#1West Virginia State Bureau for Public Health Public Health Impact Task Force West Virginia State University May 13, 2015 WEST VIRGINIA Department of Health Human Resources BUREAU FOR PUBLIC HEALTH#2WEST VIRGINIA Department of Meeting the Public Health Needs of All WV Residents Health The Vision of the Bureau for Public Health is to have healthy West Virginians in healthy communities. Human Resources BUREAU FOR PUBLIC HEALTH Ensuring "consistency" in services to residents across all 55 counties. The Mission is to help shape the environments where West Virginians can be safe and healthy in their communities. A community is where you live, work, walk, pray, play, eat and sleep. 1#3Office of Communications Allison Adler Director Director of Legislative Affairs Hallie Mason Legislative Liaison Assistant to the Secretary Jeremiah Samples Assistant to the Secretary Nancy Sullivan Director of Public Health Regulation Brian Skinner Human Resources Director Pam Holt Secretary 2 Regina Mitchell Administrative Services Personnel Assistant. Administrative Services Assistant 1 Vacant Amy Acey Assistant 3 Erica Dickerson Organization Structure BUREAU FOR PUBLIC HEALTH WEST VIRGINIA DEPARTMENT OF HEALTH AND HUMAN RESOURCES Karen L. Bowling Cabinet Secretary Office of Human Resource Management Harold D. Clifton Deputy Secretary for Administration Warren D. Keefer Deputy Secretary for Programs and Policy Vacant Inspector General David A. Bishop General Counsel Karen Villanueva- Matkovich Health Protection Deputy Commissioner Barbara S. Taylor Communications Toby Wagoner Public Information Officer Privacy, Health Informatics & Continuity Michael Morris Director Bureau for Public Health Rahul Gupta, MD, MPH, FACP Commissioner & State Health Officer Public Health Administration Deputy Commissioner Chuck Thayer Central Finance Tim Whitener CFO Health Improvement Deputy Commissioner Anne Williams Center for Performance Management Amanda McCarty Director Center for Local Health Amy Atkins Director WEST VIRGINIA Department of Health Human Resources BUREAU FOR PUBLIC HEALTH Office of Chief Medical Examiner Allen Mock, Chief Donald Raynes Administrative Director Investigations Pathology Toxicology Death Fatality Review Team Office of Environmental Health Services Walter Ivey Director Environmental Engineering Public Health Sanitation Radiation, Toxics & Indoor Air Quality Office of Laboratory Services Sharon Cibrik Interim Director Thomas Ong Interim Director Clinical Laboratory Services Environmental Laboratory Services Office of Emergency Medical Services Melissa Kinnaird Interim Director Michael Mills EMS Medical Director EMS Licensure & Certification Trauma Designation & Categorization Medical Communications Center for Threat Preparedness Jerry Rhodes Director Melissa Kinnaird Associate Director Pandemic Planning Health Care System Preparedness Public Health Preparedness Strategic National Stockpile WV Public Health Alert System Office of Community Health Systems & Health Promotion Joe Barker Director Primary Care Rural Health & Recruitment Health Promotion & Chronic Disease Tobacco Prevention Office of Maternal, Child & Family Health Christina Mullins Director Infant, Child & Adolescent Health Research, Evaluation & Planning Perinatal & Women's Health Office of Nutrition Services Cindy Pillo Director Pediatric & Pregnancy Nutrition Surveillance Women, Infants & Children Program (WIC) Farmers' Market Nutrition Program Health Statistics Center Danial Christy Director Vital Records & Data Management Statistical Services & Chronic Disease Epidemiology Behavioral Surveillance Office of Epidemiology & Prevention Services Loretta Haddy Director, State Epidemiologist Cancer Epideiology Hemophilia Program Immunization Services Infectious Disease Epidemiology Needlestick Injury Prevention STD, HIV and Hepatitis Tuberculosis Elimination Services School Health Coordinator Teresa Mace Office of Minority Health Taya Williams Director 2#4Bureau for Public Health Workforce State Health Officer and Commissioner Administration • Accountants Health Protection WEST VIRGINIA Department of Health Human Resources BUREAU FOR PUBLIC HEALTH Health Improvement ● Forensic Pathologists • Nurses ● Buyers . Grants . Engineers • Social Workers · Nurses ● Specialists . Geologists • ● Monitors and • Chemists . Auditors • Physicians . Epidemiologists Physicians Entomologists Statisticians ● Human • Microbiologists Resources Managers • Public Health Attorneys • Health Specialists · Sanitarians • CDC Assignees · Radiological Health Specialists • CDC Assignees Administrators, Program Managers, Public Information Specialists, Programmers, Data Analysts, Support Staff 3#5Public Health Evolution WEST VIRGINIA Department of Health Human Resources BUREAU FOR PUBLIC HEALTH Health Care Reform Current Trends and Expectations ● Declining federal and state public health funds. Changes in funding priorities. • ACA and Medicaid expansion. ● Payment reform - Value and Performance Based Reimbursement. 