cross-jurisdictional sharing in public health: what we do (and do not) know gianfranco pezzino,...
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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
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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
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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
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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
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Does It Work?
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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
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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
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Factors for Success
Prerequisites
Clarity of objectivesA balanced approach (mutual advantages)TRUST!
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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
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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
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Does It Work???
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“Does It Work?”
A common question from policymakers about sharing agreements:
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“Does It Work?”A common question from policymakers
about sharing agreements:
“HOW MUCH MONEY WOULD IT SAVE US?”
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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
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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.
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Efficiency
Achieving maximum results for a given investment
Achieving a given result (“goal”) at the smallest possible cost
Output Input
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Efficiency
Achieving maximum results for a given investment
Achieving a given result (“goal”) at the smallest possible cost
Output Bang Input Buck
Or,
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Does It Work??!!
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Anecdotes Versus Evidence
Subject to biasDistortionExaggerationOften from a single
sourceUntestable
Lack of standardized conditions
Potentially harmfulMultiple anecdotes do
not constitute evidence
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Most preliminary evidence of impact of
CJS activities is “semi-anecdotal”
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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
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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
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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
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ICMA Survey: Improved Efficiency
From ICMA survey:
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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 $ ?? $ ??
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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
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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
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A New Resource
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(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.