Background and Purpose
How can the Affordable Care Act benefit the neighborhood built environment? Accountable care organizations (ACO’s), a relatively new model of healthcare delivery, may be a critical component to the multidisciplinary partnerships necessary to build healthy communities. The model, which rewards doctors and hospitals for health maintenance rather than health care provision, is a logical outgrowth of health reform measures designed to improve patient outcomes and reduce costs. In the wake of the new law, as health care systems reinvent themselves to maintain viability and profitability, ACOs will continue to proliferate across the nation, presenting a timely opportunity for organizations looking to move active living research into built realities.

As defined by a task force of the American Academy of Family Physicians, an ACO is “a primary care-based collaboration of health care professionals and health care facilities that accept joint responsibility and accountability for the quality and cost of care provided to a defined patient population.” They are a relatively new phenomenon; currently ACOs now number more than 400, but cover four million Medicare enrollees and millions more people with private insurance.

Because ACO profits will be tied to keeping their patient population healthy, and recruiting health-minded patients to select their ACO, these healthcare organizations are expected to play increasingly active roles in promoting community health by aligning with public health, local government community development departments and community-based organizations(CBO. Armed with new growing empirical evidence on the relationship between the built environment and preventative health behavior, ACO’s can potentially help fund and direct neighborhood health programs such as tree planting initiatives, retrofitting parks with walking paths, or sponsoring farmers’ markets. ACO’s can also influence community and regional health by providing grant match dollars needed for transportation projects to improve transit access, close sidewalk gaps and advance complete streets. Supporting this type of neighborhood, community and regional development can further improve health, supports the work of physicians in encouraging consumers to increase physical activity, and reduces the need for costly medical care.

Description
This research collaboration which includes professionals and researchers at Sutter Eden Medical Center, Kaiser Permanente, and Design 4 Active Sacramento (D4AS), a community-based organization and advisory council in Sacramento, California, discusses the nature and growth of ACO’s in the wake of the Affordable Care Act, and its potential for active living initiatives. Using our current work in Sacramento as a case study, we outline how we have already established partnerships between public health, local government, and community based organizations to fund and implement interventions in the built environment.

Lessons Learned
D4AS has already begun the process of implementing active design guidelines and programs such as improved access to transit, complete streets initiatives, sidewalk gaps closures, and a Safe Routes to School initiative. We discuss how they have leveraged these guidelines and programs into existing infrastructure and new development projects by strategically reaching out to other agencies and organizations and focusing on the monetary benefits of active design, from attaching “price tags” to and quantifying benefits of these programs for outside investment, to finding and structuring federal grant match programs.

Conclusions and Implications
By examining both the challenges and potential in healthcare provider partnerships and quantifying costs and benefits of active design implementation, we aim to lead a practical discussion on beginning to translate the vast research on active living into realized projects in a new era of healthcare healthcare delivery.

Next Steps
We outline our current and future efforts in integrating healthcare providers, with a specific focus on ACO’s, in the wake of the Affordable Care Act.

References

1. Lowery, A. (2013, April 24). A Health Provider Strives to Keep Hospital Beds Empty. New York Times, p. A1.
2. Bovbjerg, R. R., Ormond, B. A., & Waidmann, T. A. (2011). What Directions for Public Health under the Affordable Care Act? Urban Institute Health Policy Center.
3. Rittenhouse DR, Shortell SM, Fischer ES. Primary care and accountable care – two essential elements of delivery-system reform. N Engl J Med 2009; 361(24): 2301-2303.
4. Shortell, S. M. (2013). Bridging the Divide Between Health and Health. JAMA, 309(11), 1121-1122.

Support / Funding Source
The Design 4 Active Sacramento team was one of 20 teams nationwide chosen this year by the US Centers for Disease Control to participate in the National Leadership Academy for the Public’s Health.