4#6Example: Threat Preparedness Projections WEST VIRGINIA Department of Health Human Resources BUREAU FOR PUBLIC HEALTH PHEP Funds in 2012 $ (millions) $1,400 $1,200 $1,000 $800 $600 $400 $200 Projected Impact of Funding on Public Health Preparedness Building vs. Maintenance 2003 to 2020 Funds to Maintain Funds for Build Preparedness (Overall Capability) 2020 2019 2018 2017 2016 2015 2014 2013 2012 2011 2010 2009 2008 2007 2006 2005 2004 2003 70% 60% 50% 40% 30% 20% 10% 0% 5#7Performance Management Data informed performance evaluation. Federal funding requirements and conditions. Public Health Accreditation. Bureau for Public Health Performance Management Indicators Environmental Health Services - Public Health Sanitation WEST VIRGINIA Department of Health Human Resources BUREAU FOR PUBLIC HEALTH Performance Measure COMMUNITY HEALTH OUTCOME Goals: Measures Previous Period Current Period Target Current Period Trend Direction Number of Periods Frequency % inspection results showing lower food borne illness risks than 2012 baseline 0% 0% 5% 4 Quarterly COMMUNITY IMPLEMENTATION Objectives: Measures % follow-up inspections related to identified risks conducted within required times 85% 85% 100% 4 Quarterly % inspections with exit interviews & properly signed acknowledgments COMMUNITY PROCESS & LEARNING Objectives: Measures Initiative: Quarterly analysis of data from FDA collection tool to determine necessary changes and improvements in the food program Initiative: Conduct Annual Policy review to determine needed policy change. 100% 100% 100% 4 Quarterly 1 1 1 4 Quarterly 1 1 1 Annually 6#8BPH Funding BPH Expenditures By Funding Source (SFY 2014) Special Revenue 23% State General Revenue WEST VIRGINIA Department of Health Human Resources BUREAU FOR PUBLIC HEALTH 46% Federal Revenue 31% 7#9BPH Expenditures BPH Expenditures by Budget Category (SFY 2014) Subrecipient Awards 27% Administration 19% WEST VIRGINIA Department of Health Human Resources BUREAU FOR PUBLIC HEALTH Medical Payments 16% Other Disbursements 17% Administration Subrecipient Awards Medical Payments Other Disbursements State Aid To Local Health ■WIC (EBT) State Aid To WIC (EBT) 12% Local Health 9% 8#10Other WV State and National State Agencies Associations Legislature Local Health Departments County and Municipal Governments Partnerships WEST VIRGINIA Department of Health Human Resources BUREAU FOR PUBLIC HEALTH Federal Agencies Health Systems Academia West Virginia Bureau for Public Health Trade Associations Economic Development Industry and Manufacturers Other State State Coalitions Health Departments Payers 9#11Serving West Virginia Residents Providing Comprehensive Laboratory Services WEST VIRGINIA Department of Health Human Resources BUREAU FOR PUBLIC HEALTH Operates under national public health laboratory standards to perform clinical diagnostic and environmental testing, as well as chemical and biological agent testing. Select 2014 Data . 82,679 total clinical specimens received, 1,530,433 clinical tests completed. 1,428 Rabies and West Nile specimens, 1,371 tests completed. • 262 Bioterrorism Samples received. PDX 1 • 1,921 Drinking Water samples received, 2021 tests completed. • • 13,285 Environmental Micro samples received, 9902 tests completed. 2,275 Milk Samples Received, 7,818 tests completed. 10#12Serving West Virginia Residents Protection From Adverse Environmental Factors WEST VIRGINIA Department of Health Human Resources BUREAU FOR PUBLIC HEALTH Current Activities • • • • Issues 167 bottled water distributions permits to facilities in 13 countries and 30 states annually. Over $75 Million to drinking water projects across the state affecting 187,534 people from 2011 through 2014. Inspect and regulate 90 Grade "A" dairy farms. Permits 150 large quantity infectious medical waste generators. • Inspects and regulates 110 food processing plants. Trains all registered public health sanitarians. 