Connecting Primary Care, Public Health Is Focus of Practical Playbook

Online Resource Sparks Particular Excitement Among FPs-in-Training

March 26, 2014 02:28 pm Chris Crawford

At a recent press event, panelists (from left) Lloyd Michener, M.D.; Denise Koo, M.D., M.P.H.; Jose Montero, M.D.; and Julie Wood, M.D., discuss how the Practical Playbook initiative aims to bridge the gap between primary care and public health professionals.

For decades, the medical and public health communities each have struggled to fight the illnesses that threaten population health and boost overall health care costs. Although both sectors share the same goal, they come at the problem from different perspectives, with primary care focusing on the health of individuals and public health on that of communities. This isolation has stymied progress for both groups, and, in fact, the two often wind up in competition with one another.

What's missing, says a collaboration of public and private health care stakeholders, is a step-by-step guide to breaking down the silos and integrating primary care and public health. Enter A Practical Playbook: Public Health & Primary Care Together(

The CDC; the Department of Community and Family Medicine at Duke University in Durham, N.C.; and the de Beaumont Foundation unveiled the Practical Playbook during an event at the National Press Club in Washington earlier this month. The interactive Web-based resource is designed to help primary care and public health professionals collaborate to achieve population health improvement and reduce health care costs through preventive care.

How Does It Work?

Put simply, the Practical Playbook initiative is divided into three parts:

  • Learn -- By accessing this segment of the website, users can explore what integration is, as well as what it is not. They also can discover the value of working together.
  • Do -- Action steps for starting a collaborative project are outlined, including how to engage with a communitywide health concern, such as heart disease, obesity or asthma. Users already pursuing a project can find tools and resources to help them move ahead.
  • Share -- Users can peruse case studies of successful collaborative projects organized by topic, location or population. They also can use contact information provided in each success story to reach out to the project leads.
Story highlights
  • A collaboration of public and private health care stakeholders has launched a Web-based resource that aims to foster the integration of primary care and public health resources and infrastructure.
  • Currently, about 35 success stories are posted on the Practical Playbook: Public Health & Primary Care Together website, and more are in line to be added.
  • The site also offers about 700 links to related state and federal resources that can be filtered by category, topic and location.

According to Brian Castrucci, M.A., chief program and strategy officer for the de Beaumont Foundation, the Playbook website was created to help family physicians and other primary care professionals "link back to the taxpayer-funded, 300-year-old public health infrastructure, which exists in the country to address upstream challenges with chronic disease."

"Hopefully, (physicians) will visit the website, figure out who their local health director is, and will call them," said Castrucci, who moderated a panel discussion during the March 5 launch event. "Then (they should) ask the question, 'How are we going to make our population healthier while also controlling costs, and how are we going to do it together?'"

Julie Wood, M.D., AAFP vice president of health of the public and science and interprofessional activities, participated as a panelist during the launch event and described the Practical Playbook as an essential tool for family physicians seeking to achieve population health. The climate of extreme change in the health care sector includes new payment models that require primary care health professionals to demonstrate improved population health outcomes, she told attendees.

"Once short-term measures are taken to optimize treatment, primary care providers will need the support of public health officials in structured, targeted and, ultimately, integrative health projects to have a meaningful impact throughout the community and the United States," Wood added.

"Family physicians train in community medicine now, and many work in public health, but without recognizing it," Wood told AAFP News in a subsequent interview. "We often use different terminology, yet are working toward the same goals. We are not asking them to take on more, but rather to integrate or interface with the public health community. Tools like the Playbook allow this to happen more seamlessly and actually facilitate what we are trained to do and wish to do."

After all, she noted, "As we have developed the medical home concept along with our primary care colleagues, we have come to understand the importance of team-based care and population health."

Success Stories Abound

Lloyd Michener, M.D., chair of community and family medicine at Duke University, was instrumental in developing the Practical Playbook and also participated in the launch event. He said there are many examples of family physicians working with their communities to try to make a difference, but they rarely know about each other's efforts.

