Leading Health Systems Change—Perspectives from Federal, State, and Territorial Officials

September 26, 2016|9:47 a.m.| Emily Moore

The final session of ASTHO’s Annual Meeting last week (Sept. 21-22) focused on “leading health systems change” and featured a panel representing leaders at the federal, state, local, and territorial levels. Speakers described their vision for public health as it adapts to the changing landscape and strategies we can leverage in strengthening the public health infrastructure and improving population health outcomes.

Karen DeSalvo, acting assistant secretary for HHS, described the evolving concept of Public Health 3.0. Public Health 3.0 calls on health agencies to expand public health to address all aspects of life that promote health and wellbeing. Dr. DeSalvo described findings from listening sessions held across the country with communities and states that are working together to make a measurable impact in health outcomes despite geographic or economic challenges. Emerging strategies to tackle the social determinants of health in these communities that impact population health include cross-sector partnerships (e.g., collaboration between public health, healthcare, businesses, and community organizations), actionable data to drive informed decision-making, and innovative and flexible funding mechanisms to support innovative programs.

John Auerbach, associate director of policy and acting director of the Office for State, Tribal, Local and Territorial Support at CDC, described frameworks CDC has developed to help public health agencies contribute to, and lead, health systems transformation and impress the importance of addressing the upstream factors that drive health outcomes. Given confusion over the term ‘population health,’ the Three Buckets of Prevention is a framework that explains the differences between traditional clinical prevention, innovative clinical prevention that can improve health, and total population or community-wide interventions. Auerbach noted that public health has a role to play in each ‘bucket’ and needs to think about how to be prepared to contribute to and align efforts in all three areas, particularly as state and local public health agencies engage with private healthcare insurers and providers.

Auerbach then highlighted two initiatives that are part of CDC’s efforts to support health systems change: the 6|18 Initiative: Accelerating Evidence into Action and the Health Impact in Five Years (HI-5). The 6|18 initiative encourages private and public payers to implement 18 evidence-based interventions to address six high-burden health conditions (e.g., unintended pregnancy, tobacco use, and asthma). The HI-5 initiative focuses on policies that have evidence of demonstrated health improvements in five years. State and territorial health officials can encourage adoption of these policies in their state.

Karyl Rattay, director for the Division of Public Health in the Delaware Department of Health and Social Services, provided her perspective on leading health systems change as a state health official. In order to create a strong public health infrastructure to support and drive health systems change, critical tools include accreditation, strategic planning, performance management, and cross-sector partnerships. She shared that in her state accreditation was a catalyst for work that they wanted to do. This work supported strategic planning which allowed Delaware to create a state health improvement plan and implement a quality improvement strategy in which her team meets monthly to assess progress on goals through the use of metrics. Dr. Rattay also described her state’s comprehensive statewide initiative Delaware Contraceptive Access Now to reduce unintended pregnancy as part of a private-public partnership with Upstream USA. The initiative is an excellent example of cross-sector partnerships.

Gregorio Ngirmang, minister of health in the Republic of Palau, shared information about how Palau is working to improve health outcomes through the Million Hearts Initiative. The team has worked to strengthen the healthcare system to better treat hypertension and reduce smoking through improved collection of chronic disease data, training in non-communicable disease workflows, and other educational resources. So far, Palau’s Million Hearts Project has documented a 22 percent increase in controlled blood pressure and a 2900 percent (not a typo!) increase in the number of patients receiving brief tobacco interventions (more on their successes here). In addition, Ngirmang emphasized the importance of understanding the return on investment for public health actions in order to inform policymakers about investing in the future.

The evolving role of state and local public health agencies was highlighted throughout the panel presentations and discussions. Dr. DeSalvo noted that local-level successes among communities are heavily dependent on state-level leadership and encouraged state and local health departments to work in concert. She also noted that healthcare systems and other private partners tend to try to “reinvent the wheel” when it comes to their population health efforts, rather than draw from the expertise of state and local public health, particularly in the context of payment and delivery reform. Dr. DeSalvo noted that public health agencies should be “sought after and solicited” for their expertise in these collaborations, rather than feeling as if they were “inserting themselves.” She acknowledged that inflexibility of federal funding at times may reinforce siloes between public health and healthcare, and said that this needs to be addressed to further promote collaboration.

Emily Moore

Emily Moore, MPH, is a senior analyst for health transformation at ASTHO, where she supports state and territorial health agencies to advance public health through activities in payment and delivery reform, public health partnership with public and private payers, and population health improvement.