An Examination of How National Policies are Driving Population Health Outcomes and Organizational Change in Private and Public Sectors

Abstract

The United States spends more on healthcare than any other country in the world, but still trails most other countries when it comes to important health indicators. There has been an increasing recognition that in order to address this discrepancy, the U.S. health system must begin to address the underlying social determinants contributing to poor health outcomes. In light of this, the concept of “population health” has emerged as a framework and model for how to better address the social determinants contributing to unhealthy behaviors and increased rates of morbidity and mortality in the U.S. Various national initiatives, including reform related to how doctors and hospitals are paid, have been developed with the purpose of increasing the adoption of strategies to address population health among public and private organizations. In this dissertation I attempt to assess how these national policies are driving behavior and outcomes related to improving population health in private and public sectors. It is comprised of three papers focused on 1) a systematic review of literature to assess how hospitals are responding to policies that encourage them to form partnerships to address population health, 2) a quantitative analysis of how the Affordable Care Act has impacted population health by addressing tobacco use with policies to increase Medicaid coverage for tobacco cessation services, and 3) an empirical examination to identify hospital strategic partnerships to address population health and determine hospital and market characteristics associated with these partnerships. The main findings of this study indicate that while there is a growing amount of peer reviewed literature focused on hospital partnerships for population health there is still a need for more generalizable studies with rigorous study designs in this area; Medicaid Expansion as a part of the Affordable Care Act is associated with lower prevalence of tobacco use; and policies, such as Accountable Care Organization and Bundled Payment models, may be influencing hospitals to engage with a broad set of partners to support population health activities. Collectively these studies provide new evidence to suggest that national policies may be driving behavior in private and public sectors related to population health.