The Integration of Public Health and Primary Care: A Case Study of Nebraska

Abstract

Objectives: This study examined integration between local public health agencies and primary care clinics in Nebraska, highlighting progress to date, successes, opportunities, and barriers. Methods: The study included a survey of all 19 Local Health Departments (LHD) directors in Nebraska, and semistructured follow-up interviews with five LHD directors. Results: There is considerable evidence of integration activities between primary care clinics and LHDs. Current activities focus on care coordination for high-risk chronic care patients and promoting hypertension, diabetes, and cancer screening. Six LHDs have a formal contract or memorandum of understanding with one or more clinics, and at least two LHDs are embedding nurses within clinics. Although LHDs felt there were many benefits to integration and emerging opportunities, significant barriers persist, including funding, administrative capacity, and data sharing. Conclusions: Readiness to integrate public health and primary care services varies from one community to the next. Public health and primary care must continue to build partnerships and pilot new integration activities, while state agencies, universities, professional associations, and others must work to address funding and technical barriers. Public and private insurers should encourage clinics to screen patients for major risk factors, particularly social determinants of health, and provide incentives to improve individual and population health outcomes. More funding and technical assistance are needed to enhance integration activities. Future studies should evaluate the costs and benefits of integration projects from both the provider’s and the patient’s perspective, as well as organizational and systems perspectives.