Public health departments are experts at population health management. What can healthcare providers learn from their efforts?
- Hospitals, health systems, and physician providers aren’t the only organizations heavily invested in population health management. Public health departments have combating infectious diseases, providing vaccines, monitoring lifestyle factors such as food access and tobacco use, and connecting patients with social and medical services for more than a century, improving quality of life on a parallel course with the clinical ecosystem.
As public health agencies begin to adopt the same data analytics technologies as their healthcare peers, how can both systems collaborate for the good of all patients, and what lessons can the healthcare industry learn from public health’s long-term success at managing large populations?
Health decision-making takes place everywhere
Whether it’s choosing to cut down on processed snacks or trying to quit smoking cigarettes, patients must make and maintain their healthy choices every minute of every day, whether or not they have a physician guiding them on a regular basis.
“Health primarily happens outside the doctor’s office—playing out in the arenas where we live, learn, work and play. In fact, a minority of our overall health is the result of the health care we receive,” wrote National Coordinator Karen DeSalvo, MD, MPH, MSc in a recent blog post. In order for providers to understand a patient’s daily struggles to make good decisions and stay well, healthcare organizations must incorporate multiple sources of data that work together to create a portrait of the patient’s lifestyle and environment.
Public health departments already collect, monitor, and analyze this data, even if they are lacking in some more advanced analytics capabilities. They can be an excellent resource and a beneficial partner for health systems looking to identify vulnerable populations, target patient education, and expand their footprint into the community where they will have the most impact.
Collaboration produces better performance across the board
Terms like the “learning health system” and “building a culture of health” are common refrains when discussing healthcare reform, but they’re more than just platitudes. Collaboration between healthcare providers can aid in care coordination, foster health information exchange, and prevent patients from falling between the cracks of the system, just as collaboration between public health departments across the nation has allowed the nation’s largest cities to produce meaningful results.
A study published in the most recent issue of the Journal of Public Health Management and Practice shows that public health departments participating in the Big Cities Health Coalition (BCHC) are able to provide more population health services such as chronic disease management, behavioral health services, maternal and child care, and injury prevention education than public health departments that are not part of the coalition. BCHC organizations are also more active in policy creation and data reporting at all levels of government.
Large public health departments are also working diligently to collaborate with the clinical health system on a number of shared concerns. Multi-stakeholder collaboration is one of the four key pillars for the Robert Wood Johnson Foundation’s vision of a culture of health.
“The San Antonio Health Department actively collaborates with the dental faculty of the University Health System in San Antonio to bring oral health care to public elementary schools in neighborhoods of concentrated poverty, whereas the Philadelphia Department of Health partnered with schools on multiple programs and achieved a reduction in childhood obesity,” explains John Lumpkin, MD, MPH, in a commentary on RWJF’s involvement in the BCHC organization. “Many big city health departments work with partners to establish changes that promote walking, biking, and recreation to increase physical activity; reclaim parks, making them safe for families; and reduce the number of food deserts, improving healthy eating.”
Not only can healthcare providers collaborate with public health departments on these activities to improve the community experience of patients, but they can learn from these partnerships to develop more robust working relationships with their peers and expand their network of partners in directions they might not have envisioned before.
Public health departments face the same data interoperability and health IT challenges
Neither healthcare providers nor public health departments will ever have all the resources they need to actively change the lives of every single citizen for the better. Health IT infrastructure, including the adoption of EHRs and clinical analytics on the provider side, and similar data-digesting technology on the public health side, is helping to cut the burden of being chronically underfunded, but the challenges are widespread and deeply engrained.
“Public health departments are facing extraordinary challenges that include the prospect of future budgetary challenges, the uncertainty of a future public health workforce, and the emergence of informatics and big data, as well as the questions surrounding integration with health systems that have new emerging payment and delivery models,” writes Jay Bhatt, DO, MPH, MPA, of the Office of Strategy and Innovation at the Chicago Department of Public Health. “In addition, legacy systems that are not interoperable, and numerous silo information technology systems pose budgetary, operational, and workforce challenges for health departments.”
Healthcare providers should pay attention to what public health departments are trying to achieve as they work to break down those data silos and adopt more interoperable systems. After all, interoperability cannot be achieved if the local healthcare system has all adopted one data standard and the public health sphere has opted for another. As the two ecosystems become ever more entwined, thanks in part to increased reporting requirements and the thirst for non-clinical data sources to drive population health, exchanging data across these formally disparate systems will become even more critical.
Shared resources and shared knowledge equal shared success
Public health departments may face some challenges that are slightly different than the medical system, but the two sides of the coin have many issues in common. Public health departments and the data they collect and analyze can be a rich, untapped resource for population health management on the provider side, and healthcare providers can bolster public health activities by reinforcing the importance of healthy lifestyle choices and leveraging their analytics infrastructures for tasks like reporting outbreaks of flu or hotspots of diabetes and HIV using data from their EHRs.
Both systems provide critical services to patients who often rely on safety net resources to obtain the help they need, which reinforces the need for continuous and cooperative conversation. As the overarching healthcare ecosystem works towards interoperability, advanced data analytics, and more fluid health information exchange, these partners will learn from each other, support each other, and grow more able to deliver quality care to the patients most in need of it.