BOX 5-2 Rochester Private–Public Partnership Approach One example of a coordinated, strategic private–public partnership approach has been demonstrated in Rochester, New York, with favorable results. Szylagyi (1999) prepared a randomized sample of 30,000 charts from Rochester's 80 pediatric provider practices, and reported 1993 coverage rates as follows: 55 percent in the inner city, 65 percent in the remaining urban areas, and 75 percent in the suburbs. The study tested the impact of an intervention consisting of a tiered reminder–recall–outreach intervention, with outreach (the most expensive approach) targeted to the most hard-to-reach portion (5–10 percent) of the study population. The results of the tiered intervention included a 20 percent increase in immunization coverage and an 11 percent increase in preventive service visits, which had the spillover effect of increasing anemia screening (by 12 percent) and lead screening (8 percent). The same intervention was implemented countywide, and a follow-up survey in 1996 showed significant increases in coverage. The greatest improvements were for inner-city children, whose rates increased from 55 percent in 1993 to 75 percent in 1996. These interventions have been financed by a unique collaboration between the county and state health departments that has allowed county health officials to pool money from several categorical programs. As more clients seek immunizations within their medical homes among private providers, other sources of revenue are able to finance some of the costs of the immunization program.