Longitudinal Trends in Insurer Participation in Multisector Population Health Activities.

Healthcare organizations increasingly engage in activities to identify and address social determinants of health (SDOH) among their patients to improve health outcomes and reduce costs. While several studies to date have focused on the evolving role of hospitals and physicians in these types of population health activities, much less is known about the role health insurers may play. We used data from the National Longitudinal Survey of Public Health Systems for the period 2006 to 2018 to examine trends in health insurer participation in population health activities and in the multi-sector collaborative networks that support these activities.

US Hospital Service Availability and New 340B Program Participation.

Importance: The US 340B Drug Pricing Program enables eligible hospitals to receive substantial discounts on outpatient drugs to improve hospitals' financial sustainability and maintain access to care for patients who have low income and/or are uninsured. However, it is unclear whether hospitals use program savings to subsidize access as intended.

Objective: To evaluate whether the 340B program is associated with improvements in access to hospital-based services and to test whether the association varies by hospital ownership.

Contemporary Public Health Finance: Varied Definitions, Patterns, and Implications.

The financing of public health systems and services relies on a complex and fragmented web of partners and funding priorities. Both underfunding and "dys-funding" contribute to preventable mortality, increases in disease frequency and severity, and hindered social and economic growth. These issues were both illuminated and magnified by the COVID-19 pandemic and associated responses.

Examining Characteristics of Local Public Health Systems With Exceptional Tribal Organization Participation.

Objective: To learn feasible ways to increase multisector community partnership with tribal organizations, meaning tribal health authorities or American Indian and Alaska Native (AI/AN)-serving organizations, by examining characteristics of local public health systems with exceptional tribal organization participation.

Design, Setting, And Participants: In total, 728 local public health departments were surveyed in 2018 to generate a nationally representative sample of local public health systems in the United States. A positive deviance approach using logistic regression helped identify local public health systems that had tribal organization participation despite characteristics that make such participation statistically unlikely.

Association Between Insurer Connectivity in Appalachian Population Health Networks and Preventable Hospitalizations: Evidence from Kentucky.

Introduction: Addressing complex health and social needs requires cross-sector collaboration to deliver medical, social, and population health services at the community level. Capacity in community health and social services networks may be constrained in regions like Appalachia due to the combined effects of rurality and persistently poor health and social outcomes. One way that cross-sector networks serving low-resource communities can expand their capacity is by engaging partners, like health insurers, who can leverage resources from outside the local area.

Medicaid Payment For Postpartum Long-Acting Reversible Contraception Prompts More Equitable Use.

To increase access to highly effective contraception and improve reproductive autonomy, a growing number of state Medicaid programs pay for the provision of immediate postpartum long-acting reversible contraception (LARC) in addition to providing a global payment for maternity care. Using Pregnancy Risk Assessment Monitoring System data, we examined postpartum LARC use both overall and by race and ethnicity among respondents with Medicaid-paid births during the period 2012-18 in eight states that implemented immediate postpartum LARC payment and eight states without it. Using a quasi-experimental difference-in-differences design, we found that the policy resulted in an overall 2.

Impact of state Medicaid expansion on cross-sector health and social service networks: Evidence from a longitudinal cohort study.

Objective: To examine the impact of state Medicaid expansion on the delivery of population health activities in cross-sector health and social services networks. Community networks are multisector, interorganizational networks that provide services ranging from the direct provision of individual social services to the implementation of population-level initiatives addressing community outcomes.

Data Sources: We used data measuring the composition of cross-sector population health networks 2006-2018 National Longitudinal Survey of Public Health Systems (NALSYS) linked with the Area Health Resource File.

Who Delivers Maternal and Child Health Services? The Contributions of Public Health and Other Community Partners.

Unlabelled: Policy Points Local health departments with direct maternal and child health service provisions exhibit greater social service collaboration, thereby enhancing community capacity to improve health care access and social determinant support. These findings may prioritize collaboration as a community-based effort to reduce disparities in maternal and child health and chronic disease.

