The Guide to Community Preventive Services: managed care/clinical practice commentary.

The dynamic health care environment of today is being driven by market and community forces that are impacting the way health care is delivered, paid for and used. New technologies and managed care are facilitating the transfer of acute care services to outpatient, home and other nontraditional settings of care. National perspectives on health and disease are also changing.1 A significant shift of focus from health care to health and determinants of disease is apparent; from acute illness to chronic disease and disability; from traditional medical treatment to selfcare and shared decision making; and from physical health to a broader definition of health that encompasses mental, social and spiritual well-being. Thus, health care organizations and managed care partners are challenged to respond to these forces by providing a health care delivery system that concentrates on communities and offers population-based health services with greater emphasis on health promotion and disease prevention rather than one that only treats illness and injury. The need to do more with less, and to do it more effectively whenever possible, has become a challenge for all involved in the health care industry. The Balanced Budget Act of 1997 has led to significant cuts in health care reimbursement and, subsequently, health organizations have had to look at ways to do the greatest good for the greatest number and obtain the greatest benefits for the least amount of resources. Hence, providers are recognizing that for some health problems, community-level interventions may be more effective for preventing morbidity and mortality than will preventive services delivered in the clinical setting. Community-based interventions targeting managed care members and other aligned populations, such as children and families who are served in school-based health settings, offer opportunities to have a positive impact on health status, costs of care and use of health resources. Population-based health services that are intended to change/modify risk behaviors, reduce preventable illness/injury/disability and address social problems that become health problems will be essential to the integrity of future health systems that purport to improve individual and community health.