Leading change in a state public health department: Health reform and chronic disease integration in Massachusetts

Massachusetts participates in the CDC Chronic Disease Integration Demonstration Pilot Project (IDP). The pilot's goals are to develop an infrastructure to strengthen the role of Public Health in Health Reform; an internal structure to strengthen the principles and programmatic needs of chronic disease programs; and a comprehensive community approach supporting the prevention and management of chronic diseases. In 2009, state revenue shortfalls necessitated reductions to the Department of Public Health (DPH) budget. Chronic Disease was cut 67%, more than any other program. It was assumed that since 97.4% of state residents were now insured under Health Reform, prevention and treatment services that DPH traditionally provided the uninsured would be covered and performed by medical providers. The cuts signaled that chronic disease programs should establish their relevance by better demonstrating their efficiency and effectiveness. In the IDP, programs partner to address shared risk factors, promote policy changes and build community capacity for chronic disease prevention and management. IDP leaders have prioritized developing internal structures to enable integration, understanding that achieving the other project goals requires internal collaboration. They established work groups to define the vision for program integration, create a communication plan, and accomplish specific IDP work plan objectives. A multidisciplinary team wrote an RFR to pilot a new approach for the community intervention. IDP leaders continue to refine guiding principles for Integration, which include promoting work groups' informal authority, facilitating mentoring and staff development, and upholding a culture of change. They encourage innovation and risk-taking, described as evidence-based improvisation.