Hometown Health Improvement: The Three Buckets of Prevention

Mission: To protect and improve the health and well-being of all Arkansans.

Vision: Optimal health for all Arkansans to achieve maximum personal, economic and social impact.

Health trends in the last 30 years are such that the leading causes of death and illness are now attributable to behaviors (e.g., smoking, sedentary lifestyle, and eating patterns) that are powerfully driven by the social and physical environments in which people live, learn, work, and play. There has been increasing recognition in recent years that we—in public health and beyond—must find ways to directly address the broad social and environmental determinants of health, through collaborative, cross-sector efforts. Elected and civic leaders have also become more aware of the importance of community health, realizing that a healthy community is one with a strong educational system, safe streets, effective public transportation, and affordable, high quality food and housing. (DeSalvo, 2016)

This scorecard measures the impact the Arkansas Department of Health Hometown Improvement program is making on the health of Arkansans and identifies areas where more effort is needed.

1st Bucket-Traditional Clinical Prevention
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Traditional clinical preventive interventions

These approaches involve the care provided by physicians and nurses in a doctor's office during a routine one-to-one encounter. They have a strong evidence base for efficacy in health improvement and/or cost-effectiveness. Examples include seasonal flu vaccines, colonoscopies, and screening for obesity and tobacco use. While such traditional clinical preventive interventions have historically been reimbursed by insurers, and many are now even mandated for most plans by the Affordable Care Act without cost sharing, there is often room for improvement in their promotion and rate of adoption. Improvement can be achieved by various action steps by insurers (eg, increasing the weight with which various preventive interventions are financially incentivized as quality measures), by clinical practices (eg, carefully monitoring that each clinician in the practice provides them), and by public health practitioners (eg, designing social marketing aimed at the public and/or clinical providers and promoting best practices).

2nd Bucket-Innovative Clinical Prevention
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Innovative preventive interventions that extend care outside the clinical setting

The approaches in bucket 2 are, like the approaches in bucket 1, clinical in nature and patient-focused. But they include interventions that have not been historically paid for by fee-for-service insurance and occur outside of a doctor's office setting—interventions that have nonetheless been proven to work in a relatively short time. Several have been piloted within the public health sector with grants from governmental agencies and foundations.

3rd Bucket-Total Population or Community-Wide Prevention
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Total population or community-wide interventions

With bucket 3, the focus shifts. It includes interventions that are no longer oriented to a single patient or all of the patients within a practice or even all patients covered by a certain insurer. Rather, the target is an entire population or subpopulation usually identified by a geographic area. Interventions are based not in the doctor's office but in such settings as a neighborhood, city, county or state. This bucket is the one that is most unfamiliar to the clinical sector but quite comfortable to the public health sector.

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