By Jessica Kent | June 20, 2018
Promoting and maintaining population health has always required combined effort from public health offices, private healthcare entities, and social service organizations. Each sector plays its own distinct role in addressing the community, individual, and social factors that influence health and wellness.
Many of the most severe health challenges Americans face today are closely related to the conditions in which individuals live, work, and play, including costly chronic diseases such as diabetes.
Opioid abuse, another major population health challenge, is also often significantly tied to individuals’ social and environmental circumstances.
However, many of the organizations that work to address these challenges operate in isolation and may be duplicating their efforts separately instead of collaborating to develop coordinated responses to clinical and socioeconomic factors.
To truly improve population health at scale, public health offices and private healthcare organizations cannot operate alone. Collaborations between the public and private sectors, as well as community-level organizations, will catalyze effective, coordinated care, and confront the socioeconomic conditions that can lead to poor health.
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A new framework from the Public Health Leadership Forum (PHLF) and Healthcare Transformation Task Force (HCTTF) describes the elements necessary for successful cross-sector collaborations, and provides strategies for forming or reshaping such partnerships.
“There is mounting recognition that to truly improve health in the US and curb chronic diseases there must be an interdisciplinary, coordinated, and cross-sector approach to address acute conditions and the upstream social factors that contribute to poor health outcomes,” said Jeff Micklos, Executive Director of HCTTF.
“Our hope is that this framework will help break down silos and transform the way the health and human service systems traditionally interact.”
What are the top five steps that public health and clinical care organizations should take to improve coordination and combine their efforts to tackle the socioeconomic challenges of population health?
ESTABLISH A COLLABORATIVE STRUCTURE
Public and private healthcare collaboratives should begin by setting the aim of their partnership. The framework states that this aim should be specific, measurable, and achievable, whether it is addressing a single issue or a more multifaceted goal.
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For example, collaboratives could aim to reduce diabetes within a community by 20 percent by 2020, or to become the healthiest community in America by 2025. To ensure they meet these specific goals, public and private organizations should have associated benchmarks that enable progress.
Cross-sector collaborations should also define the scope of their initiatives and coordinate their aim with big-picture efforts. This will ensure that collaboratives can maximize resources and effectively target appropriate communities and individuals.
Additionally, the framework calls for collaboratives to identify the stakeholders that will impact the aim within both the public and private sectors, as well as the greater community.
“Effective community partnerships engage a wide range of community members, community-based organizations, social services agencies and faith-based organizations,” said Dr. Mouhanad Hammami, Senior Vice President for Safety Net Transformation, Community Benefit, Health and Well-being at Trinity Health.
“Public health and healthcare leaders are well-positioned to take a leadership role in bringing together all the necessary stakeholders to realize the vision of comprehensive community wellness.”
IDENTIFY FINANCIAL IMPACTS AND SOURCES OF FUNDING
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An essential first step for collaborators is identifying initial capital, the framework states.
Defining an initial business case will allow partners to receive support from grant funding and other sources.Leaders should include potential sources of funding within their initial business plan to prepare for long-term sustainability.
After outlining an initial business case, collaboratives should enter a demonstration phase in which they find financial support from existing reimbursement structures or supplemental reimbursement structures to assess the impact of their aim.
Stakeholders should be aware, however, that achieving long-term sustainability will be challenging, even if they are successful and measurably improve health outcomes.
To ensure that they have sustainable funding, the framework calls for collaboratives to explore the utilization of public health system funding designed to support community health objectives.
Partnerships should also move away from one-time funding streams and instead incorporate support for improved public health and health outcomes into healthcare delivery and payment systems.
Finally, the framework emphasizes that any long-term sustainability plan should include strategies for addressing the social determinants of health and advancing health equity.
DEVELOP IMPACTFUL AND ACTIONABLE HEALTH INTERVENTIONS
“Collaboratives must collectively identify improvement priority area(s) and define the clinical and community health interventions that have the greatest likelihood of successfully advancing the collaborative’s aim,” the framework says.
Collaboratives can identify effective, evidence-based interventions by defining community problems, identifying risk factors, developing and evaluating interventions, and implementing beneficial programs and policies.
Cross-sector interventions may require providers, community groups, and public health workers to work together in new ways and advance the aim of the partnership.
Public and private healthcare leaders should assign specific entities to each community or clinical intervention and establish accountability structures that will allow them to determine how these interventions will fit with other components of the broader initiative.
PARTICIPATE IN DATA SHARING AND DATA ANALYTICS
In order for cross-sector collaboratives to conduct community and clinical interventions and measure their performance, they will need to design data sharing and analytics strategies.
“A data sharing strategy should be established in tandem with designing the intervention in order to determine operational feasibility, rather than after the fact when the intervention is too fully planned to make major adjustments,” the framework points out.
When designing intervention plans, collaboratives should also assess data availability and seek to use existing data sources for developing actionable insights when possible.
Additionally, data sharing strategies should consider the various technology platforms that will be used to support data sharing, as well as the costs and implementation of these platforms. Collaborative partners should ensure these platforms fit with their organizations’ current workflows and assess the interoperability of the technology.
Public and private sectors should also develop data sharing agreements to establish that they are complying with all state and federal rules and regulations.
While current HIPAA rules put certain restrictions on providers who wish to share data with community partners, the framework discusses several ways for these entities to exchange information, including allowing patients to authorize providers to share data with community organizations.
CREATE A PLAN FOR EVALUATING PERFORMANCE
Collaboratives should have an evaluation plan in place to measure the impact of health interventions on community outcomes.
“The evaluation design should identify key process and outcome measures that serve as meaningful indicators of both public health and health care performance and outcomes,” the framework advises.
To minimize repetitive data collection, collaboratives can utilize measures that serve two purposes, such as measures that can be incorporated into value-based measures sets and that can also track public health outcomes.
Collaboratives should also ensure health equity by using measures that can determine the impact of interventions on overall health disparities.
Moreover, the evaluation plan should establish how evaluation findings will be reported back to stakeholders as quickly as possible to support implementers in refining interventions and collaborative structure on a rapid basis.
The elements outlined in this framework will allow leaders from public health offices, private healthcare organizations, and community-level programs to participate in effective collaborations that will work to address the many factors that impact population health.
“This framework will be instructive as healthcare and public health leaders look to partner together to address the social determinants of health,” said Georgia Heise, Director of Three Rivers Health Department in Kentucky, and past President of the National Association of County and City Health Officials.
“Policymakers as well as health care purchasers and payers can help by removing barriers in the current financing and reimbursement structures that may unintentionally prevent collaboration.”