Dr. Nirav D. Shah Joins ASTHO to Discuss Integration Efforts in Illinois and the Role of State Public Health

June 08, 2017|4:27 p.m.| Anna Bartels

The Integration Forum is a platform for primary care, public health, and others to share ideas, learn about each other’s successes and challenges, and create closer connections. The Forum’s membership is comprised of partners from various sectors of the health industry, including, but not limited to, representatives from state and local public health agencies, medical societies, health insurance plans, federal agencies, academia, and more.

The Integration Forum sat down with Dr. Nirav D. Shah, director of the Illinois Department of Public Health, to learn more about how his state is working to develop integrated efforts that improve population health and lower healthcare costs:

ASTHO: Can you describe your work as a state health official? Does your role require you to engage in any nontraditional partnerships?

Dr. Shah: As the director of any large state agency, really what you do is almost play quarterback. There’s a lot going on, and the job of any executive – whether it’s in a company or a state agency – is to coordinate all those activities and generally make sure that everyone is going down the same field in the same direction. In public health, that’s no different. We are responsible for everything from getting people immunized to making sure the food they eat is safe. Doing so requires thousands of people, all working in generally the same direction. You can’t be an expert in every one of those things, but what you can do is instill principles that are required for everyone to move in [the same] direction.  In my time with the state, we’ve of course partnered with local health departments, partner agencies, and other state agencies – the traditional folks relied on to get us down the field.  But when we see public health issues – like the opioid epidemic – we need to think outside the box a little.  We’ve partnered with school districts, the faith community, and law enforcement to try and include all sectors in a cohesive strategy to address this growing concern.

What does the word “integration” mean to you, and how does it inform your work?

Dr. Shah: Integration means a few different things to us. The first is the idea that we are working with community partners, governmental partners, private entities, [and other organizations] that we previously may not have worked with before with the stated goal of improving our overall efforts. [It’s] the old notion that each of us working on our own can do a few things, but by working together we can achieve far more. When we think about integration in Illinois, that’s fundamentally what we’re trying to do.

More recently, what we’ve done in Illinois is take the step of working more closely with our Medicaid colleagues. We have tried to ensure that public health oversees the prevention piece of health care delivery and we work with our Medicaid colleagues to find creative and innovative ways for Medicaid to pay for those preventive services. This has yielded fruit in number of areas: everything from immunizations to, for example, pre-exposure prophylaxis, in the HIV world.

But the future of integration will most likely be about the integration not of public health and other entities, but probably more about melding different fields of medicine overall – taking a true interdisciplinary approach; for example, integrating the concept of behavioral health with traditional health and setting up systems that allow patients to have a “one-stop shop,” if you will, for their behavioral as well as physical health needs.  We see this working in our school health work and it makes sense to take that to scale. That’s really the golden target and something we’re focusing on really intently in Illinois.

What challenges or barriers to integration have you found most difficult to overcome?

Dr. Shah: Well, the biggest problem with integration is moving from what has traditionally evolved to be a very vertical, silo-based system. Now coming from Illinois, a farm state, we like siloes, but there’s always the challenge of getting people to step outside their comfort zone. Any time you think about integration, what you have to do going into it is know what exactly it is that you’re going to ask the people [on the ground] to do. It’s not sufficient to come to a table and say, “We’d like to meld our two programs to create some sort of synergy.” What’s far more important is identifying a shared goal and then mapping out what each and every person’s responsibilities are going to be ahead of time. If you wait until those problems arise, you will have most likely have missed critical opportunities and lost a lot of tempo in your overall efforts.

What role does public health play in integration efforts? Are there any specific characteristics or capabilities of public health agencies that you believe can best support the work of other health partners?

Dr. Shah: Probably the most useful way to think about modern governmental public health is in its role as a convener [and] in its role as having the organizational capacity and existing infrastructure to bring different groups of people to the table together. So one of the ways that public health can be very effective in doing this sort of integration is simply calling people to the meeting, making sure that all the right voices are being heard, and making sure that [integration] projects and efforts move forward.

Anna Bartels is an analyst for health systems transformation at ASTHO, where she supports the Integration Forum’s activities and projects related to payment and delivery reform.