Context: Improving maternal and child health (MCH) care in the United States requires solutions to address care access and the social determinants that contribute to health disparities.

Local Public Health System Capabilities and COVID-19 Death Rates.

Objectives: Efforts to contain the health effects of the COVID-19 pandemic have achieved less success in the United States than in many comparable countries. Previous research documented wide variability in the capabilities of local public health systems to carry out core disease prevention and control activities, but it is unclear how this variability relates to COVID-19 control. Our study explored this relationship by using a nationally representative sample of 725 US communities.

Best of ARM: Evaluating engagement in multisector community health networks: The case of tribal organizations.

Objective: To quantify variation in public health system engagement with tribal organizations across a national sample of communities and to identify predictors of engagement.

Data Sources: We used 2018 National Longitudinal Survey of Public Health Systems data, a nationally representative cohort of the US public health systems.

Study Design: Social network analysis measures were computed to indicate the extent of tribal organization participation in public health networks and to understand the sectors and social services that engage with tribal organizations in public health activities.

Proceedings From a National Heart, Lung, and Blood Institute and the Centers for Disease Control and Prevention Workshop to Control Hypertension.

Hypertension treatment and control prevent more cardiovascular events than management of other modifiable risk factors. Although the age-adjusted proportion of US adults with controlled blood pressure (BP) defined as <140/90 mm Hg, improved from 31.8% in 1999-2000 to 48.

Identifying Value-Added Population Health Capabilities to Strengthen Public Health Infrastructure.

Unlabelled: Policy Points While the coronavirus pandemic has underscored the important role of public health systems in protecting community health, it has also exposed weaknesses in the public health infrastructure that stem from chronic underfunding and fragmentation in delivery systems. The results of our study suggest that the public health system structure can be strengthened through the targeted implementation of high-value population health capabilities. Prioritizing the delivery of value-added population health capabilities can help communities efficiently use limited time and resources and identify the most effective pathways for building a stronger public health system and improving health outcomes over time.

Effects of Different Transitional Care Strategies on Outcomes after Hospital Discharge-Trust Matters, Too.

Background: As health systems shift toward value-based care, strategies to reduce readmissions and improve patient outcomes become increasingly important. Despite extensive research, the combinations of transitional care (TC) strategies associated with best patient-centered outcomes remain uncertain.

Methods: Using an observational, prospective cohort study design, Project ACHIEVE sought to determine the association of different combinations of TC strategies with patient-reported and postdischarge health care utilization outcomes.

Geographic Variation in the Structure of Kentucky's Population Health Systems: An Urban, Rural, and Appalachian Comparison.

Introduction: Research examining geographic variation in the structure of population health systems is continuing to emerge, and most of the evidence that currently exists divides systems by urban and rural designation. Very little is understood about how being rural and Appalachian impacts population health system structure and strength.

Purpose: This study examines geographic differences in key characteristics of population health systems in urban, rural non-Appalachian, and rural Appalachian regions of Kentucky.

Public Health Systems and Social Services: Breadth and Depth of Cross-Sector Collaboration.

To examine the extent to which social service organizations participate in the organizational networks that implement public health activities in US communities, consistent with recent national recommendations. Using data from a national sample of US communities, we measured the breadth and depth of engagement in public health activities among specific types of social and community service organizations. Engagement was most prevalent (breadth) among organizations providing housing and food assistance, with engagement present in more than 70% of communities.

The Growing Divide in the Composition of Public Health Delivery Systems in US Rural and Urban Communities, 2014-2018.

To examine changes in the scope of activity and organizational composition of public health delivery systems serving rural and urban US communities between 2014 and 2018. We used data from the National Longitudinal Survey of Public Health Systems to measure the implementation of recommended public health activities and the network of organizations contributing to these activities in a nationally representative cohort of US communities. We used multivariable regression models to test for rural-urban differences between 2014 and 2018.

