Total population health is a key tenet of health care reform efforts, evident in initiatives such as the National Quality Strategy, shifts toward population-based payments, and community benefit requirements for tax-exempt hospitals. Representing total population health in a way that guides best practices and establishes shared accountability for geographic communities, however, remains a challenge in part because of differences in how stakeholders define populations. To better understand the landscape of potential denominators for population health, this study examined a selection of relevant geographic units. The approach included a comprehensive review of health services and public health research literature as well as recent pertinent health policy documents. Units were characterized based on whether they: exhibit "breadth" of coverage across the whole US population; are "accurate" or grounded in health care utilization patterns; are "actionable" with mechanisms for implementing funding and regulation; and promote "synergism" or effective coordination of public health and health care activities. Although other key components of a total population health unit may exist and no single identified unit possesses all of the aforementioned features, several promising candidates were identified. Specifically, healthcare coalitions link health care and public health domains to care for a geographic community, but their connection to utilization is not empiric and limited funding exists at the coalition level. Although Accountable Care Organizations do not uniformly incorporate public health or facilitate coordination across all payers or providers, they represent an effective mechanism to increase collaboration within health care systems and represent a potential building block to influence total population health.

The US health care system has maintained an objective of preparedness for natural or manmade catastrophic events as part of its larger charge to deliver health services for the American population. In 2002, support for hospital-based preparedness activities was bolstered by the creation of the National Bioterrorism Hospital Preparedness Program, now called the Hospital Preparedness Program, in the US Department of Health and Human Services. Since 2012, this program has promoted linking health care facilities into health care coalitions that build key preparedness and emergency response capabilities. Recognizing that well-functioning health care coalitions can have a positive impact on the health outcomes of the populations they serve, this article informs efforts to optimize health care coalition activity. We first review the landscape of health care coalitions in the United States. Then, using principles from supply chain management and high-reliability organization theory, we present 2 frameworks extending beyond the Office of the Assistant Secretary for Preparedness and Response's current guidance in a way that may help health care coalition leaders gain conceptual insight into how different enterprises achieve similar ends relevant to emergency response. We conclude with a proposed research agenda to advance understanding of how coalitions can contribute to the day-to-day functioning of health care systems and disaster preparedness.

No abstract