Research

Massachusetts Public Health Regionalization Project
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Regionalization Project overview
 

UPDATE: Regional Health Dialogs: 4/8/09 - 4/22/09
The Massachusetts Department of Public Health invites you to discuss opportunities and challenges for our public health system. Click on flyer for more information.

UPDATE: Memo from Commissioner Auerbach
This memo addresses the concerns of the Coalition for Local Public Health regarding the impact on the Massachusetts Public Health Department’s efforts to promote voluntary formation of regional health districts in the Commonwealth.
 
UPDATE: Senate Bill 2568
Senate Bill 2568, “An Act Relative to Public Health Regionalization in the Commonwealth” was signed by the Governor and will be cited as Chapter 529 of the Acts of 2008. A brief summary of the bill can be found here.

This bill is the result of hard work by many, but especially Cheryl Sbarra and Laura Richards of MAHB. Relying upon feedback from local health officials around the state, the Working Group was able to work with the leadership of both the Joint Committee on Health Care Financing and the Joint Committee on Public Health to craft a bill that addresses the questions and concerns of local public health officials.

Special thanks should go to our legislative sponsors:
  • Senator Fargo - 617 722 1572
  • Representative Koutoujian - 617 722 2130
  • Representative Brownsberger - 617 722 2140
  • Speaker DiMasi - 617 722 2150
  • Senate President Murray - 617 722 1500

Project Goals:
To strengthen the Massachusetts public health system by creating a sustainable, regional system for equitable delivery of local public health services across the Commonwealth.

Guiding Principles:
  • The system must respect existing legal authority of local health agencies
  • As a voluntary initiative, communities need incentives not mandates to participate
  • One size does not fit all; different models of regional structures and operations will allow communities to cluster in ways that will meet their needs
  • Full implementation of the system will require adequate and sustained state funding
  • The system will augment, not reduce, the existing local public health workforce
Critical Elements:
  • Providing the ten essential public health services to ALL residents of Massachusetts through an integrated public health system that offers a legal foundation, governance structures, and financial incentives for forming regions (districts)
  • Clarifying the roles and responsibilities at local, regional and state agency levels to strengthen and support an integrated system
  • Establishing standards for local, regional and state performance including: workforce credentials; performance measures and agency accreditation
  • Recommending a system to routinely deliver comprehensive training programs for the local public health workforce; training activities must be coordinated with performance standards and measures and include supervised field training
Progress to Date:
  • Solicited input through meetings with dozens of organizations across the state, including public health coalitions, regional planning agencies and local boards of health.
  • Developed Guiding Principles (e.g. The system must respect existing legal authority of local health [home rule]) and Critical Elements (e.g. Provide the ten essential public health services to ALL residents of Massachusetts through an integrated public health system that offers a legal foundation, governance structures, and financial incentives for forming regions).
  • Conducted research on trends and disparities in Massachusetts’ local public health system, other states’ experiences transitioning to a regionalized system, the economic determinants of public health system performance, and various regionalization models and funding structures.
  • Drafted three reports with recommendations for moving forward.
  • Identified legal, funding and other concerns that need to be addressed in order to facilitate regionalization – and created subcommittees to address each head on.
  • Introduced key legislation (which has passed in the MA Senate and House) that would allow local communities to pool resources and provide public health services across multiple communities.
  • Drafted three different models for organizing regional service systems (though other models will be considered).
  • Created an incremental plan to begin to phase in regionalization.
  • Secured a 2-year Robert Wood Johnson grant to create a public health “practice-based research network” to support our regionalization efforts.
Next Steps:
To bring a subset of the larger Working Group together to identify research and evaluation needs, develop strategies for assessment and review, and incorporate a meaningful research component into our work. The research funded by this project will help the State and several local health departments understand
  • what the process of moving from a local to a regional public health delivery system entails,
  • strategies and information needed to inform decisions about this move,
  • the financial costs and advantages associated with different service delivery models,
  • which model is most appropriate for specific towns and regions.
Ultimately, the formative research will help lay the groundwork for a future case-control study of public health systems improvement resulting from the adoption of regional public health service models throughout Massachusetts.
 
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