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Pages 1-16

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From page 1...
... The 17-member Committee on Integrating Primary Care and Public Health comprises experts in primary health care, state and local public health, ser 1 The committee recognizes that mental health is an inextricable part of primary care. When primary care is discussed in this report, the committee means it to be inclusive of mental health.
From page 2...
... to promote the integration of primary care and public health. • Discuss how HRSA-supported primary care systems and state and local public health departments can effectively integrate and coor dinate to improve efforts directed at cardiovascular disease preven tion, as well as other issues relevant to health disparities or specific populations, such as maternal and child health and colorectal can cer screening, and describe actions HRSA and CDC should take to promote these changes.
From page 3...
... While public health defined broadly in this report goes beyond governmental public health, the committee recognized that health departments play a fundamental role in creating healthy communities and focused on them when possible. Integration While integration can be an imprecise term, integration of primary care and public health was defined for this report as the linkage of programs and activities to promote overall efficiency and effectiveness and achieve gains in population health.
From page 4...
... This pivotal time makes it possible to achieve sustainable improvements in population health, a key goal for health system reform. Pursuit of this goal will require a balance of investment and clarity of roles across activities that address the broad determinants of health, population-level behaviors, and individual health care -- activities in which primary care and public health have prominent roles.
From page 5...
... , and both see themselves as having a public health mission. HRSA plays a strategic role in helping to ensure access to personal health services for uninsured and vulnerable populations through its support for the provision of primary care and preventive services at health centers, Ryan White clinics, and rural health clinics, as well as training programs for the primary care and public health workforces and maternal and child health programs.
From page 6...
... Drawing on these experiences, the committee derived some lessons about the composition and focus of recent efforts to integrate primary care and public health: • In many of the examples, integration was driven by a specific health issue that was identified as a community area of concern, such as chronic disease, prevention, or the health needs of a specific population. • Participants in integration initiatives varied widely, including an array of primary care and public health entities and other con tributors, such as community organizations, academic institutions, businesses, and hospitals.
From page 7...
... AREAS IN WHICH HRSA AND CDC CAN STRENGTHEN INTEGRATION To explore the potential for interagency collaboration to foster the integration of primary care and public health, the committee examined how HRSA-supported primary care systems and public health departments could integrate efforts in three specific areas: maternal and child health (specifically the Maternal, Infant, and Early Childhood Home Visiting Program) , cardiovascular disease prevention, and colorectal cancer screening.
From page 8...
... These provisions are summarized in Table S-1. TABLE S-1 Selected Provisions of the Patient Protection and Affordable Care Act That Offer Opportunities for HRSA and CDC Affordable Care Act Provision HRSA and CDC Opportunities Community • iven that Community Transformation Grants can be G Transformation Grants viewed as the public health counterpart to the Centers for (ACA §§ 4002 and 4201)
From page 9...
... implementation of state demonstrations, particularly in outreach to community providers to enlist them as active participants in such demonstrations, training and technical support to state Medicaid agencies, outreach to public health departments and health centers in demonstration states, and collaboration with CMS on the development of outcome standards and scalability criteria. Community Health • n imperative for HRSA is to preserve and strengthen A Centers the role of health centers as core safety net providers of (ACA § 5601)
From page 10...
... (ACA § 3022) • RSA and CDC could develop models of collaboration H The provision authorizes between public health departments and ACOs that include the secretary of the safety net providers.
From page 11...
... Primary Care Extension • RSA and CDC could work with AHRQ to ensure that H Program Primary Care Extension Programs include a public health (ACA § 5405) orientation and integrate community health issues into The provision authorizes practice- and clinic-based primary care improvement the Agency for Healthcare activities.
From page 12...
... NOTE: ACA = Patient Protection and Affordable Care Act. Despite these opportunities, the current funding system for primary care and public health is not well positioned to promote integration.
From page 13...
... and the strategic place ment of assignees in state and local health departments offer ad ditional opportunities to contribute to the integration of primary care and public health by assisting community health programs supported by HRSA in the use of data for improving community health. Any opportunities identified should be utilized.
From page 14...
... To improve the integration of primary care and public health through existing HHS programs, as well as newly legis lated initiatives, the secretary of HHS should direct: • MMI to use its focus on improving community health to sup C port pilots that better integrate primary care and public health and programs in other sectors affecting the broader determinants of health; • he National Institutes of Health to use the Clinical and Trans t lational Science Awards to encourage the development and dif fusion of research advances to applications in the community through primary care and public health; • he National Committee on Vital and Health Statistics to advise t the secretary on integrating policy and incentives for the capture of data that would promote the integration of clinical and public health information; • he Office of the National Coordinator to consider the develop t ment of population measures that would support the integration of community-level clinical and public health data; and • HRQ to encourage its Primary Care Extension Program to cre A ate linkages between primary care providers and their local health departments. Recommendation 5.
From page 15...
... 1997. Developing tomorrow's integrated community health systems: A leadership challenge for public health and primary care.


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