Category Archives: Public Health Departments
The Affordable Care Act (ACA), which kicks into high gear in January, was front and center at the recent annual meeting of the National Association of County and City Health Officials (NACCHO) in Dallas. U.S. Centers for Disease Control and Prevention Director Tom Frieden, MD, MPH, addressed the benefits to population health of many of the new law’s provisions and Kathleen Sebelius, Secretary of the Department of Health and Human Resources, which has overall responsibility for the law, spoke about the ACA via video.
For the most part, the role of local health departments under the ACA is still emerging and will become better known as more provisions are implemented and clarified.
To better understand what we know about that role and what will become better known down the road, NewPublicHealth spoke with Michelle Chuk Zamperetti, MPH, Senior Advisor and Chief of Public Health Infrastructure and Systems for NACCHO.
NewPublicHealth: Are there specific provisions under the ACA that apply to local health departments?
Michelle Zamperetti: There are no provisions specifically designated for local health departments but there are many provisions that impact local and state health departments. For example, many will be involved in the outreach and enrollment efforts for the new marketplaces and some will be designated as navigators to help people enroll for health insurance coverage in both the state-run marketplaces and the federally funded exchanges. For example, I recently learned that authorities managing a state-based health insurance exchange were not pleased with some of the navigator program applicants, so they reached out to a local public health director and asked that health department to be the navigator program leader in their region. And even in communities where health departments don’t give direct enrollment assistance—such as filling out paperwork online—we are confident that people with established relationships with their health department may use it as an entry point for finding out about health insurance, and health departments will need to know how to help them enter the system.
In addition to the insurance expansion provisions of the law, there are also important provisions to strengthen the coverage provided through insurance, particularly in the area of clinical preventive services. For health departments that provide direct services, there are opportunities to become in-network providers under the ACA.
NPH: Do you think many health departments will work together with non-profit hospitals, which now have a mandate from the Internal Revenue Service (IRS) to provide some form of community benefit in order to maintain their tax-exempt, not-for-profit status under the ACA?
Up to 80 percent of family physicians are expected to use electronic health records (EHRs) by the end of this year, and experts across the country are talking about ways to leverage this influx of data to inform better health. A pre-conference workshop at the National Association of County and City Health Officials (NACCHO) Annual Meeting focused on Beacon Communities, which are part of a pilot to demonstrate how meaningful use of EHRs can lead to better health and better health care at a lower cost. The HHS Office of the National Coordinator for Health IT is providing $250 million over three years to 17 selected communities throughout the United States where numerous institutions are sharing data to inform quality improvement and other data-informed efforts.
The NACCHO meeting highlighted Beacon communities that are partnering with public health in different ways to forge data-informed population health activities.
Health departments in North Carolina have been required to do community assessments since 2002 as part of a statewide health department accreditation program and are very experienced with working with this data, whereas hospitals are just now beginning to be required to do similar assessments under the affordable care act, according to John Graham, PhD, PMP, Senior Investigator for the NC Institute for Public Health at the Gillings School for Global Public Health, which plays an integral role in the Southern Piedmont Beacon Community.
“Health assessment planning and communication are tools that can be leveraged to foster more collaboration,” said Graham. “We really try to coordinate public health prevention and health care. We can do a lot with clinical interventions, looking at it from a population health perspective.”
Public health superstars as well as local health departments took home trophies from Dallas last week after receiving awards at the annual conference of the National Association of County and City Health Officials (NACCHO).
The most cheered awardee was Mary Selecky, the former health secretary of Washington State who retired earlier this year after 34 years in leadership positions at the state and local health departments. Selecky accepted her award brandishing a condom and a small bottle of hand sanitizer—symbols of her tenure. And when Carol Moehrle, district director of Public Health-Idaho North Central District in Lewiston and a former NACCHO president, who helped present the award, asked conference attendees who had been mentored by Selecky to step toward the front of the room, the space in front of the podium filled quickly. Selecky received the Mo Mullet Lifetime of Service award, named for a former executive director of NACCHO who also attended this year’s conference.
Read a recent NewPublicHealth interview with Mary Selecky, reflecting on her years of service in public health.
Local Health Departments of the Year
This year NACCHO also awarded first time prizes to local health departments, with awards given to applicants who showed creativity; innovation; sufficient evidence of outcomes and impact on the community; and collaboration with partners, community members and key stakeholders.
Small Local Health Department Winner: Crook County Public Health Department in Crook County, Oregon with a population of 10,000
Among its many innovations, the department worked with community partners to sponsor a school-based health center run by the local Federally Qualified Health Center and is very engaged in the implementation of the Affordable Care Act.
Medium Local Health Department Winner: Gaston County Health Department, Gaston County, North Carolina
The health department serves a little more than 200,000 residents and is working on ways to use data and data analysis to help improve health and reduce disparities. It also recently merged services with the Gaston County Department of Social Services. Prior to the merger, the health department analyzed the data needs of that agency and explored how it could use mapping to help jointly deliver services more efficiently and effectively. The health department is also training data-focused personnel and creating an informatics division, so the departments can further target outreach and intervention initiatives, and was an early adopter of electronic health records.
