Health care and population health: Can payment reform help bridge the gap?

The ninth essential service of public health calls on the public health community to “evaluate the effectiveness, accessibility, and quality of personal and population-based health services.” Yet, the separation between public health and health care has been almost complete. The public health community has not participated in assessing the quality of health care or contributed to a vision of coherent reform.

Studies have documented dramatic variation in medical care across the states and regions, yet there is little relationship between the medical care delivered and its outcome. Ironically, the amount—and cost—of care received appears to be inversely related to positive outcomes. Most observers agree that we face a widening gap between the promise of advances in the science of disease biology and the effectiveness of the U.S. personal health care system at improving population health.

This session will focus on how the policies, politics, and economics of the health system in both the public and private sectors have led to the current crisis in health care. Dr. Elliott Fisher will review recent evidence on geographic and health-system variations in practice; the relationship between spending on personal health care services and the quality and outcomes of care; and the implications of these findings for practice, policy, and payment reform. Dr. Mark McClellan will review current federal and private sector efforts to increase accountability through performance measurement and payment reform initiatives—and the promise these hold for redirecting the delivery system from an emphasis on delivering services to improving health. Dr. JudyAnn Bigby, Secretary of Health and Human Services for Massachusetts, will describe health care reform initiatives at the state level and the challenges facing the public sector to effectively promote and improve population health. Dr. Bigby will advocate for innovative strategies to reduce health disparities, engage communities, and broaden the education of health professionals about the inter-relationship of social and culture factors in the lives of patients and populations.

Presenters will also discuss how current health care reform initiatives provide an opportunity for the public health community to more effectively address its responsibility to monitor and improve population health in collaboration with the medical care system.