Spending even a moment watching the news, scanning social media, or reading a newspaper will reveal a new story about the potential policy and budgetary directions of public health and health care. It is an uncertain time and even more essential now for organizations committed to population health to be innovative, flexible, and nimble while still promoting their core mission.
As a data-driven organization, HRiA aimed to supplement our insight into this changing landscape by recently conducting a rapid environmental scan to identify potential future public health and health care trends. We reviewed organizational reports, peer-reviewed papers, and media content, and interviewed national leaders from the federal government, public health, health care, philanthropy, education, and community development.
Our key insights include:
Reduced funding in public health and greater competition for funds
There is an expected contraction of the federal budget. Less public health funding at the federal level may also result in a trickle-down effect of decreased public health funding at the state and local levels as well. While it is unclear what private funders are poised to step in to address this gap, one result may be a potential redirection of philanthropic dollars to cover basic public health and health care needs (“safety net”) given the reduction in federal funding. As a result, there most likely will be greater competition for federal and philanthropic dollars.
Locus of innovation – stronger at the state and local levels
Leadership, innovation, and substantive work will likely happen at the state and local levels rather than spearheaded by the federal government. It will be important to identify and promote innovative approaches where state, county, and municipal leaders have identified common priorities, aligned resources, and collaborated across sectors including areas such as housing, community development, and early care and education to improve population health.
Changes in policy and the public health/health care landscape
An undoing or revision of the Affordable Care Act (ACA) could have significant ramifications to the field. Given the different perspectives in Congress, it is unclear what changes in the ACA will eventually occur and their implications. Some concerning possibilities include:
- Uninsurance rates rising, resulting in a growing number of people not accessing primary or secondary prevention services. This could lead to negative health outcomes across a range of conditions and populations, with particular concern for chronic disease prevention and management for conditions such as heart disease and diabetes. Other consequences could include cost increases in charity care and overutilization of emergency departments.
- Elimination of the Prevention and Public Health Fund which constitutes 12-18% of the Center for Disease Control and Prevention’s budget and covers numerous basic public health services.
- Elimination of the community health needs assessment and strategic implementation plan requirements for non-profit hospitals. This mandate, which is now part of the IRS tax code, has galvanized non-profit hospitals to adopt a public health best practice of gathering data on community needs and strengths to inform community benefits planning while also requiring them to engage with community members and stakeholders in the process.
There will continue to be major shifts in the health care system with the aim of constraining health care costs. Health care costs are steadily rising, challenging payers, businesses, health care, public health, and patients. As healthcare moves from fee-for-service reimbursement models to value-based care, accountable care organizations (ACOs) will look to improve outcomes in population health, creating a greater opening for public health-health care integration.
Accountability for outcomes
Given the current policy agenda and potential constriction of funding, it is expected that the metrics of success in public health may focus more on short-term outcomes (e.g., reduction in emergency department visits) and cost (return on investment). Organizations may want to consider for some funders re-framing the benefits of their work in relation to economic community development, efficiency, and accountability.
These trends signify both concerns and opportunities within the public health and health care fields. Now more than ever, we need to consider aligning efforts, leveraging resources, collaborating across sectors, being nimble and entrepreneurial, and promoting innovation. It will be up to those of us committed to health equity and positive health outcomes to demonstrate the value of population health approaches, maximize our efficiency and effectiveness, and advocate for those we serve.