Collaborations Between CHCs and Local Public Health Departments Mark Bertler, CAE Executive Director, Michigan Assoc. for Local Public Health And Kim E. Sibilsky Executive Director, Michigan Primary Care Assoc.

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Michigan: A Leader in Public Health Landmark public health code passed in 1978 Local health department accreditation program established in 1996 Principles of state/local collaboration signed by four state departments in 2005 Network of 45 local health departments serve all 83 counties in the state

The Growth of Community Health Centers in Michigan From the mid-1970s, CHCs have become players in providing access to primary care in Michigan’s many underserved communities In 2008, there are 32 health center organizations with more than 160 delivery sites CHCs designed using the “Community Oriented Primary Care” model which depends on community epidemiology – the domain of local public health Many health centers have public health staff representation on their Boards of Directors

Competition to Collaboration In the early years roles were not clear and there was a sense of competition for funds State and Federal funding initiatives were like “jump balls” creating nose-to- nose competition in many communities Relationships were developed over time and roles were clarified Many communities’ CHCs and LPHDs collaborate successfully

The Evolution of Michigan’s LPH System 1978 code established local “system” of local health departments Late 1970’s and early 1980’s regional teams established to manage multi-county districts Mid 1980’s to mid 1990’s state provides support and incentives for consolidation 1996 to present local public health accreditation program measures performance of local health departments

The Assurance Role in the LPHD/CHC Relationship State public health code, National Performance Standards and NACCHO Operational Definition direct local health departments to “assure” access to public health and population based services Many local public health clinical services are assumed/replaced by Medicaid managed care and county health plans Public health assurance role includes promotion of CHC’s and RHC’s

State Level Collaboration: LPH Leads and CHCs Follow State Technology Conference MSS/ISS Systems Development Smokefree Michigan Infant Mortality Initiatives Other population based initiatives

State Level Collaboration: CHCs Lead and LPH Follows Medicaid Managed Care Coalitions Medical Care Homes for Plan First Clients Special Populations Immunizations NGO Participation in Public Health Training Center Development

Local Level Collaborations: Who Cares Who’s on Top? CAP Projects: Expanding Access School-Based Clinics Rural Networking Grant Projects New FQHC Development County Health Plan Development Dental Infrastructure Development

Conclusions State level collaborations ensure inclusion of the interests and assets of CHC’s and LPHD’s Local level collaborations assure healthier communities There are many opportunities yet to be explored