An Argument for the Integration of Healthcare Management With Public Health Practice

Abstract

As the U.S. healthcare system anticipates the requirements of legislated healthcare reform, front and center is the challenge of improving the U.S. healthcare value equation--the need to improve the value received for the health dollar spent. As is often the case, the psychology of change is at play here, whereby humans turn to what they know best as a response. As many health system leaders face the uncharted waters of U.S. reform and related downturns service utilization, pressured reimbursement levels, and restrictive access to markets, managers' responses often return to the familiar calls to action: * Enhance operating efficiencies * Reduce case costs * Implement more standardized clinical protocols and evidence-based best practices * Add provider-side integration (hospitals and physicians) * Step up marketing to improve penetration of historically profitable clinical markets (e.g., cardiovascular, orthopedics). While such responses are important and helpful, the missing factors this set of solutions may be time-tested principles of public health practice, which leads to the central thesis of the argument presented here: the need for U.S. healthcare systems to adopt useful principles and models of public health practice as new core competencies for health system management. IF YES, WHY NOW? Historically, healthcare administration has largely existed to manage the business of illness delivery, principally one patient at a time. Public health practice, on the other hand, has sought to protect and manage the well-being of populations, with a focus on such basic services as clean water, safe food, disease surveillance, disease prevention, and the epidemiology of various factors and environmental conditions. To be sure, these disciplines have been necessary and complementary to healthcare delivery, especially when disease affects the individual and the population at the same time under such conditions as epidemics. Now, however, a constellation of market and policy factors and conditions has created a need for the integration of complementary disciplines through the adoption of useful principles of public health practice by healthcare providers (and health systems) to enhance the U.S. health services delivery value equation. What arguments can be made for integration at this time? * An undeniably unaffordable U.S. health cost inflation rate * Rankings for U.S. healthcare worldwide outcome measures that land at the 30th position or lower among developed countries (Robert Wood Johnson Foundation, 2009) * An economic model that rewards doing more regardless of outcomes * A consumer who is virtually blind to real costs and quality * A clinical education and delivery model that recognizes the next physician involved with any patient as the captain of the ship, whose mandate is to do all possible at the moment of care on the basis of an interpretation of the presenting clinical facts and circumstances as encountered. Enter the demands for the enhanced value equation--demands that do, and should, fundamentally transmogrify our existing approach to health services organization and care delivery: 1. The acceleration of consolidation and integration on the provider side of the field (hospitals and hospital systems with physicians and other components of the delivery system) 2. The consolidation and transformation of the payer side (the insurers of commercial and governmental healthcare) toward seeking to transfer financial risk for covered populations to the provider side 3. Large, sophisticated health systems seeking to lock in defined populations through the assumption of financial risk, which will carry with it the assumption of the health risk of populations under contract 4. A need to engender the customer and brand loyalty of populations that will likely remain free to move from health system to health system (Zismer, 2012) So, how do principles and models of public health practice factor into the future picture as painted, and what is the likelihood that the health value equation can be enhanced? …