Workshop
In 2013 the Institute of Medicine (IOM) Roundtable on Population Health Improvement organized a workshop to discuss opportunities to foster a health in all policies approach in non-health sectors such as housing, transportation, defense, education, and others. Much of the discussion focused on public-sector organizations, and roundtable members saw the need for further discussion of the role of the private sector, both as stakeholder and partner.
On June 4, 2015, the roundtable convened a follow-up workshop focused on applying a health lens to the role and potential of businesses in improving economic well-being and community health outcomes. Participants explored what businesses can offer the movement to improve population health and areas of potential, as well as models for how businesses can impact the determinants of health, and developed a platform for discussing how to promote and support health in all business practices, policies, and investments. This report summarizes the presentations and discussions from the workshop.
114 pages
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ISBN Paperback: 0-309-38051-0
ISBN Ebook: 0-309-38052-9
DOI:
https://doi.org/10.17226/21842
National Academies of Sciences, Engineering, and Medicine. 2016. Applying a Health Lens to Business Practices, Policies, and Investments: Workshop Summary. Washington, DC: The National Academies Press.
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Workshop
In March 2015, the National Academies of Sciences, Engineering, and Medicine held a workshop to explore the role that chemical exposures may play in the development of obesity. The obesity epidemic that has gripped the United States and much of the developed world for the past several decades has proved remarkably resistant to the various approaches tried by clinicians and public health officials to fight it. This raises the possibility that, in addition to the continued exploration of consumer understanding and behavior, new approaches that go beyond the standard focus on energy intake and expenditure may also be needed to combat the multifactorial problem of obesity.
The speakers at the workshop discussed evidence from both studies with animal models and human epidemiological studies that exposure to environmental chemicals is linked both to weight gain and to glucose tolerance, insulin sensitivity, inflammation, and other aspects of the metabolic syndrome. In addition to conventional environmental chemical exposures, this workshop also included one panel to discuss the potential role of other exposures, including sugar, artificial sweeteners, and antibiotics, in aiding or causing obesity. The participants also examined possible biological pathways and mechanisms underlying the potential linkages. This publication summarizes the presentations and discussions from the workshop.
172 pages
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ISBN Paperback: 0-309-38924-0
ISBN Ebook: 0-309-38925-9
DOI:
https://doi.org/10.17226/21880
National Academies of Sciences, Engineering, and Medicine. 2016. The Interplay Between Environmental Chemical Exposures and Obesity: Proceedings of a Workshop. Washington, DC: The National Academies Press.
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Workshop
The aging and evolving racial and ethnic composition of the U.S. population has the United States in the midst of a profound demographic shift and health care organizations face many issues as they move to address and adapt to this change. In their drive to adequately serve increasingly diverse communities, health care organizations are searching for approaches that will enable them to provide information and service to all persons, regardless of age, race, cultural background, or language skills, in a manner that facilitates understanding and use of that information to make appropriate health decisions.
To better understand how the dynamic forces operating in health care today impact the delivery of services in a way that is health literate, culturally competent, and in an appropriate language for patients and their families, the National Academies of Sciences, Engineering, and Medicine conducted a public workshop on the integration of health literacy, cultural competency, and language access services. Participants discussed skills and competencies needed for effective health communication, including health literacy, cultural competency, and language access services; interventions and strategies for integration; and differing perspectives such as providers and systems, patients and families, communities, and payers. This report summarizes the presentations and discussions from the workshop.
114 pages
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ISBN Paperback: 0-309-44237-0
ISBN Ebook: 0-309-44238-9
DOI:
https://doi.org/10.17226/23498
National Academies of Sciences, Engineering, and Medicine. 2016. Integrating Health Literacy, Cultural Competence, and Language Access Services: Workshop Summary. Washington, DC: The National Academies Press.
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Recent health care payment reforms aim to improve the alignment of Medicare payment strategies with goals to improve the quality of care provided, patient experiences with health care, and health outcomes, while also controlling costs. These efforts move Medicare away from the volume-based payment of traditional fee-for-service models and toward value-based purchasing, in which cost control is an explicit goal in addition to clinical and quality goals. Specific payment strategies include pay-for-performance and other quality incentive programs that tie financial rewards and sanctions to the quality and efficiency of care provided and accountable care organizations in which health care providers are held accountable for both the quality and cost of the care they deliver.
