ASTHO Annual Meeting: A NewPublicHealth Q&A with José Montero

Sep 18, 2013, 11:45 AM

José Montero, MD, outgoing president of ASTHO José Montero, MD

For the last several years there’s been a bit of a tradition at the annual meeting of the Association of State and Territorial Health Officials (ASTHO), with the incoming president introducing a year-long “President's Challenge” to focus the attention of state health officers on a critical national public health issue.

José Montero, MD, outgoing president of ASTHO and director of the New Hampshire Department of Health and Human Services, chose the reintegration of public health and health care. The starting point for the challenge was a report by the Institute of Medicine, Primary Care and Public Health: Exploring Integration to Improve Population Health. In his announcement, Montero emphasized the need to take a systems approach to health care transformation in order to achieve lasting improvements in population health.

Throughout the past year, both state health departments and other public health organizations have added their integration projects to a project list maintained by ASTHO. This includes the State of New Hampshire Department of Public Health, which has collaborated with a community health center network and others to use electronic health records to link providers and tobacco quitline services, with the goal of cutting smoking rates.

>>Follow our ASTHO Annual Meeting coverage throughout the week.

Just ahead of the 2013 ASTHO annual meeting, NewPublicHealth spoke with Montero about the importance of the challenge he put forward for his fellow state health officers and next steps.

NewPublicHealth: What participation have you seen by the state health departments in your President's Challenge on reintegration of public health and health care?

José Montero: The specific metric that I used was to have states and the District of Columbia send stories that illustrate levels of partnership and integration. During the past year, the visibility of the topic has grown dramatically. In addition, ASTHO has an ongoing partnership that has brought together more than 50 different organizations for the same purpose. We meet regularly, working together on how to advance the agenda of better coordination and integration, and every day we identify new people who want to participate, and I think that has been an amazing result. I don’t want to claim that all of this is because of the ASTHO initiative. There were a lot of things that were out there already. But this was a timely call, and all of those who were working on it are joining efforts to make it happen.

A few of the partners have included the U.S. Centers for Disease Control and Prevention (CDC), the Health Resource Services Administration, Trust for America’s Health, the Mayo Clinic and the National Academy of State Health Policy. Another key partner has been Duke University. The de Beaumont Foundation is sponsoring Duke to write a playbook for the integration of public health and primary care, a project which is also supported by the CDC. We jointly developed a tool that allows us to collect information from the field and the Duke group, based on the stories that the states are submitting. They are testing the tool right now.  

NPH: Are public health departments taking ownership of the integration of public health and health care?

Montero: I don’t think any health department needed this challenge to realize how important this is, but the fact that jointly we are highlighting examples of success is raising the level of awareness and actually helping us all learn from each other. The main intent of the challenge was not just to start raising awareness, but to identify what works and—if we could—even identify what works in one particular area and how we can make it work in a different area. And I think that the success of the challenge has been that.

The other thing that we have come to realize is that in some cases it’s not about integration but about better partnerships. There are places where we cannot integrate. The roles of government sometimes are so specialized that you cannot outsource those to any private sector or partner, but at the same time we can work it out together and figure out how to get a more successful partnership. And there are things that the private sector or the academic sector does way better than we do, so we shouldn’t try to do it instead. Integration is not the goal—it is a tool to get us to improve the health of the population.

NPH: What happens next?

Montero: ASTHO is fully committed to continue working on this. We have a whole organizational component that is going to continue to serve as the convener for all of the different work groups that we have to implement the road map that was developed for this integration process. So beyond my presidency, this becomes an initiative in its own right and ASTHO will continue to play that convener role.

Integration or partnerships do not happen because we say so. They happen because we work toward them and keep working to make it work until it becomes organic. That requires time and commitment from the top, the middle and the bottom of any of our organizations. It’s a clear leadership challenge, and that’s what we need to continue to invest on.

There are great opportunities that we need to be able to, as a system, make work. The Affordable Care Act offers really incredible opportunities and the Center for Medicaid and Medicare Innovation has put out some grants with really tight deadlines that force us to really think about these issues. Hopefully, we will be able to develop real accountable care organizations and move them even further to have accountable care communities. Public health is really good at engaging communities, it’s really good at creating rules and regulations and it’s really good at using the bully pulpit to modify things. And so these types of grants will help us to advance that agenda.

In public health and health care, we are trying to learn to speak each other’s language. I really have a lot of faith in the concepts of accountable care organizations and accountable care communities as the places where these better partnerships and the integration of these concepts are going to really be happening. That is where the population health is going to change.

>>Bonus Link: Do you have a public health/health care integration success story to share? Submit it here. The list is continually updated by ASTHO.

This commentary originally appeared on the RWJF New Public Health blog.