Health System Integration: Interesting Opportunity for Public Health

As a nation we have not done very well integrating health systems, payers, public health departments, and community based agencies. The key findings in obesity, diabetes, access, poverty, and tobacco underscore the need for service integration. The drumbeat for the integration of services among delivery systems with community-based organizations has become louder in recent years. In the past year alone two Institute of Medicine panels, the Commonwealth Fund and numerous expert thought leaders have called for a new effort to identify viable models of service integration between health systems, health departments, and community based organizations. The aging population is particularly susceptible to the ills of our current fragmented approach to health care. The baby boomer generation is turning 65 at a rate of about 8,000 a day and as this unique cohort grows older we need to establish and maintain robust integrated health systems to ensure that we achieve successful aging.

There are models that provide hope. St. Johns Well Child and Family Health Center in South Los Angeles are changing the face of their communities with collaborative health innovations. For example, through their Healthy Homes Healthy Housing program, they are partnering with community-based tenant rights and health worker organizations to help educate patients affected by environmental triggers that lead to increased asthma visits and admissions. This program has improved outcomes for local health systems as well as resulted in decreased costs for St. John’s clinic. The South Side Healthcare Collaborative in Chicago is a network of 30 service delivery units that develops community relationships to inspire wellness, prevention, and primary care. The Community Health Initiative in Baltimore is a collaborative effort to engage residents, community groups, city officials and Johns Hopkins personnel in a process to develop and implement a community health assessment. This is the first phase of a larger initiative, which aims to improve the health and well being of residents of all ages who live in East Baltimore through sustainable health collaborations and specific health interventions.

Many aspects of the Affordable Care Act (ACA) will provide opportunities for widespread adaptations of systems that promote population health. For example, the Centers for Medicare and Medicaid Services is offering a substantial amount of funding for innovative new approaches for care coordination and population health through the CMS Innovation Center. In addition, under the ACA, new funds will be appropriated for various community transformation grants, community health needs assessments, community health centers, teaching health centers, and increasing the number of National Health Service Corps scholars to commit to working primary care in underserved communities. It is vital that all of communities receiving the fruits of these new opportunities promote inter-agency integration for achieving population health. No single best solution can be prescribed to all communities, as each collaborator is going to offer unique assets to be leveraged. However, we believe that the above examples and consolidated recommendations outlined here can serve as the guiding principles for achieving optimal health for our increasing elderly population. Finally, the current health policy trajectory still lacks the necessary investment to develop integrated health systems to fully leverage the strength and potential of primary care and public health, but the ACA is certainly a catalysis and step in the right direction. Further advocacy is needed to ensure more substantial investments will be made and sustained in the future.

Jay Bhatt is part of the GovLoop Featured Blogger program, where we feature blog posts by government voices from all across the country (and world!). To see more Featured Blogger posts, click here.

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