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142nd Annual Meeting and Exposition New Orleans, LA

Learn about leadership strategies, critical issues, and models of integration in sharing public health functions. Hear about the rural New York experience and explore the benefits of cross-jurisdictional sharing. Presented by experts in the field.

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142nd Annual Meeting and Exposition New Orleans, LA

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  1. 142nd Annual Meeting and Exposition New Orleans, LA 5170.0Sharing Public Health Functions and Capabilities Wednesday, November 19, 2014: 12:30 PM – 2:00 PM • Moderator―Ann Forsberg, MA, MPH • Presenter―Patrick LibbeySharing Public Health Functions and Capabilities: Leadership Strategies • Presenters―Donald W. Rowe, PhD; Paul Pettit, MSL; Kenneth Oakley, PhD, MS, MBA, FACHE; and SumanSarkerPublic Health Cross Jurisdictional Sharing: The Rural New York Experience • Presenter―Gianfranco Pezzino, MD, MPHSharing Public Health Functions and Capabilities: Critical Issues • Presenters―Kenneth Oakley, PhD, MS, MBA, FACHE & Sandy Tubbs, RN, PHNSharing Public Health Functions and Capabilities: Models of Full and Partial Integration

  2. Sharing Public Health Functions and Capabilities: Leadership Opportunities Patrick Libbey, Co-DirectorCenter for Sharing Public Health Services phsharing.org

  3. 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

  4. Two Critical Questions • Who makes the decision to enter a CJS arrangement? • What are the drivers behind deciding to engage in CJS?

  5. The Key Players

  6. Drivers Emergency Preparedness National Public Health Standards CJS Agreements Increasing burden of chronic disease Lean fiscal environments Health care reform

  7. Cross-Jurisdictional Sharing Spectrum Shared Functions with Joint Oversight Service Related Arrangement Informal and Customary Arrangements Regionalization • “Handshake” • Information sharing • Equipment sharing • Coordination • Assistance for surge capacity • Service provision agreements • (e.g., contract to provide immunization services) • Purchase of staff time (e.g., environmental health specialist) • Joint projects addressing all jurisdictions involved (e.g., shared HIV program) • Shared capacity (e.g., joint epidemiology services) • New entity formed by merging existing LHDs • Consolidation of 1 or more LHD into existing LHD Looser integration Tighter integration

  8. Center for Sharing Public Health Services • DOB: May 2012 • National initiative • Managed by the Kansas Health Institute • Funded by the Robert Wood Johnson Foundation • Goal: • Explore, inform, track and disseminate learning about shared approaches to delivering public health services

  9. The Learning Community • Public Health Officials • ASTHO • NACCHO • NALBOH • CDC • Policymakers • ICMA • NACo • USCM • NGA • NCSL • Learning community • 16 local projects • Both groups will • Learn • Share • Explore

  10. Shared Services Learning Community 16 sites • 75 health departments • 125 political jurisdictions 14 states 2-year grants

  11. Range of Site Activities • Select sharing model • Develop strategic plan • Prepare for implementation • Begin implementation

  12. Example – Massachusetts • City of Worcester created health alliance • Six towns receive additional PH services • One health officer serves all seven towns • Alliance pursuing accreditation

  13. Example – Colorado • In San Luis Valley six HD have formalized PH partnership • Joint environmental health assessment. • Five of the counties are receiving environmental health services through the partnership that they otherwise could not have procured on their own.

  14. Example – Nevada • Carson City HD signed agreement with neighboring Douglas County to provide environmental health services • Douglas county approves ordinances, code • Carson City implements and enforces them on behalf of Douglas county (through contract)

  15. Outcomes SOURCES • Shared Services Learning Community Experience • Recent ICMA Survey and Case Study Development • Other

  16. Increased Efficiency • Reduced costs – both overall costs and unit costs • Greater productivity and economy of scale • Ability to employ more robust and current service management systems • Increased eligibility in some instances for state and federal grants

  17. Increased Effectiveness • Greater range of public health services and/or functional capacities available • Improved quality of services Timeliness Accessibility Professional level • Ability to meet state or other performance standards

  18. 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.

  19. Public Health Cross Jurisdictional Sharing: The Rural New York Experience Western New YorkA history of collaboration Don Rowe, PhD Director Office of Public Health Practice, School of Public Health and Health Professions Paul Pettit, MSL Director of Public Health Genesee & Orleans County Health Departments Kenneth Oakley , Ph.D. FACHE Chief Executive Officer, LPCCN & R-AHEC Suman Sarker, MPH

  20. Fertile ground • It is much easier to collaborate when collaboration is already part of the culture. • Past successes lay the foundation for the future

  21. History of Collaboration • WNY Public Health Coalition • WNY Public Health Alliance • www.wnypha.org • Regional Adult Behavioral Health Risk Assessment • Physician’s Guide to Public Health • Regional Office of Public Health Emergency preparedness • Multiple regional spin-offs

