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

Paul.Pettit@orleanscountyny.gov

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?