Breaking Down Siloes to Improve Population Health in Maryland

Along with increasing access to health coverage, the Affordable Care Act (ACA) presents many opportunities to reform the health care delivery system and invest in public health and prevention. Traditionally, there have been two predominantly siloed systems for supporting and improving health—the health care delivery and the public health systems—making it challenging to forge partnerships across the state agencies that direct them. In addition, leaders in the field are often separated by differences in the language and terminology they use and their ways of thinking about population health. Despite these complexities, states are working hard to create new partnerships spanning state and local government agencies, communities and private sector stakeholders in order to achieve population health goals. Maryland is leading the charge and has several initiatives underway to foster new or revitalize existing partnerships while encouraging investment in population health activities.
Maryland received a State Innovation Model (SIM) “model design” award from the Centers for Medicare and Medicaid Innovation (CMMI). As part of this initiative, the state is engaging in a planning process to develop the Community-Integrated Medical Home (CIMH) model. This model of care aims to integrate patient-centered medical care with community-based resources while enhancing the capacity of local health entities to monitor and improve both individual and community health. Public Health Services within Maryland’s Department of Health and Mental Hygiene (DHMH) took the lead on SIM efforts, supported by the governor’s office. In Maryland, the Medicaid agency sits with public health in the DHMH. This arrangement has facilitated collaboration between public health and Medicaid on the SIM initiative and successfully kept population health goals as the centerpiece of their planning.
Around Maryland, hospitals, local health departments and other community partners convene asLocal Health Improvement Coalitions (LHICs) to prioritize the needs of the community in advancing state and local health improvement goals. The state promotes these partnerships and provides technical assistance support around communication, collaboration and sharing promising practices through its State Health Improvement Process toolkit. As this work progresses, providers and agencies from the various stakeholder groups involved in LHICs are expected to further understand each other’s language, the unique perspective each brings to the table, and how they can best work together towards the shared goal of improving the health of their community.
Additionally, the Centers for Medicare & Medicaid Services (CMS) approved a waiver to modernize Maryland’s unique all-payer rate-setting system for hospital services. Maryland and CMS expect that this model will be successful in improving the quality of care while reducing costs for Maryland residents, including Medicare, Medicaid, and CHIP beneficiaries. Both the delivery and public health systems are integral to the success of this model. Hospitals are transforming the way they operate to provide more comprehensive care for people and communities, instead of just focusing on treating illness. For example, hospitals are linking with LHICs because of their unique connections to the community. These stakeholders in Maryland are catalyzing the connection between public health and health care to ultimately advance population health goals.
While this work has been challenging, Maryland has demonstrated the important role states can play in facilitating partnerships among diverse groups of stakeholders to advance shared population health goals. Action at the state-level can help eliminate siloes and help delivery system and public health leaders understand the unique perspective each brings to the table.
How are delivery system and public health leaders breaking down siloes to forge strong partnerships in your state? Let us know in a comment below.
We would like to acknowledge Dr. Laura Herrera, Deputy Secretary, Public Health Services at the Maryland Department of Health & Mental Hygiene for her valuable contributions and insight.