages us to treat many health and social issues like medical problems, or to wait until they become medical problems, rather than identifying and systematically addressing the root causes.
A payment system that provides incentives and rewards for keeping people healthy is critical to an infrastructure that supports healthy communities.
When Blue Shield of California Foundation brought together 25 leaders from all corners of healthcare to talk about healthcare innovation, they all agreed that ending the fee-for-service payment system would be a cornerstone for encouraging innovation, reducing the volume of healthcare consumed, and lowering costs for everyone. The fee-for-service payment system creates a strong business case for creating, promoting and selling new products, which has led to great innovation in drugs and services. It also creates a systemic disincentive for creating healthy communities, preventing violence, preventing illness, and avoiding unnecessary hospitalizations and procedures.
As a testing ground for innovation, California has shown that when we provide the infrastructure of data to get a better picture of the factors that impact health, and when we invest the seed money that supports and encourages cross-sector collaboration, it is possible to foster the creation of healthier communities.
About Peter Long, PhD
Peter Long, PhD, is the president and CEO of Blue Shield of California Foundation. He leads the Foundation in its mission to improve the lives of all Californians, particularly the underserved, by making health care accessible, effective, and affordable, and by ending domestic violence. Prior to joining Blue Shield of California Foundation, Dr. Long served in leadership roles at the Henry J. Kaiser Family Foundation and The California Endowment. He has extensive experience working on health policy issues at the state, national, and global levels, and has written numerous papers on the topic. Dr. Long also served as the director of development and programs for the Indian Health Center of Santa Clara Valley in San Jose, before assuming his position there as executive director.