IOM: Primary Care, Public Health Need to Work Together

Primary care providers and the public health system need to better coordinate their efforts to prevent disease and injury, promote health and well-being and provide timely, effective health care, according to an Institute of Medicine-appointed committee that wrote a blueprint for public-provider partnership.

The current lack of integration between primary care and public health "is a big problem," according to the committee’s leader, Dr. Paul Wallace, an internist and senior vice president at The Lewin Group. "But it also may be at the core of how we look at health care moving forward."

At the heart of the blueprint are five principles that the committee said are essential for successful integration of primary care and public health efforts: a shared goal of population health improvement; community engagement in defining and addressing population health needs; aligned leadership across disciplines, programs, and jurisdictions that works towards changes in the system; sustainability, including a shared infrastructure between primary care and public health; and the sharing and collaborative use of data and analysis.

The Committee on Integrating Primary Care and Public Health identified a number of examples of successful integration efforts, and found they had several common elements. For example, many targeted a specific health issue that was identified as a community area of concern, such as chronic disease, or the health needs of a specific population.

None of these successful initiatives took place on the federal level, instead, they were concentrated on state and local levels, Dr. Wallace noted. Successful initiatives "have a strategic view from the beginning," along with a plan to "get beyond pilot funding" and make the funding stream sustainable, he said.

One example cited was an effort by the Michigan Department of Community Health, which formed six independent regional networks that partner with and support providers, business and community groups to improve diabetes care. The program, which according to the IOM has demonstrated improved health outcomes for Michigan residents with diabetes, has created public awareness campaigns and developed systems for medical practices to use to promote adherence to established care guidelines.

The committee also laid out a detailed blueprint for more coordinated efforts among federal agencies, including the Health Resources and Services Administration (HRSA), Centers for Disease Control and Prevention (CDC), and the Centers for Medicare and Medicaid Services.

Specifically, HRSA-supported public health departments could integrate efforts in three specific areas: the Maternal, Infant, and Early Childhood Home Visiting Program; cardiovascular disease prevention; and colorectal cancer screening.

It noted that HRSA and CDC have very different organizational structures, a problem that creates logistical barriers to partnerships. Nonetheless, it recommended that the two agencies develop joint projects to enhance public health; evaluate existing projects and develop new initiatives involving integrated primary care and public health.

The agencies were also advised to work with CMS to identify regulatory options for graduate medical education funding that give priority to provide training in primary care and public health settings. Furthermore, they were advised to work together to develop training grants and teaching tools to prepare the next generation of health professionals for more integrated clinical and public health functions in practice.

The current lack of integration between primary care and public health "is a big problem," said Dr. Wallace. "But it also may be at the core of how we look at health care moving forward."

The 17-member committee was convened in early 2011 at the request of HRSA and the CDC.

Funding for the effort was provided by HRSA, CDC, and the UnitedHealth Foundation.

Primary care providers and the public health system need to better coordinate their efforts to prevent disease and injury, promote health and well-being and provide timely, effective health care, according to an Institute of Medicine-appointed committee that wrote a blueprint for public-provider partnership.

The current lack of integration between primary care and public health "is a big problem," according to the committee’s leader, Dr. Paul Wallace, an internist and senior vice president at The Lewin Group. "But it also may be at the core of how we look at health care moving forward."

At the heart of the blueprint are five principles that the committee said are essential for successful integration of primary care and public health efforts: a shared goal of population health improvement; community engagement in defining and addressing population health needs; aligned leadership across disciplines, programs, and jurisdictions that works towards changes in the system; sustainability, including a shared infrastructure between primary care and public health; and the sharing and collaborative use of data and analysis.

The Committee on Integrating Primary Care and Public Health identified a number of examples of successful integration efforts, and found they had several common elements. For example, many targeted a specific health issue that was identified as a community area of concern, such as chronic disease, or the health needs of a specific population.

None of these successful initiatives took place on the federal level, instead, they were concentrated on state and local levels, Dr. Wallace noted. Successful initiatives "have a strategic view from the beginning," along with a plan to "get beyond pilot funding" and make the funding stream sustainable, he said.

