Strengthening public health through integration with primary care
State and local leaders across the country are taking innovative steps to strengthen public health through integration with primary care.
Public health agencies at the state and local levels have long faced challenges such as chronic underfunding, rigid funding streams, outdated and disconnected data systems, fragmented care delivery structures, and workforce shortages. Partnerships between medical care systems, community-based organizations, and public health departments can solve some of these problems while helping communities prepare for future public health emergencies.
In a landscape analysis funded by the Commonwealth Fund, Sam Iovan, Nancy Baum, and Marianne Udow-Phillips outline three approaches to public health and primary care partnerships:
- structured collaboration,
- collective impact, and
- integrated service delivery.
To gain insights into these approaches, the authors examine public health and primary care collaborations in North Carolina, Rhode Island, Washington, and Oregon.
Structured collaboration involves aligning incentives, establishing formal communication channels, and setting a common agenda for improving community health. Communities that adopt this approach encourage partnerships between public health, community health centers, local government, and social service organizations to enhance access to care. In Lane County, Oregon, for example, the local health department director initiated a “Health Roundtable” in collaboration with healthcare leaders. This informal platform aims to build relationships, which are crucial to sustained collaboration.
In the collective impact model outlined in this 2011 Stanford Social Innovation Review article, multiple agencies join together to achieve a common goal. The model calls for a backbone agency to coordinate and champion the work, guided by four specific principles: a common agenda, shared measurement systems, mutually reinforcing activities, and continuous communication. The state of Washington, for example, received Medicaid funding to improve population health through the Accountable Communities of Health (ACH) model. ACHs act as backbone organizations, connecting stakeholders in a community to address medical and social needs. Washington currently has nine ACHs in operation.
Integrated service delivery
Integrated service delivery models involve shared data systems, co-location of agencies, integration between agencies, shared staffing, and braided or blended funding. For instance, Rhode Island’s Patient-Centered Medical Home (PCMH) model showcases how shared data can advance the effectiveness of collaboration between primary care, public health, and community-based human services organizations to address public health issues and improve health equity.
Reports and resources to strengthen public health through primary care integration
The CHRT team provides actionable recommendations from these three collaborative approaches. These steps include providing collaborative learning opportunities, leveraging Medicaid funds for innovation, establishing interoperable data sharing platforms, and more.
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