Strengthening Public Health Through Primary Care and Public Health Collaboration: Innovative State Approaches.

OBJECTIVE: Partnerships are increasingly critical to achieve the mission of public health. We sought to understand the levers and tools that states use to better connect public health and primary care in efforts to strengthen public health. DESIGN: We reviewed literature focused on collaborative or integrative efforts between primary care and public health and examined strategies employed by 4 innovative states: North Carolina, Oregon, Rhode Island, and Washington. Using a purposive convenience sample, we conducted semistructured interviews with 17 state experts from January to March 2023. We asked leaders to describe their approaches to data sharing, communication, and systems change that could be adopted or adapted by other states interested in better connecting primary care and public health systems. We recorded and coded interviews. PARTICIPANTS: Seventeen state leaders from North Carolina, Oregon, Rhode Island, and Washington. MAIN OUTCOME MEASURES: Key experiences, strategies, policy levers, and lessons for integration or collaboration between primary care and public health sectors, both common and divergent, across the states. RESULTS: State activity can be categorized by 3 actions: (1) endeavors to support relationship building, both formal and informal; (2) efforts to employ coordinating bodies and champions to ensure all necessary actors are included in planning and communications with clear roles; and (3) approaches to identifying and elevating essential system elements and the change levers to support them. The integration is built primarily on the well-resourced medical care system rather than the public health system. CONCLUSION: States are engaged in creative approaches to collaboration between public health and primary care. Building blocks include backbone organizations, leadership training programs, payment reform spheres, interoperable data platforms, and intentional efforts to build relationships. Collaboration between primary care, public health, and community-based organizations is an opportunity to strengthen public health systems while staying focused on improving the public's health.

Implementing the Collaborative Care Model as Part of a Countywide Initiative.

This column describes the planning and implementation of an integrated behavioral health project which was facilitated and endorsed by a developing accountable health community, the Washtenaw Health Initiative (WHI). The WHI is a voluntary countywide coalition of academic, community, health system, and county government agencies dedicated to improving access to high-quality health care for low-income, uninsured, and Medicaid populations. When lack of access to mental health services was identified as a pressing concern, the WHI endorsed pilot testing of collaborative care, an evidence-based treatment model, in county safety-net clinics. Challenges, outcomes, and relevance of this initiative to other counties or regional entities are discussed.

Primary care capacity as insurance coverage expands: examining the role of health information technology.

OBJECTIVES: Under the Affordable Care Act, many newly insured Americans have the challenge of establishing care with a primary care physician (PCP). We sought to examine whether health information technology (HIT) use in primary care practices was associated with anticipated capacity to accept new patients. STUDY DESIGN: Secondary analysis of a cross-sectional survey of Michigan PCPs from the specialties of pediatrics, internal medicine, and family medicine, conducted from October to December 2012. HIT use was considered independently for 8 types of HIT and in aggregate as a total count of HIT in use. Primary care capacity was assessed as self-reported capacity to accept new patients. RESULTS: Of 739 respondents, 83% reported they anticipated capacity to accept new patients. In multivariable analysis, we found that physiians using a greater number of HITs were significantly less likely to anticipate capacity to accept new patients (adjusted odds ratio [OR] = 0.86; 95% CI, 0.76-0.97). PCPs with higher HIT use were also less likely to accept patients with private insurance (adjusted OR 0.87; 95% CI, 0.77-0.97), but not with Medicaid (adjusted OR 0.94; 95% CI, 0.84-1.05) or Medicare (adjusted OR 0.91; 95% CI, 0.83-1.01). Among individual HITs, electronic health records (adjusted OR 0.54; 95% CI, 0.30-0.96) and electronic access to admitting hospital records (adjusted OR 0.46; 95% CI, 0.22-0.96) were the only HITs significantly associated with lower anticipated primary care capacity. CONCLUSIONS: PCPs using a greater number of HITs were less likely to anticipate capacity to accept new patients. Implementation of HIT and other practice innovations must be carefully coordinated to optimize capacity to care for the newly insured.

How a regional collaborative of hospitals and physicians in Michigan cut costs and improved the quality of care.

There is evidence that collaborations between hospitals and physicians in particular regions of the country have led to improvements in the quality of care. Even so, there have not been many of these collaborations. We review one, the Michigan regional collaborative improvement program, which was paid for by a large private insurer, has yielded improvements for a range of clinical conditions, and has reduced costs in several important areas. In general and vascular surgery alone, complications from surgery dropped almost 2.6 percent among participating Michigan hospitals-a change that translates into 2,500 fewer Michigan patients with surgical complications each year. Estimated annual savings from this one collaborative are approximately $20 million, far exceeding the cost of administering the program. Regional collaborative improvement programs should become increasingly attractive to hospitals and physicians, as well as to national policy makers, as they seek to improve health care quality and reduce costs.