Bridging Systems: How Kentucky is Improving Response to Emerging Health Threats

May 18, 2026 | Maggie Nilz

Strong collaboration between public health agencies and health care systems is essential to preparing for and responding to emerging health threats. From supply chain disruptions to large-scale public health emergencies, coordinated planning helps ensure health care facilities have the resources they need to continue serving their communities.

ASTHO sat down with Grant Gillion, Emergency Preparedness and Response Manager for Kentucky, and Ken Kik, Community Health and Medical Operations Manager for Kentucky, to discuss the importance of their work in streamlining state-level Public Health Emergency Preparedness (PHEP) and Hospital Preparedness Program (HPP) efforts while building collaborative relationships with health care partners. 

Can you briefly describe your roles and how it interfaces with health care partners in your jurisdiction?

We provide leadership and strategic direction for the PHEP and HPP programs, as well as other branch activities. In Kentucky, these programs are housed within a single branch, which allows for a more coordinated approach to preparedness and response.

We have 26 regional field personnel who support health and medical partners across the state. While field staff may focus on either PHEP or HPP, they are cross-trained and regularly collaborate. Building strong relationships is essential to this work. Field staff engage directly with Emergency Support Function (ESF)-8 partners — including local health departments, congregate care facilities, and regional health care systems — to enhance preparedness, coordination, and response capabilities statewide.

There continues to be a national conversation about increasing integration between PHEP and HPP. What gaps or challenges led Kentucky to pursue greater alignment between these programs?

Although our response operations were already highly integrated, our daily program structure did not fully reflect that alignment. This caused inefficiencies and reduced coordinated planning and engagement. Funding uncertainty further emphasized the need for a more sustainable model. In response, we integrated PHEP and HPP into a single operational structure, aligning both daily activities and response functions to enhance efficiency and coordination.

What challenges did you encounter and how did you address them?

One of the main challenges was restructuring field operations, which included merging regions into unified service areas and creating new Area Supervisor roles. This process involved geographic realignment and changes in leadership structure. Although the transition caused some growing pains, the new model has improved coordination, simplified oversight, and enhanced operational consistency. Field staff are becoming more versatile through cross-training, increasing the system's overall adaptability.

Did any policy changes accompany the operational alignment of HPP and PHEP?

Aligning HPP and PHEP in Kentucky did not require sweeping new policy development. We focused on standardizing and aligning processes across both programs to better reflect how they already function. This included updates to field operations, such as redefining service areas, establishing Area Supervisor roles, and clarifying expectations for cross-trained staff. Additionally, we enforced coordination protocols — particularly those tied to State Health Operations Center (SHOC) activation, ESF-8 functions, and information sharing — to ensure consistency across both programs. Overall, the changes were less about formal policy overhaul and more about operationalizing alignment through clearer guidance, unified structures, and intentional communication, allowing both programs to function as a single, coordinated system in both day-to-day activities and emergency response.

What outcomes or improvements have you seen because of alignment?

The integration of PHEP and HPP has improved communication and collaboration across programs. Staff now engage more frequently and intentionally, helping to break down silos and increase understanding of each program’s needs. This alignment is already visible in more coordinated training and exercises.

How has this collaboration changed the way your jurisdiction approaches disaster preparedness today?

Programmatic and field staff now engage in regular, intentional communication, making our work more unified. This increased collaboration has expanded staff knowledge of both programs and their requirements. Over time, we expect our response operation to be more coordinated and effective.

Can you describe how Kentucky coordinates its health care system's needs during emergencies, such as evacuations, bed alerts, or other surge events?

During major incidents, Kentucky activates the SHOC, which establishes a structured coordination framework with defined roles and responsibilities. Activation of the SHOC includes leadership positions for health care coordination and ESF-8 operations. Branch field staff oversee response activities in their regions and relay needs back to the SHOC for additional support. During disease outbreaks, the SHOC supports epidemiological and local response efforts, focusing on coordination, information sharing, public communication, and the distribution of medical countermeasures and supplies.

In your experience, what strategies have been most effective for maintaining situational awareness and communication between public health, health care facilities, and emergency management during incidents?

Strong relationships formed during non-emergency times are essential. Building trust and rapport among agencies before an incident significantly enhances coordination during a response. Equally crucial is having clear, predefined processes for information sharing. When roles, expectations, and communication channels are understood beforehand, agencies can operate more efficiently and with less confusion, especially in the early stages of an incident, when clarity is most critical.

What advice would you give to other states or territories interested in implementing a similar approach?

There is no one-size-fits-all model. Each state must consider its own geography, governance structure, and operational requirements. It is crucial to involve staff at every level in collaborative planning. Recognizing strengths, gaps, and opportunities through structured discussions can help create a model that is both practical and sustainable. Looking at other jurisdictions’ approaches can also offer valuable insights, but solutions should always be customized to fit the local environment. In the end, success depends on adapting the approach to your state’s unique circumstances while making sure the structure is practical, sustainable, and aligned with operational needs.

Looking ahead, what systems, partnerships, or investments would further strengthen coordination between health care and public health in future emergencies?

Ongoing investment is necessary to close any remaining gaps. Hospitals need more support to handle mass casualty incidents and care for highly infectious patients. EMS agencies and local health departments also face staffing and resource challenges that impact their operational capacity. Local health departments encounter similar issues in maintaining core services and specialized programs with limited resources. Continuous funding across health care and public health systems is essential to sustain and improve preparedness. Much of this work currently relies on federal funding, highlighting the need to evaluate long-term investment strategies to build resilience.