11#13Serving West Virginia Residents Chief Medical Examiner WEST VIRGINIA Department of Health Human Resources BUREAU FOR PUBLIC HEALTH Conducts comprehensive forensic death investigation utilizing forensic pathology, toxicology and death investigation protocols. WV Drug Overdose Deaths for Selected Drugs 2001-2013 Occurrences by Year 250 D e 200 a 150 100 h * S 50 0 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 -Alprazolam -Oxycodone Diazepam -Methadone -Hydrocodone Cocaine --Morphine -Fentanyl 12#14Serving West Virginia Residents Supporting Maternal, Child and Family Health WEST VIRGINIA Department of Health Human Resources BUREAU FOR PUBLIC HEALTH Creates comprehensive systems of care for women, infants, children and adolescents focused on the full spectrum of public health services from prevention to clinical treatment programs. Current Trends ● The Family Planning and Breast and Cervical Cancer Screening Programs (BCCSP) estimate a 57% reduction in utilization of cervical cancer screening services from 2013. BCCSP is estimated to screen 4,700 women this year, compared to 14,000 women two. years ago. This is an estimated 67% reduction. Home Visitation program funding has increased dramatically from $1 Million in 2010 to $17 Million in 2015. 13#15Serving West Virginia Residents Increasing Access to Health Care in Rural Communities WEST VIRGINIA Department of Health Human Resources BUREAU FOR PUBLIC HEALTH Operates under national guidelines and best practice programs to recruit and retain health care professionals in rural communities. 43 RGOTTEN WORLD HIGHWAY Healthcare 819 km Nearest Town 87 km Select 2014 Data • • Conducts Health Professional Shortage Area (HPSA) designation assessments. The J-1 Visa Waiver Program placed 32 health care providers in 2014. State Loan Repayment Programs placed 50 health care providers in underserved or rural areas in 2014. 14#16Serving West Virginia Residents Comprehensive Statewide Epidemiological Services WEST VIRGINIA Department of Health Human Resources BUREAU FOR PUBLIC HEALTH Oversees statewide surveillance, investigation, and tracking of: required reportable conditions; communicable diseases; chronic diseases; maternal and child health indicators; and environmental related illnesses. Data Health Epidemiology People Current Activities • BPH employs a wide range of specialized epidemiologists, including infectious disease, environmental, maternal and child health, disaster and chronic disease epidemiologists. Maintains the statewide WV Immunization Information System. • Investigate an average of 134 outbreaks per year since 2009. 15#17Serving West Virginia Residents Emergency Medical Services WEST VIRGINIA Department of Health Human Resources BUREAU FOR PUBLIC HEALTH Increase the quality of emergency care for West Virginians by overseeing emergency medical services and systems. 00 Jas-Care AMBULANCE MARION COUNTY Alan Ca RESCUE SQUAD • A Current Activities · • State authority for Trauma Center designation. Certifies over 8,000 EMS personnel such as paramedics and EMTs. Inspects, licenses and regulates EMS agencies. • Oversees interoperable radio communications network infrastructure. 16#18WEST VIRGINIA Department of Health Human Resources BUREAU FOR PUBLIC HEALTH Serving West Virginia Residents Reduce The Incidence of Preventable Disease and Death RAZE 'tear down tobacco lies. Breathe Easy You're in Smoke-Free Territory Current Trends and Activities Policy, environment and systems change. Evidence based interventions. Community coordinated care systems. Clinical and public health linkages. Social and Economic determinants of health. 17#19Summary WEST VIRGINIA Department of Health Human Resources BUREAU FOR PUBLIC HEALTH Public Health is evolving - Public Health System must adapt. Health In All Policies approach. Maximize effective use of decreasing public health funds. Consistency in administration of public health services and programs. Focus on performance management, health outcomes, and accountability. 