While immunizations are a ubiquitous symbol of public health, in the last decade or so many public health departments have shied away from using the icon on their home pages or even adding it to a top ten list of what they do in the hopes of making both citizens and policymakers realize that public health extends far beyond infectious disease. Yet as public health departments integrate their work with the private sector, who will do the vaccinating, how immunization records will be kept and who gets paid for the work are pivotal issues that local health officials are grappling with.
A well-attended session at the NACCHO Annual conference yesterday provided a few more questions than answers, but armed attendees with new information as implementation of the Affordable Care Act (ACA) begins and both public health and private providers see their roles change and merge. Significantly, the ACA is expected to enroll millions of children, and under new rules the Vaccines for Children program will no longer cover the cost for vaccines for children who can receive immunizations under their own insurance. That will reduce funding for some health departments.
Other changes ahead for vaccination coordination include the role of accountable care organizations (ACOs) in coordinating care under the ACA, electronic registries and billing for public health services, said Paul Etkind, MPH, DrPH, head of infectious diseases at NACCHO.
“Much of this has yet to play out, so there are many unknowns,” said Etkind, who added that vaccines are a good example of the need for up front conversations with providers about what public health has to offer and a good way for health departments to become part of ACOs. “Going forward there will be a greater emphasis on coordinating care between the public and private sectors, than in delivering the care in many cases and public health needs to be active players in this process.”
With just 83 days to go until health insurance marketplaces open up to allow otherwise uninsured Americans to sign up for health coverage under the Affordable Care Act (ACA), NACCHO Annual has a good number of plenary and other sessions focused on the role of public health in implementing the law.
>>Read more NewPublicHealth coverage of NACCHO Annual.
In his address to the 1,000 plus attendees at this year’s NACCHO conference, Centers for Disease Control and Prevention Director Tom Frieden, MD, MPH, talked about what local health departments can do to support ACA. “This is an all hands on deck situation,” said Frieden. “We want to do a lot with improving quality of care, but first we’ve got to get people signed up.”
Frieden ticked off actions that local health departments can take to help support enrollment, including:
- Provide resources to the community on getting insured & the benefits of being insured, including free preventive care.
- Educate every resident served by the department, such as immunization, tuberculosis and STD clinic patients, on how they can enroll.
- Educate every organization that the health departments connects with, such as schools, courts and businesses, on how stakeholders can enroll.
NewPublicHealth is on the ground this week in Dallas at NACCHO Annual, the yearly meeting of the National Association of County and City Health Officials (NACCHO). The meeting theme this year is “Public Health by the Numbers” as city and county health departments face increased pressure for limited resources; an increased focus on both new and traditional public health roles; and government accountability and effectiveness.
NewPublicHealth spoke with Robert Pestronk, NACCHO’s executive director, in advance of the conference.
>> Be sure to follow our NACCHO conference coverage all week long, including stories from key sessions and interviews with speakers and thought leaders.
NewPublicHealth: What are the key issues at this year’s NACCHO conference?
Robert Pestronk: We’re focused on a conference theme of public health by the numbers because the availability and use of data is integral to the performance and operations of local health departments. The use of data and metrics is important for quality improvement in health departments, and for the development and communication of messages about health status and disease status within local communities.
A couple of other things that are new for this year’s annual meeting is that we’re recognizing the role that large cities and metropolitan areas play in modeling and demonstrating public health policy and governmental public health practice work. We have a couple of sessions with presenters from big cities to talk about the work they’re doing. And because the Affordable Care Act is influencing the work and funding and future for local health departments, there are sessions to help local health departments consider the effects from the law. We’ve also got a plenary session on reducing health disparities, which is a line of work that is very important to NACCHO. In fact, NACCHO’s work in this area has stimulated work in other parts of the governmental public health structure at the state and federal level.
NPH: What is the role that local health departments will play when it comes to implementing the Affordable Care Act?
Pestronk: I think that the specific role that local health departments play, like in most situations, will depend upon the kinds of assets that are available in a local community and the extent to which their state is implementing provisions of the law. Local health departments can be helpful informing people about the start of enrollment and helping people understand where they can go to enroll. Part of what NACCHO has been doing over the past year is to share with local health departments the kinds of opportunities that are available for implementing and educating about the health law.
A new report funded by the Robert Wood Johnson Foundation (RWJF) and produced by the University of Michigan Center of Excellence in Public Health Workforce Studies offers—for the first time ever—a comprehensive assessment of the state of nursing and nurses in state and local health departments. Enumeration and Characterization of the Public Health Nurse Workforce: Findings of the 2012 Public Health Nurse Workforce Surveys looked at—among other things—size, composition, educational background experience, retirement intention, job function and job satisfaction of nurses.
RWJF recently spoke with Paul Kuehnert, MS, RN, CPNP, team director of Public Health at RWJF, and an alumnus of the RWJF Executive Nurse Fellows program, to discuss the report.
