Primary care, when prioritized in the health system, results in people living longer lives with more equitable outcomes. Texas Health Institute (THI), as the non-profit, non-partisan public health institute in the state, serves as a trusted, leading voice on public health and health care issues in Texas and the nation. Our expertise, strategies, and nimble approach make us, alongside the Texas Medical Home Initiative (TMHI), integral and essential partners in driving systems change efforts. THI and TMHI have joined forces in creating the Texas Primary Care Consortium (TPCC), with a mission to advance equitable, comprehensive, and sustainable primary care for all Texans.

Primary care is the foundation of a strong and effective health care system. Abundant data shows that people in communities with more primary care practitioners—measured in proportion to the population of the county or city—are overall healthier and live longer. Research has proven the fundamental role of primary care in improved chronic disease management, providing preventive care, ensuring patient engagement, leading care coordination, and delivering person-centered care. Yet, our current healthcare system consistently falls short for everyone involved.

Inequities, high costs, lack of access, and disparities in care and quality lead to frustration and sub-optimal outcomes for not only patients and providers, but communities, businesses, payers, government, and policymakers alike. This is especially true in Texas, where the large number of rural counties, growing health professional shortage, and high rates of uninsured or underinsured residents make access to primary care services difficult. Subsequently, care is frequently obtained later in the course of an illness at higher-cost venues such as emergency departments. Together, these factors are contributing to a growing health care crisis in Texas.

As we highlight National Primary Care Week, TPCC continues to focus on advancing primary care through its framework: educate, activate, and transform.

• Educate by expanding our knowledge base through sharing best practices, lessons learned, and replicable tools.
• Activate by facilitating opportunities to build and strengthen lasting partnerships for shared and sustainable impact.
• Transform by creating spaces for dialogue and action to generate a shift in the healthcare system through policy and system change initiatives.

TPCC’s activities include:

• Eight highly successful annual statewide summits on primary care and the health home and a series of webinars
• Making Primary Care Primary: A Prescription for the Health of All Texans, a comprehensive report on issues essential to advancing primary care and health system transformation in Texas and a real-time, 360-degree view of how the state’s health system plans to continue adapting and innovating in a changing health care environment
• Data Dashboard: What is the State of Primary Care in your County?, a live, first-of-its-kind, interactive dashboard of national and state data for all 254 Texas counties—consolidating demographics, health needs, facilities, health behaviors, workforce, and social determinants of health across five domains—intended to guide and advance primary care and health transformation efforts across Texas

To learn more, register for our upcoming convenings, or join the state’s only multisectoral network focused on primary care in Texas, visit our website: txprimarycareconsortium.org

August provides The Immunization Partnership the opportunity to reach out to parents and the public in general about the importance of keeping current on adult and children vaccines. By combining social media and traditional media messaging for National Immunization Awareness Month and Back to School, we can reach out to Texans in a variety of ways.
 
We made available to Texas county health districts and public health agencies a NIAM and Back to School proclamation template, which allows customization by inserting the name and title of the proclamation issuer, such as mayor or county judge. We also will provide targeted news releases about NIAM and Back to School, which include quotes from the local public health professional and our interim Executive Director. The local public health person can revise or extend the quote. We use the main news release, which includes only quotes from our interim Executive Director, for the rest of the state.

We are proud to announce the distribution of a series of English/Spanish animated videos we hope will answer COVID-19 vaccination questions and lead to more Texans exercising their right to bare arms and take a shot for Texas. Americagroup Texas funded the project, which The Immunization Partnership produced.

​August 25th marks the fourth anniversary of Hurricane Harvey slamming into Rockport, Texas- most people will remember the devastating rainfall. The Category 4 hurricane and its 130-mph winds created a path of destruction through the city of 10,000 people as it came ashore. Over 2.5 million cubic yards of debris were removed from Rockport in the five months after the storm. By comparison, Houston, a city 216 times Rockport’s size cleared 3 million cubic yards of debris. A front row seat watching the eye roll across Rockport provides an eye-opening view of Harvey’s force. Cleared cubic yards of debris are not necessarily based on the size of the city.
 
National Oceanic and Atmospheric Administration (NOAA) predicts another active hurricane season this year, which began June 1st, and forecasters predict multiple major Category 3 to 5 storms. It’s not too early to prepare for a hurricane or tropical storm. The CDC provides excellent guidance including what emergency supplies to stock in your home, planning to evacuate, and protecting older adults and pets. CDC’s practical information and guidance should be bookmarked on your browser. Staying safe after a storm is just as important as preparing for one.

