At The New York Academy of Medicine, we advance solutions that promote the health and well-being of people living in cities. In doing so, we have been relentless in our focus on population health—that is the health of the total population in a geographic area. That has led us to look beyond clinical care delivery networks that may manage populations of patients using systems for patients with specific diseases such as diabetes or asthma, to address the broad determinants of health that affect people where they live, work, play and learn.

Traditionally, efforts at health care reform dealt mostly with cost and, more recently, quality, but there is now a third goal of reform, an expanded emphasis on improving health. Called the Triple Aim, this concept is at the core of national health care reform as is attention to population health in its broadest sense. The challenge is assuring the integration of financial incentives and definitions of quality with actions that improve the health of communities. 

Here in New York, the Academy is proud to be a key change agent in driving and supporting this integration and assuring that activities that promote geographic population health are seen as a critical success factor in achieving the goals of the Triple Aim—better care, lower costs and improved health.  Below are a just a few examples of health system reforms that have the promise of advancing population health.

An important framework for improving the health of New Yorkers at the community level is the New York State Prevention Agenda.  I am proud to have led the effort with my colleagues at the State Department of Health, Mental Health and the Office of Alcoholism and Substance Abuse Services and leaders in academia, business, labor, professional organizations and community based organizations across the State, to develop this blueprint to achieve population health and reduce disparities statewide by 2018.

The effort, driven by local community coalitions convened by local health departments and hospitals, is in its third year and already seeing progress in several key areas. With support from the New York State Health Foundation, the Academy provides technical assistance to local health departments as they implement their Prevention Agenda activities.  

Another effort underway is the State Health Innovation Plan (SHIP), which focuses on spreading a model of comprehensive, coordinated primary care called Advanced Primary Care (APC) and promoting value-based payments. Through our efforts on working committees, we have ensured that a core competency of APC providers will be population health activities in their communities that connect to the work of local Prevention Agenda partnerships. 

And in one of the largest current health system reforms, the Delivery System Reform Incentive Payment (DSRIP) program, the Academy supported more than a dozen health systems in New York City in conducting community health needs assessments, to ensure that the planned programs and activities took community needs into account. As part of that effort, we asked thousands of low-income New Yorkers about their health needs and concerns and we are delighted to elevate their voices in a new report series, launched in late 2015, City Voices: New Yorkers on Health. We are also working with the leadership of DSRIP to strengthen attention to hospital and Performing Providers Systems activity in communities (Domain 4) that align with the Prevention Agenda.

The State has launched 11 regional Population Health Improvement Programs (PHIP), which promote population health and a reduction in health care disparities. In New York City, the Academy is a partner with the Fund for Public Health in New York, the city Department of Health and Mental Hygiene and the United Hospital Fund in operationalizing PHIP NYC. As part of that effort, we co-chair a multi-sector working group with leaders in the fields of health care, transportation, parks, community development and more to advance city environments that promote healthy eating and active living. Our new publication “Interventions for Healthy Eating and Active Urban Living: A Guide for Improving Community Health,” highlights initiatives that hospitals, community groups and others may start or scale to achieve these goals.

Finally, the Academy has been a leader in New York State in analyzing the potential for increasing the alignment of current voluntary hospital investments in certain categories of Hospital Community Benefit, as required by the IRS, with their investments in community health under DSRIP and in their local Prevention Agenda priorities.

Despite the promising advances described above, more work is needed to ensure that these reforms will truly address population health for the benefit of all New Yorkers.  Stay tuned for more detail and highlights of our work in these areas. We look forward to continuing to work with you—our partners—to make New York the healthiest state. 

Warmly,

Jo Ivey Boufford, MD