Finance-Resource Management & Cost Containment
Room: Thoroughbred 4
Wednesday, April 9, 2014, 10:45 am-12pm
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AUDIO
KC14 Session 3D on Finance: Resource Management & Cost Containment by NCC for PHSSR
MODERATOR
Simone Singh, Ph.D.
PRESENTERS
Phaedra Corso, Ph.D., M.P.A.
Evaluating the Impact of Reallocating Georgia's Funding for Local Public Health Infrastructure
Co-Investigators: None Listed
Background: General Grant-in-Aid (GGIA) is the core funding allocation for public health (PH) infrastructure from Georgia’s state health department to the 159 local county health departments (LHDs). The GGIA allocation formula was modified in fiscal year (FY) 2012 based on the 2010 county population and poverty rates. As a result, some LHDs (n=113) experienced an increase in GGIA funding whereas others (n=46) were kept constant at pre-GGIA formula change levels.
Research Objectives: The purpose of this study is to assess the impact of a modified GGIA allocation formula on PH infrastructure spending and consequently, on PH outcomes.
Data Sets and Sources: Five year budget data (FY2008 to FY2012) provided by the Georgia Department of PH. Study Design Quasi experimental (Pre/Post) study design.
Analysis: Separate logistic regressions were conducted for each infrastructure category. Independent variables consisted of the following revenue streams – Local, Federal, Fees, Other and GGIA. Dependent variables were the infrastructure categories – Personnel, Regular Operating and Equipment.
Principal Findings:Prior to FY2012, all 159 LHDs showed a significant relationship between GGIA funding and Personnel expenditures. In FY2012, there was a statistically significant (p
Conclusions: The results indicate a transformation in PH infrastructure spending for FY2012. LHDs with an increase in GGIA due to the new funding formula continue to have a significant relationship with PH infrastructure spending (especially personnel expenditures), while the LHDs that did not experience an increase in GGIA failed to show a significant relationship between GGIA and PH infrastructure spending.
Implications for Public Health Policy and Practice: This study will continue to track the impact of the modified GGIA formula over the next several years and the results will help inform PH leaders and guide the consideration of future formula changes.
L. Michele Issel, Ph.D., RN
Using Cluster Analysis to Characterize LHD Responses to the Economic Downturn
Co-Investigators: Arden Handler, Ph.D., Allyson Holbrook, Ph.D.
Background: The population size of the LHD jurisdiction has been used as a key variable in understanding local differences in LHDs. We sought an alternative approach to grouping LHDs for comparative analyses.
Research Objectives: We sought to develop an empirically driven and meaningful approach to group LHDs based on LHDs’ approaches/strategies to responding to the economic downturn.
Data: Primary data collected in spring 2012 using a questionnaire with items which asked about LHD characteristics, the essential public health services (EPHS), Maternal and Child and Adolescent Health (MCAH) processes, and strategies used to respond to the economic downturn.
Study Design: With NACCHO, we conducted an online survey using Qualtrics. A random sample of NACCHO members stratified by size of LHD was selected within strata. Of the 546 LHDs invited to participate, 269 (49%) MCAH program directors returned usable surveys.
Analysis: We conducted cluster analysis to develop a typology of strategies used by LHDs to respond to the economic downturn. We used the Ward’s statistic to determine cluster similarity and assessed the extent to which each solution yielded differences on key variables (e.g., population size, number of FTEs). Ultimately, the 3 cluster solution for strategies provided the most meaningful distinctions. Using the clusters, LHD differences on various characteristics were tested by ANOVA.
Principal Findings: The three cluster solution for strategies used by LHDs to respond to the economic downturn are described as “staying the course” (n=51%) with minimal changes, “middle of the road” (n=27%) with a few changes, and “doing a lot of things” (n=22%). Based on ANOVA, LHD clusters differed significantly on jurisdiction size (p
Conclusion: Use of cluster analysis provided distinct groupings of LHDs which yielded new insights into the ways that LHDs differ, particularly in terms of performance.
Implications: New analytic approaches can yield more nuanced insights which are useful in identifying LHDs exemplars in performance of the essential public health services. Such information has relevance to accreditation and other health policies affecting LHDs.
Richard Ingram, Dr.P.H., M.Ed.
Roles for Local Health Departments in Accountable Care Organizations
Co-Investigators: Julia Costich, Ph.D., J.D., F. Douglas Scutchfield, M.D.
Background: Accountable care organizations (ACOs) have been established under the auspices of the Centers for Medicare and Medicaid Services (CMS) to serve Medicare and Medicaid beneficiaries. ACOs have the triple aim of improving health care and population health while containing costs. Medicare ACOs follow one of 3 models, while Medicaid ACOs are intentionally more diverse and innovative. The technical capacities and population health orientation required of ACOs have much in common with the work of public health agencies.
Research Objective: This study assesses the nature and extent of local health department (LHD) involvement in ACOs and identifies models for increased LHD-ACO relationships. Data Sets and Sources: CMS data on existing ACOs and detailed key informant interviews support a comprehensive assessment of LHD engagement with ACO initiatives.
Study Design: This study uses a cross-sectional design and a combination of semi- structured interviews and database analyses to determine the extent of LHD engagement with ACOs.
Analysis: Data and key informant interview findings were compiled to identify and classify the type and extent of current and prospective LHD involvement with ACOs.
Principal Findings: LHDs are involved with ACOs in relatively small numbers at present, but their diverse roles suggest options for future development. Distinct categories of LHD-ACO relationships include (1) contracted clinical service provider, (2) contracted non-clinical service provider, (3) governing board membership, and (4) strategic advisor. These roles appear almost exclusively in the context of Medicaid- and safety net-oriented ACOs.
Conclusions: LHD involvement in ACOs is very limited at present, but the handful of ACOs that include LHDs may provide useful models for broader future engagement.
Implications for Public Health Practice and Policy: LHDs are increasingly challenged to balance core public health services with potential new revenue streams. ACOs may provide an opportunity to expand funding options without compromising the core LHD mission, but participation options are currently limited to Medicaid- and safety net-oriented ACOs.