Like distant cousins who get paired up for the egg toss game at a family reunion, hospital and public health department officials generally have been uneasy partners on joint health care endeavors.
But they soon will have more incentive to become closer allies: the growing emphasis on population health management. As the Institute of Medicine noted in its 2012 report, "Primary Care and Public Health: Exploring Integration to Improve Population Health," providers and public health officials could "yield substantial and lasting improvements in the health of individuals, communities and populations," by working more closely together.
To ease the process of combining the efforts of health care providers and public health workers, three organizations last month launched an online guide called "A Practical Playbook: Public Health and Primary Care Together,". Produced by the Centers for Disease Control and Prevention, Duke University's Department of Community & Family Medicine and the de Beaumont Foundation, the guide offers a framework to implement joint strategies between the two historically separate arenas.
"I think it is necessary to have a tool like the Practical Playbook because many clinical providers, insurers and also public health officials and advocates haven't had as much experience as they'd like collaborating on joint initiatives to improve health and reduce costs," says John Auerbach, a former Massachusetts commissioner of public health and a distinguished professor of practice in health science and director of the Institute on Urban Health Research at Northeastern University in Boston.
The issue is an important one, Auerbach says, based on his experience in Massachusetts, first implementing the state health reform law and then the Affordable Care Act.
"In Massachusetts, we're working on these issues and we think we're making very good progress, but even in a state that's in its sixth or seventh year of health care reform, where the environment is really encouraging, we're talking about changing the way health care is provided and public health operates," he says. "You need to have some expertise, and the playbook will provide access to that expertise."
Lloyd Michener, M.D., professor and chairman of Duke's Community and Family Medicine department, recommends that hospital executives widely distribute the guide, which will be available in hardcover this fall, especially to those responsible for adopting new care and reimbursement models. It also is useful for officials who oversee the community needs assessment, which is mandated by the ACA.
An assessment in Green Bay, Wis., helped to band together three hospitals, two public health departments and a United Way chapter, points out Heidi Selberg, vice president of advocacy and community benefit for Hospital Sisters Health System–Eastern Wisconsin.
By her estimate, the region would have needed to complete six or more separate community needs assessments had they not joined in 2011–2012 to produce one for the entire community.
"It seemed very logical that we come together to do this," Selberg says.