How Can Public Health, Traditional Healthcare Transform Community Wellness?

For true comprehensive community wellness to take place, barriers between the old silos of what is considered “healthcare” and what is considered public health must be removed in order to improve health outcomes and curb rising costs, according to a new report from The Health Care Transformation Task Force (HCTTF) and The Public Health Leadership Forum.

The project, funded by the Robert Wood Johnson Foundation, created a framework intended to facilitate partnerships between governmental public health departments and healthcare systems. The white paper, Partnering to Catalyze Comprehensive Community Wellness: An Actionable Framework for Health Care and Public Health Collaboration, calls for cross-sector partnerships and improved collaboration in order to overcome the fragmentation that hinders new models of care and prevention. New models are needed to reverse inequities and stem chronic diseases—like obesity, poorer life expectancy, and worse infant mortality—that are afflicting Americans at an alarming rate.

There are 3 ways that public health leaders, industry leaders, policy makers, and others can use the framework in order to fulfill a comprehensive community wellness vision, according to the report.

• Public health and healthcare leaders can convene collaborative groups, devote the time and resources needed to effectively collaborate on a shared vision, and develop the next generation of health professionals who view multisector collaboration as the norm.
• Local, state, and federal policy makers can learn from the examples of effective cross-sector collaboration to advance similar policies and programs.
• Health practitioners can identify opportunities to engage and support community-based organizations in structured partnerships to ensure health interventions are implemented.

The overarching considerations in the framework to achieve comprehensive community wellness are equity, person-centeredness, and sustainability. The framework lists 5 elements of collaboration: governance structure, financing, cross-sector prevention models, a data-sharing strategy, and performance measurement and evaluation.

All determinants of care must be considered, including social deterimants of health, and purchasers, payers, and policymakers must “recognize the need to help finance cross-sector collaborative models and remove barriers in current payment models that prevent collaboration,” wrote 2 of the white paper’s authors in a blog post on NEJM Catalyst.

Bellinda Schoof, MHA, CPHQ, a member of HCTTF, and John Wiesman, DrPH, MPH, a member of the The Public Health Leadership Forum, urged CMS to consider the examples contained in the report as it tries out new models for payment and performance.

One such example came from Idaho, which created a State Healthcare Innovation Plan, catalyzed by State Innovation Model funding from CMS. The grant supported the creation and maintenance of 7 regional collaboratives across the state in each of its 7 public health districts. Each regional collaborative is led by the local public health director and 2 primary care physicians.

While local cross-sector leadership has been effective at gaining buy-in among various stakeholders, including behavioral health clinicians, dental/eye doctors, food banks, transportation, and schools, stakeholders recommend bringing commercial players into the process early on, according to the report.