Combining efforts

Despite a history of generally limited cooperation, hospitals and public health departments are responding to new incentives to work together on improving health at the population level.

Federally required reporting, accreditation mandates and the changing face of healthcare are pushing the two closer, feeding collaborative efforts in areas that include access, disaster response, policy and prevention.

Negative hospital outcomes have shown to be associated with lower public health. A report released last week by the Robert Wood Johnson Foundation, the 2013 County Health Rankings, found an association between county public health and such things as preventable hospital stays and numbers of primary-care physicians.

But the pressure to focus on public health is growing as a result of the Patient Protection and Affordable Care Act. The law is pushing the industry away from fee-for-service reimbursement and toward payments based on patients' health as a whole.

In addition, the law changed the tax code to require not-for-profit hospitals to conduct community health needs assessments and create plans to address those needs, an effort made easier by working with other members of the community, such as public health departments. The ACA provision, effective in tax years starting after March 23, 2012, required hospitals to report on their progress each year when they file their Internal Revenue Service Form 990.

“When we look at how healthcare reform is impacting the future and how we forecast what the future will look like, it is tremendously important for healthcare organizations to partner,” said Erin Inman, director of Healthier Communities, a department of Spectrum Health, a five-hospital not-for-profit system based in Grand Rapids, Mich. “The delivery of healthcare is going to change. We need to be creative, we need to be innovative,” Inman said.

Spectrum created formal partnerships with health departments in five counties when working on its community health needs assessments and action plans, she said. But Spectrum also has a number of other partnerships with varying degrees of formality.

The struggling economy also has effectively pushed hospitals into a greater relative role because the protracted downturn hit county health departments harder than hospitals, said Glen Mays, the F. Douglas Scutchfield endowed professor in health services and systems research at the University of Kentucky College of Public Health, Lexington. Researchers found that spending by government public health departments fell about 10% between 2006 and 2012, while hospital spending fell only about 5%.

Hurricane Isaac in August of last year helped spur healthcare community players in the New Orleans area to work more collaboratively, said Dr. Karen DeSalvo, health commissioner for the city. The storm caused a five-day power outage that demonstrated the region needed a better way to track people who might need special assistance or be moved into the city's medical special needs shelter, DeSalvo said.

As a result, a public-private partnership was formed to tackle the issue of better identifying high-risk patients. The storm proved the city's passively collected registry of names to be incomplete. “There were a lot of people that I didn't know about,” DeSalvo said.

DeSalvo said the partnership is trying to figure out how to legally use electronic health-record systems in the region to know who relies on an oxygen diffuser during a power failure or who can't get around easily. It's not clear yet what information would be used and how to get permission. “I don't need to know why you're in a wheelchair, I just need to know that you're in a wheelchair,” DeSalvo said.

Meanwhile, a nascent effort to accredit public health departments by the not-for-profit Public Health Accreditation Board, which requires departments to conduct assessments and craft improvement plans, is another factor pushing hospitals and health departments to work together more closely, said Kaye Bender, the board's president and CEO.

But the reform law's emphasis on improving population health will be the primary force driving different players in the community together, said Michael Stoto, professor of health systems administration and population health at Georgetown University, and a senior scholar in residence at research-focused AcademyHealth. “I think it's the wave of the future.”