Policy issue
The Challenge of Attribution: Responsibility for Population Health in the Context of Accountable Care

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Diverging Concepts of Population

A central and long-recognized misalignment in historic and current efforts to coordinate health care and public health systems lies in this question: How should “populations” be defined, and by what criteria should individuals be attributed to a particular population for measurement?

Public health agencies characteristically define populations on the basis of residential location, stratified, perhaps, by race, ethnicity, gender, age, language spoken, disability, or disease status.10 In New York

New Paradigms Needed to Link Delivery Systems and Public Health Agendas

What, then, can be done to better align these two concepts of population and so to advance health goals through accountable care contracts? The measure set for which ACOs will be accountable under Medicare contracts, together with the imperative to create aggregate savings, suggests that ACOs will focus substantial effort on care coordination among primary care providers, specialists, and hospitals. For some measures that reflect both ACO and public health objectives, however, a collaborative

Conclusion

Accountable care is in its nascent stages, and there is much room for experimentation and innovation in incentive and measurement models, within Medicare and more broadly in Medicaid and commercial insurance. Public health institutions and advocates for patient-centered care have an opportunity to develop models that better align healthcare delivery financing with population health actions.

As currently configured, the advent of ACOs may do little to advance population health in urban areas. The

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