Anyone who has had to see multiple health care providers has likely experienced the problem of one practice not communicating or collaborating with another. It can be frustrating when the proverbial left hand doesn’t know what the right hand is doing, especially when personal health is at stake. On the flip side, receiving coordinated health care can make a life-changing difference.
The same is true on a broader scale for large populations of patients experiencing all sorts of medical concerns. Many different entities—from hospitals and community health centers to state and federal governmental agencies—are charged with protecting and improving the health of Americans nationwide, and they often are working independently toward the same or similar goals. However, when their approach is synergistic instead of siloed, these public health efforts have the potential to result in significant improvement in health outcomes.
One way that policymakers and state leaders have been able to coordinate the related efforts of different agencies is by establishing data-driven public health partnerships between organizations charged with improving the public’s health. State and local public health departments and state Medicaid agencies tend to have complementary initiatives and datasets, and so are ripe for collaborations that can yield more than the sum of their parts.
Seeing the potential to improve health outcomes and lower costs, some states have forged data-driven partnerships between their Medicaid agencies and public health departments. Here are just a few examples:
Rhode Island established a data-sharing agreement between its Department of Health and state Medicaid agency, and the two organizations worked together to gather and assess data on the Home Asthma Response Program (HARP). This evidence-based intervention provides asthma control counseling to families in their homes with the goal of reducing preventable asthma emergency department visits and hospitalizations among high-risk children. After participating in HARP for one year, data shows that patients had an approximately 75% reduction in asthma-related hospital and emergency department costs. Based on this and other positive data, Rhode Island is working to expand access to HARP as a covered Medicaid benefit.
In Oregon, the state’s Medicaid agency and public health department forged a long-term partnership aimed at reducing tobacco use, coordinating their complementary, evidence-based strategies as well as collaborating on joint initiatives. The public health authority’s Tobacco Prevention and Education Program (TPEP) has focused on policy and systems change, such as increasing smoke-free environments and conducting public awareness campaigns about the dangers of tobacco use, while the state Medicaid agency has concentrated on clinical interventions and prioritizing coverage of evidence-based programs to help people stop smoking. Data from their respective efforts is shared and informs the ongoing improvement and targeting of tobacco reduction work.
The two organizations have also collaborated directly on joint initiatives, including the creation of a quality care metric designed to reduce the prevalence of tobacco use. This metric not only required Oregon’s coordinated care organizations (CCOs)—the health plans that serve Oregon’s Medicaid patients—to provide access to evidence-based interventions and policies like smoking cessation counseling and medications, it also incentivized plans to achieve a measurable decrease in smoking rates. Within two years of implementing the incentive metric, as part of the CCO Quality Incentive Program, all the CCOs met the requirements for providing smoking cessation benefits, and the statewide smoking prevalence rate among Medicaid patients decreased by nearly 3%—from 29.3% to 26.6%.
The state has since been able to build on the success of this program, linking the Medicaid delivery system and public health system to support a wide range of cross-agency disease prevention initiatives.
To help address stagnant COVID-19 vaccination rates in the summer of 2021, the New York City health department partnered with seven insurance companies that covered more than 90% of the city’s Medicaid market to implement the Vaccine Outreach and Counseling Program (VOCP). This program incentivized health care providers to proactively reach out to unvaccinated patients and encourage COVID-19 vaccination, and by comparing insurance files with the health department’s Citywide Immunization Registry, it identified more than 960,000 patients for vaccination counseling. During the program’s three-month time frame the proportion of New Yorkers with at least one dose of COVID-19 vaccine increased from 71% to 82%. And while that progress cannot be directly attributed to VOCP given the number of different vaccination efforts ongoing at that time, health care providers participating in VOCP thought the counseling was effective. In fact, the indicators were promising enough that just two months after the completion of VOCP, the U.S. Centers for Medicare & Medicaid Services authorized state Medicaid programs to cover similar efforts.
While these are just a few examples of the ways that states and localities are improving health outcomes and reducing costs through data-driven public health partnerships, it’s an approach that any state can leverage to address the full spectrum of population health issues. If these partnerships are set up in a sustainable way, they can ideally become a foundational part of state public health infrastructure across the country moving forward.
David Hyun, M.D., is project director and Rachel Zetts, M.P.H, is a senior officer with The Pew Charitable Trusts’ state health solutions project.