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CDC's 6|18 Initiative: A Cross-Sector Approach to Translating Evidence Into Practice

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

Journal of Public Health Management and Practice: September/October 2018 - Volume 24 - Issue 5 - p 424–431
doi: 10.1097/PHH.0000000000000782
Research Reports: Research Full Report

Context: As the US health care system continues to undergo dynamic change, the increased alignment between health care quality and payment has provided new opportunities for public health and health care sectors to work together.

Program: The Centers for Disease Control and Prevention's 6|18 Initiative accelerates cross-sector collaboration between public health and health care purchasers, payers, and providers and highlights 6 high-burden conditions and 18 associated interventions with evidence of cost reduction/neutrality and improved health outcomes. This evidence can inform payment, utilization, and quality of prevention and control interventions.

Implementation: The Centers for Disease Control and Prevention focused initially on public payer health insurance interventions for asthma control, unintended pregnancy prevention, and tobacco cessation. Nine state Medicaid and public health agency teams—in Colorado, Georgia, Louisiana, Massachusetts, Michigan, Minnesota, New York, Rhode Island, and South Carolina—participated in the initiative because they had previously prioritized the health condition(s) and specific intervention(s) and had secured state-level leadership support for state agency collaboration. The Centers for Disease Control and Prevention, the Centers for Medicare & Medicaid Services, the Center for Health Care Strategies, the Robert Wood Johnson Foundation, and other partners supported state implementation and dissemination of early lessons learned.

Evaluation: The Centers for Disease Control and Prevention conducted exploratory interviews to guide improvement of the 6|18 Initiative and to understand facilitators, barriers, and complementary roles played by each sector. Monthly technical assistance calls conducted with state teams documented collaborative activities between state Medicaid agencies and health departments and state processes to increase coverage and utilization.

Discussion: The 6|18 Initiative is strengthening partnerships between state health departments and Medicaid agencies and contributing to state progress in helping improve Medicaid coverage and utilization of effective prevention and control interventions. This initiative highlights early successes for others interested in strengthening collaboration between state agencies and between public and private sectors to improve payment, utilization, and quality of evidence-based interventions.

Centers for Disease Control and Prevention, Atlanta, Georgia (Dr Seeff); Center for Health Care Strategies, Hamilton, New Jersey (Ms McGinnis); and Robert Wood Johnson Foundation, Princeton, New Jersey (Ms Heishman).

Correspondence: Laura C. Seeff, MD, The Office of the Associate Director for Policy, the Office of Health Systems Collaboration, Centers for Disease Control and Prevention, Roybal Campus, Bldg 21, Rm 11103, 1600 Clifton Rd, MS D-28, Atlanta, GA 30333 (

The authors acknowledge the state participants and many subject matter experts from CDC and external partners for their participation in CDC's 6|18 Initiative and their review of this manuscript. See Supplemental Digital Content Appendix 1, available at, for individual participants and reviewers.

The Center for Health Care Strategies is currently receiving a grant (#74278) from the Robert Wood Johnson Foundation to support technical assistance and dissemination related to CDC's 6|18 initiative.

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.

The authors declare no conflicts of interest.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (

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