by Laura C. Seeff, MD; Tricia McGinnis, MPP, MPH; Hilary Heishman, MPH

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As the US health care system undergoes dynamic change, increased alignment between health care quality and payment is providing new opportunities for the public health and health care sectors to work together. The Centers for Disease Control and Prevention’s (CDC) 6|18 Initiative is accelerating cross-sector collaboration between public health and health care purchasers (employers responsible for employee health and insurance coverage), payers (public and private health insurers), and providers (health systems, physicians, and providers of ancillary services)that enhance payment, use, and quality of prevention practices. The Initiative focuses on six high-burden health conditions and 18 associated evidence-based interventions designed to control costs and improve health outcomes.

CDC has led the initiative with support from the Centers for Medicare & Medicaid Services (CMS). CDC and CMS collaborate with the Center for Health Care Strategies (CHCS) – with support from the Robert Wood Johnson Foundation – and with the Association for State and Territorial Health Officials (ASTHO) to coordinate technical assistance to state Medicaid agency and public health department teams and to facilitate shared peer-to-peer, state-to-state learning. Here are 5 things to know about the 6|18 Initiative now underway in 34 states, territories, and localities across the country.

1. The CDC’s 6|18 Initiative is strengthening partnerships between public health departments and state Medicaid agencies.

The 6|18 Initiative fosters collaboration between state public health departments and Medicaid agencies that may not otherwise regularly occur. The initiative brings together federal and state partners on a routine basis to help improve coverage and utilization of evidence based interventions. CDC’s Catalyst for Collaboration infographic includes reflections from states on how these agencies are succeeding together through critical partnerships forged through the 6|18 Initiative, through better coordination and accountability to each other and with increased cross-sector knowledge.

2. States are using the 6|18 Initiative to help improve Medicaid coverage and utilization of effective prevention and control services.

Among several mechanisms used to expand coverage for 6|18 Initiative interventions, states participating in the CDC’s 6|18 Initiative pursued state plan amendments and negotiated with their Medicaid managed care organizations. For example, as of July 2017, the South Carolina Medicaid agency removed co-payments and prior authorization requirements for tobacco cessation medications and now provides consistent medication and cessation counseling coverage across all Medicaid Managed Care Organizations. The South Carolina 6|18 Initiative team is now educating providers and consumers about these new cessation services and aligning quitline and claims data to monitor the impact of their efforts.

3. Important facilitators of collaboration included 1) the targeted nature of the activities and 2) complementary skills from both state public health departments and state Medicaid agencies required to implement the 6|18 interventions.

The targeted and discrete nature of the activities within this initiative provided a clear focus for the cross-sector work, and the mix of skills and knowledge from state public health departments and Medicaid agencies required for this effort created an effective division of labor. This allowed participating state agencies to collaborate and leverage each other’s skills toward shared goals. For example, some public health partners highlighted and promoted the strongest evidence-based clinical and community interventions to Medicaid partners, while Medicaid partners used Medicaid claims data to develop a business case for 6|18 interventions. In doing this, the two state agencies collaboratively made the case for the positive health and cost impact associated with this effort.

4. The opportunity within the 6|18 Initiative to routinely bring together federal and state partners to jointly address coverage and utilization helped accelerate payment change processes.

Regular individual and multi-state calls and in-person meetings facilitated ongoing collaboration within cross-agency state teams, as well as across states and federal agencies. States found value in these structured learning and technical assistance opportunities and were able to leverage the expertise and guidance shared during these calls and meetings to advance their 6|18 Initiative implementation efforts.

5. This initiative offers lessons for others interested in strengthening collaboration among and between state agencies and public and private sectors to jointly improve coverage, use, and quality of services.

Through the partnerships fostered by the 6|18 Initiative, participating states were able to accelerate both new and existing efforts and realize successes that may otherwise not have been possible – or may have taken much more time to implement. Recent state accomplishments include: (1) making the case for Medicaid to pay for a pediatric asthma home visiting program; (2) passing a bill to allow pharmacists to prescribe evidence-based tobacco cessation medications; and (3) unbundling payment for long-acting reversible contraceptives from other postpartum services, thereby improving postpartum initiation of contraception. Additional accomplishments from participating states are included in Appendix 2 in the recently published Journal of Public Health Management and Practice article, “CDC’s 6|18 Initiative: A Cross-Sector Approach to Translating Evidence Into Practice.”

