Integration in Action: Idaho Department of Health and Welfare Advances Healthy Connections
Integrating health-related social needs into healthcare delivery can both improve population health and lower healthcare costs. State and territorial public health agencies have expertise and capabilities that support care coordination and create linkages between healthcare and social services. As legislative and fiscal environments shift, states can look to primary care and public health integration as a promising model to deliver care in an equitable and cost-efficient manner.
Idaho, for example, has integrated and coordinated care with different medical and health-related services. The Idaho Department of Health and Welfare (IDHW) is engaging providers in the patient-centered medical home (PCMH) model and fostering linkages with clinical care, community-based organizations, and social services to transform the primary care system. In the PCMH model, physicians build ongoing relationships with each patient to understand the full array of patient needs and preferences across the lifespan. The physician can then coordinate the delivery of culturally and linguistically appropriate, high-quality medical care and social services that address both individual patient needs and related community health concerns.
Through the CMS State Innovation Model (SIM) test awards, Idaho plans to create 180 PCMH practices (75 of which are virtual) over four years. Idaho will also focus on improving care coordination through electronic health records and aligning public and private payers to support practice transformation. As of February 2017, an estimated 110 primary care clinics were currently implementing this model, and the state hopes to reach 165 clinics by 2019.
Under a subgrant with the Idaho Division of Public Health, officials from Idaho’s seven local public health districts administer and serve on regional health collaboratives (RCs), which support primary care medical practices as they transition to a PCMH model and become integrated into the broader medical-health neighborhood. Idaho’s Population Health Workgroup, chaired by the administrator of the Division of Public Health, defines the medical-health neighborhood as the clinical-community partnership that includes the medical, social, and public health supports necessary to enhance health and disease prevention. The PCMH serves as the patient’s primary “hub” and coordinator of healthcare delivery with a focus on prevention, wellness, and linking to services available outside the clinical setting. The medical-health neighborhood can include community services, such as food, housing, and transportation, as well as medical and behavioral health specialists, dietitians, home health providers, dental professionals, community health workers, community health emergency medical services, education, social services, and other resources which help provide wrap-around, community-level support for the PCMH and the patient to achieve better health outcomes and wellness.
This year, state public health department staff who are involved in the Statewide Healthcare Innovation Plan (SHIP) have also updated, “Get Healthy Idaho: Measuring and Improving Population Health,” the Division of Public Health’s population health improvement plan, incorporating community health needs assessments collected from across the state, Idaho’s Leading Health Indicators, and the requirements of the SIM grant.
Several aspects of the PCMH model also align with common themes addressed though the Integration Forum, a partnership of state and local public health agencies, primary care, academia, medical professional organizations, federal agencies, and other stakeholders seeking to inform, align, and support the implementation of integrated efforts to improve population health and lower healthcare costs. The work conducted by the Integration Forum and IDHW offers useful models that state and territorial health officials can use and replicate in their states.
The following emerging lessons may be particularly useful to inform and support the work of ASTHO members:
Public health agencies are well-suited to serve as regional conveners.
In Idaho’s model, the RCs and local public health departments have access to regional data through community health assessments and SHIP analytics that can support local population health improvement. A SHIP-funded grant program allows the RCs to support local efforts by providing resources for initiatives that align with local jurisdictions’ community health needs assessment results, population health priorities, and strategic plans. These local initiatives address caregivers, care coordination, suicide prevention, and use of emergency medical services. IDHW is also involving other state agencies in elder care, education, and corrections to advocate for aligned program requirements and payment mechanisms (see: How are IDHW divisions involved with SHIP). As a result of these partnerships, the health department is well-positioned to share best and promising practices with PCMHs and other stakeholders across the state.
“Public health in Idaho has been actively involved in the SIM work from its inception in 2011. We are using our expertise as ‘conveners’ to develop and implement innovative solutions to healthcare. These include the use of community health workers, community health emergency medical services programs and the expansion of telehealth services across our rural and frontier state,” says Elke Shaw-Tulloch, state health official and administrator of Idaho’s Division of Public Health. “These services form the virtual PCMH, an extension of the primary care PCMH model. Local public health leaders and staff know their communities and how to build local support so patients are supported in getting the right care in the right place at the right time. Statewide, both state and local public health provide myriad services that can help patients more readily receive coordinated care, as well as make healthier choices in their own communities.”
Health information technology offers important tools to coordinate care and improve population health.
Idaho’s SIM work entails connecting providers across the entire medical-health neighborhood through electronic health exchanges. This includes electronic prescribing, messaging, and clinical results delivery that can reach and connect multiple medical providers, improve patient access to care, and reduce fragmentation of service delivery. Health information technology will also enable Idaho to track population health measures statewide, conduct performance analyses, and improve quality.
Integrating behavioral health into primary care and other clinical services has many benefits.
In Idaho, the PCMH model has strengthened access to behavioral health services, increased the number of referrals, and initiated follow-up among clients with missed appointments. Integrated behavioral health and primary care recognizes the value of caring for the whole person.
In the years ahead, Idaho and other SIM states will continue to yield lessons learned and opportunities as they continue to work to create health system transformation. The integration and coordination of health systems, public health, and social services will be especially important to improve population health, lower healthcare costs, and support upstream prevention efforts by addressing determinants of health within and beyond the medical healthcare system.
Anna Bartels is an analyst for health systems transformation at ASTHO, where she supports the Integration Forum’s activities and projects related to payment and delivery reform.