Re-envisioning Health Care: Integrating Community and Clinical Prevention

With unprecedented investments in population health, the Affordable Care Act (ACA) provides an opportunity to transform health care delivery in a way that not only increases quality and efficiency but also increases community health and health equity. Because research has shown that environments and behaviors have the greatest sum impact on patient health, effectively integrating community prevention into health services delivery will be critical to ACA implementation and overall efforts to expand coverage, improve quality, and reduce costs. This session presents the concept and elements of a “community-centered health home” (CCHH), which builds on both ACA investments in community prevention and health homes and the tradition of community-focused work in community clinics. The CCHH takes these models a step further: encouraging health care institutions to take an active role in strengthening their surrounding community, in addition to improving the health of individual patients. The defining attribute of the CCHH is active involvement in community advocacy and systems change. A CCHH not only acknowledges that factors outside the health care system affect patient health outcomes but also actively participates in improving them. Health care providers, however, often do not have the tools or support systems to engage in community change. Through research and key informant interviews, Prevention Institute developed a set of elements for health care institutions to implement that comprise a comprehensive approach to patient health that integrates efficient clinical practice with community change. The approach mirrors the diagnosis, monitoring, and treatment framework employed by physicians for their work with individual patients, broadening it to the larger community as inquiry, assessment, and action. In this session, the presenter from Prevention Institute will begin by covering the importance of community prevention for reducing rates of chronic disease and costs and explain how health care institutions can initiate engagement in community prevention efforts. They will then describe in detail the elements of the CCHH model, and conclude by covering the capacities needed within a health care institution to effectively implement the model.