How Public Health Sharing Arrangements Fit Into the Value Equation

Oct 6, 2015, 11:05 AM, Posted by Meshie Knight

In recent years, cross-jurisdictional sharing has been a focus for policymakers and public health officials wishing to increase effectiveness and efficiency in the delivery of public health services. Measuring its impact is next.

Well-functioning, high-value public health departments are critically important to ensuring the conditions for good health in communities. In recent years, however, health departments have been faced with exceptional financial challenges mostly in the form of repeated reductions in state and local funding for public health budgets. At the same time, expectations for their roles and responsibilities—as monitors and chief health strategists for communities and as partners within and beyond the health sector—are growing.

In 2012, RWJF launched a program to investigate a potential strategy for strengthening health departments that could be especially effective in times of financial or administrative hardship, and importantly, could also help to augment the capabilities of health departments serving particularly small or rural jurisdictions: cross-jurisdictional sharing (or more simply, publicly authorized sharing of public health services across jurisdictions). The Center for Sharing Public Health Services (CSPHS) was designed to help build the evidence for how cross-jurisdictional sharing (CJS) arrangements can be planned for and implemented in different environments.

The initial learning community of 16 CJS sites overseen by CSPHS experienced several successes. For example, in North Carolina, the Public Health Authority of Cabarrus County partnered with the Guilford County Health Department to explore opportunities for sharing dental services. Accomplishments to date include joint development of an enhanced client referral process; shared staff training; and an agreement for Guilford County to use the Cabarrus mobile dental unit. As a result of this work, Cabarrus is well-positioned to work with other counties in developing flexible and affordable dental services. These include but are not limited to a turnkey dental operation, consultation services, financial billing assistance, training and technical assistance. Other examples of successes include: establishing a formal learning community and funding mechanism for collaboration (in Minnesota); cutting management personnel costs in half in two upstate New York counties through shared staff; and bringing environmental services to five Colorado health departments that would not have been able to afford them individually.

As a result of its work over the past three years, CSPHS has been able to produce an extensive inventory of lessons on what works, and what does not, when planning for and implementing a sharing arrangement. Additionally, there is a wealth of media resources such as this really great podcast from our partner in this work, Pat Libbey, co-director, Center for Sharing Public Health Services, reflecting on the different types of sharing arrangements he’s seen and the types of supports that the Center can provide to interested communities.

While the case studies above are great examples of how some regions have benefited from sharing arrangements, effectively demonstrating the impact—both in terms of enhanced capacity and, often, enhanced efficiencies –of a CJS arrangement is not an easy endeavor. And yet being able to do so is critical for obtaining buy-in and support for entering into formal sharing relationships.

To begin to address this issue, RWJF is pleased to announce a new call for proposals that will further explore the “value proposition” of CJS arrangements. Up to seven teams engaged in public health CJS implementation efforts will be funded to work with CSPHS and the National Network of Public Health Institutes to capture and communicate the impact of their sharing arrangement on how effectively, and how efficiently (perhaps through increased capacity, reach, or dollars saved), their services are delivered. 

In a Culture of Health, the communities in which we live, work, learn, and play must promote the conditions for health. For public health systems to be strong and active contributors to building a Culture of Health, they need to be able to address challenges of economic instability effectively and efficiently while continuing to promote and protect the health of the people in the communities they serve.

Meshie Knight, MA, is a program associate at the Robert Wood Johnson Foundation working to improve the value of the nation’s health care and public health systems. Read her full bio.