Getting Public Health Out of Its Silo | AHIP 2024

Despite its broad mandate to keep people healthy and respond to shared health threats, public health has something of a poor relationship with the rest of the $4.5-trillion-a-year U.S. healthcare, its providers and payers.

Mandy K. Cohen, M.D., M.P.H.

Mandy K. Cohen, M.D., M.P.H., director of the Centers for Disease Control and Prevention (CDC) wants to change that relationship and hopes to persuade health insurers that it is in their interest to do so.

“If public health is strong and it is doing the work it is meant to do, your job gets easier,” Cohen said Tuesday at the opening keynote session of AHIP 2024, the annual meeting of AHIP, the health insurance’s largest trade organization, in Las Vegas.

Cohen, who was appointed head of the CDC in June 2023, spoke about the health data modernization efforts, interoperability and strategies for gathering information in real time. She said one reason she could speak confidently about the relatively low public health risk from the bird flu outbreak affecting poultry, dairy cows and a small number of dairy workers, is that the CDC now receives “syndromic data” from 90% of the country’s emergency rooms.

Cohen, reprising some of the points she made with two CDC colleagues in an opinion piece published in early April 2024 in The New England Journal of Medicine titled “Integrating Public Health and Health Care — Protecting Health as a Team Sport,” said CDC funding has been organized around responses to particular diseases, such as COVID-19 and before that, HIV. She said the agency is shifting to organization and funding that builds up data, laboratory and workforce capabilities so the agency is “disease agnostic” and can help lead the response to any emerging health threat

“What I hope to see us do is fund these core infrastructures to allow us to respond no matter the health threat, so we can pivot our data systems, our lab capacity, our manufacturing capability, our supply chain, no matter the health threat what comes to us,” she said.

Cohen referenced data modernization, including Trusted Exchange Framework and Common Agreement (TEFCA) and Fast Healthcare Interoperability Resources (FHIR) standards, several times in her pitch for public health to have a closer, working relationship with the rest of U.S. healthcare. She noted that as a practical matter, “folks don’t walk into a public health department when they are sick, they walk into the emergency rooms with their insurance card” and said improving electronic case reports of diseases such as measles to public health databases should be a goal. She also mentioned lobbying and public advocacy efforts; one of AHIP’s main functions is lobbying to protect the health insurance’s interests. She told the audience that when they go to Washington, D.C., and to the Hill “I hope advocating for public health aligns with your agenda.”

Cohen made her first keynote remarks in a one-on-one interview with Bechara Choucair, M.D., executive vice president and chief health officer at Kaiser Permanente. That session segued into a panel discussion with Dave Chokshi, M.D., who was the New York City health commissioner from 2020 to 2022 and is now professor at the City of New York; Michelle Williams, Sc.D., a professor of epidemiology at the Harvard T.H.Chan School of Public and former dean of the school; and Dan Hanfling, M.D., director of the private sector strategic partnerships in the White House Office Pandemic Preparedness and Responses. There were differences in emphasis and perspective among the panelists but no real disagreement.

Dave Chokshi, M.D.

Chokshi is the chair of the Common Health Coalition, whose founding members include AHIP and four other prominent and powerful U.S. healthcare organizations: the Alliance of Community Health Plans, the American Hospital Association, the American Medical Association, and Kaiser Permanente. Chokshi said a bright spot of the COVID-19 pandemic is that the “walls between public health and healthcare came tumbling down” and the coalition’s purpose is to map out collaborations and relationships that will keep them from getting rebuilt.

“Let’s put in place the ways for these relationships to blossom during peacetime, at least relatively speaking, so we are much better equipped for the next health crisis," Chokshi said.

Williams, noting the massive disruption caused by COVID-19 called for a “mindset shift” about public health: “We have to stop thinking public health as just a cost and think about public health as a strategic pillar of investment for all of us.” Williams also called for more public-private partnerships and investment in data collection and analysis to break the feast-or-famine funding cycle for public health.

Hanfling spoke about the 400 local healthcare coalitions throughout the country organized after 911 and the anthrax attacks that coordinate hospitals, emergency medical service agencies and other organizations to respond to emergencies. He said the coalitions, which HHS supports with $200 million to $250 million annually, would be a good place for payer organizations to “plug into” to be involved in broader health issues.