We welcome guest blogger and AcademyHealth board member Paul Wallace, M.D., of The Lewin Group. Dr. Wallace serves as the chair of the Institute of Medicine’s Committee on Integrating Primary Care and Public Health, which released its report on March 28. The report relates to our previous discussions of public health’s role (here and here), and Dr. Wallace referenced the report in his remarks at the 2012 PHSR Interest Group Policy Breakfast (recording available here). Dr. Wallace shares his thoughts on the findings and the impact for the HSR community below. This last week the Institute of Medicine released a new report, Primary Care and Public Health: Exploring Integration to Improve Population Health. I was fortunate to have the opportunity to chair the diverse and talented committee producing this report, and to work with the IOM staff. The key high-level finding of this work is that the traditional separation between primary health care providers and public health professionals is impeding greater success in meeting their shared goal of improving population health. This report is not the first, nor is it likely to be the last, to address this overall issue. However, we believe strongly that the time and environment are more conducive to greater integration among these sectors now and the need greater than in the past. A key positive factor is the sponsorship of this work by the U.S. Centers for Disease Control and Prevention (CDC) and U.S. Health Resources and Services Administration (HRSA), two critical HHS agencies with national perspective, local feet on the ground and strong links and leadership ties to primary care and public health. The United Health Foundation also supported this work. Equally significant drivers include an increasingly shared focus by both primary care and public health on the same individuals – patients with non-communicable chronic diseases, the growing base of knowledge about what works to improve population health, and the accelerating use of health IT by both public health and primary care. Finally, the policy environment, driven by both ARRA funding and the ACA, is producing both new ideas and incentives to increase collaboration. Increased integration of these fields will require national leadership as well as substantial adaptation at the local level plus development of specific structures, relationships, and processes. Importantly, the report also notes several areas where CDC and HRSA are now both aware of each other’s efforts and actively working toward more robust partnerships. The report recommends ways that CDC and HRSA could further foster integration between primary care and public health through use of funding, policy levers, and other means. The committee's recommendations are based on its review of the literature as well as case studies in specific communities such as Durham, N.C., New York City, and San Francisco, where successful local and regional integration efforts have taken place. The review showed that fruitful integration of primary care and public health requires community engagement to define and tackle local population health needs, leadership that bridges disciplines and jurisdictions and provides support and accountability, shared data and analyses, and sustained focus by partners. The report’s recommendations urge CDC and HRSA, along with other HHS agencies to identify and actively collaborate on actions such as joint funding of population health research and initiatives, development of strategy for the population health infrastructure including HIT, and workforce development to include both improved population management skills for current professionals plus expanding the roles of community health workers and others embedded within communities. Of importance to health services and policy researchers, the committee’s expectation is that generating new knowledge and undertaking disciplined program evaluation will be increasingly in demand and ever more critical if the right balance is to be found between a grand vision of population health and the operational need for rigorous yet innovative guidance for those from public health and primary care who seek to improve population health. Quoting from the report: "While integrating fields that have long operated separately may seem like a daunting endeavor, our nation has undertaken many major initiatives, such as building a national hospital system and an extensive biomedical research infrastructure and we significantly expanded high-tech clinical capacity through investments in specialty medicine; It's time we did the same for primary care and public health, which together form the foundation of our population's overall health and wellbeing. Each of these foundational elements could be stronger if they were better coordinated and collaborated more closely." AcademyHealth members Kevin Grumbach, Catherine McLaughlin, and J. Lloyd Michener also served on the IOM committee and contributed to this report. For more information on this report, visit the IOM website.  

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