As clinical providers seek ways to improve the health of their patients at the population level, one great resource that they should tap is their county health department. There are many resources and skills that health departments will share with physicians and other providers that will improve their ability to improve the health of their patients.
In my work I have had numerous occasions to collaborate with the chief epidemiologist of the Kent County Health Department of Michigan-Mr. Brian Hartl. Through these contacts and through an introductory epidemiology course I have found that health departments are experts at providing population level health services. This is in contrast to most clinical providers who excel at working with their patients on a face-to-face level. Both staff of physician offices and staff of health departments are concerned with the health of individuals and groups of people.
Clinicians most often work with individuals during face-to-face encounters. They treat the disease or injury of an individual one at a time. For instance, if a physician is treating a patient with hypertension, she will plan a course of treatment with the individual in mind. If the physician considers the population level in her work, then she is looking at how the treatments and instructions that she provides affect a group of her patients. For instance, she may consider how effective she is in treating her patients with hypertension collectively.
The patients of a county health department are the population of the county. Only in a few instances do health departments treat individuals one at a time. Much of their work would not be considered clinical interventions. However, their work does affect the population as a whole. For instance, health departments are responsible for seeing that food at restaurants is handled and cooked correctly. Health departments track reports of communicable disease to identify potential clusters or outbreaks, such as measles, in order to mobilize the community and physician groups to respond and prevent further transmission.
Can these two health groups benefit each other in improving the health of their patients and, if so, how? I recently interviewed Brian Hartl about this and he shared some thoughts that I believe can help clinical providers do a better job. As an expert in population level health, Mr. Hartl sees much of his work as preventive in nature. In the emerging world of population level medicine it is important for physicians and other clinical staff to focus on prevention too-prevention of chronic diseases worsening for patients, such as prevention of patients diagnosed with prediabetes advancing to diabetes, and prevention of teen patients from misusing alcohol and other drugs, including tobacco. The Kent County Health Department has many resources that can help physicians achieve their goal and would be very willing to collaborate with clinical groups. In fact, KCHD currently has a grant whose funds can be used to improve patient opportunities for chronic disease prevention, risk reduction or management through clinical and community linkages.
Mr. Hartl believes there is potential to work together with physicians to establish a system for prescribing healthy living activities and lifestyles as non-clinical interventions for the prevention/management of chronic disease. For instance, the Kent County Health Department is actively engaged in helping communities develop walking paths in underserved areas in the City of Grand Rapids. He thinks that patients with chronic diseases can greatly benefit if they became more active by walking. He is willing to share maps and information about the location of such paths so that a physician can prescribe a walking agenda for a patient and then point them to nearby paths that they can easily access.
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The Kent County Health Department is also engaged in working with community partners to bring fresh foods to locations in the county where access to fresh fruits and vegetables is difficult. These are known as ‘food deserts’ and often only have retail food stores that are ‘quick markets’ that have only boxed food, such as those found in many gasoline stations. His group is working with such retailers in the community to overcome the barriers to providing fresh foods. Mr. Hartl is willing to share with physician groups the locations of fresh food sources in the community so that clinicians can inform their patients of the locations and improve their food lifestyles.
These are just two examples of information that the health department is willing to share with clinical groups so that their patients can achieve healthy, active lifestyles. Besides information, health departments also have community contacts that could be useful. For instance, the Kent County Health Department works with the YMCA of Greater Grand Rapids, which has a nationally recognized program (the Diabetes Prevention Program) that helps prevent individuals diagnosed with prediabetes from becoming diabetic. The health department also has links with community educators, the Grand Rapids Urban League and prevention groups that focus on the prevention of the misuse of alcohol and other drugs.
As you can see there are many resources that are available from health departments. Will it be beneficial to clinical providers to access these resources? I believe that accessing these resources will help physicians and other clinical providers greatly improve the quality of life of their patients. Also, it will help in improving the outcomes of patients at the population level. This is very important for groups that have risk-based contracts with private payers and for those who serve patients who are covered by Medicare. According to an article in Modern Healthcare dated January 16, 2015, about 40% of all private payer contracts are incentive based now; those with such contracts need to focus on population level health.
There is a treasure of information at the health department for patient-centered medical homes that have patient care coordinators. One of the responsibilities of these coordinators is inform their patients of community resources that would be useful to them. The health department is an excellent source of such information.
The goals of healthcare providers remains to provide safe and high quality care to their patients while their management staff work to improve the bottom line. With the rise of risk based contracts that dictate managing care at the population level, I believe that county health departments can do a great deal to help providers meet their goals.