By Megan Reeve, MPH, Associate Program Officer, Board on Health Sciences Policy, Institute of Medicine

“There is a commonly held notion that preparedness is separate and distinct from everyday operations and that it only affects emergency departments,” said Gregg Margolis, director of the Division of Health Systems and Health Care Policy in the Office of the Assistant Secretary for Preparedness and Response at the U.S. Department of Health and Human Services (HHS). “But time and time again, catastrophic events challenge the entire health care system, from acute care and emergency medical services down to the public health and community clinic level, and the lack of preparedness of one part of the system places preventable stress on other components,” he continued. With the implementation of the 2010 health reform law, the Affordable Care Act (ACA), its focus on achieving higher quality care, healthier populations, and lower costs provides an opportunity to consider how to incorporate preparedness into all aspects of the healthcare system so preparedness becomes fundamental to the health framework instead of an afterthought.

View the infographic featuring the impacts of the ACA on preparedness on the IOM website.

View the infographic featuring the impacts of the ACA on preparedness on the IOM website. In the fall of 2013, the Institute of Medicine’s (IOM’s) Forum on Medical and Public Health Preparedness for Catastrophic Events convened a workshop in Washington, D.C. to discuss how changes to the health system as a result of the ACA might impact medical and public health preparedness programs across the nation. Attendees ranged from­­­ academic research institutions like RAND and the Uniformed Services University of the Health Sciences to the Departments of Homeland Security and Health and Human Services to state and local health departments such as Mississippi, Chicago, New York City, New Orleans, and Los Angeles. While many authorized provisions and expected changes have not been implemented yet and others have yet to be fully funded, the workshop sought to explore adjustments and transformations being made on the ground across the country as the ACA begins to shift the landscape of healthcare. Speakers from organizations including state and local health departments, universities, federal agencies, and health information exchanges, covered topics ranging from the expected impacts of new care delivery methods and financing matrices, to issues of expanding workforce roles and opportunities through health information technology. Throughout the discussions, various speakers noted a continuing need for public health and healthcare emergency preparedness programs, especially as uncertainties of funding and implementation persist during transitions.

Throughout the two-day workshop, several individual participants highlighted many important opportunities provided by the ACA that may be relevant for local health departments to consider moving forward:

• The impact of insurance coverage expansion on preparedness and how the changing reimbursement systems and incentives will affect preparedness activities;
• The increased use of data to help inform preparedness, response, and recovery measures;
• How existing resources can be used to improve both day-to-day operations and response during public health emergencies;
• Workforce transformation and training needs; and
• Opportunities for collaboration, coalition building, and relationships among healthcare delivery systems that may not have been involved in preparedness activities in the past.

Following are stories that workshop presenters shared about the impacts of the ACA on local public health preparedness efforts that are starting to take shape.

Potential Impacts Explored

Dr. Nicole Lurie, Assistant Secretary for Preparedness and Response, highlighted the opportunity to improve partnerships and preparedness within the provision of the ACA that requires a Community Health Needs Assessment for non-profit hospitals. Local health departments can help hospitals achieve this requirement and in the process, create a better population health picture of their community, allowing for improved knowledge of community needs in a disaster.

With the support of ACA provisions around data collection and health IT, some organizations such as PCCI, a nonprofit research and development program in Dallas, are beginning to take the use of electronic health records a step further to give a more holistic view of the patient, including social services they have used and other programs. Connie Chan, project director at PCCI, said their program fits within the “triple aim” of health care, striving for higher quality care, lower cost, and better population health. In addition, PCCI’s model can add an unspoken “fourth aim” of making the country more resilient in disasters by connecting people to social and clinical services. Collaborative sharing of this type of data could be useful for local health departments during both planning and recovery phases.

Karen DeSalvo, former Commissioner of Health for New Orleans and now National Coordinator for Health IT at HHS, described her experiences in New Orleans and the goal to transform the health department from treatment focused to prevention focused. The department worked to transition out of direct health care service and towards promoting and protecting the health of people where they live, learn, work, and play. However, she pointed out, there will still be people who are uninsured, and they are likely to be the ones who are most vulnerable. As neighborhood clinics and Federally Qualified Health Centers become more widespread under ACA support, local health departments can support them by understanding the network and direct community members to needed services, keeping hospitals from being over-burdened.

Role of Health and Medical Preparedness Programs

Atyia Martin, Director of the Office of Public Health Preparedness at the Boston Public Health Commission, noted that following the Boston Bombings in 2013, HHS provided a mental health response team of approximately 25 persons to help Boston increase its capacity to support the mental health needs of those impacted. Although Massachusetts has 97 percent insurance coverage, more than 200 mental health support sessions were coordinated in the city of Boston and in surrounding areas to meet the demand. Thousands of individuals were served with support from service providers from HHS, the Massachusetts Department of Mental Health, Red Cross, Salvation Army, and a number of other partners. Group counseling was often not covered under insurance plans, so local health departments, working with community services, may need to continue to fill in gaps such as these after future disasters.

The health care system is changing rapidly, and several participants discussed a variety of ways that the ACA implementation could enhance preparedness through new and expanded uses of health IT, while mitigating any negative impacts such as reductions in payments to safety net hospitals. Citing the triple aim framework, Margolis said that quality care, healthier populations, and lower cost are all interrelated, and achieving the triple aim is what can lead us to become a more prepared nation.

Is your local health department experiencing the impacts of ACA implementation? Let us know in the comments section below.

For the full IOM workshop summary on Impacts of the Affordable Care Act on Preparedness, download the final report and view the full infographic. For more information on specific provisions that may potentially affect preparedness activities, download the ACA and preparedness table.