Standardizing Excellence: Missouri is Helping Local Health Departments Achieve PHAB Accreditation
Success StoriesMissouri has a decentralized public health system, with 115 local health departments, and the state health department is using PHIG to incentivize local agencies to pursue accreditation while helping them overcome barriers like staffing shortages, contracting costs, and training needs. The Missouri Department of Health and Senior Services uses PHIG to provide cost reimbursement funding that local agencies can use to hire staff or contractors to support accreditation. They also partnered with the Public Health Accreditation Board (PHAB) to offer PHAB’s trainings and readiness assessment to local health departments at no cost, and even tied some of their general revenue incentive payments to participating in these offerings. This approach allows local health departments to access accreditation training, coaching, and readiness assessments while also receiving financial support.
As a result, over 80% of Missouri’s local health departments are now on a pathway toward accreditation or reaccreditation. Accreditation provides a framework for effective strategic planning, performance management, and quality improvement. It ensures health departments operate efficiently, support their workforce, and deliver essential services at a high standard. Missouri’s goal is to maintain a standard of excellence across all public health agencies, and accreditation is key to achieving this.
Video Transcript
This transcript has been lightly edited for clarity.
How have you been able to use PHIG funding?
So, the Public Health Infrastructure Grant (PHIG) is a really unique funding stream that comes to us non-disease specific, right? Wide-ranging. So when we got the notification that PHIG was on the way, we really met and we spent a long time thinking about: how we can maximize this funding? What can we do to really fix our infrastructure? That’s why it’s in the title of the grant, right?
In the state of Missouri, we have 115 local public health agencies. We’re a decentralized system. So, I like to say we’re a big sister, little sister relationship. The more we can do to encourage those partnerships with the locals and foster accountability with them, the better. And accreditation is the way to do that – it’s that framework to get you there. So, you really have a real strategic plan. You’re using performance management for real impactful things. You’re focusing on quality improvement. With the tenets of transformation, if you can achieve accreditation, you know your operations are up to snuff. If you can focus on your workforce through accreditation as well, you know your people are happy. We want to elevate all of the public health jurisdictions in the state of Missouri to that level of excellence, and accreditation is the key.
How have you made accreditation more attainable?
When we wrote our PHIG application, we made sure we had a diverse set of ways to support locals on their accreditation journeys. We knew we couldn’t tie everything to straight-up achieving accreditation because that is a very far-away dream for a few of our jurisdictions. So, we tied it to making progress on your journey. You may not be accredited next year, but you’ve got this north star of a plan that you know what you’re going to do for your folks now. That is a net positive for public health.
At the state level, we decided to address those barriers with cost reimbursement funding that you can use to hire or pay for staff time or contract out to get some of those big, scary things done for accreditation. We made sure folks had access to the training and their readiness assessment from the Public Health Accreditation Board (PHAB) at no cost. We even tied some of our general revenue incentive payments to engaging in that offering, so our locals could get the training, the one-on-one coaching, the recommendations, and take the readiness assessment while making money. We tried to incentivize that and remove the barriers of people, time, and money through support from the state.
How have local health departments responded to this help?
One of the big barriers toward accreditation is the cost associated with contracting out, if you choose to, and spend the staff time to make it happen. So we knew that that was one of the big ones we needed to address through PHIG support. We had 10 jurisdictions that were already accredited and we wanted to make sure they maintained their accreditation. Beyond that, we thought maybe one or two locals will get there for us. But we’re in year three now, with $50 million distributed in cost reimbursement over two years to 50 jurisdictions in our state out of 115. That’s pretty great that that many actually are interested, and put in budgets, and were granted that support. And through our readiness assessment contract with PHAB and the incentive dollars tied to that, over 80% of our local public health agencies have engaged in that offering. That is progress toward accreditation; that is them learning about pathways, learning about whether they could go ahead and go for accreditation, and determining whether they are ready.
Furthermore, with the recent readiness assessment for reaccreditation that engages those 10 who were already on their game, it makes sure that the entire population is involved.
What does this look like for small health departments?
Very proud of Michelle – shout out to Michelle and Carter County. They recently completed their site visit for the first time ever for accreditation with PHAB, and it was in person. Michelle really is tenacious, and she took advantage of the support we have out there. She is part of our technical assistance cohorts. I see emails from her asking, “How did y’all do this?” weekly. She’s a great example of a health department that is so under-resourced; she has five FTE (Full Time Employees) in her agency and probably 4,000 people in her county. So – tiny. But what they did, they took advantage of the support options and she threw herself into this. She learned it, she did it. She is my shining example of anyone being able to do this if you have the chutzpah, the energy, and the support to do it. So, engage in the resources there and you can get there. I will be bragging about Carter County for the rest of my life.
Why is funding of this kind worth it?
We’re able to be more flexible with PHIG funding because it is so wide-ranging. If folks are doubting the effectiveness of the PHIG dollars, I want them to look around at their local agencies and their state agencies and see the amazing work that is being done with this money. I firmly believe the more money you put into public health, the better the folks that live in your jurisdiction are.
Some of the things we rattle off in Missouri: if you want to reduce Medicaid spending, did you know that $1 in public health spending saves $7 in Medicaid spending? We need to always have those talking points out and ready, and we need this kind of funding that lets us put money where we most need it to build that system up, rather than having siloed little programs like we’ve always done.