Integrating Health and Health Care: Richard Umbdenstock Q&A


In connection with the 2012 American Public Health Association Annual Meeting, we convened a group of thought leaders from across sectors for conversations on the future of health and health care. Richard Umbdenstock, president and chief executive officer of the American Hospital Association, discussed the trend toward greater integration between public health and health care.

What is an example you’d like to share of an intersection between public health and health care?

There’s a strong example in Louisiana around hospitals and the state working together on preventing unnecessary early deliveries. They call it a 39-week Initiative, reflecting the goal to have all pregnancies to go full-term for the sake of the baby’s full development and fewer complications down the road. Of course, hospitals have a major role to play, but health departments are working with pregnant women all the time, especially those who don’t have ready access to primary care physicians and who are without insurance or have other access problems. That effort is really showing incredible downstream impact by reducing the utilization of neonatal intensive care units, and we’ll have other data after the collaboration is in place longer term. For example, longer term data is likely to show that children who don’t have to go to NICUs generally avoid other complications down the line as they grow and mature. So that is a really exciting thing. We have endorsed a 39-week policy and practice in hospitals, and the more we can work with public health departments as they work with pregnant women, the more successful the whole effort will be. I think it’s a good example of where how hospitals and health departments working with the same patient population can collaborate and extend the reach of this type of effort.

What do you think the key ingredients are in making these relationships work?

When hospitals and public health departments collaborate on community health needs assessments, I think it creates an overall set of community priorities and helps all parties better understand community needs. It also helps to focus their own strengths where they can to contribute to addressing those needs and to avoid duplication over all. We have many examples of hospitals being part of community-based health needs assessment efforts with health departments, United Way organizations and others, so you get one clear and agreed-upon picture of a community.

That’ the longest term view. Coming in a little closer, clearly hospitals and public health departments can focus and coordinate around wellness and prevention, trying to avoid the need for significant utilization of the more expensive medical and health delivery systems. And so you see a lot of hospitals and health departments working on child health collaboratively, hospitals supporting public schools in their school nurse programs, nutrition programs, and so on. So lots of things can be done in the health and wellness space. There is also a growing focus on early detection and proper referral to the best locations of care—that’s a space where hospitals and public health and other community-based entities can collaborate. It isn’t just about medical care; it’s also about social-support systems. The broader term in this regard is not just disease management, but case management. How do you work with a patient, regardless of what the disease or illness is, in a way that helps them access the system, live in the community, be able to keep appointments, get transportation, and get help in the home? These different aspects help us look at the collaborations from way out in front on a planning basis, down to how we can collaborate when we are actually all dealing with the same patient. That’s the wide spectrum.

What leadership qualities best help the collaborations between public health and health care?

Leaders in all areas -- hospitals, public health and elsewhere -- have to rise above a focus on their organization only, to focus on the community. It helps to lessen competition and increase collaboration. It helps to better coordinate and target total community resources, not just any agency or entity’s budget, and it helps to decrease duplication. And you have to be willing to share information. A lot of people work very hard to do their own analysis and work up their own projects. Health needs assessments are a good example. Maybe in too many cases we see multiple health needs assessments being done in the same community. You have to be willing to share information. You know the old saying about information is power. You have to be able to rise above that.