Encourage greater integration of public health and health care systems
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?
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.
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
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.
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
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.
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
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?
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
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.
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?