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This article summarizes approaches to achieving value-based care in Pediatrics, providing a framework for understanding the continuum of models from fee-for-service to advanced alternative payment models. We present key examples of how alternative payment models have been developed and applied at the federal level within Medicare through the work of the Centers for Medicare and Medicaid Services (CMS) and the Center for Medicaid and Medicaid Innovation (CMMI). We further describe key lessons learned and opportunities to adapt value-based payment models to promote whole child health and equity. Finally, we summarize policy considerations and challenges in achieving accountability and aligning financial incentives for children's health within a complex payer landscape., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Purpose of Review: This review provides a critical assessment of recent pediatric population health research with a specific focus on child health equity. The review addresses: the role of the healthcare sector in addressing fundamental social drivers of health, challenges within healthcare organizations in addressing health-related social needs and the social determinants of health, and the rationale for incorporating race and racism in pediatric population health research and practice., Recent Findings: The coronavirus disease 2019 pandemic brought greater attention to the disparities and inequities in American health and healthcare. In response to these stark inequities, many health systems are adopting efforts and initiatives to address social needs, social determinants of health, racism, and health equity. However, empirical evaluation detailing the effectiveness of these interventions and initiatives is limited., Summary: While attention to identifying social needs among pediatric populations is increasing, there is limited evidence regarding the effectiveness of these interventions in producing sustained reductions in health disparities. To advance child health equity, researchers should move beyond individual behavior modification and directly examine fundamental drivers of health inequities. These drivers include government and health policies as well as societal forces such as systemic racism., (Copyright © 2022 The Author(s). Published by Wolters Kluwer Health, Inc.)

We examine whether zoning can increase health equity and population health by assessing a new zoning ordinance in the City of Baltimore that forced 76 liquor stores in residential areas to relocate, close, or convert to an approved use. To do so, we undertake a baseline assessment of neighborhoods with affected liquor stores, and predict the potential impact of the zoning change by estimating the impact of previous closures and openings of liquor stores on neighborhood crime in Baltimore using a spatial Poisson random trend fixed effects model. We find that affected stores are concentrated in high poverty, majority black neighborhoods with high vacancy rates, and that liquor store closings are associated with a statistically significant reduction in violent crime on the block group in question with no negative spillover affects onto the nearby block groups.

Objective: To develop and implement a measure of how US hospitals contribute to community health with a focus on equity. Data Sources: Primary data from public comments and hospital surveys and secondary data from the IBM Watson Top 100 Hospitals program collected in the United States in 2020 and 2021. Study Design: A thematic analysis of public comments on the proposed measure was conducted using an iterative grounded approach for theme identification. A cross‐sectional survey of 207 hospitals was conducted to assess self‐attestation to 28 community health best practice standards in the revised measure. An analysis of hospital rankings before and after inclusion of the new measure was performed. Data Collection/Extraction Methods: Public comment on the proposed measure was collected via an online survey, email, and virtual meetings in 2020. The survey of hospitals was conducted online by IBM in 2021. The analysis of hospital ranking compared the 2020 and 2021 IBM Watson Top 100 Hospitals program results. Principal Findings: More than 650 discrete comments from 83 stakeholders were received and analyzed during measure development. Key themes identified in thematic analysis included equity, fairness, and community priorities. Hospitals that responded to a cross‐sectional survey reported meeting on average 76% of applicable best practice standards. Least met standards included providing emergent buprenorphine treatment for opioid use disorder (53%), supporting an evidence‐based home visiting program (53%), and establishing a returning citizens employment program (27%). Thirty‐seven hospitals shifted position in the 100 Top Hospital rankings after the inclusion of the new measure. Conclusions: There is broad interest in measuring hospital contributions to community health with a focus on equity. Many highly ranked hospitals report meeting best practice standards, but significant gaps remain. Improving measurement to incentivize greater hospital contributions to community health and equity is an important priority. [ABSTRACT FROM AUTHOR]

The opportunities for healthy choices in homes, neighborhoods, schools, and workplaces can have decisive impacts on health. We review scientific evidence from promising interventions focused on the social determinants of health and discuss how such interventions can improve population health and reduce health disparities. We found sufficient evidence of successful outcomes to support disparity-reducing policy interventions targeted at education and early childhood; urban planning and community development; housing; income enhancements and supplements; and employment. Cost-effectiveness evaluations show that these interventions lead to long-term societal savings, but the interventions require more routine attention to cost considerations. We discuss challenges to implementation, including the need for long-term financing to scale up effective interventions for implementation at the local, state, and national levels. [ABSTRACT FROM AUTHOR]

Objectives. The social determinants of health (SDH) include factors apart from genes and biology that affect population health. Zoning is an urban planning tool that influences neighborhood built environments. We describe the methods and results of a health impact assessment (HIA) of a rezoning effort in Baltimore, Maryland, called TransForm Baltimore. We highlight findings specific to physical activity, violent crime, and obesity. Methods. We conducted a multistage HIA of TransForm Baltimore using HIA practice guidelines. Key informant interviews identified focus areas for the quantitative assessment. A literature review and a zoning code analysis evaluated potential impacts on neighborhood factors including physical activity, violent crime, and obesity. We estimated potential impacts in high- and low-poverty neighborhoods. The findings resulted in recommendations to improve the health-promoting potential of TransForm Baltimore. Results. Mixed-use and transit-oriented development were key goals of TransForm Baltimore. Health impacts identified by stakeholders included walkability and healthy communities. For Baltimore residents, we estimated that (1) the percentage of people living in districts allowing mixed-use and off-premise alcohol outlets would nearly triple, (2) 18% would live in transit-oriented development zones, and (3) all residents would live in districts with new lighting and landscaping guidelines. Limiting the concentration of off-premise alcohol outlets represented an opportunity to address health promotion. Conclusions. Changes to Baltimore's zoning code could improve population health including decreasing violent crime. HIAs are an important platform for applying SDH to public health practice. This HIA specifically linked municipal zoning policy with promoting healthier neighborhoods. [ABSTRACT FROM AUTHOR]

The article offers information on the different changes being incorporated by Obama administration for incorporating health considerations while forming new housing policies. The U.S. Department of Housing and Urban Development (HUD) has now adopted the health in all policies approach but is still faced by challenges like limited knowledge and lack of shared understanding among the staff. The study demonstrates that the approach can be extremely beneficial for public if implemented well.