On February 5, 2015, the Institute of Medicine (IOM) Roundtable on Population Health Improvement hosted a workshop to explore the relationship between public health and health care, including opportunities, challenges, and practical lessons. The workshop was convened in partnership with the Association of State and Territorial Health Officials (ASTHO)-supported Primary Care and Public Health Collaborative.
Paul Jarris, executive director of ASTHO, welcomed participants and explained that the ASTHO-supported Primary Care and Public Health Collaborative was organized in response to the IOM report Primary Care and Public Health: Exploring Integration to Improve Population Health (IOM, 2012). In 2012, the IOM, ASTHO, and the United Health Foundation convened a meeting of leaders in public health and primary care to develop a strategic map for the collaborative to move forward on the issue of integration of primary care and public health toward the goal of improving population health and lowering costs. Areas of focus, as described by Jarris, included collecting success stories; considering the value proposi-
1 This workshop was organized by an independent planning committee whose role was limited to identification of topics and speakers. This workshop summary was prepared by the rapporteur as a factual summary of the presentations and discussion that took place at the workshop. Statements, recommendations, and opinions expressed are those of individual presenters and participants and are not necessarily endorsed or verified by the Institute of Medicine or the roundtable, and they should not be construed as reflecting any group consensus.
tion; measuring the impact of collaboration on population health; investigating resources to support the infrastructure for collaboration; and discussing workforce integration. The group reconvened in 2014 to revisit the strategic map, review accomplishments, refine the focus, and set new directions.
As background for the discussion, Jarris listed four ideal outcomes of a collaborative: participating organizations make connections and become more informed by other sectors; organizations work more effectively by aligning with others that are doing related work; some organizations in the collaborative may partner on projects; and the collaborative as a whole takes on initiatives that all the organizations work on jointly.
George Isham, senior advisor at HealthPartners and senior fellow at the HealthPartners Institute for Education and Research, said that although collaboration between health care and public health is not a new topic, the roundtable was seeking new insights and fresh examples to motivate further progress. To foster discussion, Isham quoted Wikipedia, which states that collaboration is “working with others to do a task and to achieve shared goals.” Furthermore, collaboration is “more than the intersection of common goals seen in cooperative ventures, but a deep collective determination to reach an identical objective.”2 In considering the intersection between the public health and the health care delivery sectors, Isham challenged participants to reflect on this deep, collective determination to reach a common goal or identical objective and think about what it will take to get there, including potential barriers.
A major activity of the roundtable is to hold workshops for its members, stakeholders, and the public to discuss important issues in the effort to improve the nation’s health. An independent planning committee, co-chaired by José Montero and Julie Wood, and including Terry Allan, John Auerbach, Ron Bialek, Christopher Holliday, Paul Jarris, and Sarah Linde, was charged with developing a workshop to explore opportunities for collaboration and innovation at the interface of public health and health care (see Box 1-1). The workshop was designed to
- discuss and describe the elements of successful collaboration between health care and public health organizations and professionals;
- reflect on the five principles of primary care–public health integration (which can be applied more broadly to the health care–
Statement of Task
An ad hoc committee will plan and conduct a public workshop on current issues at the interface of public health and health care, including opportunities presented by and lessons learned from the Centers for Medicaid & Medicare Services State Innovation Models program. The workshop will feature presentations on several dimensions of the public health–health care relationship. The committee will develop the agenda and identify specific meeting objectives, select and invite speakers and other participants, and moderate the discussions. An individually authored summary of the presentations and discussions at the workshop will be prepared by a designated rapporteur in accordance with institutional guidelines.
- public health relationship): shared goals, community engagement, aligned leadership, sustainability, and data and analysis; and
- explore the “elephants in the room” when public health and health care interact: what are the key challenges and obstacles and what are some potential solutions, including strengths both sides bring to the table.
As explained by Wood, senior vice president for Health of the Public and Interprofessional Activities at the American Academy of Family Physicians, the workshop was organized around exploring collaboration in the context of four topics: payment reform; the Million Hearts initiative; hospital and public health agency relationships and collaboration; and asthma care. Montero, director of the New Hampshire Division of Public Health Services, elaborated that the analysis of these four case examples would consider not only what was done to achieve improvement in the area but also what the drivers of system change were and how those drivers might also be used to impact population health. Wood and Montero both stressed that the four examples for discussion have areas of overlap and that these discussions about collaboration are not separate from, but rather build on, the previous workshop discussions of the IOM roundtable. For example, Montero said that it is not possible to talk about advancing payment reform without discussing how to finance the change, improving asthma outcomes without discussing social determinants of health, or improving high blood pressure rates without looking at the infrastructure for healthy activities.
The workshop explored collaboration between health care and public health in the context of four case examples over the course of four panel sessions. Chapter 2 discusses the advancement of payment reform in the state of Ohio as a result of collaboration between public health and clinical medicine. Chapter 3 describes the Million Hearts Initiative as an example of a successful national public health and health care collaborative. In Chapter 4, the collaboration between hospitals and public health agencies is considered, and in Chapter 5 the Boston Asthma Home Visit Collaborative is discussed as an example of a community-level multisector collaboration. Over lunch, participants were engaged in a facilitated conversation about how to enhance the culture of collaboration to build a culture of health; this discussion is summarized in Chapter 6. An overview of common themes across the case examples, as summarized by one of the workshop facilitators, is presented in Chapter 7, along with key takeaway messages highlighted by participants.