Transforming Health Systems

The Affordable Care Act can help transform the U.S. health system from one focused on treating illness to one that promotes prevention and healthy living.

Public health has the chance to play a large role in this transformation. Its focus on preventing disease and creating conditions that enhance the health of both individuals and communities makes public health a vital part of systems change.

The ACA is necessary because, despite high levels of spending, health outcomes in the U.S. are poor. Too many people go without care. Health disparities are common. The law increases access to insurance coverage and to preventive services like screenings for diabetes and high blood pressure and counseling to help people quit smoking. The law also includes initiatives, like the State Innovation Model program, that support states in reforming payment and delivery systems to encourage prevention and improve population health. Public health, with its emphasis on prevention and the health needs of communities, is critical to the success of these reforms.

The ACA also presents challenges to public health. The increase in insurance coverage means many people will no longer need to turn to health departments for clinical care. But millions will remain uninsured and still rely on health departments and other safety net providers. Health departments must also adapt and be involved in the law's new payment and delivery reforms. Without health department engagement, reforms will not be as successful as they could be. Also, health departments could lose an opportunity to serve their communities and define their role in the changing health system.

Healthy Outlook: Public Health Resources for Systems Transformation  (PDF) is a series of fact sheets, issue briefs and other resources designed to: (1) highlight policy issues outlined in the ACA and their implications for public health; and (2) identify opportunities and promote active engagement of public health in health systems transformation efforts.

Integrating Public Health into State Innovation Models (PDF) is an issue brief that describes ways state officials can engage public health practitioners into state innovation model initiatives and design innovation models that incorporate public health as a full partner.

The Taking Part in State Innovation Models (PDF) issue brief provides recommendations and examples of public health engagement in innovation model efforts.

School-Based Health Centers and Health Systems Transformation

The ACA also presents opportunities to implement health reforms in school-based health centers. These case studies (PDF) show how some SBHCs are taking part in the process and offer recommendations for building on their best practices. APHA has also developed resources (all are downloadable PDFs) for school-based health center sponsors and policymakers identifying health reform opportunities. These resources also include a template school-based health centers can use to highlight their work and contact information for advocacy