Accounting For Social Risk Factors in Medicare Payment: Criteria, Factors, and Methods is the third in a series of five brief reports that aim to inform ASPE analyses that account for social risk factors in Medicare payment programs mandated through the IMPACT Act. This report builds on the conceptual relationships and empirical associations between social risk factors and performance indicators used in value-based payment identified in the first report to provide guidance on which factors could be considered for Medicare accounting purposes, criteria to identify these factors, and methods to do so in ways that can improve care and promote greater health equity for socially at-risk patients.
124 pages
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ISBN Paperback: 0-309-44293-1
ISBN Ebook: 0-309-44294-X
DOI:
https://doi.org/10.17226/23513
National Academies of Sciences, Engineering, and Medicine. 2016. Accounting for Social Risk Factors in Medicare Payment: Criteria, Factors, and Methods. Washington, DC: The National Academies Press.
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Workshop
More than 2 million Americans below age 24 self-identify as being of American Indian or Alaska Native descent. Many of the serious behavioral, emotional, and physical health concerns facing young people today are especially prevalent with Native youth (e.g., depression, violence, and substance abuse). Adolescent Native Americans have death rates two to five times the rate of whites in the same age group because of higher levels of suicide and a variety of risky behaviors (e.g., drug and alcohol use, inconsistent school attendance). Violence, including intentional injuries, homicide, and suicide, accounts for three-quarters of deaths for Native American youth ages 12 to 20. Suicide is the second leading cause of death—and 2.5 times the national rate—for Native youth ages 15 to 24.
Arrayed against these health problems are vital cultural strengths on which Native Americans can draw. At a workshop held in 2012, by the National Academies of Sciences, Engineering, and Medicine, presenters described many of these strengths, including community traditions and beliefs, social support networks, close-knit families, and individual resilience. In May 2014, the Academies held a follow-up workshop titled Advancing Health Equity for Native American Youth. Participants discussed issues related to (1) the visibility of racial and ethnic disparities in health and health care as a national problem, (2) the development of programs and strategies by and for Native and Indigenous communities to reduce disparities and build resilience, and (3) the emergence of supporting Native expertise and leadership. This report summarizes the presentations and discussions from the workshop.
74 pages
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ISBN Paperback: 0-309-37613-0
ISBN Ebook: 0-309-37614-9
DOI:
https://doi.org/10.17226/21766
National Academies of Sciences, Engineering, and Medicine. 2016. Advancing Health Equity for Native American Youth: Workshop Summary. Washington, DC: The National Academies Press.
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Health care is in the midst of a dramatic transformation in the United States. Spurred by technological advances, economic imperatives, and governmental policies, information technologies are rapidly being applied to health care in an effort to improve access, enhance quality, and decrease costs. At the same time, the use of technologies by the consumers of health care is changing how people interact with the health care system and with health information.
These changes in health care have the potential both to exacerbate and to diminish the stark disparities in health and well-being that exist among population groups in the United States. If the benefits of technology flow disproportionately to those who already enjoy better coverage, use, and outcomes than disadvantaged groups, heath disparities could increase. But if technologies can be developed and implemented in such a way to improve access and enhance quality for the members of all groups, the ongoing transformation of health care could reduce the gaps among groups while improving health care for all.
To explore the potential for further insights into, and opportunities to address, disparities in underserved populations the National Academies of Sciences, Engineering, and Medicine held a workshop in October 2014. The workshop focused on (1) how communities are using digital health technologies to improve health outcomes for racial and ethnic minority populations, (2) how community engagement can improve access to high-quality health information for members of these groups, and (3) on models of successful technology-based strategies to reduce health disparities. This report summarizes the presentations and discussions at the workshop.
82 pages
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ISBN Paperback: 0-309-43891-8
ISBN Ebook: 0-309-43892-6
DOI:
https://doi.org/10.17226/23439
National Academies of Sciences, Engineering, and Medicine. 2016. The Promises and Perils of Digital Strategies in Achieving Health Equity: Workshop Summary. Washington, DC: The National Academies Press.