As the initiative grows, CDC and its partners will continue to expand the 6|18 Initiative and engage new stakeholders, including non-Medicaid partners (such as employer organizations and health care providers), and provide tools and resources for interested stakeholders. Over time, the CDC plans to expand the reach and impact of the 6|18 Initiative, with the goal of achieving population health improvements and lowering health care costs in states across the country.

Read the recently published article CDC’s 6|18 Initiative: A Cross-Sector Approach to Translating Evidence Into Practice in the Journal of Public Health Management and Practice:

Seeff LC, McGinnis T, Heishman H. CDC’s 6|18 Initiative: A Cross-Sector Approach to Translating Evidence Into Practice. J Public Health Manag Pract. 2018 Sep/Oct;24(5):424-431. doi: 10.1097/PHH.0000000000000782.

The authors thank Sana Hashim, Program Officer, MPH, CPH, CHES, at the Center for Health Care Strategies, for her editorial contributions.

The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

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Laura Seeff, MD, is Director of the Office of Health Systems Collaboration in the Centers for Disease Control and Prevention’s (CDC) Office of the Director. In this position, she helps maximize CDC’s collaboration between public health and the health care sector, including partnering with health care purchasers, payers, and providers to improve health and control health care costs. In her current and previous position as the Deputy Medical Director of CDC’s National Center for Chronic Disease Prevention and Health Promotion, she helped shape CDC’s relationship with the Centers for Medicare and Medicaid Innovation’s population health programs.

She focused much of her career on cancer control, helping develop CDC’s Colorectal Cancer Control Program and representing CDC on the National Commission on Digestive Diseases, the National Colorectal Cancer Roundtable, and the National Call to Action for Cancer Prevention and Survivorship Council of Experts. She came to CDC in 1998 through the Epidemic Intelligence Service program and has authored over 50 publications.

Before joining CDC, Dr. Seeff was a practicing General Internist at Emory University School of Medicine’s Grady Memorial Hospital, where she established a colorectal cancer screening program and provided primary care. She trained at the Emory University School of Medicine. She and her husband have three children.

Tricia McGinnis, MPP, MPH, is senior vice president at the Center for Health Care Strategies (CHCS). In this role, she oversees CHCS’ broad delivery system and payment reform portfolio, and directs the organization’s far-reaching communications efforts and unique Medicaid leadership and capacity-building programs.

Ms. McGinnis leads a wide range of projects working directly with state Medicaid agencies, health plans, and providers to advance value-based payment models, including: (1) CHCS’ multi-pronged efforts to advance accountable care organizations (ACOs), including the Medicaid ACO Learning Collaborative, funded by The Commonwealth Fund; (2) technical assistance to states awarded the CMMI State Innovation Models (SIM) grants; and (3) the Center for Medicaid and CHIP Services’ Innovation Accelerator Program to promote adoption of advanced payment models within Medicaid. In partnership with the Centers for Disease Control and Prevention and the Robert Wood Johnson Foundation, Ms. McGinnis leads a team working with state Medicaid agencies, public health departments, and commercial health plans to implement the 6/18 Initiative. She also oversees several projects to address social determinants of health.

Prior to joining CHCS, Ms. McGinnis managed the provider performance measurement, improvement, and transparency program as a senior program manager at Blue Shield of California.

Ms. McGinnis holds master’s degrees in public policy and public health from the University of California, Berkeley. She received a bachelor’s degree in political science and economics from Kenyon College.

Hilary Heishman, MPH, joined the Robert Wood Johnson Foundation (RWJF) in 2011. As a senior program officer, her work to develop strategies and grants for the Foundation’s Transforming Health and HealthCare Systems strategy focuses on connecting and aligning health care, public health and other systems to enable people to live healthier lives. She also supports grantmaking to help communities have more capability to improve health. She is program officer for Data Across Sectors for Health, 100 Million Healthier Lives, Health Leads, the Social Interventions Research & Evaluation Network, and other RWJF grantees. Previously, Heishman was in the Centers for Disease Control and Prevention’s Public Health Prevention Service. She has worked with the Northwest Center for Public Health Practice and the Washington State Department of Health’s Public Health Improvement Partnership. Heishman served in the Peace Corps in Ghana, where she taught biology then coordinated HIV/AIDS prevention programs country-wide. Heishman received a BA in Biology from the University of Virginia and a MPH in Community Oriented Public Health Practice from the University of Washington. She is a West Virginian by birth.