Health Systems & Health Policy

Health Systems & Health Policy

Domain 1: Clinical and Public Health Systems Domain 2: Health Services Financing Domain 3: Clinical and Public Health Workforce Domain 4: Health Policy

Domain 1: Clinical and Public Health Systems

A. Clinical health services across the care continuum
1. Care settings
a. Ambulatory, home, hospital, long‐term care, subacute care, urgent care, pharmacies
2. Critical components of the health care system
a. Pharmaceutical and device industries, insurance companies, insurance brokering, health care institutions, health care professionals, biomedical researchers, telehealth, and telemetry
3. Models of care delivery
a. Integrated care systems, telehealth, convenient care models, Accountable Care Organizations (ACOs), patient-centered medical homes (PCMH), community care organizations (CCOs)
4. Determinants of access to care
a. Affordability, accessibility, availability, accommodation, acceptability
B. Responsibilities of public health systems
1. Public health core functions and 10 Essential Public Health Services across levels of prevention
2. Addressing digital determinants of health
a. Internet access, availability of digital devices, and digital literacy
C. Structure of public health systems
1. Roles of federal, state, tribal, county, and local public health agencies
2. Partnerships with community-based organizations, private sector, and academia
3. Financing and governance
4. Data and information systems
D. Collaboration between clinical practice and public health
1. Coordination between clinical health systems and public health departments
a. Gaps, challenges, and barriers to health care access
b. Communication, reporting process, referral process, and effective use of resources
2. Community planning for health assessment
a. Community Health Assessments (CHAs) and community health improvement plans (CHIPs)
b. Integration of clinical, public health, and community data
3. Clinical and community partnerships
a. Health education, advocacy, and linkages to community-based services
b. Public-private partnerships
E. Impact of health systems organization on health outcomes
1. Population health status and differences in health outcomes across communities and populations
2. Contributors to patient safety and medical errors
3. Patient and community feedback addressing structure, process, and outcomes of care
4. Impact of health system design and organization on costs and error rates
a. Resource waste, duplication of services, communication barriers
5. Continuous quality improvement (CQI) of systems and structures

Domain 2: Health Services Financing

A. Financing and paying for health care services
1. Sources of public and private payments
a. Medicare, Medicaid, Children’s Health Insurance Program (CHIP), Veterans Health Administration (VA), TRICARE, Indian Health Service (IHS), federal and state insurance marketplaces under the ACA
b. Employer-sponsored health insurance, individual market, self-pay
2. Alternative payment models
a. Value-Based Purchasing, capitation, bundled payments, managed care
3. Strategies used by managed care organizations (MCOs) and other payers that impact utilization and costs
a. Utilization management including prior authorization and step therapy
b. Health care professional reimbursements based on capitation instead of fee for service or per diem payments
c. Pharmacy benefit managers (PBMs), direct and indirect remuneration (DIR) fees, relationship to Medicare financing and to pharmaceutical access
d. Role of insurance brokers and influence on cost
4. Safety net providers for the uninsured or underinsured
a. Public hospitals and health systems, Federally Qualified Health Centers (FQHCs), Rural Health Clinics (RHCs), emergency departments, faith-based, free and reduced clinics
B. Financing of public health services
1. Public health budgets, including structure and allocation of funding at federal, state, and local levels
2. Government funding mechanisms such as taxes, categorical and block grants
3. Private and philanthropic support for social and public health services
C. Impact of global financial models on costs, quality, and health outcomes
1. International comparisons of financial models
2. Comparisons of public, private, and mixed financing models
3. Universal coverage compared to single-payer systems
D. Ethical principles in health care financing
1. Financing objectives and their impact on health and health care services
2. Efficiency and outcomes of financial models on health of communities and populations
3. Expansion of health care financing to address impact of social determinants of health

Domain 3: Clinical and Public Health Workforce

A. Discipline‐specific history, roles and responsibilities
1. Clinical and non-clinical health professional roles, education, and scopes of practice, with and without licensure
2. Diversity of perspectives, experiences, backgrounds, and access within the workforce
3. Historical evolution of health professions and their contributions to public health
B. Regulating health professionals and health care institutions
1. Certification, licensure, credentialing, and privileging of health professionals
2. Accreditation processes for health care institutions and development and enforcement of standards
3. Regulatory oversight by state, federal, and professional bodies governing practice and institutional operations
C. Interprofessional team approach and impact on health outcomes
1. Evidence supporting interprofessional and team-based practice
2. Joint clinical and public health education for collaborative practice
3. Workplace codes of ethics and conduct
D. Legal and ethical responsibilities of health professionals
1. Patient privacy, confidentiality, and HIPAA compliance
2. Privileged communications and maintenance of trust
3. Ethical use of communication platforms including social media
4. Professional liability and scope of practice
5. Duty to report, mandated reporting policies, and immunity protections
6. Good Samaritan laws and responsibilities
7. Accountability for population health outcomes

Domain 4: Health Policy

A. The policy process
1. Problem identification
2. Policy analysis
3. Strategy and policy development
4. Policy enactment
5. Policy implementation
6. Policy modification or termination
7. Stakeholder engagement
B. Participation in the policy process
1. Review of legislative and regulatory processes
2. Advisory roles in shaping policy
3. Strategies to influence the policy process
4. Policy analysis and preparation of effective policy briefs
5. Difference between advocacy and lobbying including opportunities and limitations
6. Identification of barriers to participation in the policy process
C. Impact of policies on health and health care
1. Chronic disease and injury prevention laws and regulations
a. Tobacco taxation, smoking bans, school meal standards, Highway Safety Act, National Traffic and Motor Vehicle Safety Act
2. Environmental and occupational health laws and regulations
a. Clean Air Act, Clean Water Act, Resource Conservation and Recovery Act (RCRA), Occupational Safety and Health Act (OSHA)
3. Infectious disease control and prevention laws and regulations
a. Immunization mandates and food safety standards, public health powers during a public health emergency
4. Health care access and equity laws and regulations
a. Affordable Care Act (ACA), Mental Health Parity and Addiction Equity Act (MHPAEA), Americans with Disabilities Act (ADA)
5. Impact of policy decisions on health outcomes
D. Ethical frameworks in public health decision‐making
1. Comparison of clinical and public health ethical principles
a. Clinical ethics: beneficence, nonmaleficence, autonomy, justice
b. Public health ethics: permissibility, reciprocity, effectiveness, responsible use of scarce resources, social justice, proportionality, accountability, transparency, equity, public participation
2. Balancing individual rights and population responsibilities
a. Autonomy, collective welfare, and justification for public health actions
3. Equity and distribution of benefits
a. Fair allocation of resources and protection of vulnerable populations
4. Decision-making in resource scarcity
5. Ethical use of data and information