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In April 2015, the Institute of Medicine convened a workshop to explore the potential uses of simulation and other types of modeling for the purpose of selecting and refining potential strategies, ranging from interventions to investments, to improve the health of communities and the nation's health. Participants worked to identify how modeling could inform population health decision making based on lessons learned from models that have been, or have not been, used successfully, opportunities and barriers to incorporating models into decision making, and data needs and opportunities to leverage existing data and to collect new data for modeling. This report summarizes the presentations and discussions from this workshop.
120 pages
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ISBN Paperback: 0-309-37848-6
ISBN Ebook: 0-309-37849-4
DOI:
https://doi.org/10.17226/21807
National Academies of Sciences, Engineering, and Medicine. 2016. How Modeling Can Inform Strategies to Improve Population Health: Workshop Summary. Washington, DC: The National Academies Press.
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Workshop_in_brief
On March 2, 2016, the Roundtable on Health Literacy of the National Academies of Sciences, Engineering, and Medicine convened a workshop to examine the relevance of health literacy to precision medicine, a growing field that takes into account individuals' differences in genes, environments, and lifestyles. The workshop explored the intersection of health literacy and precision medicine through a number of topics, but its impetus was the Precision Medicine Initiative (PMI). The PMI is a multiyear effort announced in 2015 and launched in 2016, led by the White House and including agencies across the federal government, to advance the practice of precision medicine. The information and viewpoints summarized in this Workshop in Brief reflect the knowledge and opinions of the workshop participants.
4 pages
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ISBN Ebook: 0-309-44405-5
DOI:
https://doi.org/10.17226/23538
National Academies of Sciences, Engineering, and Medicine. 2016. Relevance of Health Literacy to Precision Medicine: Workshop in Brief. Washington, DC: The National Academies Press.
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Hepatitis B and C cause most cases of hepatitis in the United States and the world. The two diseases account for about a million deaths a year and 78 percent of world's hepatocellular carcinoma and more than half of all fatal cirrhosis. In 2013 viral hepatitis, of which hepatitis B virus (HBV) and hepatitis C virus (HCV) are the most common types, surpassed HIV and AIDS to become the seventh leading cause of death worldwide.
The world now has the tools to prevent hepatitis B and cure hepatitis C. Perfect vaccination could eradicate HBV, but it would take two generations at least. In the meantime, there is no cure for the millions of people already infected. Conversely, there is no vaccine for HCV, but new direct-acting antivirals can cure 95 percent of chronic infections, though these drugs are unlikely to reach all chronically-infected people anytime soon. This report, the first of two, examines the feasibility of hepatitis B and C elimination in the United States and identifies critical success factors. The phase two report will outline a strategy for meeting the elimination goals discussed in this report.
186 pages
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ISBN Paperback: 0-309-43799-7
ISBN Ebook: 0-309-43800-4
DOI:
https://doi.org/10.17226/23407
National Academies of Sciences, Engineering, and Medicine. 2016. Eliminating the Public Health Problem of Hepatitis B and C in the United States: Phase One Report. Washington, DC: The National Academies Press.
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The Institute of Medicine Roundtable on Health Literacy convened a 1-day public workshop to explore the relationship between palliative care and health literacy, and the importance of health literate communication in providing high-quality delivery of palliative care. Health Literacy and Palliative Care summarizes the discussions that occurred throughout the workshop and highlights the key lessons presented, practical strategies, and the needs and opportunities for improving health literacy in the United States.
136 pages
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ISBN Paperback: 0-309-38036-7
ISBN Ebook: 0-309-38037-5
DOI:
https://doi.org/10.17226/21839
National Academies of Sciences, Engineering, and Medicine. 2016. Health Literacy and Palliative Care: Workshop Summary. Washington, DC: The National Academies Press.
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On March 19, 2014, the National Academies of Sciences, Engineering, and Medicine held a workshop on the topic of the sharing of data from environmental health research. Experts in the field of environmental health agree that there are benefits to sharing research data, but questions remain regarding how to effectively make these data available. The sharing of data derived from human subjects—making them both transparent and accessible to others—raises a host of ethical, scientific, and process questions that are not always present in other areas of science, such as physics, geology, or chemistry. The workshop participants explored key concerns, principles, and obstacles to the responsible sharing of data used in support of environmental health research and policy making while focusing on protecting the privacy of human subjects and addressing the concerns of the research community. Principles and Obstacles for Sharing Data from Environmental Health Research summarizes the presentations and discussions from the workshop.