  22. Organizational collaborations • P2 Collaborative • http://www.p2wny.org/ • AHEC’s • http://www.ahec.buffalo.edu/ • NYSARH • www.nysarh.org • Rural Health Networks • Lake Plains Community Care Network • S2AY RHN • Allegany Western Steuben RHN • Chautauqua County Health Network • Healthy Community Alliance

  23. Planting the seed • With decades long history of multidisciplinary collaboration and partnership, coupled with economic imperatives, the notion of cross jurisdictional sharing in public health was an idea whose time had come. • Thus begins the story of a collaboration between a university, 2 health departments and a not for profit agency exploring the potential for cross jurisdictional sharing

  24. The Genesee & Orleans Project Two rural counties in Western New York

  25. Local Landscape • Background • First Discussions in 2007 • Lack of NYSDOH & Local support / feasibility • Changes in Public Health Law – 2012 allowed for favorable environment • Opportunity arose with retirement of Genesee County PHD • Process began in October 2012

  26. Establishing Buy In • Identify a Project Driver • Preliminary meeting with Genesee BOH • Fall 2012 • “coffee time” • Establishing buy in from key players • 5 decision making body’s to agree on plan • Summer 2012 – general agreement to proceed with PILOT project • Memorable week – “stars aligned” • Began development of Inter-municipal agreements • Shared services start in October 2012 • PILOT thru 2014 • Participation in RWJ shared service learning community • First Counties in NYS

  27. Return On Investment • Quantitative • Over $400,000 saved between the two counties • Includes splitting costs of 4 administrative positions • Shared travel / meeting expenses • Common/Shared Consulting and professional services • CDC PHAP associate

  28. Return On Investment • Qualitative • Coordination of public health education and community messaging – including joint Community Health Assessment / Community Health Improvement Plan • Joint Purchasing / Vendors – cost reports • Program changes – septic program alignment (in Orleans – theoretical savings of $185,000) • Sharing interns between the counties • Shared service staffing agreement

  29. Moving Forward • Finishing up second year of RWJ project • Beginning joint strategic planning • Exploring joint accreditation • Meeting with decision makers • Making recommendations on future direction • Renewing inter-municipal agreements • Merging Boards of Health • Institutionalizing shared services relationship

  30. For further information on this project, please contact us at: Don Rowe: dwrowe@buffalo.edu Paul Pettit: paul.pettit@orleansny.com Kenneth Oakley: koakley@lakeplains.org

  31. Thank You

  32. Sharing Public Health Functions and Capabilities: Critical Issues Gianfranco Pezzino, Co-Director Center for Sharing Public Health Services phsharing.org

  33. Overview of this Session

  34. Overview of this Session

  35. Factors for Success • Prerequisites: • Take care of these before you even start planning • Facilitating factors: • Leverage them if they apply to your team and project • Project characteristics: • Build them in your project

  36. Factors for Success

  37. Factors for Success

  38. Factors for Success

  39. Overview of this Session

  40. Is There a Good Path? • A roadmap to develop cross-jurisdictional sharing (CJS) initiatives • Developed by the CSPHS • Based on what we have learned from demonstration sites (and other published material) • See handout • Also available at: http://www.phsharing.org/roadmap/

  41. Phase 1: Explore Is CJS a feasible approach to address the issue you are facing? Who should be involved in this effort? Phase 2: Prepare and Plan How exactly would it work? Phase 3: Implement and Improve Let’s do it!

  42. Phase 1: Explore Is CJS a feasible approach to address the issue you are facing? Who should be involved in this effort?

  43. Phase 2: Prepare and Plan How exactly would it work? (1 of 2)

  44. Phase 2: Prepare and Plan How exactly would it work? (2 of 2)

  45. Phase 3: Implement and Improve Let’s do it!

  46. Overview of this Session

  47. The Uncomfortable Questions • We have about 2,500 LHDs in the U.S. • Do we need 2,500? • Can we afford 2,500? • Can we imagine a day when all of them would meet accreditation standards? • Is it politically feasible to change the current LHD structure? Adapted from: Gene W. Matthews, JD

  48. Key Points: CJS, QI, Accreditation • QI and PM tools can support successful CJS efforts • CJS can provide QI and PM documentation for accreditation • CJS may increase accreditation readiness • Use shared services to show conformity in shared areas • Some jurisdictions can achieve standards jointly, but not independently • Working jointly on accreditation may strengthen the coalition of sharing jurisdictions

  49. What is Next? • Many questions remain: • Is this model applicable to CJS involving: • States? • Tribes? • System-wide changes? • Public-private and public-non profit collaborations? • What are the fiscal implications? • Cost of separate versus shared services • Apportionment: how do we split the tab? • Is there a taxonomy of CJS agreements that can be developed? • What are the long-term effects of CJS? • How do we measure success beyond a single project?

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