Health care payment and delivery models that challenge providers to be accountable for outcomes have fueled interest in community-level partnerships that address the behavioral, social, and economic determinants of health. We describe how Hennepin Health--a county-based safety-net accountable care organization in Minnesota--has forged such a partnership to redesign the health care workforce and improve the coordination of the physical, behavioral, social, and economic dimensions of care for an expanded community of Medicaid beneficiaries. Early outcomes suggest that the program has had an impact in shifting care from hospitals to outpatient settings. For example, emergency department visits decreased 9.1 percent between 2012 and 2013, while outpatient visits increased 3.3 percent. An increasing percentage of patients have received diabetes, vascular, and asthma care at optimal levels. At the same time, Hennepin Health has realized savings and reinvested them in future improvements. Hennepin Health offers lessons for counties, states, and public hospitals grappling with the problem of how to make the best use of public funds in serving expanded Medicaid populations and other communities with high needs.

Integrating public health and medicine to address social determinants of health is essential to achieving the Triple Aim of lower costs, improved care, and population health. There is intense interest in the United States in using social determinants of health to direct clinical and community health interventions, and to adjust quality measures and payments. The United Kingdom and New Zealand use data representing aspects of material and social deprivation from their censuses or from administrative data sets to construct indices designed to measure socioeconomic variation across communities, assess community needs, inform research, adjust clinical funding, allocate community resources, and determine policy impact. Indices provide these countries with comparable data and serve as a universal language and tool set to define organizing principles for population health. In this article we examine how these countries develop, validate, and operationalize their indices; explore their use in policy; and propose the development of a similar deprivation index for the United States.

Missed appointments have been linked to adverse outcomes known to affect racial/ethnic minorities. However, the association of missed appointments with race/ethnicity has not been determined. We sought to determine the relationships between race/ethnicity and missed appointments by performing a cross-sectional study of 161 350 patients in a safety net health system. Several race/ethnicity categories were significantly associated with missed appointment rates, including Hispanic/Latino patients, American Indian/Alaskan Native patients, and Black/African American patients, as compared with White non-Hispanic patients. Other significant predictors included Mexico as country of origin, medical complexity, and major mental illness. We recommend additional research to determine which interventions best reduce missed appointments for minority populations in order to improve the care of vulnerable patients.

Lessons from community-oriented primary care in the United States can offer insights into how we could improve population health by integrating the public health, social service, and health care sectors to form accountable communities for health (ACHs). Unlike traditional accountable care organizations (ACOs) that address population health from a health care perspective, ACHs address health from a community perspective and consider the total investment in health across all sectors. The approach embeds the ACO in a community context where multiple stakeholders come together to share responsibility for tackling multiple determinants of health. ACOs using the ACH model provide a roadmap for embedding health care in communities in a way that uniquely addresses local social determinants of health.

PR has markedly altered the manner in which primary care research is undertaken in partnership with communities and its principles and philosophies continue to offer means to assure that research results and processes improve the health of all communities.

BackgroundTobacco use remains the leading cause of preventable disease and death in the United States and is concentrated among disadvantaged populations, including individuals with a history of criminal justice involvement. However, tobacco use among individuals with a history of criminal justice involvement has been understudied in the United States, and data are needed to inform policy and practice.MethodsWe used data from the 2008–2016 National Survey on Drug Use and Health (unweighted N = 330,130) to examine trends in tobacco use, categories of tobacco use, characteristics of cigarette use, and health care utilization and tobacco use screening among individuals (aged 18–64) with and without a history of criminal justice involvement in the past year. We used multiple logistic and Poisson regression models with predictive margins to provide adjusted prevalence estimates.ResultsThe weighted sample in each year was, on average, representative of 8,693,171 individuals with a history of criminal justice involvement in the past year and 182,817,228 individuals with no history of criminal justice involvement in the past year. Tobacco use was significantly more common among individuals with a history of criminal justice involvement compared with individuals with no criminal justice involvement, and disparities increased over time (Difference in adjusted relative differences: − 10.2% [95% CI − 17.7 to − 2.7]). In 2016, tobacco use prevalence was more than two times higher among individuals with a history of criminal justice involvement (62.9% [95% CI 59.9–66.0] vs. 27.6% [95% CI 26.9–28.3]). Individuals with a history of criminal justice involvement who smoked reported a significantly earlier age of cigarette initiation, more cigarettes used per day, and higher levels of nicotine dependence and chronic obstructive pulmonary disease. Individuals with a history of criminal justice involvement were less likely to report an outpatient medical visit in the past year and, among those reporting an outpatient medical visit, were less likely to be asked about tobacco use, but paradoxically, more likely to report being advised to quit.ConclusionsNovel programs and tobacco control policies are needed to address persistently high rates of tobacco use and reduce cardiovascular morbidity and mortality among individuals with a history of criminal justice involvement.

An address-based indicator can identify a large proportion of Medicaid enrollees who are experiencing homelessness. This approach may be of interest to researchers, states, and health systems attempting to identify homeless populations.

COVID-19 outbreaks have been reported in homeless shelters across the United States (1). Many persons experiencing homelessness are older adults or persons with underlying medical conditions, placing them at increased risk for severe COVID-19-associated illness. The proportion of persons experiencing homelessness who are fully vaccinated against COVID-19 in the United States is currently unknown. Many persons experiencing homelessness express a willingness to receive the COVID-19 vaccine (2,3).Through conversations with public health and housing assistance partners, CDC identified six* urban public health jurisdictions with data on vaccination coverage among persons experiencing homelessness. These six jurisdictions reported data on COVID-19 vaccinations † administered to persons experiencing intermittent homelessness during December 13, 2020-August 31, 2021. Full vaccination status § and evidence of coverage with at least 1 COVID-19 vaccine dose ¶ among persons experiencing homelessness were obtained by performing data linkage between immunization information systems and homeless services data systems or through data collection during vaccination events at homeless service sites. Total populations of persons experiencing homelessness were estimated using either the total number of persons accessing homeless * The six jurisdictions included