Submitted on Mon, 2015-08-24
By SMART Health Claims

3 Surprising Things We Learned From NACCHO’s 2015 Forces of Change Study

Public health agencies can no longer rely on public funding to keep American communities healthy. Data now shows that 9 out of 10 Local Health Departments are actively billing third-party payers, signaling a monumental change in the way local health is funded.

The Dawn of a New Age in Public Health
The age of the grant-dependent local health is coming to an end. For nearly a decade, local health departments have suffered the consequences of reductions in federal, state and local government assistance. Local health professionals have largely bore the brunt of this impact with more than 52,000 positions eliminated since 2008.

While economic recovery has washed over most of America, the unsung heroes of healthcare are still dealing with the fallout.

“Budget cuts and the increased cost of providing preventive and clinical services have motivated LHDs to seek additional revenue streams to sustain essential public health services in their communities” -The Changing Public Health Landscape, Findings from the 2015 Forces of Change Survey, June 2015, NACCHO

A New Public Health Fiscal Strategy

This continual drop in annual funding has caused a seismic shift in public health financial strategy. Health departments have transitioned from being largely dependent on government funded grants into a hybrid model supported with reimbursements from public and private health insurers.

While the dense fog of economic uncertainty has clouded the last seven years, clear skies lie on the horizon. New opportunities to generate sustainable, annual revenue within the Affordable Care Act, along with a rise in patients with insurance, suggest that financial stability is attainable.

INFOGRAPHIC: The State of Local Health Departments in 2015

3 Surprising Things We Learned About Local Health Departments in 2015

In their June 2015 survey, “The Changing Public Health Landscape, Findings from the 2015 Forces of Change,” NACCHO asked local health departments across the nation how they have been affected by dwindling resources. This year’s survey found some surprising trends that tell of this new era for LHDs.

1) Nearly Everyone is Now Billing

  • 90% of LHDs reported billing third-party payers (including Medicaid, Medicare, and private insurers)
  • LHDs were billing only for a subset of the clinical services they provide
  • Nearly one-quarter of LHDs reported billing public but not private payers
  • Some LHDs have found working with private insurers challenging

2) The Number of Patients with Insurance is Increasing

  • Almost two in five LHDs reported serving a higher percentage of patients with insurance in 2014 compared to 2013
  • In states expanding Medicaid, 46% of LHDs reported serving a higher percentage of patients with insurance
  • In states without expanding Medicaid, 29% of LHDs reported serving a higher percentage of patients with insurance
  • “While LHDs are serving fewer patients in their clinics, findings show that patients with insurance are still visiting LHDs for services.”

3)  Staff Time is the Biggest Obstacle in Billing

  • Factors related to internal LHD capacity are the most important factors influencing LHDs’ decision to bill third-party payers
  • Developing a billing infrastructure is time-consuming and requires a high level of staff engagement and commitment
  • LHDs could benefit from additional training, technical assistance, and peer support to continue to bill third-party payers
  • Funding to support improved information technology and workforce capacity is needed

Taking Matters Into Their Own Hands

Public health professionals touch the lives of more than 200 million Americans every day. They handle preventative and responsive services to address a variety of illness and injuries, abusive behaviors, and natural events. Even more, LHDs ensure America’s safety, educate the public and provide vital vaccinations against disease.  

No other public service organization is closer to protecting public health than LHDs. Unlike fire, police, and EMS, public health agencies find themselves in a more difficult financial situation.

“Communities don’t wait until a big fire breaks out to hire all the firefighters they need and buy new fire engines.We can’t afford to leave our local health departments dangerously understaffed, underfunded, and without adequate public health infrastructure until a horrific epidemic, disaster or outbreak of violence strikes - NACCHO Executive Director, LaMar Hasbrouk.

For LHDs, their financial world has changed, yet the power to control their future remains. The question is whether or not this is the best use of their time. Rather than focusing solely on the health issues of an entire community, they now have to figure out how they can finance their efforts as well.

If you need help maximizing the revenue from your billing program, we urge you to schedule a meeting today with one of our medical billing specialists today.


The Changing Public Health Landscape, Findings from the 2015 Forces of Change survey was distributed to a statistically representative sample of 948 LHDs in the United States from January to February 2015. An impressive total of 690 LHDs (73%) responded to the survey.


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