Common to both the community health center movement

Common to both the prostaglandin receptors health center movement and the ACA is an emphasis on activating communities to prevent illness and promote wellbeing. Population medicine, as a result, is thought to intervene before the onset of preventable diseases in order to address fundamental causes (Phelan, Link, & Tehranifar, 2010).
Changing medical relationships under the ACA One major cause of the impact patients are having (and will continue to have) on these transformations stems from the fact that the ACA has dramatically increased the number of access points to the American health system, especially through expanded Medicaid eligibility for those states that have opted to accept federal funds, and through the establishment of a new health care marketplace for those who are not eligible for Medicaid and lack access to employer sponsored health care (Rosenbaum, 2011; Obama, 2016). Even as expanded access through the ACA has solved one critical problem, it has put pressure on existing relations – especially doctor–patient relations – by raising questions about the capacity for existing practices to meet the needs of the some-odd 13 million Americans who now have health insurance who previously did not (Hall & Lord, 2014; Kaiser Family Foundation, 2016). This decrease in uninsured ranks, and attendant influx of new patients, is also putting pressure on the various moving parts of the American health care system to innovate, particularly through the introduction of team based care and new forms of interprofessional cooperation, comprised of traditional medical providers as well as new team members. New team members, such as navigators, are in fact necessary precisely because the ACA establishes new relationships between insurance providers and patients, many of whom are unfamiliar with basic concepts such as deductibles, premiums, open enrollment periods, and other technical insurance terms. At the same time, especially in the area of the expanded Medicaid population, the ability of existing medical relationships and systems to meet the needs of these new patients is, in many ways, a test of the ACA\'s promise to transform medicine, not only through increased access, but in quality and cost as well. For these reasons, patients who are entering the system for the first time are a test case for working with, as well as a driver in the formation of new relationships that are forming as a function of health care reform. Because non-medical, upstream determinants are increasingly being considered as key factors driving health disparities and outcomes, new collaborative strategies must address not only the health of individual patients but also the neighborhoods they inhabit (Leong & Roberts, 2013). Examples of interventions on this level include working with civic associations to provide safe and affordable housing, deploying medical professionals to schools to provide health education, partnering with churches or other community organizations to develop a stable source of healthy food, and collaborations with community members to conduct health needs assessments and understand local problems. In communities, as well, potential corporate partners – especially in the fast growing retail medicine sector – will undoubtedly play a role (Pollack, Gidengil, & Mehrotra, 2010). Accordingly, physicians and other providers are being asked to rethink the medical relationships necessary to improving population health. This maneuver, however, will require critical reflection on the meaning of medicine as well as the meaning of community. Yet, though increased access might be a key driver, the developments we have described also create new financial dynamics that are having a dramatic effect on the formation of new medical relationships. Specifically, under new Alternative Payment Models – Accountable Care Organizations, practices that utilize episode-based payment systems, and Patient Centered Medical Homes, among others (DeVore & Champion, 2011) – medical practices and systems are assuming higher levels of risk for patient care in exchange for financial rewards. This, in turn, is fundamentally changing the actuarial context in which patients are situated (Wynne & Horowitz, 2016). In other words, the fact of increased access and the rise of Alternative Payment Models is fundamentally altering patient relationships to medicine in the areas of quality and cost as well, since new models incentivize, cajole, and even force practices to innovate and become more efficient (Shih, Chen, & Nallamothu, 2015; Greenwald, Bassano, Wiggins, & Froimson, 2016). Beyond practice management, however, such developments also incentivize investments in population health insofar as they have the potential not only to reduce health disparities, but to do so in a way that promotes population-level wellness while encouraging institutions to reduce costs and increase efficiencies (Laverack, 2006; Lantz, Lichtenstein, & Pollack, 2007; Frerichs, Hassmiller Lich, Dave, & Corbie-Smith, 2016). The bond developed between patients – seen increasingly as members of communities – and practitioners, accordingly, must be viewed in a new way.