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​9. Public Health Services

Chapter 9 covers the importance of coordination among the broad spectrum of health care and public health services to ensure that patients’ needs are met.

UCare Values Coordination with Public Health
Research suggests that one of the most powerful ways that health care professionals and public health can interact is by coordinating the broad spectrum of services they provide for individuals and their families. There are over 100 cases described in the book, Medicine and Public Health: The Power of Collaboration (Lasker, 1997), that illustrate how collaboration enhances the success of medical care and addresses the additional determinants of health that go beyond medical care. This is achieved by combining clinical services (encompassing diagnosis, prevention, treatment, and rehabilitation) with one or more of the following:

  • Wraparound services that overcome logistical, linguistic, cultural and social barriers to care.
  • Counseling and educational services directed at personal risk behaviors, the management of particular health problems, and the use of health services.
  • Outreach services, such as home visits, that assure the delivery of needed care and that promote adherence to complex treatment programs.
  • Case management services that identify health-related needs of individuals, link individuals with health professionals and programs in the community, and coordinate care.
  • Social services that address socioeconomic determinants of health.

Emphasis on primary care has encouraged each of the health sectors to strive for more integrated, comprehensive, and longitudinal care for selected populations. These populations may include lower income, limited English proficient or other groups with identified risks or special service needs (e.g., pregnant or newly delivered women). Linkages between clinical and public health services, are useful not only in enhancing medical care but also in addressing additional determinants of health such as social conditions. Public health, together with social services and community-based organizations, are key partners in helping health care providers ensure that patients’ broader needs (such as food, housing, supplemental income, parenting skills, protection from domestic violence, etc.) are met.

This collaboration can contribute to achieving improved health and social outcomes. Support services can also enhance patient satisfaction with care by making the health system more responsive to individual/family needs and by reducing the dangers and inconvenience of fragmentation. A number of case studies in the report noted above (Lasker) demonstrate that connecting support services to medical care can enhance the productivity of health professionals, reduce the underutilization of needed health services and programs, and reduce duplication of effort. Based on this rationale, UCare encourages primary care providers to make arrangements for UCare members with local public health agencies for an array of health promotion/counseling services that may include:

  • Home Health Visits for: maternal and child health clients (including prenatal and postpartum care), children with special needs, children and adults at risk for abuse/neglect.
  • Child & Teen Checkups, including immunizations.
  • Infectious disease assessment and/or follow-up.
  • Medication management.
  • Nutritional risk assessments, nutritional counseling, education and/or follow-up for all ages.
  • Safety assessments.
  • Senior health classes.
  • Refugee health screening public health follow-up services.
  • Tuberculosis testing, completion of therapy (e.g., Direct Observed Therapy (DOT), and follow up services.

The services listed above are provided by licensed registered nurses (within the scope of practice as defined by Minnesota Statutes and certified in public health nursing by the Minnesota Board of Nursing, or received certification from the Minnesota Department of Health prior to January 1990) and may be delivered at Public Health Nursing Clinics or in the home setting. The public health agency does not need to be Medicare-certified to provide health promotion/counseling services.

Public health home visiting is used to:

  • Improve pregnancy outcomes.
  • Improve parents' ability to care for their children.
  • Decrease injuries.
  • Decrease emergency room visits.
  • Improve health care utilization.
  • Decrease hospitalizations.
  • Improve child health and development.

It may be provided to individuals in need (targeted services) or provided to an entire population (universal).

Authorizations for Public Health Services

1. Contact your local county public health agency to refer for public health services. Current contact information is available on the Minnesota Department of Health web site at: http://www.health.state.mn.us/divs/opi/gov/find
 
2. Health promotion/counseling public health services as identified on the previous pages do not need prior authorization, nor is there a limit to number of PHN home visits allowed for identified needs.

3. For other home care services such as skilled nursing visits, physical, speech or occupational therapy, home health aides and home IV therapy, please refer to the authorization requirements grid on the Eligibility & Authorizations page of the UCare provider website. Contact information for the appropriate authorizing entity is listed at the end of the chapter. The agency needs to be Medicare-certified to provide therapeutic home care services.

