Last month, a leadership team including CDC Director Mandy K. Cohen New England Journal of Medicine The team, which calls for the integration of public health and health care delivery within the U.S. health care delivery system, included Dr. Cohen as well as Charlene A. Wong, MD, MSHP, senior advisor for health strategy at CDC, and Debra Houry, MD, MPH, CDC’s chief medical officer and deputy director for programs and science.
And under the headline it says: “Integrating Public Health and Medical Care – Protecting Health as a Team Sport” On April 10, the three CDC leaders stated, “Health protection is a team sport, but the systems for advancing this goal have long been siloed. The United States needs an integrated system of public health protection that goes far beyond the CDC, the Department of Health, and ‘traditional’ public health forces.” In fact, the three physician leaders argued, “When it comes to preventing and treating acute and chronic diseases, the medical sector is at the forefront. Clinicians have trusting relationships with individual patients and use clinical findings to address current and future health problems. Meanwhile, the public health sector provides data and promotes evidence-based interventions to protect and promote the health of communities. Public health surveillance of health threats also enables early detection and containment of outbreaks.”
In fact, they note, “Public health and healthcare partnerships can also lead to improvements in routine health care delivery. For example, perinatal quality collaboratives are a form of critical public health infrastructure in many states, contributing to obstetrics quality improvement efforts by providing maternal health data to health systems and supporting systems-level collaborative change. These partnerships have improved the timeliness of treatment for severe maternal hypertension at participating Illinois hospitals and reduced planned early inductions and cesarean sections at participating New York hospitals, resulting in an increased rate of full-term babies.”
The article authors identify three areas where they believe the entire health system must take action: first, around data sharing; second, around aligning and sharing priorities for resource investment in both public health and health delivery; and third, around shared responsibility and accountability across public health and health delivery sectors.
First, they write:[R]Real-time, bidirectional sharing and utilization of public health and medical data is crucial to promote preparedness and response to emerging health challenges. Significant progress has been made during the COVID-19 pandemic. 78% of emergency departments (EDs) now transmit respiratory disease syndromic data in real time, including influenza-like illness case data, allowing CDC to monitor unusual trends across the country, as they did after cases of Mycoplasma pneumonia were reported internationally in fall 2023. “However, despite such progress, they noted that “only 33% of health care facilities transmit automated electronic case reports for reportable illnesses to public health agencies. CDC is working to further standardize and streamline this work across all facilities.”
Meanwhile, they urge the public health and health sectors to “identify aligned priorities and make co-investments.” “COVID-19 was the only common enemy and a generational challenge that accelerated the formation of public-private partnerships and led to significant investments in infrastructure,” they point out. Now, “COVID-19 is just one of many major health threats that both sectors need to respond to together. Strong integration of public health and health data can determine co-investment priorities for prevention, management, and control efforts at all levels of the health system. CDC has prioritized advancing preparedness and response to health threats through investments in critical data, laboratories, workforce, and response infrastructure, combating the U.S. overdose and mental health crises, and supporting young families. The agency is leading multiple joint efforts with health partners in these areas,” they point out.
Finally they say,[W]Working as a team to protect health requires clear roles and responsibilities, as well as shared accountability. The table outlines the roles and responsibilities of the public health and health care sectors for addressing major public health threats. There are multiple ways to share accountability, all of which require agreement on indicators of success. Implementing prevention-oriented quality measures (e.g., screening for cervical cancer, lead exposure, and clinical depression) is one mechanism to support shared accountability. Providing incentives or instituting requirements for participation in data integration activities is another. Finally, new payment arrangements and flexibilities can integrate sectors by covering community-based prevention programs (e.g., school-based mental health supports) or rewarding improved population-level outcomes (e.g., Medicare’s Shared Savings Program and the National Advanced Research Projects Agency’s Health Care Rewards for Achieving Improved Outcomes Program).
The article’s authors acknowledge that “protecting the health of every person in every community in the United States requires action now and a sustained focus across public health and clinical care. Beyond broader public health and health partnerships, a team-based approach to support community health and address broader health drivers can include social services, academia, industry (e.g., employers, technology and media companies), and global partners.” Ultimately, the authors conclude that “by investing in strong relationships and acting together to protect health, we can prepare our integrated health system to respond to the next major health emergency and improve the everyday health and well-being of our residents.”
