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Cross-jurisdictional sharing in public health: what we do (and do not) know
Gianfranco Pezzino, Co-DirectorCenter for Sharing Public Health Services
phsharing.org
Overview of This Session
Introduce the Center for Sharing PH Services
Describe success factors for CJS projects
Frame efficiency issue
Review available information on impact of CJS projects
Center for Sharing Public Health Services
DOB: May 2012National initiative
Managed by the Kansas Health InstituteFunded by the Robert Wood Johnson
FoundationGoal:
Explore, inform, track and disseminate learning about shared approaches to delivering public health services
Definitions
Cross-jurisdictional sharing is the deliberate exercise of public authority to enable collaboration across jurisdictional boundaries to deliver essential public health services.
Collaboration means working across boundaries and in multi-organizational arrangements to solve problems that cannot be solved – or easily solved – by single organizations or jurisdictions.*
*Source: Rosemary O’Leary, School of Public Affairs and Administration, University of Kansas
Does It Work?
Available Data About Impact
Qualitative information from demonstration projects 75 LHDs, 125 jurisdictions
5 in-depth case studies (ICMA)*Quantitative information
Survey administered to local jurisdictions (ICMA)*
1,119 responses
* ICMA data focused on back-office service sharing
Summary of Factors for Success
Prerequisites:Take care of these before you even start
planningFacilitating factors:
Leverage them if they apply to your team and project
Project characteristics:Build them in your project
Factors for Success
Prerequisites
Clarity of objectivesA balanced approach (mutual advantages)TRUST!
Factors for Success
Prerequisites Facilitating factors
Clarity of objectives
Success in prior collaborations
A balanced approach (mutual advantages)
A sense of “regional” identity
TRUST! Positive personal relationships
Factors for SuccessPrerequisites Facilitating factors Project characteristics
Clarity of objectives Success in prior collaborations
Senior-level support
A balanced approach (mutual advantages)
A sense of “regional” identity
Strong project management skills
TRUST! Positive personal relationships
Strong change management plansEffective communication
Does It Work???
“Does It Work?”
A common question from policymakers about sharing agreements:
“Does It Work?”A common question from policymakers
about sharing agreements:
“HOW MUCH MONEY WOULD IT SAVE US?”
Framing the Cost Issue
“Return on Investment”:How much money will be generated by our
“investment”?Investment: “the action or process of
investing money for profit or material result”Government is not a for-profit entity
Focus on material results
Framing the Cost Issue
“Return on objectives:”What is the impact of our
program/service/capability?How does our “investment” position us closer
to achieving our goals/objectives?Shifting focus from $$ to impact.
Efficiency
Achieving maximum results for a given investment
Achieving a given result (“goal”) at the smallest possible cost
Output Input
Efficiency
Achieving maximum results for a given investment
Achieving a given result (“goal”) at the smallest possible cost
Output Bang Input Buck
Or,
Does It Work??!!
Anecdotes Versus Evidence
Subject to biasDistortionExaggerationOften from a single
sourceUntestable
Lack of standardized conditions
Potentially harmfulMultiple anecdotes do
not constitute evidence
Most preliminary evidence of impact of
CJS activities is “semi-anecdotal”
Improved Effectiveness
Greater range of public health services and/or functional capacities available
Improved quality of servicesTimeliness
Accessibility
Professional level
Ability to meet state or other performance standards
Improved Efficiency
Reduced costs – both overall costs and unit costs
Greater productivity and economy of scaleAbility to employ more robust and current
service management systemsIncreased eligibility in some instances for
state and federal grants
ICMA Survey: Cost Savings
55% report cost savingsCost saving reported more often among
smaller jurisdictionsGreatest savings reported in:
Executive leadershipBillingOffice and facility maintenanceCommunications and outreach
Little or no hard data available
ICMA Survey: Improved Efficiency
From ICMA survey:
Consolidation of Three Summit County, OH Health Departments: Pre/Post 2011 Merger Local PH Revenue
Fiscal Year
City of Akron
City of Barberton
Balance of Summit County
Combined Public Health Spending
2008 $16,445,449 $1,992,618 $12,769,359 $31,207,426
2009 $18,584,664 $1,548,593 $12,662,176 $32,795,433
2010 $15,993,025 $1,009,468 $13,655,691 $30,658,184
2011 $8,856,632 $135,800 $19,620,983 $28,613,415
2012 $4,020,810 $135,163 $ ?? $ ??
Integration in Genesee & Orleans Counties, NY
Criteria DescriptionGenesee Co.
Enhanced Benefit
Orleans Co. Enhanced
Benefit
TOTAL Enhanced
Benefit
Shared Staffing Savings
Public Health DirectorEnviron Hlth DirectorPatient Svcs Director
$66,000/yr$21,941/yr$51,000/yr
$66,000/yr$ -0- /yr$51,000/yr
$132,000/yr$ 21,941/yr$102,000/yr
Travel Expense Savings
PH Director attending conferences and trainings $514/yr $652/yr $1,166/yr
Shared Consultation Savings
Existing Genesee Co. consultation shared with Orleans Co.
$ -0- /yr Medical: $ 7,500/yrEnviron Eng: $13,000/yr $20,500/yr
CDC PHAP Associate Benefit
Provided and paid for by CDC to assist with research /analysis
$21,843/yr $21,843/yr $43,686/yr
Shared Transportation Savings
Joint RFP for 3-5 Preschool and Early Intervention Transportation
$ -0- /yr $107,295/yr $107,295/yr
TOTAL $428,588/yr
What Is Next?
Focus on implementation:Measuring effectiveness (i.e., changes in quality/quantity of
services) AND efficiency (i.e., ROO) Moving from anecdotes to evidence
Is what we learned applicable to CJS involving:States?Tribes?System-wide changes?Public-private and public-non profit collaborations?
What are fiscal implications?Cost of sharing services:
We need to measure costs before we measure savings
Apportionment
A New Resource
(855) 476-3671
The Center for Sharing Public Health Services is a national initiative managed by the Kansas Health Institute with support
from the Robert Wood Johnson Foundation.