Julie Wood, M.D., AAFP vice president of health of the public and science and interprofessional activities, says the Practical Playbook is an essential tool to aid family physicians in achieving population health.

"What the Playbook does is collect those stories, distill them and synthesize them into practical advice so that family docs working in their practices and in their communities can get other ideas, suggestions and people to talk to so we can do this better, faster and help our communities be healthier," Michener told AAFP News.

Currently, some three dozen success stories are posted on the Playbook site, according to Denise Koo, M.D., M.P.H., CDC senior adviser for health systems, but many more are in the process of being added as staff members working on the initiative continue to verify stories, write summaries and track down contact information for each entry.

"We want to collect more success stories because we feel that people might resonate more with success stories that might be from a more rural environment, if they are (in a) more rural (environment), or from the Northwest if they are from the Northwest," said Koo. "We want stories to cover the gamut."

During the panel discussion, Wood offered a success story from Anne Arundel Medical Center (AAMC) in Annapolis, Md., and the Housing Authority of the City of Annapolis (HACA). The two organizations were awarded Health Enterprise Zone funding through the Maryland Community Health Resources Commission to establish a patient-centered primary care medical home within a public housing facility. The practice opened in October and is staffed by a full-time family physician.

"For the residents of the housing facility and its surrounding neighborhood, significant health care disparities have persisted for decades," Wood said. "These disparities include high rates of perinatal mortality, low birth weights, emergency room use, hospital admissions and readmissions, and medical 911 calls. By establishing culturally proficient and readily accessible primary care directly in the heart of a community with unmet need, AAMC and HACA hope to reduce outcome disparities and improve the health of their local population."

Site Offers Additional Tools and Resources

According to Michener, the Practical Playbook website provides about 700 links to state and federal resources that can be filtered by category, topic and location.

"There is great information for family physicians on how to find their local public health officer and what activities they are involved in," he said. "My experience is that in the smaller communities, folks know each other -- they buy groceries together and their kids play together. In bigger towns and communities, this is less often true."

Another key part of this collaboration is finding out what the major causes of preventable illnesses are in the community and what (programs) already are taking place, Michener added.

"Say you are in California and you are a family doc involved in starting up a Medicare shared savings model or an accountable care organization," he said. "There are links (on the site) to data and information on interventions and programs already underway."

What's the Takeaway for FPs?

"My hope is that family physicians will come away with new contacts, ideas and information that they won't just learn, but that they will use in forming stronger partnerships with their local communities and departments of public health," said Michener, "and that these efforts will make a positive difference in the lives of the people they serve."

Koo said she hoped the site would motivate and empower physicians to do something. "Too often, primary care physicians feel they are too busy -- they don't have enough time to address the 'other' factors that impact their patients' health," she said. "We want them to know you can do something, and here are partners to work with you, and here are some tips how (to go about doing it), so go do it."

An unanticipated aspect of participating in the project, according to Michener, was discovering how excited young clinicians are about it. "It's the students and residents who find this type of (online resource) quite natural," he said. "What's really exciting for the Academy is watching the student and resident reps that have picked up on this."

Witness the fact that organizers of the 2014 AAFP National Conference of Family Medicine Residents and Medical Students, to be held Aug. 7-9 in Kansas City, Mo., requested that two educational sessions be presented on integration concepts and examples highlighted in the Playbook, according to Michener. "They (students and residents) see improving the health of their communities through integration and population health as the future and the way in which they will practice medicine," he noted.

Wood said that using the strategies outlined in the Practical Playbook will better leverage the critical public health infrastructure, which has evolved over the years into a "sophisticated frontline service protecting those of us who live in the United States."

"Couple that with the patient-centered medical home, where a team of health care professionals provides preventive and sick care in the context of family and community, and you have an unstoppable health care force."