Frontiers of Health Services Management - Summer 2014 - (Page 17)

direction while preserving autonomy and sensitivity to community preferences. Next Steps the approach we outline here is a departure from much current policy and management practice. But new models are needed to drive action-not just thinking-to address the enormous challenge of improving population health. We believe that a community business model that involves all sectors in partnership can function as a road map. We recommend the following next steps to do so. first, public- and private-sector policymakers should stimulate conversations and efforts to better understand the specific opportunities for improvement within each segment of society. as in the HealthPartners example, care should be taken to identify those improvement opportunities that fall within the sectors' primary control; those not under primary control should move to multisectoral partnerships. Policymakers should then use these perspectives to make the business case for population health improvement and the resources and policies each type of community actor requires through its national networks and directly to leaders in each sector. for example, healthcare leaders could work with the national Quality forum and the institute for Healthcare improvement to improve outcomes in healthcare, a determinant that they directly control, while reducing total expenditures. they must think beyond healthcare to health and to achieving it through broad community partnerships. Similarly, business leaders could turn to the Business roundtable or local chambers of commerce to develop efforts to improve workforce wellness, productivity, and health directly while looking beyond D avid A. K indig a nd Ge org e Is ha m * 17 f e a t u r e and counties to reference. for each profile, using the best evidence available from sources such as the MatcH What Works (county Health rankings 2013c) and the centers for Disease control and Prevention's "guide to community Preventive Services" (epidemiology Program office 2002), a set of investment priorities could be developed that covers all the determinants of health. it would be as broad as the global evidence allows but would be tailored to a community's strengths and weaknesses. options for improving behaviors such as smoking would not be as highly suggested for places already doing well in this factor. the packages would not be prescriptive, but merely a menu of the investments likely to produce the best health outcome improvement. Where possible, options would include the strength of public- and private-sector policies beyond dollar investment in specific programs. as with most initiatives, the initial set of policy packages would not be the ideal set, for a variety of reasons. We still have incomplete evidence of effectiveness of different programs and policies, particularly regarding cost-effectiveness beyond effectiveness itself. it is not clear which level of investment in a particular determinant or factor is optimal, or where diminishing return sets in and when resources should be moved to other factors. We are limited in evidence for different types of outcomes, particularly disparity reduction. However, we should not let the perfect be the enemy of the good. a beginning set would be extremely helpful to guide the work in many places where discussions are taking place regarding improving the health of their communities. it would help ensure that local passion and commitment is channeled in an evidence-based

Table of Contents for the Digital Edition of Frontiers of Health Services Management - Summer 2014

Table of Contents

Frontiers of Health Services Management - Summer 2014