Plan & prepare for public's sake: Population-based approach needed for public health issues

November 1, 2006

When it comes to public health, experts agree: Fail to plan and the health plan fails.

When it comes to public health, experts agree: Fail to plan and the health plan fails.

Fortunately, a growing number of health organizations have recognized the critical need to prepare and collaborate for public health emergencies such as data sharing-making patient's medical records available to all providers; prevention-averting the burdens of health problems on patients and society before they happen; planning for potentially catastrophic flu or other pandemics; resolving disparities in lower-income Americans' access to quality care; and planning for better, more effective responses to disasters such as hurricanes and tornadoes.

According to a forecast summary from Center for Medicare & Medicaid Services (CMS), healthcare spending in the United States is projected to reach $2.164 trillion in 2006. Of that total, $67 billion, or 3.1%, is estimated to be spent on government public health activities.

"These are some of the most important issues facing both public health and health plans," says Georges Benjamin, MD, FACP. executive director. American Public Health Assn. (APHA), in Washington, D.C.

Public health takes a population-based point of view, something health plans are already practicing.

"Health plans are beginning to make progress in addressing the needs of their members from a population-based approach," Dr. Benjamin says. "Plans evaluate both financial and clinical performance of their plans using a variety of measures that look at the needs and characteristics of their memberships. This is the same thing that people responsible for governmental public health do. The opportunity to make a huge difference in the health and well-being of health plan members is lost unless plans think of their practice from this perspective."

Carolyn Cocotas, director of Community Health Innovation at Affinity Health Plan, Bronx, N.Y., agrees that managed care organizations have both the responsibility and the infrastructure to address issues of the public's health. "Every day we prioritize where resources are brought to bear using the best available evidence. We strive to allocate resources where we have a high likelihood of making a difference in the health of our enrolled population," says Cocotas. "In many ways, this is not unlike others involved in public health, such as state and local health departments, and we should be collaborating with them to address issues of common concern."

There is also an opportunity for greater collaboration among health plans and provider partners in a community, Cocotas points out. "With greater collaboration, we could create economies of scale, and our resources could be used more efficiently to expand our impact to the broader community," she points out. "We should use the infrastructure we have within our organizations to promote improved health outcomes not just for our enrollees, but for all patients."

To that end, in January 2006, Affinity launched its "Making a World of Difference" community health innovation grant-giving program, but Cocotas notes, "it is especially complicated when the public health issues have a social component. In that case it takes collaboration with organizations outside of health and medicine to realize change." The grants funded this year by Affinity are collaborations with community-based organizations such as public housing projects, the New York City Department of Health and daycare centers.

Public health has a major impact on health plans, especially publicly funded plans such as AmeriHealth Mercy. "People often move between insured and uninsured status, so whatever we can do from a public health standpoint to improve the health status of our society in general benefits all of us," says Jay Feldstein, DO, AmeriHealth Mercy's senior vice president of medical affairs and chief medical officer. "It is incumbent on all health plans to take an active interest in public health-not only because it affects the health status of our society, but also because it drives the bottom line."