Alliance to Reduce Disparities in Diabetes

Encourage greater integration of public health and health care systems

Policy Consideration:
In what ways could public health be better integrated with health care systems to increase communication and care coordination for people at risk of or living with diabetes?

The Problem

Connecting health providers and patients is only one component of an effective health system. Health promotion and disease management is another critical component and public health has a vital role to play. This is particularly true with diabetes, which is a largely manageable condition. The successful management of diabetes, particularly for vulnerable individuals with complex disease conditions, requires a more integrated health system with primary care and public health working closely together to help manage and coordinate care.

While health care systems and public health have primarily functioned independently of each other, there has been recent attention on the need for more integration between the two fields. In March 2012, the IOM released a report calling for more integration between primary care and public health. The report reviewed new and promising integration models, many of which include shared accountability for improved community and population health outcomes and suggested a set of principles that are deemed essential for successful integration. v

Unfortunately, the current lack of communication and insufficient care coordination has created a fragmented system, particularly for those low-income, uninsured or underinsured individuals who must rely on safety-net providers for their care. Many times these safety-net providers, such as hospital emergency rooms, public health clinics and federally qualified health centers, face barriers to enhanced coordination such as patient confidentiality issues, proprietary concerns among providers and insufficient or incompatible information technology systems. More needs to be done to help facilitate coordination in general and in particular, the sharing of timely patient data. For example, the creation of community-based data sets that include hospital data, community-level claims data, or information from community-level health information exchanges (HIEs) could enhance care coordination and decrease duplication of services. Community-based datasets can enable these providers to more effectively identify high-risk patients and target education and support resources to patients.


Alliance Experience

The need for greater integration between health systems and public health emerged as a consistent theme at the Alliance’s National Summit held in March 2012. Experts from around the country identified this as a top concern. Alliance grantees have been partnering with public health organizations in their communities to help improve health outcomes and reduce disparities for individuals at risk of or living with diabetes.

  • The Camden Diabetes Educators workgroup created a standardized referral form and process for all diabetes outpatient education in the city of Camden. They trained many Camden clinical providers and staff on how to use the form so that they can optimize their patients’ chances of actually attending and receiving diabetes education available in the community setting.
  • The Wind River Reservation Diabetes Coalition is part of a coalition of providers comprised of Eastern Shoshone and Northern Arapaho Tribal Health and Tribal Diabetes programs, the Wind River Indian Health Service, the State of Wyoming Diabetes Prevention Program, Fremont County Public Health Nurses, and the University of Wyoming who meet regularly to identify ways that linkages between clinical providers and public health can facilitate better coordinated care and help to identify those at risk of diabetes or its complications.
  • The Chicago team has forged partnerships with many health promotion organizations in their community such as:
    • Chicago Park District that provides free gym membership for 6 months for patients;
    • Sav-a-Lot that provides grocery gift cards for the purchase of healthy food; and
    • A local community center that provides nutrition and physical activity education and health screenings to patients.


Policy Questions Arising from the Alliance Experience:

  • How can greater coordination between health care, public health systems and community-based programs be achieved? What incentives would increase opportunity for partnership regarding education and support services?
  • How can communities utilize new funding through the ACA (e.g. Community Transformation Grants or funding from the new Prevention and Public Health Fund) to facilitate greater collaboration between health systems and public health?
  • What federal or state resources/incentives can be used to improve the sharing of health information data between health systems and public health? For example, the development of electronic health records (EHRs), diabetes registries and health information exchanges (HIEs) that share timely patient data and identify at risk and vulnerable patients.
  • How can new federal funding available for health information technology (e.g., through the ARRA or HITECH programs) be used to establish connectivity between health care systems and the public health community?
  • How can CHWs serve as a link or bridge between community, public health and health systems? Would an expanded role for CHWs increase the chances for reimbursement of services?