Among the report’s findings is that while public health nurses report high levels of job satisfaction, they’re also concerned with issues such as job stability, compensation and the lack of opportunities for advancement. It also found that about 40 percent of public health departments have “a great deal of difficulty” hiring nurses.
“It should be a high priority to address gaps and take steps to strengthen the public health nursing workforce,” said Pamela G. Russo, MD, MPH, RWJF senior program officer. “Public health nurses are likely to need training to keep pace with the changes as health care reform is implemented and public health agencies focus more on population health. The size, makeup, and preparation of the public health nursing workforce greatly affect the ability of agencies to protect and improve the health of people in their jurisdictions.”
As scholars together at the Columbia Mailman School of Public Health in New York City, public health researchers Kimberley Roussin Isett, PhD, and Miriam Laugesen, PhD, watched major policy changes unfold across the city over the past several years. They decided to look at New York City as a model for improving public health that other cities could replicate. “Things were happening in New York City rapidly, and in a health-focused way that really not seen before,” says Isett. Since then, other cities across the country have enacted similar, comprehensive smoke-free policies. Voluntary calorie postings on restaurant menus were also integrated as a requirement in the Affordable Care Act. The researchers decided to look at New York City as a model for improving public health that other cities could replicate. NewPublicHealth recently spoke with Drs. Isett and Laugesen about their research. Dr. Isett recently took a new position as an Associate Professor in the School of Public Policy at the Georgia Institute of Technology in Atlanta, and Dr. Laugesen is an Assistant Professor of Health Policy and Management at Mailman and a former Robert Wood Johnson Foundation Health & Society Scholar.
NewPublicHealth: Because of its large budget and powerful public leaders, New York City isn’t always seen as a model for other, particularly smaller, health departments. But your work shows some of their efforts to be important, maybe critical for other departments to study and replicate. How did you come to that conclusion?
Miriam Laugesen: In our research, one theme that kept coming across again and again was the scientific basis—the amount of research and data—that the Bloomberg administration and staff had collected to justify and design their policies. That was a very big component, we thought, of many of their policies and that New York City had many innovative, interesting examples of how policymakers can base their policies on evidence.
The Three Rivers district health department in Owenton, Kentucky was one of three health departments in that state and eleven in the country to receive national public health accreditation from the Public Health Accreditation Board. NewPublicHealth has been speaking with directors from accredited health departments about the value of the credential; how it can change their operations and outcomes; and what they’d like to share with departments considering applying for the credential. We recently spoke with Georgia Heise, DrPH, Three Rivers’ health director and a vice president of the National Association of County and City Health Officials, about the benefits she sees from both the application process and the new status accreditation confers.
NewPublicHealth: What has the reaction been from community members and policymakers to the news that you’re now accredited?
Georgia Heise: It has been wonderful. Our health department has talked about accreditation from the day we started working on it, so people have been waiting to see what the decision was going to be. We’ve gotten flowers, cards, letters, and emails and there have been celebrations hosted by us and by others. And we did get some attention from policymakers, which was wonderful.
We have, for the past three years now, introduced into the Kentucky legislative process a bill that would require health departments in Kentucky to be accredited by 2020. We haven’t got that bill approved yet, but we continue to work on it and we think we will eventually. But that effort means that the legislators are familiar with the concept of accreditation. While maybe they haven’t paid that much attention to it before, they’re paying more attention now because Kentucky had three health departments receive accreditation in the first round and that’s gotten some attention statewide.
NPH: In terms of the process, what has been harder than you thought and what was easier
NewPublicHealth is speaking with directors of several health departments who recently were accredited by the Public Health Accreditation Board. Eleven health departments received the credential so far. We recently spoke with Mary Selecky, director of the Washington State health department, one of the first two state health agencies receive national accreditation status. Ms. Selecky recently announced her plans to retire from the health department.
>>Also read our interview with Terry Cline, health commissioner of Oklahoma, which also was recently accredited by PHAB.
NPH: How do you think accreditation will improve delivery of public health services and care in Washington State? Now that the health department is accredited, do you feel as though you are leaving the department in even better shape than it was?
Mary Selecky: Accreditation is really a quality improvement tool, and the standards that have been set by the Public Health Accreditation Board force you to examine whether you have the right processes in place for continuous, sustained quality improvement. And if you have found that you are not quite up to par in an area, then the processes help you ask what you will do to improve your performance in that area? The process helps you increase your performance, your effectiveness, and your accountability.
Public health touches people every single day—everybody in the state, from the moment they get up until they go to bed at night and even while they’re sleeping. This credential shows us that we have effective programs and measures in place to meet the needs of our communities. Drinking water systems are a good example. We regulate 16,000 drinking water systems, and I have a lot of drinking water engineers who are out in communities checking on water systems. I have to know that they’ve got a common set of operating procedures to assure the public that we’re looking out for their interests and when they turn on their tap from a municipal water system, that the water’s safe to drink. You can only do that when you have some procedures in place and that goes for the engineers, for laboratories or programs to make sure they are operating well in the community. Accreditation touches every part of the department.
NPH: How will you be promoting and explaining accreditation to policymakers?