Public health and health care: creating a culture of accountability and coordination

Optimal health depends on coordinated and sometimes integrated public health and health care systems. Public health systems aim to support health at the population level through the prevention of acute and chronic diseases, the prevention of injuries, and the detection, prevention and response to emerging infectious diseases. Although similar, the healthcare system strives to provide care and treatment to individuals (eg, diagnosis and treatment, prescription drugs and rehabilitation services).

Compared to other industrialized countries, the United States spends more on health care, but performs worse on key health indicators such as chronic disease and maternal and child health. In recent years, health professionals and policy makers have increasingly recognized that the social factors of health, or the conditions in which an individual is born, lives, learns, plays and works, are an important indicator of the health outcomes.

The COVID-19 pandemic has shown the importance of having a resilient and robust public health system. The two sectors are interdependent; they work to contain and mitigate the rate of spread of infections, but with different perspectives. Public health strives to intervene before rather than after an illness or injury occurs. From developing high-level frameworks to cross-sectoral policies to tackle the social drivers of health, governors and heads of state are taking concrete steps to better align public health and systems. health.

Historically, many efforts have been made to improve health outcomes in the United States. These efforts have primarily focused on access to care rather than the social drivers of health. Access to health care is vital and can be improved by public health capacities, since health care focuses on the health of an individual while public health focuses more broadly on the population as a whole. together. A lack of coordination, communication and fragmented data systems have hampered attempts at reform. Integrating public health and health care services can reduce health expenditures and improve health and social outcomes.

Strengthening the links between the two sectors enables individuals to receive comprehensive care that meets their direct treatment and care needs. Some state Medicaid programs address these concerns by focusing on population health and social drivers of health through Medicaid authorities, including integrated models of care such as accountable care organizations, Medicaid managed care flexibilities, such as requiring plans to contribute certain benefits to community investments, Section 1115 waivers that allow states to test approaches to address social determinants of health, and state plan changes that allow states to include optional benefits that address social factors of health. More than 30 states work with managed care organizations to address the social drivers of health through a variety of strategies. The Centers for Medicaid and Medicare released guidance for states to address the social drivers of health to improve outcomes, reduce costs, and support state value-based care strategies. Additionally, 18 states have approved Section 1115 waivers to address the social drivers of health of their Medicaid enrollees as a population. Adopting a population health-based approach in health care settings provides an opportunity to facilitate population-based research to better understand a community’s health needs and design interventions. more effective in responding.

Public health and health care systems can identify urgent health needs and prioritize resource allocation by working together. A collaborative approach is syndromic surveillance, which allows public health departments to collect and analyze emergency department health data to identify emerging trends of public health concern and determine the need for answer. By working together, the two systems can identify the most pressing health needs and prioritize resource allocation accordingly.

Ensuring that data can be shared and used by both public health and health systems can improve emergency preparedness and response efforts, increase access to data sources such as social needs and risks affecting health outcomes. Eighty-five percent of all health data in the United States is electronic. Maryland, Nebraska, Rhode Island and Vermont have enacted legislation formalizing their states’ health information sharing, establishing a unified flow of information between health-related entities and public health agencies . Public and private partnerships can also strengthen efforts to improve data sharing and use. For example, the Minnesota Department of Health has partnered with the Mayo Clinic to develop a clinical risk scoring system that helps clinicians make accurate diagnoses and provide ongoing patient care.

Many policy levers can be used to hold health systems accountable for health outcomes. The Michigan Medicaid program publicly releases Health Equity Reports with information on health plan quality measures by race and ethnicity to show progress and opportunities to improve health equity.

States like Nebraska and Maryland are developing frameworks to better connect the public health and health care sectors. For example, Nebraska looked at the links between local health departments and primary care clinics to understand where connections existed, what barriers, limited better coordination, and what were opportunities for better collaboration. Maryland has linked primary care and public health during the state’s response to COVID-19 by developing the Maryland Primary Care Program, which improves primary care practices through funding, data, and technical assistance. Beneficiaries enrolled in the program had higher vaccination rates, therapeutic use, and use of telehealth services and, as a result, experienced lower COVID-19 cases, hospitalizations, and deaths. Other states, such as Indiana and Kentucky, are creating high-level plans to modernize their public health systems to break down silos between public health and healthcare systems. Other states have leveraged their COVID-19 health equity task forces to facilitate coordination among agencies.

The COVID-19 pandemic has shown how vulnerable America’s health and public health systems are without increased coordination across sectors. Improving innovative policies, programs, and technologies that enhance collaboration will lead to the development of a more robust system of care that prioritizes quality health care and stronger public health.

This article was written by Eden Moore, CDC Public Health Associate and Brittney Roy, Program Director, Public Health, NGA Center for Best Practices. For more information on the governors’ public health efforts, please contact

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