Cross-jurisdictional sharing in public health: what we do (and do not) know Gianfranco Pezzino,...

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

www.PHSharing.orgPHSharing@KHI.org

(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.