114 pages
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ISBN Paperback: 0-309-37085-X
ISBN Ebook: 0-309-37086-8
DOI:
https://doi.org/10.17226/21703
National Academies of Sciences, Engineering, and Medicine. 2016. Principles and Obstacles for Sharing Data from Environmental Health Research: Workshop Summary. Washington, DC: The National Academies Press.
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The environment for women's health has changed over the last 25 years. Increased use of automobiles can lead to health risks from lack of physical activity. There has also been an increase in access to and consumption of unhealthy food. Other changes in the past 2 to 3 decades include the significant increase in the number of women who are heads of households and responsible for all aspects of a household and family. Many women now are also having children later in life, which poses interesting issues for both biology and sociology. The growing stress faced by women and the effect of stress on health and illness are issues that need a more comprehensive examination, as do issues of mental health and mental illness, which have been more common and thus increasingly prominent issues for U.S. women.
In September 2015, the National Academies of Sciences, Engineering, and Medicine convened a workshop to shed light on important determinants, consequences, effects, and issues attending the relative disadvantage of women in the United States in comparison with women in other economically advanced nations. This report summarizes the presentations and discussions from the workshop.
88 pages
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ISBN Paperback: 0-309-43904-3
ISBN Ebook: 0-309-43905-1
DOI:
https://doi.org/10.17226/23441
National Academies of Sciences, Engineering, and Medicine. 2016. Improving the Health of Women in the United States: Workshop Summary. Washington, DC: The National Academies Press.
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The Centers for Medicare & Medicaid Services (CMS) have been moving from volume-based, fee-for-service payment to value-based payment (VBP), which aims to improve health care quality, health outcomes, and patient care experiences, while also controlling costs. Since the passage of the Patient Protection and Affordable Care Act of 2010, CMS has implemented a variety of VBP strategies, including incentive programs and risk-based alternative payment models. Early evidence from these programs raised concerns about potential unintended consequences for health equity. Specifically, emerging evidence suggests that providers disproportionately serving patients with social risk factors for poor health outcomes (e.g., individuals with low socioeconomic position, racial and ethnic minorities, gender and sexual minorities, socially isolated persons, and individuals residing in disadvantaged neighborhoods) may be more likely to fare poorly on quality rankings and to receive financial penalties, and less likely to receive financial rewards.
The drivers of these disparities are poorly understood, and differences in interpretation have led to divergent concerns about the potential effect of VBP on health equity. Some suggest that underlying differences in patient characteristics that are out of the control of providers lead to differences in health outcomes. At the same time, others are concerned that differences in outcomes between providers serving socially at-risk populations and providers serving the general population reflect disparities in the provision of health care.
Systems Practices for the Care of Socially At-Risk Populations seeks to better distinguish the drivers of variations in performance among providers disproportionately serving socially at-risk populations and identifies methods to account for social risk factors in Medicare payment programs. This report identifies best practices of high-performing hospitals, health plans, and other providers that serve disproportionately higher shares of socioeconomically disadvantaged populations and compares those best practices of low-performing providers serving similar patient populations. It is the second in a series of five brief reports that aim to inform the Office of the Assistant Secretary of Planning and Evaluation (ASPE) analyses that account for social risk factors in Medicare payment programs mandated through the Improving Medicare Post-Acute Care Transformation (IMPACT) Act.
94 pages
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ISBN Paperback: 0-309-39197-0
ISBN Ebook: 0-309-39198-9
DOI:
https://doi.org/10.17226/21914
National Academies of Sciences, Engineering, and Medicine. 2016. Systems Practices for the Care of Socially At-Risk Populations. Washington, DC: The National Academies Press.
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On February 5, 2015, the Institute of Medicine Roundtable on Population Health Improvement hosted a workshop to explore the relationship between public health and health care, including opportunities, challenges, and practical lessons. The workshop was convened in partnership with the Association of State and Territorial Health Officials (ASTHO)-Supported Primary Care and Public Health Collaborative. Organized in response to the 2012 IOM report Primary Care and Public Health: Exploring Integration to Improve Population Health, this workshop focused on current issues at the interface of public health and health care, including opportunities presented by and lessons learned from the Centers for Medicaid and Medicare Services State Innovation Models program. The workshop featured presentations on several dimensions of the public health-health care relationship. Collaboration Between Health Care and Public Health summarizes the presentations and discussion of the event.
