IOM Roundtable

FPs Share Expertise on Primary Care, Public Health Integration

February 11, 2015 02:44 pm Chris Crawford

Once again, family physicians have played an integral role in shaping national efforts to integrate primary care and public health.

(From left) Mary Applegate, M.D.; Theodore Wymslo, M.D.; and moderator Rear Adm. Sarah Linde, M.D., discuss payment reform at a Feb. 5 Institute of Medicine Roundtable on Population Health Improvement.

On Feb. 5, the Institute of Medicine (IOM) Roundtable on Population Health Improvement hosted a workshop(www.nationalacademies.org) in Washington, D.C., in partnership with the ASTHO (Association of State and Territorial Health Officials)-Supportive Primary Care and Public Health Collaborative to explore the relationship between primary care and public health, and examine opportunities, challenges and practical lessons.

Julie Wood, M.D., AAFP vice president of health of the public and science and interprofessional activities, co-chaired the event, and two other family physicians led targeted discussions, as well.

"We knew that many of the (participating) organizations had been working on elements of integration, but we wanted to move beyond systems-level discussion and discuss practice-level work," Wood told AAFP News.

Story highlights
  • Family physicians led discussions about the relationship between health care and public health at a Feb. 5 workshop hosted by the Institute of Medicine Roundtable on Population Health Improvement.
  • Family physician Theodore Wymslo, M.D., chief medical officer for the Ohio Association of Community Health Centers, discussed innovative approaches to payment reform in his home state.
  • Lloyd Michener, M.D., chair of community and family medicine at Duke University and one of the leaders of the Practical Playbook initiative, led a session on enhancing a culture of collaboration to build a culture of health.

Workshop Overview

Wood said the group set out to answer the following questions:

  • What are the elements of true collaboration between public health and primary care that will make it succeed in improving our nation's health care?
  • What are the hard conversations to have, how do we have them, and with whom do we need to engage?
  • What strengths do both public health and primary care have, and how can we leverage those?
  • How can we address barriers to collaboration in a meaningful way?

Discussion centered on four key conversation areas -- dubbed "case studies" -- each with its own speaker panel.

In one case study, family physician Theodore Wymslo, M.D., chief medical officer for the Ohio Association of Community Health Centers, discussed innovative approaches to payment reform in his home state. Speaking in tandem with pediatrician and Ohio Medicaid director Mary Applegate, M.D., Wymslo said the two of them had worked with the state's governor to shift toward a population- and episode-based payment system with active stakeholder and payer involvement -- focusing on paying for value rather than volume.

Family physician Lloyd Michener, M.D., chair of community and family medicine at Duke University and one of the leaders of the Practical Playbook(practicalplaybook.org) initiative, led a session on enhancing a culture of collaboration to build a culture of health. Joining Michener was Paul Mattessich, Ph.D., executive director of Wilder Research in Saint Paul, Minn. Wilder Research is a multidisciplinary team of about 80 people who study how to increase effectiveness of services, programs, organizations and policies intended to improve the lives of individuals, families and communities.

During their interactive session, Michener and Mattessich discussed best practices and barriers to collaboration in a broad sense, as well as how these factors specifically apply to the integration of public health and primary care.

A third workshop session highlighted the Million Hearts initiative(millionhearts.hhs.gov) as a concrete example of primary care and public health working together to improve health outcomes. And a fourth case study looked at how a home visit program in Boston tackled asthma by effectively integrating public health and primary care, which greatly improved outcomes in both adults and children with the condition.

Integration Efforts to Build On

According to Wood, the IOM's March 2012 report(www.nationalacademies.org) Primary Care and Public Health: Exploring Integration to Improve Population Health spurred this most recent movement to integrate primary care and public health.

"After the paper was released, there was significant activity among many organizations and key stakeholders to discuss how to truly implement its recommendations in a dynamic, meaningful fashion rather than the report becoming a book on a shelf or a link on a website," Wood said.

The AAFP joined that effort early on and has been a staunch proponent of primary care/public health integration ever since. Here's a brief timeline tracing the Academy's efforts to promote this approach:

  • July 2012. The Academy participated in a two-day meeting hosted by ASTHO, IOM and United Health Foundation to develop a strategic map for primary care and public health integration. The ASTHO-Supportive Primary Care and Public Health Collaborative(www.astho.org) launched shortly thereafter.
  • March 2014. The AAFP joined a diverse group of public and private organizations in launching the Practical Playbook initiative, which offers online resources to help primary care and public health professionals in their integration efforts.
  • November 2014. The same team unveiled the BUILD Health Challenge, which aims to provide funding to foster and expand meaningful partnerships among health systems, community-based organizations, local health departments and other organizations that affect community health.
  • December 2014. The Academy published "Integration of Primary Care and Public Health," a position paper that outlines the family physician's role in these efforts.

"Over these two years, we have refocused our efforts to create a population health model that will benefit our members and their patients, as well as improve our interaction with our public health colleagues," Wood said. "We will continue to work with the ideals expressed in our position paper and our call to action for our members."

In fact, she said, the AAFP Commission on Health of the Public and Science Work Group on Integration of Public Health and Primary Care met last week to discuss how to best assist members in achieving this goal and, ultimately, "optimal population and community health for their patients."

"The goal here is to bring the full team together of health care, public health and community resources," Wood said. "It is not to increase the burden of the family physician, but rather to improve health and efficiencies of a fully functioning community team and medical neighborhood."