Very-low-income people with disabilities can get health coverage through Texas Medicaid. Children, adults in institutions, and a small percentage of adults in the community have a dental benefit. Many people react in disbelief when learning that most adults with disabilities in Medicaid community care do not have access to a dentist. This leads to very bad outcomes, like resorting to an emergency room when in severe dental pain. The treatment there is not dental, only antibiotics and painkillers, often opioids. Some people are in such bad shape they must be hospitalized, and a few actually die from complications. What caused this? Simply, untreated cavities, a treatment that is usually done in a dental clinic. That’s not all. Poor oral health leads to elevated heart disease, diabetes, hypertension, stroke, cancer and more. These facts make a strong argument for adding a dental benefit.
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Texas leadership believe in limited government and low services. Texas ranks 49th in community services for people with disabilities[1] and remains among the minority of states not adopting Medicaid Expansion. To succeed, we would need a collective effort. CTD is well positioned in the Capitol and would serve as advocacy lead, including bringing self-advocates, individuals with disabilities. We would need to make the business case, that requires a skilled health research organization. Texas Health Institute filled that role. Influential legislative champions had to be recruited and supported. Our top champions are Senator Lois Kolkhorst and Representative Joe Deshotel. And we needed to show broad support from other groups. That meant putting together a strong list of supporting organizations. Among those would be some obvious groups like the Texas Oral Health Coalition and the Texas Dental Association, but we went beyond and added major trade associations for doctors, hospitals, nurses, health plans and dozens of disability organizations.

It took time. In 2017, we secured a study of the issue. In 2019, we passed a bill to pilot comprehensive dental care. In 2021, after the language passed through five bills, on the last day, a preventive dental benefit was passed. This was the result of many hearings, legislative visits, and organizing. It’s not over as we will continue to monitor the rollout. Yet, the impact is huge. Around 450,000 adults with disabilities, who would have had no dental visits in their adulthood, will now be able to see a dentist every year. The smiles will look very nice indeed.


[1] United Cerebral Palsy and ANCOR Foundation, The Case For Inclusion Report 2019

The coronavirus pandemic of 2020-2021 has had a profound impact on the mental health and well-being of Texans, as well as the rest of the US. The pandemic highlighted the need to revitalize the infrastructure of our public health system and to protect it from political influence at all levels. The trauma inflicted by the pandemic has touched all of us. Many have lost family members or friends. Other stresses include loss of employment, insurance coverage, housing, and access to healthcare. Children have lost more than a year of seeing their classmates and friends in person and have had to learn how to learn through a virtual school environment. Many small business owners lost their sole source of income due to restrictions required to minimize the spread of the virus.
 
The CDC reports that as a result of all of this, there has been a 27% increase in symptoms of anxiety and depression between April 2020 and February 2021. Emergency room visits due to overdoses and suicide attempts were up 36% and 26%, respectively. More than 87,000 Americans died of drug overdoses in the year ending in September 2020, representing a profound increase. Behavioral health service providers reported increased demand at the same time that they were decreasing staff sizes and closing clinics. Although the use of telehealth has risen dramatically, the effect on providing care for those with behavioral health and substance use disorders (SUD) has yet to be determined. The impact of the pandemic has disproportionately affected our communities of color. It has highlighted how a system that prioritizes a law enforcement and criminal justice approach to psychiatric crises often results in unnecessary injuries and deaths.
 
The health care community has responded rapidly to the new environment created by the pandemic. Some best practices have emerged:

• Increased access to behavioral health and SUD providers via telehealth
• Integration of behavioral health into primary care practices
• Integration of evidence-based treatment of SUD into behavioral health and primary care practices (medication-assisted therapy or MAT)
• Use of mobile applications to support healthier behaviors and activities including use of rewards when individuals are behaving in ways that support improvement in mental health symptoms and maintenance of recovery (contingency management)

 
There has also been a significant increase in enrollment in Medicaid and the Healthcare Exchange during the pandemic leading to many gaining or regaining access to health care.
 
As the public health institute of Texas, Texas Health Institute (THI) is committed to helping Texas overcome the trauma from the pandemic through their continued devotion to advancing the health of all Texans and their communities. THI’s dedicated staff continues to produce outstanding research and translational activities such as the recent work on health equity through the HOPE Initiative that is featured by the New England Journal of Medicine. THI works with the Texas Primary Care Consortium to integrate behavioral health into primary care practices throughout Texas. THI has been a leader in advancing collaborative action on chronic pain, SUD, obesity, oral health, genetic disorders and other topics important to Texans. To quote THI, “We strive to advance the health of all.”

April is National Minority Health Month, and this year’s theme sponsored by the HHS Office of Minority Health is #VaccineReady, underscoring the importance and urgency of vaccinating racial and ethnic minorities disproportionately impacted by COVID-19.

