Research

Massachusetts Public Health Regionalization Project
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Regionalization Project overview

UPDATE: Request for Response: 8/31/09
With funding from the Robert Wood Johnson Foundation, the Boston University School of Public Health (BUSPH) has initiated a practice-based research network project (PBRN) to answer the question: “What is the best process for local health departments/boards of health to use for making decisions about moving to a regional public health delivery system?" Click here for the full RFR description.

Groups of communities interested in working with BUSPH and the Institute for Community Health to develop a pilot program to test a planning process and related tools for decision-making (when communities are considering a regional strategy for the delivery of essential public health services) are encouraged to submit an application. Click here for the RFR application template.
Application Deadline Extended: 11/15/09

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.
  • As described above, introduced key legislation (which was signed into law in January 2009 by Governor Deval Patrick) that removes several legal roadblocks and enables local communities to pool resources and provide public health services across multiple municipalities.
  • Framed two 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 “practicebased research network” (described below) to support our regionalization efforts.
  • Encouraged the 5 Coalition of Local Public Health associations to provide feedback to the national Public Health Accreditation Board (PHAB) on draft standards for voluntary state, local and territorial health department accreditation.
Next Steps:
Over the 2009-2010 year, The MA Public Health Regionalization Project Working Group has several activities designed to move our agenda forward including:
  • Provide recommendations to the MA Deaprtment of Public Health and MA municipalities considering a regional approach on methods for improving delivery of regional public health serves and public health workforce development in light of the current financial crisis.
  • Documenting, assessing and evaluating the regionalization process using the resouces of a 2-year grant from the Public Health Practice-Based Research Network (PBRN) Initiative.
  • Hold several regional meetings throughout the Commonwealth with local public health officials, emergency preparedness coalitions and public health association boards of directors to discuss this status report and its recommendations.
  • Meet with state legislators in an effort to broaden our base, build upon their past support of our efforts, strategize how best to move forward, and create a funding stream for local health districts.
  • Present a workshop on public health regionalization at the January 2010 Massachusetts Municipal Association meeting.
  • Work with the Health and Human Services administration to provide input into their regionalization conceptualization.
  • Create a Rapid Response communications team to enable the Working Group to immediately address regionalization portrayals within various media outlets throughout the Commonwealth.
  • Support local communities’ investigations into, planning for or transition to a regional model of public health service delivery, including distributing resources designed to facilitate the process under Chapter 529 (e.g. Template By-Laws).
  • Continue to work with MDPH to further refine the regionalization structure, including being responsive to the Working Group’s subcommittee findings.
  • Continue the work of some of the Working Group subcommittees, including employee protections, performance standards and agency accreditation, and social marketing.
 
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