Creating Community Gadflies in Population Health Promotion: Illuminating the Value of Learning About the Medical Services Payment System


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Our health system is in a disordered state. Costs continue to rise without concomitant improvements in outcomes. A population health approach to improving health, rooted in the understanding that health outcomes are the result of a complex interplay of determinants, brings together all community stakeholders whose actions contribute to health outcomes to work in coordination. Getting funding and aligning financial incentives with planning goals is critical. Our current payment system’s complexity and distorted incentives create barriers to successful population health initiatives that are invisible to members of the community outside the health care sector. A “gadfly” is “a person who interferes with the status quo of a society or community by posing novel, potentially upsetting questions, usually directed at authorities.” (Wikipedia, 2020.) Here, “gadflies” represent community representatives to whom the payment system is made visible. With that knowledge, they become empowered to challenge powerful health care sector interests in service of the public interest and increase their ability to deliberate in all stages of population health improvement planning. They stimulate genuine community engagement, increasing the likelihood of a successful improvement plan. This capstone is a two-part educational intervention targeted at health care activists. Part One introduces healthcare activists to how the payment system works, how it creates barriers to innovation, and how it creates incentives that do not align with improving outcomes. Part Two introduces activists to ways they could apply knowledge of the payment system in population health improvement planning on a community level. Participants (8 in Boston; 6 in DC) in two proof of concept sessions of Part One reported that my presentation convinced them they should devote time and energy to understanding the medical services payment system to be competent agents of change and they all agreed to attend a Proof of Concept session for Part Two.

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