As seen across the nation and Texas, Black, Hispanic, and Indigenous populations have faced the brunt of cases, severe illness, death, and economic loss from the pandemic, yet they continue to have lower rates of receiving the COVID-19 vaccine. Local data shed further light into these realities. For example, a new report from the COVID-19 Modeling Consortium finds that areas across Austin with higher social vulnerability and rates of infection, such as the Eastern Crescent, have lower rates of vaccination. Similar gaps in vaccination rates by race and place have also been reported across Harris County, Dallas area, and other parts of the state.

Upending these inequities will require centering equity in the COVID-19 vaccine rollout. What that means is working to ensure the vaccine is accessible to all people—especially to those most at-risk, and not just to those with means to navigate the system. As the supply and availability of vaccines continues to increase, the objective is to work quickly, safely, and effectively to get as many shots in arms as possible, and to take explicit measures to simultaneously reach at-risk low-income and communities of color to minimize preventable infections, severe illness, and death. Doing so will require working authentically with communities and their trusted leaders and partners to learn their concerns, provide accurate and credible information, and access to the vaccination.

Lessons, promising strategies, and guidance are emerging on how to more equitably rollout the vaccine. Kaiser Family Foundation released a summary of promising state-level actions for addressing racial equity in COVID-19 vaccine efforts, and Johns Hopkins produced detailed guidance for working with communities of color to ensure equity in COVID-19 vaccination. Leading public health experts Dr. Faith Fletcher and Dr. Aletha Maybank recently penned 5 Ways to Make the Vaccine Rollout More Equitable, and Dr. Kingsley Okafor with Kaiser Permanente highlighted steps for getting to vaccine equity by addressing health equity. Our own work in the wake of the H1N1 pandemic 10 years ago with the HHS Office of Minority Health provides important guidance and steps on engaging communities of color in public health crises, also offering equity lessons from the H1N1 vaccination and response efforts.

Taken together, the following are highlights of what we have learned and what is emerging as strategies for ensuring all communities and people across Texas have access to information, resources, and the COVID-19 vaccine to be #VaccineReady. 

Translating evidence and ideas, or “sense-making,” is a core competency of Texas Health Institute (THI) as the state’s public health institute. The Community Health team’s work over multiple projects in East Texas uncovered trends occurring regionally. That work offers a case study of how THI has strengthened local partnerships for collaborative impact at the regional level.

THI conducts community health needs assessments (CHNA) throughout the state. Two years ago, we conducted CHNAs for four of CHRISTUS Health System’s integrated health care delivery facilities in East Texas (read more here).

Although we used the same approach, each CHNA was a separate product informed by local data, including the voice of the local community. Despite that, we observed similar patterns across health systems. Each health system identified at least one social determinant of health need, and all identified mental and behavioral health as a top priority.

Our CHNA work provided invaluable perspective for the East Texas Local Government Expenditures Project which focused on Harrison and Angelina Counties and their respective capital cities. Our CHNA for CHRISTUS Good Shepherd covered Harrison County, but we were also familiar with CHI St Luke’s CHNA for Angelina County which, incidentally, identified access to behavioral health as the second highest priority in the county. The project was a collaborative effort with the Stephen F. Austin University (SFA) School of Social Work who recruited informants and conducted interviews and was funded by Episcopal Health Foundation. Authorized by the county and municipal legislators and executives, the project was designed to support recommendations to improve community health based on an analysis of budget spending trends over 10 years as well as informant interviews with officials familiar with the budget process. Although unexpected, the need to address behavioral health arose as a research finding.
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Study interviewees from the two counties described the interaction between homelessness, substance abuse, co-occurring mental health conditions, and the criminal justice system. They painted a picture that researchers have observed across the country. This includes prior unrelated SFA research documenting the vicious cycle of substance abuse, prison time, and homelessness operating across rural counties in East Texas.

Recommendations offered by Harrison County interviewees suggested the need for a community-led effort to address these complex issues from a systems and regional perspective. This was the rationale for THI to partner again with SFA to respond to HRSA’s Rural Communities Opioid Response Program—Planning (RCORP) opportunity. The Panola-Gregg-Harrison Community Initiative to Address Substance Misuse is the result of our successful HRSA proposal. The initiative involves a regional gap analysis and community action plan to address prevention, treatment, and recovery from opioid and methamphetamine misuse in the targeted rural community.

The partnership with SFA creates synergies that ensure that we have a trusted local partner grounded in the community as we work regionally. THI is the convenor for the consortium responsible for implementing the community action plan.
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This work emerged as a result of working with local stakeholders while seeing the big picture and seizing opportunities for collaborative action. It exemplifies the kind of regional work for which state public health institutes like THI are uniquely suitable.