What If? Integration of Public Health and Primary Care
State of Reform is proud to launch, in collaboration with the Univ of Washington School of Public Health – Health Policy Center Initiative, a series titled “What If: A Post-Supreme Court World.” This is the eight piece in a series of contributions hosted on our news site, by a range of authors, about the possibilities for health care in a still hypothetical world after a Supreme Court decision.
While most attention from health leaders has understandably been focused on the upcoming Supreme Court decision on PPACA, I urge you all to also pay attention to two reports recently released by the Institute of Medicine (IOM). Their titles summarize their subjects:
Primary Care and Public Health: Exploring Integration to Improve Population Health (released in March 2012)
For the Public’s Health: Investing in a Healthier Future (released in April 2012)
Both of these reports make an economic argument for closer collaboration between primary care and public health and do so from a systems/service delivery perspective. They both recognize the role economic and social determinants of health play in the health of individuals, communities, and populations. And both reports reference opportunities created by the passage of PPACA to move forward on these initiatives.
Primary Care and Public Health notes that dissatisfaction with the way the US health care system is organized and financed creates new opportunities for closer connections between primary care and public health. The report notes that recent research has recognized the importance of social and environmental determinants of health and the effect of primary prevention on the health of the public.
The passage of PPACA, the report argues, has created the possibility for new opportunities to explore closer integration of primary care and public health. The report proposes a continuum of options for integration, from mutual awareness to partnership.
The report concludes that new initiatives within PPACA should be used to further service integration. These include the involvement of the CMS Innovation Center, the community transformation grants, support of community health centers, accountable care organizations, expansion of the National Health Service Corps, and the National Prevention Strategy.
For the Public’s Health is the final of three reports commissioned by the IOM focusing on topics of relevance to public health – data and measurement, law and policy, and in this report, funding. Like the first report, this document links support of public health to economics and the overall need to reform the system and to opportunities that come with PPACA. The report focuses on the gap in life expectancy and capital health spending between the US and comparable high-income nations and recommends closing that gap within 20 years.
Three related initiatives are recommended. First, an expert panel should develop a minimum package of public health services that all departments should provide. Second, the development of consistent systems for tracking health revenues and expenditures needs to be linked to health outcomes. Finally, the report recommends that Congress authorize a dedicated, stable, and long-term financing structure for public health. This is envisioned as a national tax on all health care transactions that will generate the enhanced federal revenues required to deliver the minimum package of public health in every community.
What if PPACA is struck down in part or in total by the Supreme Court? I would argue that the findings and recommendations in these reports will only be as important as the energy all the partners mentioned in the reports place on the systems improvements both reports recommend. Even if PPACA is struck down, the time has surely come for more formal integration between primary care and public health, creating a system that can adequately fund population health and support the partner clinical care organizations.