Public health cross jurisdictional sharing: The rural New York experience

Under enormous fiscal pressures, health departments at the state and local level are seeking innovative solutions that preserve essential public health services, reduce cost and increase efficiency. Rural health departments are disproportionally impacted.  The Robert Wood Johnson Foundation’s Cross Jurisdictional Sharing (CJS) grant program is exploring promising strategies that address these issues. Cross jurisdictional sharing arrangements range from informal agreements around sharing discrete services or programs, to regionalization including the formal merger or consolidation of multiple public health agencies. In New York State, the process began  prior to the CJS grant, with regulatory relief that enabled two or more county health departments to share a common Commissioner or Public Health Director. Genesee and Orleans Counties are rural and demographically similar with a combined population of just over 100,000 and were the first to adopt this strategy resulting in substantial cost savings to both counties. With CJS grant funding it was possible to evaluate the potential for sharing additional resources and service integration. This paper is a year 1 progress report that will articulate the rigorous planning process, early successes, challenges, and planned next steps.  Preliminary results are encouraging from both a cost and efficiency perspective. Combined savings in shared personnel, transportation and contracting expenses derived from joint policy and procedural changes exceeded $340,000 without any decrease in service to both counties.  Political, regulatory and labor issues are under discussion and will shape the direction of the program in year 2 and beyond.