Jose Montero Announces ASTHO President Challenge: Integration of Public Health and Health Care
Jose T. Montero, MD, director of the Division of Public Health Services at the New Hampshire Department of Health and Human Services, was elected president of the Association of State and Territorial Health Officials (ASTHO) during the association’s recent annual meeting in Austin, Texas.
Dr. Montero began his medical career in Putumayo, Colombia, where he served as a local, county and state health official. He then went to teach family and preventive medicine and later became Colombia’s public health director. Dr. Montero began his service in New Hampshire in 1999 as chief of the New Hampshire Communicable Disease Section in the Division of Public Health. Before becoming director of the New Hampshire Division of Public Health Services, Dr. Montero was the state epidemiologist. He is an adjunct professor of family medicine and a member of the preventive medicine residency advisory committee at Dartmouth Geisel School of Medicine.
NewPublicHealth spoke with Dr. Montero about the new ASTHO President's Challenge, which will focus this year on the integration of public health and health care.
NewPublicHealth: Why is so critical now to work toward the improved integration of public health and health care?
Dr. Montero: We keep talking about the health system but there is not much that is health-focused—it’s currently mostly about providing care after people becomes ill. From a public health perspective we’re trying to improve outcomes and quality, without spending the amount of money on health that we’re currently spending because we can’t sustain that. The system needs to continue changing and evolving, but we don’t yet know what exactly how it will look or how it should look. We need to create a new system. Based on the experiences of some states, such as Massachusetts and Oregon, we know gaining access to health insurance has expanded use, but we don’t know if they’ve achieved improved health outcomes yet. We’re working toward that. But we need to work on the right indicators that allow us to consistently measure total population health.
When you look across the country, you see that public health entities provide the continuum of care throughout the life cycle. We are already integrating health care and the public health system at several different places and levels, but it’s not consistent. To prepare ourselves for the future, we need to be able to look at public health and health delivery systems and integrate them philosophically. We need to capture examples, decode them, and see what works and what doesn’t and how to use which in different parts of the country. We have different cultures, different investment levels, and different expectations. We can’t just copy and paste.
NPH: What are the critical issues you’re looking at?
Dr. Montero: The integration is not just going to be making sure we get people into the system for the delivery of a clinical preventive intervention or test; it’s also what happens before and after the test. Did we have the conditions to help keep that person healthy, to allow the healthy choice to be the default choice? Does the person have access to the right counseling or diagnostics and follow up after the initial assessment? Do we have enough access to treatment? And reintegration after that? At a sustainable cost? The systems of care are changing. We are looking into medical homes, accountable care organizations, bundled payments and more. All of these new models put a premium on outcomes and quality rather than fee-for-service. The public health system is in a great position to help drive those changes. We look at the health of the whole population, we have access to data for the whole population, and we have expertise on serving complex populations with complex needs. This wealth of knowledge and experience makes the public health system a key partner for the success of the changes that we all in health care strive for.
NPH: Decades ago, public health and health care were more integrated. How are the goals different now?
Dr. Montero: Yes it was, but it was a simpler time as well. It’s very different now. We have a different society, different diseases, and, at least in this country, the social conditions that determine health have evolved favorably. We’re looking at the integration of the future, not bringing back a romanticized version of the past. At ASTHO and across the country in several of our states, we’ve actually been working on this for quite some time. There are great examples of integration already happening. As with previous challenges, I don’t expect to accomplish everything in the year of my presidency. It has to continue after that, because the goals of better care, better quality and lower cost require it.
The point of the challenge is to build a systematic approach—give it visibility and make public health accountable and responsible for making the integration happen. We’re mapping out how to measure outcomes of the integration and the challenge itself. We’re at the point where we can highlight what we’ve done and where we are going. And using the examples of integration to help us understand why they work, not just that they do work.
If we can get people healthier we will need less and less expensive interventions. Through and with public health systems we continue to build on what we’ve done and we keep moving it forward. We need to develop integrated health systems that are high quality and improve health outcomes at a cost we can afford.