104 pages
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ISBN Paperback: 0-309-37446-4
ISBN Ebook: 0-309-37447-2
DOI:
https://doi.org/10.17226/21755
Institute of Medicine. 2016. Collaboration Between Health Care and Public Health: Workshop Summary. Washington, DC: The National Academies Press.
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Recent health care payment reforms aim to improve the alignment of Medicare payment strategies with goals to improve the quality of care provided, patient experiences with health care, and health outcomes, while also controlling costs. These efforts move Medicare away from the volume-based payment of traditional fee-for-service models and toward value-based purchasing, in which cost control is an explicit goal in addition to clinical and quality goals. Specific payment strategies include pay-for-performance and other quality incentive programs that tie financial rewards and sanctions to the quality and efficiency of care provided and accountable care organizations in which health care providers are held accountable for both the quality and cost of the care they deliver.
Accounting for Social Risk Factors in Medicare Payment: Identifying Social Risk Factors is the first in a series of five reports commissioned to provide input into whether socioeconomic status (SES) and other social risk factors could be accounted for in Medicare payment and quality programs. This report focuses on defining SES and other social factors for the purposes of application to Medicare quality measurement and payment programs.
110 pages
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paperback
ISBN Paperback: 0-309-38124-X
ISBN Ebook: 0-309-38125-8
DOI:
https://doi.org/10.17226/21858
National Academies of Sciences, Engineering, and Medicine. 2016. Accounting for Social Risk Factors in Medicare Payment: Identifying Social Risk Factors. Washington, DC: The National Academies Press.
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On November 10, 2014, the Roundtable on Environmental Health Sciences, Research, and Medicine held a 1-day workshop titled "Bringing Public Health into Urban Revitalization." The purpose of the workshop was to explore public health issues related to the redesign of major U.S. cities, focusing on recent examples from Detroit, Michigan; New York City; and Washington, DC. Workshop speakers showed how rebuilding efforts provide an opportunity to reimagine the built environment, increase a sense of community, increase the role of public health departments and health systems, and increase the use of green technologies.
8 pages
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ISBN Ebook: 0-309-38076-6
DOI:
https://doi.org/10.17226/21847
National Academies of Sciences, Engineering, and Medicine. 2015. Bringing Public Health into Urban Revitalization: Workshop in Brief. Washington, DC: The National Academies Press.
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Since its creation by the Institute of Medicine (IOM) in 2007, the Roundtable on the Promotion of Health Equity and the Elimination of Health Disparities has been fostering dialogue on racial and ethnic disparities in health and health care, examining the development of programs and strategies to reduce disparities, and encouraging the emergence of new leadership focused on health equity. For the past several years, a prominent topic of discussion within the roundtable has been the Patient Protection and Affordable Care Act (ACA). The ACA has multiple provisions specific to race, ethnicity, and language and other provisions with significant implications for racially and ethnically diverse populations.
In April 2013, the roundtable held a workshop to address many issues surrounding the ACA, including expansion of coverage, delivery systems, and access points, service delivery and payment reform, public-private partnerships, and challenges to the safety net. This report summarizes the presentations and discussions from the workshop.
100 pages
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ISBN Paperback: 0-309-29463-0
ISBN Ebook: 0-309-29464-9
DOI:
https://doi.org/10.17226/18551
National Academies of Sciences, Engineering, and Medicine. 2015. Achieving Health Equity via the Affordable Care Act: Promises, Provisions, and Making Reform a Reality for Diverse Patients: Workshop Summary. Washington, DC: The National Academies Press.
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Spread, Scale, and Sustainability in Population Health is the summary of a workshop convened by the Institute of Medicine's Roundtable on Population Health Improvement in December 2014 to discuss the spread, scale, and sustainability of practices, models, and interventions for improving health in a variety of inter-organizational and geographical contexts. This report explores how users measure whether their strategies of spread and scale have been effective and discusses how to increase the focus on spread and scale in population health.
144 pages
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ISBN Paperback: 0-309-37117-1
ISBN Ebook: 0-309-37118-X
DOI:
https://doi.org/10.17226/21708
Institute of Medicine. 2015. Spread, Scale, and Sustainability in Population Health: Workshop Summary. Washington, DC: The National Academies Press.
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