Although the Patient Protection and Affordable Care Act (PPACA) was signed by President Obama in March, 2010, it has been phased in and was not fully implemented until January 1, 2014.1 This landmark legislation included key insurance market reforms, insurance expansion provisions, and health care system delivery reforms and has as one of its aims to make strategic investments in the public's health through both an expansion of clinical preventive care and community investments.1 The law includes the development of a national prevention plan and the establishment of a Prevention and Public Health Trust Fund to finance community investments to improve population health. The PPACA has opportunities for population health improvement as public health agencies interact (or not) with the health care system in assessing community health, in improving chronic disease care, in delivering and/or ensuring clinical preventive services, and with employers, employees, and communities in achieving prevention and wellness goals.

This special issue of the Journal of Public Health Management and Practice has some early reports on the implementation of PPACA related to public health. The intent of the editors in proposing this topic to the Journal is to get an early report on implementation progress. What public health work is currently under way as part of PPACA? How are state and local systems changing to integrate clinical care and public health services? Are there system issues that deserve a more detailed examination? These are only a few of the questions that this issue attempts to explore. The issue is divided into 3 different sections: community health assessment, organization and delivery of care, and public policy.

How did we arrive at this division of topics? And what are the key themes related to public health that the PPACA evokes? One key theme is certainly the increased focus on collaborative community health assessment (CHA), community health needs assessment, and community health improvement plan (CHIP) activities as noted by Laymon and her colleagues from the National Association of County & City Health Officials in a study2 that provides baseline data that will help determine whether PPACA and public health accreditation will result in more collaborative community assessment and community health improvement activity by describing trends in collaborative CHA CHIP activities. There are many good examples of public health/health care system collaborative efforts such as the report by Sampson and Gearin3 describing their experience in performing a community health needs assessment with 3 medical centers serving a rural, Wisconsin county of 45 000 residents. In this example, the community health needs assessment emphasized the social determinants of health and paved the way for a more "upstream" orientation toward population health goals. The revised Internal Revenue Service Schedule H requirement in 2010 for nonprofit hospitals to report annually on their efforts to improve health in their service market provides a strong incentive for collaborative CHA/CHIP work between hospital systems and public health systems. How big a factor is this requirement in providing an incentive for public health/health care system collaboration? Bakken and Kindig4 analyze the Internal Revenue Service Schedule H community benefit reports to provide us with data on this question. Thus, we focus the first section of this issue on CHA.

The PPACA has prompted a number of changes in the organization and delivery of health care including preventive services. It has the potential "to re-establish primary care as the foundation of U.S. health care delivery."5 The new law seeks "to strengthen the nation's primary care foundation through enhanced reimbursement rates for providers and the use of innovative delivery models such as patient-centered medical homes."6 In addition, the PPACA establishes a common, perhaps unifying, vision for health care delivery in the United States. The elements of the Triple Aim provide a framework for enhanced collaboration between public health and the traditional delivery components of the health care industry. Developing models that enhance collaboration and promote the joining of forces and pooling of resources will be necessary to enhance the public's health, reduce costs, and improve outcomes. Examples of such efforts are presented in this section, with an evaluation by Rissi et al7 from Portland State University of Oregon's Patient-Centered Primary Care Home program and the adoption of the patient-centered medical home model by primary care providers, with an exploration of different strategies for integrating community health worker models within PPACA implementation by Islam et al8 from the New York University School of Medicine, and with an exploration by Dybdal et al9 from the University of Minnesota of lessons applicable to the Navigator programs required under PPACA. So, the second section focuses on the organization and delivery of health services.

The PPACA also includes public policy innovations with an emphasis on prevention. Deville and Novick note that this approach was foreshadowed in Barack Obama's 2008 "Plan for a Healthy America," stating that covering the uninsured was not enough: "Simply put, in the absence of a radical shift towards prevention and public health, we will not be successful in containing the costs or improving the health of the American people."10 What is our foundation for evaluating the policies of PPACA? Bias et al11 from West Virginia University develop a foundation for policy evaluation that includes health outcomes, economic outcomes, and consumer processes and perceptions. They describe evaluation methods that are easily adaptable to state, federal, and partnership marketplaces. How do these policies affect different aspects of the public health and health care system? The PPACA establishes numerous provisions intended to increase the primary care and public health workforce. Montes and Webb12 describe the history of the enumeration of the public health workforce and the limitations that hampered Enumeration 2000 that persist today. So, the third area of focus is on policy aspects of PPACA.

These 3 sections of articles have commentaries from 3 thoughtful observers: Michael Hatcher,13 Mark Bittle,14 and Brenda Stevenson Marshall.15 There are also 3 broad editorials: John Williams, past Chair of the APHA Health Administration Section, kicks off the issue with a view of PPACA through a systems thinking approach; Peggy Honore'16 reviews the issue's articles through the lens of funding and financing; and Karen Minyard17 has general comments on how to activate public health agencies to take advantage of these numerous opportunities in PPACA for population health improvement. Thanks to article authors for their early contributions on the implementation of health reform under PPACA and thanks to commentary and editorial authors for their wisdom and insights.

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