Telehealth insights from an integrated care system.

The COVID-19 pandemic accelerated telehealth expansion trends as policy makers instituted flexibilities and coverage changes. Federal telehealth flexibilities expire, however, at the end of 2024. To decide whether to extend those flexibilities, policy makers need information about consumer telehealth preferences, impacts of telehealth on care usage and quality, and telehealth accessibility for the full diversity of patients. Research from one of the nation's largest integrated, value-based health systems provides insights. Findings suggest that telehealth utilization has dropped since the peak of the pandemic but remains higher than prepandemic levels. Telehealth appears to be replacing in-person visits rather than leading to more total visits. Patients generally prefer in-person care but many like having the option to use video- and phone-based telehealth, and both video- and phone-based care appear to be helping patients access primary care. An integrated, value-based care approach may assist a diverse range of patients in accessing telehealth services. Action is still needed, however, to ensure that the full diversity of patients can easily access telehealth offerings. Based on experiences within our health system, we recommend that policy makers maintain public and private payer coverage for video- and phone-based telehealth services; encourage well-designed value-based payment models to simplify and expand telehealth access; improve broadband accessibility and broadband and device affordability so that all patients can access telehealth services; and hold digital health to equivalent high standards for care quality, safety, patient satisfaction, clinical outcomes, and health equity as in-person care.

The Building Blocks Collaborative: advancing a life course approach to health equity through multi-sector collaboration.

Too many children are born into poverty, often living in disinvested communities without adequate opportunities to be healthy and thrive. Two complementary frameworks-health equity and life course-propose new approaches to these challenges. Health equity strategies seek to improve community conditions that influence health. The life course perspective focuses on key developmental periods that can shift a person's trajectory over the life course, and highlights the importance of ensuring that children have supports in place that set them up for long-term success and health. Applying these frameworks, the Alameda County Public Health Department launched the Building Blocks Collaborative (BBC), a countywide multi-sector initiative to engage community partners in improving neighborhood conditions in low-income communities, with a focus on young children. A broad cross-section of stakeholders, called to action by the state of racial and economic inequities in children's health, came together to launch the BBC and develop a Bill of Rights that highlights the diverse factors that contribute to children's health. BBC partners then began working together to improve community conditions by learning and sharing ideas and strategies, and incubating new collaborative projects. Supportive health department leadership; dedicated staff; shared vision and ownership; a flexible partnership structure; and broad collective goals that build on partners' strengths and priorities have been critical to the growth of the BBC. Next steps include institutionalizing BBC projects into existing infrastructure, ongoing partner engagement, and continued project innovation-to achieve a common vision that all babies have the best start in life.

Addressing the social determinants of health through the Alameda County, California, place matters policy initiative.

In Alameda County, California, significant health inequities by race/ethnicity, income, and place persist. Many of the county's low-income residents and residents of color live in communities that have faced historical and current disinvestment through public policies. This disinvestment affects community conditions such as access to economic opportunities, well-maintained and affordable housing, high-quality schools, healthy food, safe parks, and clean water and air. These community conditions greatly affect health. At the invitation of the Joint Center for Political and Economic Studies' national Place Matters initiative, Alameda County Supervisor Keith Carson's Office and the Alameda County Public Health Department launched Alameda County Place Matters, an initiative that addresses community conditions through local policy change. We describe the initiative's creation, activities, policy successes, and best practices.

Meaningful, measurable, and manageable approaches to evaluating healthy food financing initiatives: an overview of resources and approaches.

More than 23 million Americans have limited access to grocery stores. Healthy food financing initiatives have been emerging at local, state, and federal levels to address grocery gaps. Through public-private partnerships, retailers have been awarded funding to open or renovate a variety of food outlets. Preliminary findings have reported increased access to healthy foods, as well as improved community and economic development. As policy makers continue to consider enacting or expanding these initiatives and as all program stakeholders increasingly seek information on program impacts, this article provides guidance on using meaningful, measurable, and manageable methods to evaluate program's multifaceted outcomes.