Population Health Funding and Accountability to Community: Proceedings of a Workshop (2023)
Chapter: 6 Final Reflections
6
Final Reflections
Roundtable co-chair Raymond Baxter thanked all the panelists for their participation and offered closing remarks and reflections on some of the main themes covered during the workshop. Baxter discussed how the speakers showcased various efforts of upstream funding that aim to improve population health, advance health equity, and have accountability to the communities served. He said that the sessions highlighted the perspectives of practitioners, researchers, public sector leaders, and others, who discussed accomplishments and challenges in reaching these three goals. Baxter reiterated a point made by Minyard, and emphasized throughout the workshop, which was that there is a “once-in-a-lifetime” opportunity of $350 billion in American Rescue Plan funds that must be encumbered by December 2024 and spent by 2026. The funds can be used to accelerate the shifting of power and create partnerships between health care and public health systems. This important work cannot occur using a fragmented fee-for-service health care model, Baxter said. Without a transition to pre-paid capitated or globally budgeted systems of care, he continued, it will be impossible to harness the funding and power of national health plans and large health systems that are necessary to improve population health. Nor can this effort be led by community and philanthropic efforts alone; instead, all levels of government must play a role.
Additionally, Baxter reflected on the discussion surrounding community benefit spending and how this will probably not be the most promising source of funding for the future of population health improvement.
There has not been measurable change in community benefit spending over the last two decades, despite the noteworthy examples of how this money could fuel broad population health improvement centered on equity. Another important topic covered was the critical role of braided and blended funding and how these can be used by states and counties to combine fragmented federal funds so that communities can effectively use the money. Baxter also highlighted Terry’s presentation on how the authority of the Center for Medicare and Medicaid Innovation to bring payment change and reform will alter incentives for population health and drive health equity.
Baxter spoke about how the panelists’ dialogue demonstrated that real equity and community accountability are very challenging to achieve. Effective multi-sector collaboration requires engaging powerful and resource-rich partners such as hospitals and insurance companies, which are not accustomed to sharing their power or privilege. The sessions highlighted how trusted brokers, coalitions, and networks can play a critical role in rebalancing power and how research and evaluation methods can support equity and partnership but can also undermine these efforts if not used effectively.
To conclude, Baxter commented that across all panels there was the theme of “moving from the margins to the mainstream.” The successful efforts discussed for funding population health are voluntary and depend on the good will of leaders, the activism of communities, and trust between the two, Baxter said. He added that it is critical to move from transactional partnerships toward effective policy and, ultimately, toward developing a model for population health funding and accountability to communities that is no longer considered “a model” but rather the standard for how this work is done.
