Tearing Down Silos, Collaboration Work to Benefit Public Health

Making the community a partner in healthcare and delivering a range of coordinated services are starting to show results across Garden State

Cathleen Bennett, New Jersey's Commissioner of Health
Efforts to improve New Jersey’s public health through a greater focus on local prevention programs, more effective clinical care, and better coordinated state policies are showing promising results, according to those involved with this effort.

Despite the often limited resources and other challenges that can make the work slow going, many speakers at the New Jersey Population Health Summit 2017 held Wednesday at Rider University said this work to keep communities healthier has already paid off. More poor children have eaten healthy meals at school and at home, no-smoking zones and exercise opportunities have grown, and emergency room use has declined in several urban hubs.

State officials have started working more closely on policies to address lead pollution and its effects, emergency housing and other issues that impact multiple departments, these leaders said. And healthcare providers are finding new alliances with insurance companies, technology providers, and other stakeholders in a quest to provide better care without driving up costs.

Wellness and collaboration

“Shifting the healthcare system’s focus to wellness and collaborating with communities to build healthier environments that promote wellness are cornerstones of the department’s work,” said Department of Health Commissioner Cathleen D. Bennett, who has made population health a focus of her tenure. “We need to work together to send a concrete message that population health is important.”

Bennett hosted the first population health summit last year; both times she has been joined by the leaders of six other state departments: agriculture, children and families, community affairs, environmental protection, human services, and transportation. This year’s event, sponsored by the New Jersey Innovation Institute, also served as an opportunity to honor eight different entities as “Population Health Heroes” for their work to better serve diverse cultures, reduce obesity, encourage more physical activity, and other beneficial goals.

While New Jersey’s population is generally fairly healthy, there remain significant racial disparities for some health outcomes — including infant mortality, which is three times higher among black babies than white ones — and certain urban and rural communities lack access to appropriate, affordable clinical services.

In addition, experts agree that focusing on population health, and prevention in particular, can drastically reduce the need for costly care in the future. This becomes particularly important in a high-cost state like New Jersey, and at times like this, when there is considerable uncertainty about the future of federal funding for healthcare.

Preventing chronic conditions

Princeton Mayor Liz Lempert stressed the potential savings that can result from investing in programs that help prevent chronic conditions as she discussed the ways her community has worked to reduce smoking by expanding tobacco-free zones, raising the purchasing age for cigarettes, and licensing e-cigarette shops.

The municipality also added recreation paths and parks, started a bike-share program, and arranged for healthier food options at the community pool snack bar, Lempert said. And it has partnered with Princeton University on a number of efforts, including a shuttle bus program to improve access to a nearby hospital.

“Often the municipality is not going to be the direct provider of healthcare services, but we can provide information and be a connector,” she added.

Fruits and vegetables

Bridgeton residents, in Cumberland County, benefitted from a summer-feeding pilot program Mayor Albert Kelly first hosted two years ago, with support from the state Department of Agriculture, the New Jersey Health Care Quality Institute’s Mayor’s Wellness Program, and the Robert Wood Johnson Foundation. Scores of youngsters, and poor families, who may have faced food insecurity in the past now have better access to fresh fruits and vegetables all year round, Kelly said.

State agencies are an essential part of this effort on several levels, speakers said. The state Department of Transportation has worked with communities to help them construct bike paths and more walkable streets that better connect to pubic transit, DOT Commissioner Richard Hammer said. The Department of Environmental Protection has partnered with communities to protect open space and reduce pollution in the soil and water.

When the DOH gets word from a local public health official that a child has been found to have high blood-lead levels — which can cause serious, lifelong issues when high enough — it coordinates with the Department of Community Affairs to ensure that child’s home is tested for lead paint or other hazards, officials said. The Department of Human Services, which oversees Medicaid, may also be involved to make sure the child gets follow-up healthcare services.

Charles Richman, the DCA commissioner, said his agency’s work to remediate lead from homes where it is found has been “extremely effective;” it will soon require landlords to post notices that remind tenants to report any violations to the state. “We are continuing to push the boundaries to make it stronger,” he said of the program.

Gov. Chris Christie has been strongly criticized for diverting funding from lead-remediation efforts, but Richman noted there is $10 million for this work in the proposed budget for fiscal year 2018. While several thousand children tested positive for high lead levels in recent years, the state has a rigorous screening program in place and Christie recently signed a law that tightened the standard to provide youngsters greater protection against the toxin.

Housing First

The state has also seen tremendous benefits from its Housing First program, Richman said, an effort that has been launched to help more than 500 chronically homeless individuals statewide get permanent homes; the program is based on a successful pilot program in Camden. Experts have found that stable housing is critically important for health, and Richman said participants in the Camden program — all “frequent fliers” at local hospitals, where they received healthcare — made half as many visits to the ER as they had in the past.

Reducing emergency room visits has also been a driving force behind efforts in Passaic County, where a diverse healthcare coalition has come together to map all the local healthcare assets — including clinical providers, social services, and key community members — in an effort to improve access to primary and preventative care. The group is training a team of community-based healthcare coordinators who “speak the same language and look like” the clients they serve, explained Ken Morris, the vice president for external affairs at St. Joseph’s Healthcare System, in Paterson, and a coalition leader.

In Camden, a similar quest — to reduce ER use — led to school nurse Robin Cogan to partner with the Camden Coalition of Healthcare Providers to try and improve care for her students and their families, the majority of whom are undocumented and don’t speak English as a first language. Cogan helped create “café” meetings that gave parents a chance to come and talk freely about the challenges they faced: difficulty in getting doctors’ appointments, help with translations, or care that is culturally appropriate, among others.

“Population health really isn’t in the acute care setting,” Cogan said. “It’s in the community.”