Over the past year, NASHP, with support from The Commonwealth Fund, convened four cross-agency state teams for a one-year learning collaborative with the goal of improving cross-sector alignment, coordination, and collaboration between public health and the health system.
Four state teams, representing Arkansas, Indiana, Michigan, and Rhode Island, each developed action plans to engage key cross-agency and external partners in advancing policy goals. State teams received technical assistance from NASHP and invited subject matter experts during monthly virtual team meetings. Building on lessons learned from the COVID-19 pandemic, teams worked to scale and sustain effective partnership strategies and engage impacted communities in policy development and implementation.
Different States, Shared Challenges and Goals
While the four participating states were geographically, politically, and socioeconomically distinct, team members identified similar challenges to successful implementation of public health modernization efforts. These included workforce shortages and changes in leadership, uncertain funding, communications silos, lack of federal guidance, political challenges, and declining trust in public health. These issues can present challenges to developing and sustaining successful partnerships that work to create change in systems that have traditionally functioned independently.
Within these unique state contexts, teams worked to advance their own specific policy objectives. Despite differences in policy priorities and work plans across state teams, the state teams shared several common goals for their projects. These included:
Developing a “proactive,” not “reactive,” vision of public health that centers partnership and collaboration
Improving data exchange and communication: getting the right info to the right people at the right time.
Building trust with policymakers, partners, and the public
Articulating the value proposition for partnering with public health
Developing effective communication strategies and mechanisms
Team Goals and Accomplishments
Each of the four teams was charged with identifying a goal and developing a work plan that was refined over the year-long learning collaborative. Highlights from these plans included:
Arkansas
Leverage data exchange to make better public health decisions
Indiana
Identify and address barriers to conducting and reporting developmental screening
Michigan
Improve public health preparedness and capacity by building trust and effective partnerships
Rhode Island
Identify long-term, sustainable funding strategies to scale and sustain Health Equity Zones
Arkansas: Leverage data exchange to make better public health decisions
- The Arkansas team included representatives from the Department of Health, Department of Human Services, and Arkansas Hospital Association. The team set a goal of expanding the Department of Health’s Data Hub to include additional disease conditions and enhance disease reporting processes. Over the course of the learning collaborative, the team was able to expand the Data Hub to include data for HIV/AIDS, Mpox, and substance misuse and was able to create a fillable online communicable disease reporting form to streamline the reporting process and reduce provider and agency burden. State leaders worked closely with the Arkansas Hospital Association to map the organizations that report laboratory data. This can help them gain a better understanding of where laboratory submissions originate and identify steps to streamline the reporting process while reducing provider and agency burden. Moving forward, the team is looking to use machine learning to further streamline and standardize the disease reporting process, as well as roll out additional training resources for the state public health workforce.
Indiana: Identify and address barriers to conducting and reporting developmental screening
- The Indiana team consisted of pediatric specialists and representatives from the State Department of Health, Family and Social Services Administration, and Indiana Perinatal Quality Improvement Collaborative. The group sought to address the low level of developmental screenings reported by providers, including understanding the root cause of the low rates. Over the course of the learning collaborative, the team was able to survey 265 early childhood programs and medical providers to understand the challenges to conducting developmental screening — finding great success with sharing the survey via a QR code at relevant gatherings and conferences. The survey revealed a lack of training and familiarity with screening tools as the greatest screening barriers. The team was also able to engage the state’s immunization program to take steps toward including developmental screening test results in CHIRP (Children and Hoosiers Immunization Registry Program), the state’s immunization information system. Collecting survey data and identifying the underlying cause of low developmental screening reporting has set the stage for Indiana in identifying concrete strategies to make progress moving forward. The Indiana team plans to identify further training opportunities to support providers and continue collaborating across public health, Medicaid, and other partners.
Michigan: Improve public health preparedness and capacity by building trust and effective partnerships
- The Michigan team included several officials from the Michigan Department of Health and Human Services, as well as the University of Michigan School of Public Health. The Michigan Public Health Advisory Council (PHAC) is a cross-sector committee established in 2017 by Executive Order 2017-10 and was leveraged over the course of the learning collaborative to support implementation of the seven recommendations published in its “Public Health Call to Action: Recommendations from the Michigan Public Health Advisory Council, 2023.” These recommendations were designed to “strengthen public health infrastructure and trust in public health messaging and measures” using lessons learned from the COVID-19 pandemic. The state is currently working to realize these public health goals through several actions, including by improving connections between public health and the health care system through regular engagements and increasing public knowledge of what public health does. These actions included convening a Vaccine Champions meeting that brought together health systems, local health departments, physicians, pharmacists, vaccine manufacturers, and academic institutions to create a path forward for increasing vaccination rates across Michigan. Additionally, the state plans to organize a public health campaign to improve legislators’ and the public’s knowledge of what public health does. The campaign will engage trusted messengers from diverse communities and feature regular news updates to raise awareness of public health issues and respond to questions from the public.
Rhode Island: Identify long-term sustainable funding strategies to scale and sustain Health Equity Zones
- Rhode Island brought together a cross-agency team from the Executive Office of Health and Human Services and the Department of Health. Rhode Island’s “Health Equity Zone (HEZ) Initiative” began in 2016 with the identification of “economically disadvantaged communities in geographically defined areas with documented health risks” and the goal of using place-based strategies to improve the health of these communities and eliminate health disparities. The Rhode Island team worked across agencies and built on input from community partners convened through a HEZ Scaling and Sustainability workgroup to consider a host of strategies to support HEZs moving forward. Over the course of the learning collaborative, the Rhode Island team was able to identify long-term sustainable financing strategies through Medicaid and other authorities and work toward expanding the HEZ project statewide. The state is planning to continue building out leading indicators to demonstrate the impact of the HEZ initiative and building partnerships both internally and externally to scale and sustain HEZs.
Lessons Learned and Next Steps
Each of the four state teams mentioned the same ongoing desire to bolster communication and connection with key internal and external partners as they worked toward policy goals. Through the learning collaborative, states were able to connect with key experts and learn from other states on shared challenges and best practices. As state leaders continue to invest public health infrastructure grants and work toward a public health system that is robust, interconnected, and capable of promoting the health of all communities, partnerships between public health and the health care system will continue to play an important role.