One example cited was an effort by the Michigan Department of Community Health, which formed six independent regional networks that partner with and support providers, business and community groups to improve diabetes care. The program, which according to the IOM has demonstrated improved health outcomes for Michigan residents with diabetes, has created public awareness campaigns and developed systems for medical practices to use to promote adherence to established care guidelines.

The committee also laid out a detailed blueprint for more coordinated efforts among federal agencies, including the Health Resources and Services Administration (HRSA), Centers for Disease Control and Prevention (CDC), and the Centers for Medicare and Medicaid Services.

Specifically, HRSA-supported public health departments could integrate efforts in three specific areas: the Maternal, Infant, and Early Childhood Home Visiting Program; cardiovascular disease prevention; and colorectal cancer screening.

It noted that HRSA and CDC have very different organizational structures, a problem that creates logistical barriers to partnerships. Nonetheless, it recommended that the two agencies develop joint projects to enhance public health; evaluate existing projects and develop new initiatives involving integrated primary care and public health.

The agencies were also advised to work with CMS to identify regulatory options for graduate medical education funding that give priority to provide training in primary care and public health settings. Furthermore, they were advised to work together to develop training grants and teaching tools to prepare the next generation of health professionals for more integrated clinical and public health functions in practice.

The current lack of integration between primary care and public health "is a big problem," said Dr. Wallace. "But it also may be at the core of how we look at health care moving forward."

The 17-member committee was convened in early 2011 at the request of HRSA and the CDC.

Funding for the effort was provided by HRSA, CDC, and the UnitedHealth Foundation.

Primary care providers and the public health system need to better coordinate their efforts to prevent disease and injury, promote health and well-being and provide timely, effective health care, according to an Institute of Medicine-appointed committee that wrote a blueprint for public-provider partnership.

The current lack of integration between primary care and public health "is a big problem," according to the committee’s leader, Dr. Paul Wallace, an internist and senior vice president at The Lewin Group. "But it also may be at the core of how we look at health care moving forward."

At the heart of the blueprint are five principles that the committee said are essential for successful integration of primary care and public health efforts: a shared goal of population health improvement; community engagement in defining and addressing population health needs; aligned leadership across disciplines, programs, and jurisdictions that works towards changes in the system; sustainability, including a shared infrastructure between primary care and public health; and the sharing and collaborative use of data and analysis.

The Committee on Integrating Primary Care and Public Health identified a number of examples of successful integration efforts, and found they had several common elements. For example, many targeted a specific health issue that was identified as a community area of concern, such as chronic disease, or the health needs of a specific population.

None of these successful initiatives took place on the federal level, instead, they were concentrated on state and local levels, Dr. Wallace noted. Successful initiatives "have a strategic view from the beginning," along with a plan to "get beyond pilot funding" and make the funding stream sustainable, he said.

One example cited was an effort by the Michigan Department of Community Health, which formed six independent regional networks that partner with and support providers, business and community groups to improve diabetes care. The program, which according to the IOM has demonstrated improved health outcomes for Michigan residents with diabetes, has created public awareness campaigns and developed systems for medical practices to use to promote adherence to established care guidelines.

The committee also laid out a detailed blueprint for more coordinated efforts among federal agencies, including the Health Resources and Services Administration (HRSA), Centers for Disease Control and Prevention (CDC), and the Centers for Medicare and Medicaid Services.

Specifically, HRSA-supported public health departments could integrate efforts in three specific areas: the Maternal, Infant, and Early Childhood Home Visiting Program; cardiovascular disease prevention; and colorectal cancer screening.

It noted that HRSA and CDC have very different organizational structures, a problem that creates logistical barriers to partnerships. Nonetheless, it recommended that the two agencies develop joint projects to enhance public health; evaluate existing projects and develop new initiatives involving integrated primary care and public health.

The agencies were also advised to work with CMS to identify regulatory options for graduate medical education funding that give priority to provide training in primary care and public health settings. Furthermore, they were advised to work together to develop training grants and teaching tools to prepare the next generation of health professionals for more integrated clinical and public health functions in practice.

The current lack of integration between primary care and public health "is a big problem," said Dr. Wallace. "But it also may be at the core of how we look at health care moving forward."

The 17-member committee was convened in early 2011 at the request of HRSA and the CDC.

Funding for the effort was provided by HRSA, CDC, and the UnitedHealth Foundation.