4. Public health agencies need to communicate with primary care clinics regarding services they have provided to their patients so that this information can be incorporated into the patient’s medical home chart. This is often done by way of fax forms listing services rendered but may also be transmitted electronically.

5. Home care from Personal Care Assistants (PCA) still requires prior authorization.

Population Health Improvement Collaboratives
UCare strives to understand local public health priorities and foster constructive relationships with providers, public health professionals, and community partners. We do this to improve the delivery of health care services and address the many determinants impacting the health of our members and their communities.

UCare actively participates in over 60 private/public health collaboratives at the state, regional, and local level that address population health improvement goals. The many collaborative projects include such initiatives as improvement in preventive health visits and screening, infant mortality reduction, improved perinatal health services, obesity prevention, tobacco prevention and control, prevention and management of chronic diseases, addressing health disparities, and creating health equity. Minnesota ranks among the healthiest states, yet has some of the greatest health inequities between white and non-white populations in the nation. The February 2014 Minnesota Department of Health (MDH) Report to the Minnesota Legislature, “Advancing Health Equity in Minnesota,” notes that after 15 years of tracking health data in Minnesota for populations of color and American Indians, youth, immigrants, refugees, and LGBTQ, serious health inequities persist. Additional health disparity and health equity reports are also listed below.

If your clinic would like to be involved in any community-based health initiatives in your service area, contact UCare’s Public Health Manager at 612-676-3635. Below are links to resources related to the Statewide Health Assessment report, the Healthy Minnesota framework and Partnership and Advancing Health Equity.

 

References

Medicine and Public Health: The Power of Collaboration by Roz D. Lasker, MD, and the Committee on Medicine and Public Health, New York Academy of Medicine, New York, 1997.

A Review of the Research on Home Visiting: A Strategy for Preventing Child Maltreatment by the Health Care Coalition on Violence, Minneapolis, 1998.

Healthy Minnesota Partnership – A broad statewide coalition of community leaders from business, government, academia, nonprofits, advocacy groups, providers, insurers and others: http://www.health.state.mn.us/healthymnpartnership/
Healthy Minnesota 2020 -  A framework for creating a Minnesota where everyone has the opportunity to be healthy: http://www.health.state.mn.us/healthymnpartnership/hm2020/
Statewide Health Assessment – A two-part assessment that provides a comprehensive look at the state of health in Minnesota.: http://www.health.state.mn.us/healthymnpartnership/sha/

Advancing Health Equity in Minnesota (February 2014): http://www.health.state.mn.us/divs/chs/healthequity/ahe_leg_report_020414.pdf 

White Paper on Health and Income (February 2014)- Research and data on income and poverty in Minnesota; documents the relationship between total household income (or proxy measures of income) and indicators of health: http://www.health.state.mn.us/divs/opa/2014incomeandhealth.pdf.
 
Stratifying Health Care Quality Measures Using Socio-demographic Factors - Findings from study about stratifying MDH’s Quality Reporting System measures based on disability, race, ethnicity, language and other socio-demographic factors correlated with health disparities and that impact performance on quality measures: http://www.health.state.mn.us/healthreform/measurement/SQRMSreportMarch2015.pdf

Minnesota Community Measurement Reports:
2014 Health Care Disparities Report for Minnesota Health Care Programs - Provides health care performance rates for patients enrolled in managed care programs and includes Medical Assistance and MinnesotaCare. The report explores performance differences between MHCP members and members enrolled in other managed care programs: http://mncm.org/wp-content/uploads/2015/03/2014-Health-Care-Disparities-Report-Final.pdf

2014 Health Equity of Care Report - Stratification of medical group performance results in Minnesota by race, Hispanic ethnicity, preferred language and country of origin.  Features information on health care outcomes in five areas: (1) Optimal Diabetes Care; (2) Optimal Vascular Care; (3) Optimal Asthma Care for Adults; (4) Optimal Asthma Care for Children; and (5) Colorectal Cancer Screening: http://mncm.org/wp-content/uploads/2015/01/2014-MN-Community-Measurement-Health-Equity-of-Care-Report.pdf