New Performance Effectiveness and Efficiency Measurement Initiative

Since the start of our work, the Center has frequently been asked, “Does cross-jurisdictional sharing (CJS) really work? Does it make a difference?” These questions come from health officials, who want to know if improvements in public health service delivery resulting from CJS efforts can be demonstrated, and from policymakers, who want to know if cost or other efficiency improvements resulting from CJS efforts can be quantified. Based on our work to date and our review of others’ experiences, our answer is yes — but it is a qualified yes.

Since 2012, the Center for Sharing Public Health Services has provided technical assistance, resources and best practices to communities interested in CJS approaches. During that time, we have learned that CJS — if carefully implemented — can help policymakers and public health officials increase effectiveness and efficiency of public health services. CJS does this by generating economies of scale that allow public health departments to enhance services and provide programs that otherwise would not be economically feasible.

So our answer is, “Yes, it does appear that CJS can make a positive difference in performance and efficiency.” But it’s a qualified yes, because the answer is most often based on case-specific, self-reported and qualitative evidence. As of yet, there hasn’t been a systematic way of measuring differences in performance and efficiency resulting from CJS arrangements. Not being able to provide a more comprehensive and evidence-based answer to these questions has been frustrating.

Given this, we now are extremely pleased to announce the launch of our new CJS Implementation and Impact Measurement Program. We will be working with four sites located in Michigan, Minnesota, North Dakota and Wisconsin. Teams at these sites will work with us to quantify changes in effectiveness and efficiency that result from using cross-jurisdictional sharing approaches.

We will be testing a systematic, common and shareable methodology for measuring changes in effectiveness and efficiency resulting from CJS implementation and, at the same time, we’ll learn more about the specific CJS-related outcomes in each of these four sites. More information on the individual projects can be found below.

With this new measurement initiative, the Center is transitioning from learning how CJS approaches work to measuring their impact. Along the way, we will share what we learn through this newsletter and other venues. This new learning objective should prove to be very interesting, and we hope you will come along with us on this journey. Measuring impact, after all, is applicable in many areas of public health and government.

We also are launching a new mini-grant opportunity that will support the efforts of public health jurisdictions in moving their CJS efforts forward and at the same time will help us improve understanding and knowledge of some select issues related to cross-jurisdictional sharing. For more information on this ongoing funding opportunity, please read the call for proposals.

While we are now turning our attention and efforts more toward measuring the impact of CJS models, we are still available to provide information, guidance and technical support to any jurisdictions or organizations interested in knowing more about CJS or implementing a CJS project.

If you have questions about our new focus, or questions about CJS in general, please feel free to email us at

– Pat Libbey and Gianfranco Pezzino, Center Co-Directors

Read past messages from the co-directors.