Hidden in Plain Sight: Premier Data Reveals the Public Health Partnership Gap Undermining Hospital Strategy

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Key Takeaways

• Health system collaboration with local health departments (LHDs) remains fragmented and inconsistent. Many health systems duplicate services, remain unaware of LHD capabilities or operate independently, compromising population health outcomes and financial efficiency.
• Findings indicate that many hospitals may be underutilizing high-impact LHD services such as maternal and child health, rural support and comprehensive prevention programs that can leave communities underserved.
• Data sharing with public health officials, especially data regarding immunizations and social determinants of health (SDOH), is inconsistent. This limits actionable insights and real collaboration.
  

Health system leaders are under pressure to deliver better community health outcomes despite relentless financial pressure. Yet the partners best positioned to help close that gap - local health departments (LHDs) - are often underutilized, misunderstood and,in many cases,operating in parallel rather than in concert with health system strategies.

A new resource from Premier, entitled Health System Collaboration with Public Health Entities, surveyed more than 500 healthcare executives to help determine how health systems engage with LHDs. The findings show that while most health systems think they collaborate with public health, the reality is that these partnerships are fragmented and inconsistent at best. This disconnect positions health systems far away from the strategic, integrated partnerships needed to materially improve outcomes and deliver sustainable return-on-investment (ROI). Worse, the cracks are widening at a time when hospitals cannot afford misalignment.

Below are key findings and why they demand C-suite action now.

Just half of U.S. health systems say they "strategically partner" with LHDs, suggesting an opportunity for engagement.

On paper, 73.8 percent of surveyed organizations report some level of partnership with their LHD, but just 50.3 percent say it's strategic. More alarmingly, close to 23 percent report clear disengagement.

• Up to 15 percent of VP-level leaders say their organizations operate completely independently of LHDs, duplicating or overlapping public health services.
• Shockingly, 8 percent of large organizations (1,000-plus employees) report being unaware of their LHD's services at all.

For C-suite leaders, the potential for misaligned and duplicative programming with LHDs translates directly to waste and eroded margin. Worse, the misstep comes at a time when hospitals face persistent cost pressures and shrinking reimbursement. Meanwhile, fragmentation in public health efforts can impede population health metrics, quality-incentive targets and community-benefit requirements, which carries additional financial risk.

In short, what appears on paper as strategic partnership is, in reality, a structural gap with cascading consequences.

Health systems are missing out on the services they need most.

Executives overwhelmingly ranked health education and prevention (72.4 percent) and behavioral health support (57.5 percent) as the most valuable LHD services, aligning with industry trends toward preventive care models. Yet there are a host of other LHD services that remain chronically underutilized:

• Rural systems participating in the survey prioritize only these two public health services and underutilize nearly everything else, including infectious disease control, immunizations, chronic disease management, emergency preparedness and environmental health.
• Maternal and child health, which the National Institutes of Health has declared "a public health crisis," lands at the bottom of LHD priorities among hospitals, even though the National Institutes of Health has declared poor outcomes in this area "a public health crisis."
• Of large systems (1,000-plus employees), 63.1 percent rank emergency preparedness as one of the most valuable LDH services but engage inconsistently despite COVID-19 demonstrating the existential cost of fragmentation.

This data illustrates that while hospitals may value prevention, coordination and population health management, they are not fully optimizing LHD partnerships in practice. For C-suite leaders, the numbers represent not just a missed opportunity but a direct threat to financial performance, operational resilience, regulatory compliance and community credibility.

Hospitals say they're "integrating community health workers." The reality is patchwork at best.

The survey shows 80.8 percent adoption of community health workers (CHWs), navigators or home-visiting programs across health systems. That sounds like progress until you look at the extremes:

• Small organizations (100 to 199 employees) report both the highest rate of high integration (51.5 percent) and the highest rate of no integration at all (24.2 percent).
• Urban systems are nearly twice as likely as rural systems to report high integration (47 percent versus 26.8 percent), despite rural communities needing theserolesthemost given limits on service access.

Executives acknowledge the importance of CHWs, but deployment remains inconsistent and uncoordinated with LHD workforce structures, failing to bridge the gaps they were designed to close.

Data sharing is stuck in the dark ages.

Despite national pressure to better integrate care and public health, the survey reveals that data sharing remains an opportunity for improvement, with most respondents sharing only part of what is needed. Consider the gaps:

• Rural organizations have the highest rate of "no data shared," at 7.1 percent, compared to 4.4 percent for urban facilities.
• Immunization data sharing lags in rural areas (26.8 percent), where coverage gaps are widening.
• Social determinants of health (SDOH) data sharing (arguably the foundation for community health strategy) is inconsistent and lowest among small systems, shared by just 33.3 percent of these respondents.

Partial or inconsistent data sharing is a strategic vulnerability that undermines the ability to accurately assess community needs, prioritize interventions and implement coordinated population health programs. Without closing these gaps, hospitals risk preventable hospitalizations, repeat visits and unnecessary clinical interventions that can be particularly costly in value-based care models where reimbursement is tied to outcomes.

Most organizations participate in public health initiatives but at uneven rates.

Nearly 75 percent of surveyed organizations participate in one to five community health initiatives, which is encouraging. But the distribution reveals the real story of a widening divide in the industry.

• Larger systems (1,000-plus employees) are two times more likely to manage more than five initiatives, leveraging deeper benches, dedicated social determinants teams and more sophisticated partnerships. In essence, the data shows that scale drives capacity.
• For rural organizations, 8.9 percent lack any programs, and 44.6 percent engage in only one or two initiatives, indicating a struggle to keep pace.

The result is a growing tale of two healthcare systems. On one side are providers with the infrastructure and capital to invest in upstream health and population-level impact, while the other fights just to maintain basic access. As community-level outcomes become more central to reimbursement models, regulatory scrutiny and competitive positioning, this imbalance threatens to entrench disparities and leave rural and resource-constrained providers behind.

The bottom line: Hospitals and public health aren't "partners." They're parallel systems missing out on the full benefits of collaboration.

Premier's data reveals a sector caught between intention and execution. Hospitals see the value of public health, yet they haven't implemented the governance, data sharing, workforce integration or strategic alignment necessary to turn fragmented activities into measurable population health gains.

These findings align with other research on the topic, including the Centers for Disease Control's recommendations for better data sharing and partnerships to modernize information flow, as well as empiricalresearch showing disconnects in health system and LHD funding streams, governance and staffing models.

Now is the moment for CEOs, CFOs and CMOs to stop treating public health as a "nice to have" and instead view LHDs as essential extensions of their enterprise strategy. Systems that establish true public health partnerships now will win on outcomes, resilience and market trust. Those that don't will be left with higher costs, deeper disparities and communities that look elsewhere for leadership.

Ready to turn these findings into action?

Download the full surveyresults on health system collaboration with local health departments (LHDs) to learn more about the collaboration challenges and opportunities for health system leaders to initiate meaningful change.

For deeper support in closing these gaps, Premier's Clinical Transformation and Community Health Advisory Services teams help health systems:

• Build fully integrated public health partnership strategies.
• Stand up unified CHW and navigator models.
• Create shared governance with LHDs.
• Integrate data and population health analytics.
• Develop community health ROI frameworks.
• Align prevention to enterprise financial strategy.

If your organization is ready to stop operating in parallel and start building real, measurable community impact, download the report now.