Because of the changes in both the public and private sectors, the Turning Point project provides an opportunity for Nebraska to change its public health system. In the private sector, managed care organizations are reshaping the health care environment. In  response to this new environment, integrated health networks are forming in both rural and urban areas. Currently, Public Health is not a major partner in these networks, but most of these integrated health networks have expressed interest in collaborating with public health agencies.

In the public sector, Nebraska created a new Health and Human Services organization by merging five old agencies - the Department of Health, the Department of Public Institutions, the Department of Social Services, the Department on Aging, and the Office of Juvenile Services - into three new agencies called Health and Human Services, Licensure and Regulation, and Finance and Support. This new organization provides a strong foundation for the integration of public health activities into the public health and human services system. One of the challenges, however, is to determine how public health  service capacity can be enhanced at both the state and local level.

In order to strengthen and transform public health into the 21st Century, building a strong public health coalition in Nebraska is critical. Prior to submission of the Turning Point letter of intent, a 35-member Community Health Partners Stakeholder Group (CHPSG) was formed to advise and guide the Health and Human Services system in its strategic public health planning efforts. The CHPSG is a broad-based coalition consisting of  public and private entities at both the state and community level. This group has the potential to frame public health policies and act as a catalyst for communicating these policies to appropriate policy makers.

Challenges & Opportunities

As stated, one of the major challenges facing Nebraska is to expand core public health function capacity throughout the state. Only 18 of the state's 93 counties provide some type of public health services, and the vast majority of these agencies provide only  limited services. However, several new broad-based, multi-county coalitions are forming across the state. As these coalitions mature, there is an opportunity to expand significantly the capacity to provide core functions.

A second challenge is to determine how state and local public health agencies can form new partnerships with managed care organizations. Although these partnerships are  building slowly, several areas show signs of progress. For example, Public Health, along with hospitals and physicians, is an equal partner in one of the new rural integrated health organizations that will serve as a pilot project for rural Medicaid managed care. The role of public health is to assist in the enrollment process, screen clients for at risk behaviors, and assess barriers to health care services. This agency also provides a 24-hour-a-day, toll-free computerized telephone triage program and follow up on all Medicaid clients receiving care at one of the hospital emergency rooms.

Another example of close cooperation is in the formulation of treatment guidelines.  Epidemiologists in the Chronic Disease Program are working with managed care organizations to develop appropriate treatment guidelines for diabetes. Also, the potential exists to develop guidelines in areas such as breast and cervical cancer, asthma, and tuberculosis. Finally, the state is implementing an immunization registry capable of tracking immunization rates for all children. Managed care organizations are very interested in the registry, which will enable them to track immunization rates more effectively for their members.

A third major challenge for public health in Nebraska is to improve the health status of racial and ethnic minority populations. Nebraska has a relatively small but growing minority population. Unfortunately, many racial and ethnic minorities lack access to health care services. In order to help ensure that the needs of racial and ethnic minority populations are met, technical assistance will be provided to community coalitions and networks to help them conduct special surveys, organize focus groups, and develop appropriate intervention strategies.

Dave Palm is a member of the Nebraska Turning Point Partnership. Two local communities in Nebraska are also recipients of Turning Point grants: Buffalo County Community Health Partners, and the North Central Community Care Partnership that includes Brown, Cherry, Rock, Keya, Paha, Holt, Boyd, Knox, Antelope, and Pierce Counties.