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Public Health: 'The prognosis for accountable care ... is excellent!'

By Dr. David C. Pate, News and Community
April 8, 2013

Since 1995, the first full week in April has been National Public Health Week, providing the American Public Health Association and other organizations the opportunity to bring attention to health improvement.

 Elke Shaw-Tulloch, administrator for the Idaho Department of Health and Welfare’s Division of Public Health.

I recently met with Elke Shaw-Tulloch, administrator for the Idaho Department of Health and Welfare’s Division of Public Health.

We discussed the fact that government funding is being threatened, and in some cases cut, while at the same time there is an increasing emphasis on prevention. Given that public health and St. Luke’s have shared goals, I’m very interested to know how we can work together to achieve better health for the people of Idaho.

Elke got me thinking that St. Luke’s, the state of Idaho, and local public health districts can be even more successful together. After all, the journey is a transformation toward accountable care: better health, better care, and lower cost. And there is a strong public health aspect to accountable care that hasn’t gotten a lot of attention. Here’s what we talked about: 

How do we identify the health issues and concerns of different communities?

All of our hospitals conduct community health needs assessments, but we could do an even better job working with the state and local public health agencies to access data the state has. The state and local public health also have epidemiologists and we don’t. With their help, we can better identify specific health needs and tailor our approaches to improving health in each community.

How do we reach the people we need to reach to identify health status and risk factors?

Doctor’s offices and hospitals are filled with sick and injured people; people who are already identified as patients. How do we reach those who are not yet patients? We have to be with them in their homes, schools, and workplaces. We could extend our reach by working with public health officials who already spend a lot of their time in these settings. 

Once we identify at-risk people, how do we address the socioeconomic barriers that often interfere with care and follow-up?

This is a real strength of the public health experts in the Department of Health and Welfare and local public health districts. They have programs directed at those with caregiver, transportation, and other needs and issues that are barriers to better health.

What if we could take some of our Healthy U program to the communities? What if we could better identify obese preteens so that we could get them and their families into our YEAH! Program?  It seems to me that there are many ways for us to partner to the benefit of so many.

How can we achieve better care for our patients and all Idahoans?

We have exciting opportunities. Wouldn’t it be great if we could coordinate the activities of public health and St. Luke’s Health System? 

Take, for example, a youth with asthma who is having frequent exacerbations and missing a lot of school. What about home visits to identify possible triggers of his asthma attacks? What about referring a senior who needs social connectedness and physical activity to a local Fit and Fall Proof™ class, or referring a patient with one or more chronic diseases to a local Living Well in Idaho class?

How can we lower costs and provide better care?

We could share information and then ensure better medication compliance through home visits.  Medication noncompliance is a common reason for excess and costly hospital readmissions.   Often the noncompliance is due to lack of understanding about medications, how to take them, and/or how often to take them, or the inability to afford them. 

We could identify patients in need for screenings and preventative measures, and work together to ensure those patients receive their immunizations and other health basics. 

And no one tracks emerging health threats as well as our public health infrastructure. We can coordinate our efforts to address disease outbreaks and minimize the impacts on the people of Idaho. 

How do we create environments that support better health and healthier people?

St. Luke’s is usually responding to people who are already sick. Working with public health, we can better reach people and prevent illness. This is another area for a great partnership opportunity: developing policies to effectively promote and improve health, creating an atmosphere of health in all policies, and making the healthy choice the easy choice for the hardworking people of our state.

And I’ve just started thinking about this! There are clearly plenty of opportunities. St. Luke’s already leads the way in working with other community organizations to solve difficult health care challenges. It would be natural for us to work more closely with the state. 

I have written before, and I have a number of blog pieces forthcoming, about our work with Boise State University, WhiteCloud Analytics, March of Dimes, Barnes & Noble, Micron, Regence BlueShield of Idaho, and SelectHealth, just to name a few!

I am so excited that we have such a progressive Department of Health and Welfare under the leadership of Director Dick Armstrong and with extremely knowledgeable and talented leaders like Elke Shaw-Tulloch who are willing to think in new ways and try new things. The prognosis for accountable care for Idaho is excellent!

About The Author

David C. Pate, M.D., J.D., is president and CEO of St. Luke's Health System, based in Boise, Idaho. Dr. Pate joined the System in 2009. He received his medical degree from Baylor College of Medicine in Houston and his law degree from the University of Houston Law Center.