Applying A 3.0 Transformation Framework To Guide Large-Scale Health System Reform

Abstract

Implementation of the Affordable Care Act is unleashing historic new efforts aimed at reforming the US health system. Many important incremental improvements are under way, yet there is a growing recognition that more transformative changes are necessary if the health care system is to do a better job of optimizing population health. While the concept of the Triple Aim-dedicated to improving the experience of care, the health of populations, and lowering per capita costs of care-has been used to help health care providers and health care systems focus their efforts on costs, quality, and outcomes, it does not provide a roadmap for a new system. In this article we describe the 3.0 Transformation Framework we developed to stimulate thinking and support the planning and development of the new roadmap for the next generation of the US health care system. With a focus on optimizing population health over the life span, the framework suggests how a system designed to better manage chronic disease care could evolve into a system designed to enhance population health. We describe how the 3.0 Transformation Framework has been used and applied in national, state, and local settings, and we suggest potential next steps for its wider application and use.

An Integrated Framework For The Prevention And Treatment Of Obesity And Its Related Chronic Diseases

“…A new framework is required that extends and integrates existing chronic care and population health models and articulates the distinct and shared roles of care delivery and community systems to improve population health. The prevention and treatment of obesity offers an ideal example of how a transformation framework 5 can be applied to a specific disease.…”

Life Course Research Agenda (LCRA), Version 1.0

“…Similarly, the scientific advances and research that led to the development of the more dynamic and multilevel biopsychosocial framework begin to underwrite the upgrade and reengineering of the 2.0 chronic disease system with its greater focus on managing behavioral and lifestyle influences on chronic disease over longer time horizons. The emergence of the LCHD framework is already providing a way of underwriting the need for a more horizontally and longitudinally integrated, anticipatory, and developmentally primed health system (3.0 health system) that is structured to optimize health and health-promoting environments over the life span (Halfon et al 2014b). Moving forward, it will be important to consider how the LCHD framework can be more fully exploited to inform healthcare innovations and health systems transformation.…”

“…ACA-stimulated health system reform is also accelerating the consideration of transformational strategies that are challenging the dominant 2.0 operating logic, structure, and organization that arose to address the diagnosis, treatment, and management of adult chronic health conditions. What is now emerging is a new 3.0 operating logic aimed at optimizing lifelong health by leveraging the new science of life course health development (Halfon et al 2014b). The findings from the life course health sciences can continue to support this transition from 2.0 to 3.0 by providing the empirical basis for justifying healthcare systems that are more horizontally integrated to address multiple interacting dimensions and influences on health development, as well as longitudinally integrated to anticipate future health development scenarios and build long-term pull strategies into the structure and design of health and health-related social and educational services.…”

Childhood Poverty

“…115 Other neighborhood-based models have taken a less costly approach of linking existing services and resources to provide networked, wraparound supports for families. 116 Through the federally funded Promise Neighborhoods 117 and Promise Zones 118 initiatives, neighborhood-based approaches focusing on diverse areas of poverty-related community needs, from community-engaged policing to food security, are being carried out nationally. 119 These have great promise for lifelong reduction in the harms experienced by children in poverty.…”