Savings, Service and Sensitivities: The Rural New York Cross Jurisdictional Sharing
Experience
Donald W. Rowe, PhD
Director Office of Public Health Practice, University at Buffalo, State University of New
York
Paul Pettit, MSL Public Health Director
Genesee and Orleans County
Background
Programmatic and fiscal environment
National
State
Local
National View
Politics
Continued downward trend in money and resources
Annual uncertainty with funding streams
Large difference in delivery system from state to state
Accreditation - focus
New York State View
Politics
NYS structure State DOH, regional/district offices, county LHDs
State adopts/sets direction – carried out LHDs
New focus by NYS Health Commissioner
Provide reimbursements/funding to Counties Grants, article 6 – state aid
Local Health Department View
Shrinking county budgets – NYS tax cap
Focus on mandates
Limited capacity for “add-on's”
Reducing direct service delivery Certified Home Health Agencies
County run nursing homes
Mental health clinical services
2014 – NYS budget – tax rebates tied to staying with cap and shared services
County Collaboration efforts - Healthy Orleans Network
LHD Workforce
LHD Workforce
Need for Collaboration – background to Cross Jurisdictional Sharing
Current Federal, State & local environment
Limited resources on the ground
Philosophical shift facilitators vs. doers
New reality for government including Public Health
RWJF – Shared Services Learning Community Grant
Two year study (2013-14) through the Kansas Institute focused on cross jurisdictional activities in public health
75 public health departments and 26 local and state governments - explore ways to share resources with the goal of providing more efficient and effective public health services
$125,000 over to two years to study cross jurisdictional services (CJS) across geographical barriers
3 - on site project meetings & site visits at each participating project
Applied through Lake Plains Community Care Network
RWJF –Cross Jurisdictional Sharing Grant
16 sites were identified and accepted into the project
Notified of award in early December 2012
National Announcement released January 31st.
Definitions
Cross-jurisdictional sharing is the deliberate exercise of public authority to enable collaboration across jurisdictional boundaries to deliver essential 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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• “Handshake”• MOU• Information
sharing• Equipment
sharing• Coordination
• Service provision agreements
• Mutual aid agreements
• Purchase of staff time
• Joint projects addressing all jurisdictions involved
• Shared capacity
• Inter-local agreements
• New entity formed by merging existing LHDs
• Consolidation of 1 or more LHD into existing LHD
Informal and Customary Arrangements
Service Related Arrangement
Shared Functions with Joint Oversight
Regionalization
Cross-Jurisdictional Sharing Spectrum
A Tool For Sharing
A roadmap to develop cross-jurisdictional sharing (CJS) initiatives Developed by the CSPHS
Based on what we have learned from your projects (and other published material)
Also available at: http://www.phsharing.org/technical-assistance/
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Next Step
Genesee & Orleans PILOT
Agreements put in place in September for October 1, 2012 start date
Sharing PHD, Deputy PHD/Environmental Health Director
Notification of RWJF grant came in November 2012
First quarter – learning systems, cultures, getting our feet wet
Move to RWJ grant – overlap of the projects
Year 1
Focus on programmatic and fiscal savings
Brought on board nursing director (now 3 shared staff)
Reduced travel to meetings (1 covering both)
Sharing educational messaging
Aligning policies, fee schedules, local sanitary codes
Sharing consulting services (medical, engineering, transportation)
2 joint Boards of Health meetings
Return on Investment – year 1
Quantitative Over $400,000 saved between the two counties
Includes splitting costs of 3 administrative positions
Shared travel expenses
Consulting services
CDC PHAP associate
Return on Investment – Year 1
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
CJS Fiscal impact/Savings to date
Criteria DescriptionGenesee County
Enhanced Benefits/ Savings
Orleans County
Enhanced Benefits/ Savings
Annual Enhanced Benefits/ Savings
Total Enhanced Benefits/
Savings to Date (from 10/1/12)
Shared Staffing*
Public Health Director $66,000 $66,000 $132,000.00
$396,000
Emergency Preparedness Coordinator
$34,506 $34,506 $69,011 $86,264
Director of Children with Special Needs
$41,790 $41,790 $83,581 $20,895
Environmental Health Director
$21,941 $0 $21,941.00 $65,823
Director of Community Health Services
$51,000 $51,000 $102,000.00 $178,500
PHD Travel Expenses Savings Attending conferences, education and training
$513.89 $651.89 $1,165.78 $2,332
Sharing Medical and Environmental Engineering Consultation Savings
Existing Genesee County consultation being shared with Orleans County
$0 Medical: $7,500
Environ:$13,000
$20,500.00 $56,375
CDC PHAP Associate Benefit Assist both counties with research/analysis. Provided and paid for by CDC
$21,843.1 $21,843.1 $43,686.23 $87,372
Shared TransportationSavings
Joint RFP for Early Intervention and 3-5 Preschool Transportation
$0 $107,291.61
$107,291.61 $295,052
Total $ 428,584.62 $1,188,613
*Shared staffing estimates consists of both salary and benefits
Service
Shared medical director
Shared environmental engineering consultant
Shared training
Shared Early Intervention transportation
Shared public health education
Shared emergency response functions
Joint Community Health Assessments
Shared governance
Increased service efficiency
Sensitivities
Political change
Cultural differences
State continued support
Maintaining autonomy
Funding
Regulatory
Separate collective bargaining units
Necessities for Successful Sharing
Clarity of objectives
Present and acceptance of mutual benefit
Decision maker buy in & commitment difficult with changing leadership
Strong leadership skills – change management
Transparency
TRUST
Factors / Barriers to Sharing
CHANGE!
Cultural differences in each organization
Buy in of staff – leadership and workers
Logistics - Reduced physical presence by shared staff
Keeping decision makers happy & informed
burnout
Summary
Savings exceeding $1,000,000
No loss of Service
No person has lost their job
Significant increase in efficiency
Sustainable for the foreseeable future
Model has broad rural health application
Contact
For additional information please contact
Paul Pettit, Public Health Director, Genesee and Orleans Counties
Acknowledgement
The Robert Wood Johnson Foundation
The New York State Department of Health
The Lake Plains Community Care Network
The University at Buffalo School of Public Health and Health Professions
Thank You
Questions?