SAN DIEGO — During a breakout session at the 21st Health Forum–AHA Leadership Summit yesterday, Michelle Lyn of Duke Medicine suggested that providers have lost their way a bit.

She was detailing Duke's comprehensive approach toward community health and pointed out that the system, through the Duke Center for Community Research, has "reinvented" some old concepts like home visits and putting clinicians back in the community. "We are talking about rediscovering good old-fashioned public health," Lyn said.

For the past 15 years, Duke has worked with other providers, social service agencies, government agencies and people in the community to improve population health on a block-by-block basis. The center uses detailed data to study patient utilization patterns and feeds that information into a homegrown electronic health record that alerts care teams of patient actions. Lyn and her team also meet regularly with people in the community to ask if the health system is meeting their needs.

The idea of improved community health was just one of the hot topics being discussed on Day 1 of the Leadership Summit. Implementation of the ACA was also high on the agenda. The AHA hosted a Town Hall meeting on the approaching launch of insurance exchanges, or marketplaces, that included a call-in address from CMS Administrator Marilyn Tavenner.

With HHS and the CMS continuing to ramp up promotion of the exchanges to try to maximize enrollment, Tavenner was eager to get the word out that an important final rule will be released next week. The final rule spells out requirements of certifying application counselors. Being able to certify application counselors is a major avenue for hospitals to directly assist people in getting enrolled.

Also on the panel was Joel Ario, managing director for Manatt Health Solutions, who is still optimistic on the outlook for the exchanges despite some setbacks, such as less-than-hoped-for insurer participation. "I do think they're going to revolutionize the way people [pay for] healthcare," Ario said.

Another session, led by two HealthPartners executives, detailed the Minnesota-based system's formula for improving clinical integration.

HealthPartners put the Institute for Healthcare Improvement's Triple Aim framework at the center of its clinical integration effort, said Nancy McClure, chief operating officer.

Key to the approach was acting simultaneously on both changing culture and changing care design, work that did not face opposition from its medical staff, says Brian Rank, M.D., executive medical director.

"There's a common notion that doctors aren't willing to buy into change," but that turned out to not be the case for HealthPartners, he said.