Integrating primary care and public health has long been an aim of health system transformation. Better coordination and collaboration between these disciplines is important to improving population health. Progress has been slow, however, and the COVID-19 pandemic has strained already over-burdened resources and services in both areas, threatening response efforts and exacerbating racial and economic disparities. On the positive side, the pandemic has provided new insights into the complexity and constraints of governmental public health, opening new opportunities for collaboration.
In a March webinar, we brought our collective practical and policy experience to bear to address gaps in public health and primary care integration that the COVID-19 pandemic has highlighted. The U.S. and global response to the pandemic has fallen short in many ways, and we aren’t completely out of the woods yet. The webinar was an opportunity to use our awareness of those shortcomings to envision new ways to approach integration and collaboration. We identified some exciting possibilities, including six important steps toward supporting better collaboration and cooperation:
- Remember. As we move into a new phase of the pandemic, with a sizable percentage of the population vaccinated and infection rates and deaths declining, there is a powerful temptation to leave behind the many missteps and challenges of the past 15 months. In working to do better, it’s important to remember what actually happened and to acknowledge what can be improved through better partnerships and system improvements. For example, initial planning for large-scale vaccination efforts did not include independent primary care practices, even though half of all visits to physicians are to primary care physicians; primary care practices are experienced in giving vaccines and providing vaccination counseling; and community practices across the country were eager to provide their patients with COVID-19 vaccinations. We can remember by sharing collective learning and by revisiting what happened through in-progress reviews and after-action assessments.
- Act locally. Integrating public health and primary care requires national and state funding and support, but successful integration efforts have typically been local responses to specific community and sub-community needs and circumstances. Local action is especially important when working together to reduce health inequities, and to develop locally appropriate plans for crisis response. It’s also essential to make a place at the table for community members who can provide key insights into accomplishing successful local solutions.
- Build on existing strengths. Public health and primary care can reinvigorate their joint commitment to prevention as the foundation for population health. This commitment provides an overarching framework for collaboration. A focus on preventing disease and promoting health can guide the development of joint activities to meet community needs; help partners at all levels concentrate on reducing health disparities in screening and other preventive services; and inform investments in prevention research and evaluation that involve both public health and primary care. When all partners leverage their core skills to collaborate, they amplify their effects and mitigate competition between disciplines.
- Communicate. Although primary care and public health share many of the same goals and activities, differences in professional training, culture, and responsibilities can make it hard to connect and communicate easily. The limited availability of resources to support ongoing interaction further impedes collaboration. For example, although many local public health departments have created detailed response plans in the wake of previous public health crises, individual primary care physicians who aren’t in regular communication with their public health colleagues might be unaware of these plans or their role in them. Good communication requires that all partners be at the table to plan, implement, and evaluate programs, and also to ensure effective communication with the communities they serve. Becoming better partners means working to understand each other’s circumstances, commitments, challenges, and strengths.
- Share data. Existing data systems make collaboration and cooperation much more challenging than they have to be. Innovation and funding are needed to create and sustain systems that create collective knowledge and support joint action between public health officials and primary care professionals. This is a shared responsibility across national, state, and local levels and across players in the health system. Accurate data on race, ethnicity, and other disparity factors are crucial to achieving equity in health and health care; acquiring, sharing, and using these data is a responsibility of clinical and public health providers and possible only with fully interoperable data systems that are integrated into practice.
- Innovate. More robust and stable funding is needed for both public health and primary care to maximize population health and to meet the challenges of future pandemics and natural disasters. Financing for primary care and public health should incentivize working together under routine and crisis circumstances. Primary care needs a financing model that enables clinicians to step off the fee-for-service treadmill and begin to address population health. For public health, stable, adequate funding from year to year—for example, to enable the creation and maintenance of robust infrastructure (including health information technology and data sharing capabilities)—is essential. The American Rescue Plan provides a strong foundation with multi-year funding to states and localities for public health workforce investments. Funding is also needed to support the training and development of a health workforce that sees collaboration as part of its mandate and mission, and has the skills and time to build and sustain effective partnerships.
The COVID-19 pandemic provides an unprecedented opportunity to break with the past and plan for a healthier, more equitable, and more resilient future. The pandemic has been devastating in the number of lives lost, and in egregious inequities in exposure, illness, and death. It has also been extremely costly in the burden of acute illness, the growing number of long-term cases, economic and social upheaval, and the effects on mental health and well-being. The silver lining might be tremendous opportunities for creativity. The task now is to respond by casting off previous limitations and collaboratively envisioning what can be. If we do nothing, we risk the same types of losses and costs in the next pandemic or major natural disaster. If we act now to improve partnerships and planning, we can reduce disparities, save lives, and start to build a system for health.
Disclaimer: The opinions expressed here are those of the authors alone and do not necessarily represent the positions of AHRQ or the Department of Health and Human Services.