The role of the community health delivery system in the health and well-being of justice-involved women: a narrative review.

Background: Over seven million imprisoned and jailed women are released into the community each year and many are ill-equipped to meet the challenges of re-integration. Upon release into their community, women are faced with uncertain barriers and challenges using community services to improve their health and well-being and reuniting with families. Few studies have identified and described the barriers of the community health delivery system (CHDS)- a complex set of social, justice, and healthcare organizations that provide community services aimed to improve the health and well-being (i.

Examining the Trade-off Between NICU Length of Stay and Postdischarge Monitoring: An Instrumental Variables Approach.

Treatment of very low birth weight infants in a neonatal intensive care unit (NICU) can be expensive, particularly in rural areas, but may potentially reduce long-term treatment costs and improve short- and long-term health outcomes. Few studies look at this trade-off. We employed an instrumental variables approach (fuzzy discontinuity) based on changes in practice for the treatment of very low birth weight infants in a perinatal referral center's NICU in 2000-2001.

Changes in Local Public Health System Performance Before and After Attainment of National Accreditation Standards.

Objective: The aim of this study is to investigate the impact of Public Health Accreditation Board (PHAB) accreditation on the delivery of public health services and on participation from other sectors in the delivery of public health services in local public health systems.

Design: This study uses a longitudinal repeated measures design to identify differences between a cohort of public health systems containing PHAB-accredited local health departments and a cohort of public health systems containing unaccredited local health departments. It uses data spanning from 2006 to 2016.

Insurance coverage mandates: Impact of physician utilization in moderating colorectal cancer screening rates.

Precision public health requires research that supports innovative systems and health delivery approaches, programs, and policies that are part of this vision. This study estimated the effects of health insurance mandate (HiM) variations and the effects of physician utilization on moderating colorectal cancer (CRC) screening rates. A time-series analysis using a difference-in-difference-in-differences (DDD) approach was conducted on CRC screenings (1997-2014) using a multivariate logistic framework.

Estimating the Cost of Providing Foundational Public Health Services.

Objective: To estimate the cost of resources required to implement a set of Foundational Public Health Services (FPHS) as recommended by the Institute of Medicine.

Study Design: A stochastic simulation model was used to generate probability distributions of input and output costs across 11 FPHS domains. We used an implementation attainment scale to estimate costs of fully implementing FPHS.

The Economics of Public Health: Missing Pieces to the Puzzle of Health System Reform.

The United States continues to experiment with health care delivery and financing innovations, but relatively little attention is given to the public health system and its capacity for improving health status in the U.S. population at large.

Public Health Spending and Medicare Resource Use: A Longitudinal Analysis of U.S. Communities.

Objective: To examine whether local expenditures for public health activities influence area-level medical spending for Medicare beneficiaries.

Data Sources And Setting: Six census surveys of the nation's 2,900 local public health agencies were conducted between 1993 and 2013, linked with contemporaneous information on population demographics, socioeconomic characteristics, and area-level Medicare spending estimates from the Dartmouth Atlas of Health Care.

Data Collection/extraction: Measures derive from agency survey data and aggregated Medicare claims.

Preventable Death Rates Fell Where Communities Expanded Population Health Activities Through Multisector Networks.

The US health system faces mounting pressure to improve population health. Research suggests a need for greater coordination and alignment across the sectors that deliver medical, public health, and social services. This study uses sixteen years of data from a large cohort of US communities to measure the extent and nature of multisector contributions to population health activities and how these contributions affect community mortality rates.

Public Health and Hospitals: Lessons Learned From Partnerships in a Changing Health Care Environment.

Recent changes in policymaking, such as the passage of the Patient Protection and Affordable Care Act, have ushered in a new era in community health partnerships. To investigate characteristics of effective collaboration between hospitals, their parent systems, and the public health community, with the support of major hospital, medical, and public health associations, we compiled a list of 157 successful partnerships. This set was subsequently narrowed to 12 successful and diverse partnerships.