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Integrating our work with primary care

Posted By Katrina Hedberg, Thursday, August 7, 2014
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The landscape for both public health and the healthcare delivery system is changing for several reasons: the Affordable Care Act (ACA); efforts toward public health department accreditation; and requirements for community health assessments conducted by public health departments, hospitals, and accountable care organizations (ACOs). In Oregon, we use a coordinated care organization (CCO) model that envelopes a patient in medical, mental health, and dental care to provide care for the whole person.
For CCOs to be successful in achieving the triple aim of improved quality of care, improved population health, and lower costs, CCOs will need to focus on upstream prevention as well as improved care. CCOs are responsible for achieving metrics related to this triple aim, which should include receipt of clinical preventive services.
Public health epidemiologists can play an important role in helping to identify important metrics for CCOs and ACOs and to encourage these organizations to think about improving the health of the entire community in which their enrolled population lives. In addition, these organizations must work together with public health departments on community health assessments, as we have a role in determining the health status of our communities.
In Oregon, the Public Health Division is part of a larger agency, the Oregon Health Authority. The Office of Health Analytics, a separate division within the Oregon Health Authority, is responsible for analyzing healthcare service delivery data for Oregon’s CCOs. The Public Health Division is implementing an analytics tool that allows users to analyze public health data (e.g. birth, death, and reportable diseases) by not only the traditional state or county delineations but also by CCO service area. Looking at our data through different lenses and denominators helps us work with the CCOs to integrate healthcare and public health. Oregon also has a State Innovation Model grant from the Centers for Medicare and Medicaid Services, funds from which are being used to conduct a BRFSS-like survey of the Medicaid population to look at upstream health indicators.
Last year, CSTE Executive Director Jeff Engel and I attended a conference about the integration of public health and primary care for public health practitioners and clinicians. It was a good meeting, but epidemiologists were missing from the table. Coming away, we knew that epidemiologists have an important piece to inform the discussion, including data availability, metrics, and evaluation. Public health and healthcare systems have different definitions of ‘population health’—Epidemiologists generally think of their population as ‘everyone in a defined geographic location at a particular time,’ whereas healthcare systems hear this phrase to mean 'everyone enrolled or who received a service.' These realms are similar but slightly different, and these two definitions of the same word illustrate the difference. The epidemiologists' definition of population encompasses that of the healthcare system. We have to make sure we are using the same language and terms in order to work together to make our environment conducive to health as well.
From this meeting and these ideas, the Public Health and Primary Care Integration Subcommittee was born. It is clear CSTE can contribute to this new area for epidemiology and for public health. The subcommittee will have conversations that talk about, for example, the ways public health and healthcare use different terminology, what epidemiologists around the country are doing in this area, and how epidemiology can continue to have a seat at the table as health care transformation is implemented.
Katrina Hedberg - State Epidemiologist Oregon

Tags:  affordable care act  healthcare  member spotlight 

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Looking ahead to 2014-2015

Posted By Alfred DeMaria, Thursday, July 3, 2014
The CSTE Annual Conference was stimulating and thought provoking—there were many excellent examples of “epidemiology in action.” Attendees shared ideas and experiences, and created a real “community of practice.”
Now that we’re back from Nashville, I’m looking ahead to 2014–2015. Issues raised at the annual conference reinforced ideas I had about priorities for this coming year:
  • Informatics capacity continues to be a struggle, but we’re making progress. CSTE’s advocacy efforts educate policy makers to increase awareness and encourage funding. CSTE’s workforce development initiatives improve existing and new epidemiologists’ competencies in informatics skills. These continued efforts are important to sustain progress in this area.
  • Developments in laboratory technology are just beginning to have a huge impact on public health surveillance. We will have to adapt to these changes to preserve our ability to do effective surveillance.
  • Public health must align with the changes occurring in healthcare delivery and the focus on accountable care. Accountable care organizations (ACOs) are going to be responsible for the health of the populations in their care, not just their medical care. Public health epidemiologists should be the ones who are recognized as monitoring population health, identifying needs and holding ACOs truly accountable.
  • Hepatitis C, as a public health challenge, is entering a whole new level of complexity. Literally millions of cases are diagnosed and being diagnosed. We are entering an era of cure with more easily tolerated, shorter course, highly effective, but expensive therapy. We will be called on to define the burden and monitor trends, but we have never had the needed resources.
Together we can improve applied epidemiology, improve public health, and improve the health of our communities.
Alfred DeMaria, Jr. is the president of CSTE and the State Epidemiologist at the Massachusetts Department of Public Health.

Tags:  healthcare  infectious disease  informatics  laboratory 

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