The traditional separation between primary healthcare providers and public health professionals isn’t helping to ensure population health, according to 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 authors of 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 in a press release.
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, according to IOM.
The medical home model and the new accountable care organizations (ACOs) established by ACA offer opportunities for integration, the researchers said. 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. As ACOs begin operating, they should reach out to health departments to forge links to community programs and public health services, the committee said.
"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 in 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,” Wallace said. “Each of these foundational elements could be stronger if they were better coordinated and collaborated more closely."
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