The more stories I hear from friends and colleagues, the more I am convinced that the numerous changes in our lives resulting from the pandemic response have not been all bad. We’ve learned a lot about how to spend our time and organize our activities better.
At the top of my list of positive changes are the fruitful public health collaborations that were born of our regional Covid response. The way Barnstable County, Cape Cod Healthcare, and the community health centers came together to provide organized testing and, later, the immunizations, was remarkable.
Though painfully gained, we also developed a new understanding that it is necessary for everyone to have access to health care, and that those excluded are not only at risk themselves but put the health of every one of their contacts at risk as well. We now understand that only with high levels of vaccination can we break the recurring waves of illness that the world has seen.
Covid jabs are available to everyone. No one is excluded for inability to pay. That’s a tangible and powerful first step toward health equity — toward health care as a human right.
The question now is whether we can direct what we have learned at other compelling health and social concerns.
Consider mental health and substance abuse issues, which affect substantial numbers of our neighbors. Responsibility for care and management of those now falls largely in the not-for-profit domain, where a host of independent agencies address components of these complex problems. No one finds the maze easy to navigate — not even the professionals involved.
This patchwork system, built on good intentions and supported by fundraising and donations, means a good deal of any “provider” agency’s work involves grant-seeking or begging for operating funding. And because there are only so many major donors, these nonprofits end up competing for limited dollars.
Another big challenge to better integration of the work of these independent agencies is the frustrating lack of information sharing among an array of electronic medical records systems. They truly don’t talk to each other. It is like dealing with the Tower of Babel Medical Center. The result is that people are pigeonholed — our complex and interlocking developmental, social, and medical issues, dis-integrated — even by responsible providers.
Health care is a “system” in only the most limited way. And, sadly, its management has more to do with finance than with health care.
In spite of all that, every day, very good people across the Cape are doing hard work to provide high-quality care to their patients, and to help them navigate the maze.
Imagine now that the collaborations formed on the Cape to confront the Covid pandemic were to be expanded and broadened. What if providers in our community addressing health and social welfare issues came together?
New institutional links could make HIPAA-related legal limitations much less disruptive, and communication and record-sharing among providers would be greatly facilitated.
Imagine patients with long-term health issues being discharged from the hospital via a seamless transition to outpatient care providers and social services, or public health nurses, out in the community, screening people at risk and making informed referrals as appropriate.
A health consortium would be stronger than its individual agencies and freer from the bureaucratic burdens that so hamper our health institutions. It could use the talents of our many clinical caregivers, and free administrators from so much onerous fund-finding.
With the recent expansion of its public health nursing capabilities, the county is intent on learning the lessons of this past year. We are committing to increased support of town boards of health and community institutions.
And funding available through the American Rescue Plan Act could support a much more connected Cape-wide network of service providers to meet growing needs.
We can build on the lessons of this nightmare: Everyone must have equitable health care access. Collaboration works. We have the people to do the work.
Now, a public health collaborative, involving all the players who helped steer us through Covid, as well as many other smaller community groups and organizations, should be a topic for robust discussion. Let this be a start.
Brian O’Malley, M.D., is Provincetown’s elected delegate to the Barnstable County Assembly. Write him at [email protected].
