WASHINGTON — The traditional separation between primary health care providers and public health professionals is impeding greater success in meeting their shared goal of ensuring the health of populations, says a new report from the Institute of Medicine. Integration of these fields will require national leadership as well as substantial adaptation at the local level, said the committee that wrote the report.
The report recommends ways that the Centers for Disease Control and Prevention (CDC) and Health Resources and Services Administration (HRSA) could foster integration between primary care and public health through funding, policy levers, and other means. Collaboration presents an opportunity for both primary care and public health to extend their reach and achieve the nation's population health objectives, the committee noted.
The committee's recommendations are based on its review of published papers as well as case studies in specific cities — Durham, N.C.; New York City; and San Francisco — where integration efforts have taken place. The review showed that successful integration of primary care and public health requires community engagement to define and tackle local population health needs; leadership that bridges disciplines and jurisdictions and provides support and accountability; shared data and analyses; and sustained focus by partners.
The Patient Protection and Affordable Care Act (ACA) authorizes HRSA and CDC to launch several new programs. The agencies should coordinate these programs and funding streams with other partners at the national, state, and local levels to spur momentum. Promising opportunities include building incentives to promote interactions with local public health departments into HRSA's funding for community health centers; encouraging hospitals to treat primary care and community health as priorities as they strive to earn federal tax exempt status through demonstrated community benefits; and fostering collaboration among health departments and community health centers to improve the provision of preventive clinical services to Medicaid recipients.
The medical home model and the new accountable care organizations (ACOs) established by ACA also offer opportunities for integration. As more primary care practices move toward the patient-centered medical home model, public health departments could work with these practices and spread the benefits of care coordination to the community, the committee said. As ACOs — groups of hospitals and clinicians that work together to provide primary care and other health care services to Medicare beneficiaries — begin operating, they should reach out to health departments to forge links to community programs and public health services.
Training primary care and public health professionals in aspects of each other's fields will help promote a more integrated work force, the report adds. HRSA and CDC should work together to develop training grants and teaching tools that can prepare the next generation of health professionals for shared practice. For example, HRSA should use its Title VII and VIII primary care training programs to support curriculum development and training opportunities that involve aspects of public health, and CDC's Epidemic Intelligence Service officers could assist HRSA-supported community health centers in using public health data to guide the care they provide.
"While integrating fields that have long operated separately may seem like a daunting endeavor, our nation has undertaken many major initiatives, such as building both a national hospital system and an extensive biomedical research infrastructure and significantly expanding high-tech clinical capacity through investments in specialty medicine," said committee chair Paul J. Wallace, senior vice president and director, Center for Comparative Effectiveness Research, The Lewin Group, Falls Church, Va. "It's time we did the same for primary care and public health, which together form the foundation of our population's overall well-being. Each of these foundational elements could be stronger if they were better coordinated and collaborated more closely."
The report was sponsored by the Centers for Disease Control and Prevention, Health Resources and Services Administration, and United Health Foundation. Established in 1970 under the charter of the National Academy of Sciences, the Institute of Medicine provides objective, evidence-based advice to policymakers, health professionals, the private sector, and the public. The Institute of Medicine, National Academy of Sciences, National Academy of Engineering, and National Research Council together make up the independent, nonprofit National Academies. For more information, visit http://national-academies.org or http://iom.edu. A committee roster follows.
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Copies of Primary Care and Public Health: Exploring Integration to Improve Population Health are available from the National Academies Press; tel. 202-334-3313 or 1-800-624-6242 or on the Internet at http://www.nap.edu. Additional information is available at http://www.iom.edu/ . Reporters may obtain a copy from the Office of News and Public Information (contacts listed above).
INSTITUTE OF MEDICINE
Board on Population Health and Public Health Practice
Committee on Integrating Primary Care and Public Health
Paul J. Wallace, M.D. (chair)
Senior Vice President and Director
The Lewin Group
Falls Church, Va.
Anne Barry, J.D., M.P.H.
Deputy Commissioner
Minnesota Department of Finance
St. Paul
Jo Ivey Boufford, M.D.
President
New York Academy of Medicine;
Professor of Public Service, Health Policy, and Management
Wagner Graduate School of Public Service; and
Clinical Professor of Pediatrics
New York University School of Medicine
New York City
Shaun Grannis, M.D., M.S., FAAFP,
Director and Principal Investigator
Regenstrief Institute Inc., and
Assistant Professor of Family Medicine
Indiana University School of Medicine
Indianapolis
Larry A. Green, M.D.
Professor and Epperson-Zorn Chair for Innovation in Family Medicine
University of Colorado
Denver
Kevin Grumbach, M.D.
Professor and Chair
Department of Family and Community Medicine
University of California, and
Chief of Family and Community Medicine
San Francisco General Hospital
Fernando A. Guerra, M.D., M.P.H.
Director of Health
San Antonio Metropolitan Health District (retired)
San Antonio
James Hotz, M.D.
Clinical Services Director
Albany Area Primary Health Care
Albany, Ga.
Alvin D. Jackson, M.D.
Director
Ohio Department of Health (retired)
Fremont
Bruce E. Landon, M.D., M.B.A., M.Sc.
Professor of Health Care Policy
Harvard Medical School, and
Associate Professor of Medicine
Beth Israel Deaconess Medical Center
Boston
Danielle Laraque, M.D.
Professor of Pediatrics;
Endowed Debra and Leon Black Professor of Pediatrics; and
Chief
Division of General Pediatrics
Mount Sinai School of Medicine
New York City
Catherine G. McLaughlin, Ph.D.
Senior Fellow
Mathematica Policy Research Inc., and
Professor
Department of Health Management and Policy
University of Michigan
Ann Arbor
J. Lloyd Michener, M.D.
Professor and Chairman
Department of Community and Family Medicine, and
Director
Duke Center for Community Research
Duke University Medical Center
Durham, N.C.
Robert Phillips Jr., M.D., M.S.P.H.
Director
Robert Graham Center for Policy Studies in Family and Primary Care
American Academy of Family Physicians
Washington, D.C.
David N. Sundwall, M.D.
Professor of Public Health
Department of Family and Preventive Medicine
Division of Public Health
School of Medicine
University of Utah
Salt Lake City
Mary Wellik, M.P.H., B.S.N.
Community Health Services Administrator
Olmsted County Public Health Services
Rochester, Minn.
Winston F. Wong, M.D., M.S.
Medical Director for Community Benefit
Kaiser Permanente
Oakland, Calif.
STAFF
Monica N. Feit, PH.D., M.P.H.
Study Director