18 18#20Local Health Projected Budgets for Fiscal Year 2015 WEST VIRGINIA Department of Health Human Resources BUREAU FOR PUBLIC HEALTH Projected Revenues State Revenue (A) $16,697,292 County Commission (B) $ 2,151,531 County Levy (C) $ 2,009,335 $ 6,000 Projected Revenues by Funding Source 4.64% State Revenue Local Support $ 298,150 Clinical Service $ 6,082,599 21.22% 39.35% Revenue Environmental Fee City Levy (D) Municipalities (E) Board of Education (F) Clinical Service Revenue (G) Environmental Fee Permits (H) Environmental Fee Services (1) Federal Revenue (J) Additional Revenue (K) Total $ 324,800 $ 3,203,173 $ 684,620 $ 9,003,593 7.55% Permits $ 1,967,072 1.61% Environmental Fee $42,428,165 14.34% 11.2996 Services Federal Revenue Projected Expenditures Classified Service Personnel (L) $30,242,640 Current Operating Expenditures (M) $11,528,637 Capital Outlay Expenditures (N) Total $ 887,628 $42,658,905 Additional Revenue WV Bureau for Public Health Center for Local Health (2015) FY 2015 LHD Annual Plans of Operation Statewide Summary 19#21Local Health Projected Expenditures: Basic Public Health Services WEST VIRGINIA Department of Health Human Resources BUREAU FOR PUBLIC HEALTH 49% 1% 5% 1% Community Health Promotion 23% Environmental Health Epidemiology ■HIV/AIDS Immunizations Office Management/Administration 2% Sexually Transmitted Diseases 1% Tuberculosis Services 13% WV Bureau for Public health Center for Local Health (2015) FY 2015 LHD Annual Plans of Operation Statewide Summary 20#22Summary of Local Health Departments Operating with a Deficit WEST VIRGINIA Department of Health Human Resources BUREAU FOR PUBLIC HEALTH LHD 1 LHD 2 LHD 3 LHD 4 Less than 3 months cash/cash equivalents reflected in most recent audit for 6 agencies. Audits for 2011 - 2013 reflect an annual deficit for 8 agencies. % of Projected Personnel Expenditures to Projected Total Expenditures: Range: 52% - 89% Mean: 74.3% LHD 5 LHD 6 LHD 7 LHD 8 LHD 9 LHD 10 LHD 11 LHD 12 LHD 13 LHD 14 LHD 15 LHD 16 LHD 17 LHD 18 LHD 19 $0 ($50,000) ($100,000) ($150,000) ($200,000) ($250,000) Data Source: Published Audits on File http://www.wvsao.gov/CID/pdfAuditWebApp/ 21#23Summary of Local Health Departments Operating with a Deficit (Estimated OPEB Liability Removed) WEST VIRGINIA Department of Health Human Resources BUREAU FOR PUBLIC HEALTH LHD 3 LHD 1 LHD 4 LHD 5 LHD 6 LHD 7 LHD 8 LHD 9 LHD 10 LHD 12 LHD 13 LHD 14 LHD 15 LHD 16 LHD 17 LHD 18 LHD 19 $0 The degree to which the OPEB liability contributes to the agency's annual financial deficit appears to be minimal. ($50,000) ($100,000) ($150,000) ($200,000) ($250,000) Data Source: Published Audits on File http://www.wvsao.gov/CID/pdfAuditWebApp/ 22#24100 90 Summary of Local Health Department Personnel Expenditures Percent of Personnel Expenditures to Total Expenditures WEST VIRGINIA Department of Health Human Resources BUREAU FOR PUBLIC HEALTH 80 70 60 50 40 30 20 10 0 9 LHD LHD LHD LHD LHD LHD LHD LHD LHD LHD LHD LHD LHD LHD LHD LHD 17 2 13 19 15 8 10 12 4 7 1 11 5 3 14 Data Source: Personal services expenses as reported in the most recent published audit. Personal services were not able to be determined for LHD 6, 16 and 18. 23#25The West Virginia Public Health System Functions: Legal Authority Policy Development Partner Engagement Continuous Improvement Oversight of Operations Governing Body Administration WEST VIRGINIA Department of Health Human Resources BUREAU FOR PUBLIC HEALTH Functions: Develop and implement local health services Assure compliance with state and federal laws Interpret program needs and objectives Responsible for efficient and effective utilization of fiscal and personnel resources Reports to local board Services Intent of the System: To assure public health services are provided to all citizens. The authority of the Bureau for Public Health is to monitor the administration, operation and coordination of local boards of health and local health officers. Functions: To prevent and control epidemics (infectious diseases) Promote a safe and health environment (environmental health) Promote health lifestyles (community health promotion) 24 24#26Powers and Duties of Public Health Agencies WEST VIRGINIA Department of Human Resources BUREAU FOR PUBLIC HEALTH Public Health Governance • State Public Health System 25 25#27Powers and Duties of Public Health Agencies Local Boards of Health ● . Authority to Create, Establish and Maintain Powers and Duties of Local Boards of Health Financial Responsibilities WEST VIRGINIA Department of Human Resources BUREAU FOR PUBLIC HEALTH 26#28Powers and Duties of Public Health Agencies • State of West Virginia ● Powers and Duties of the Commissioner WEST VIRGINIA Department of Human Resources BUREAU FOR PUBLIC HEALTH Powers and Duties of the Commissioner Over Local Health Contributions from Legislative Appropriations and Receipt and Disbursement of Federal Aid 27#29WEST VIRGINIA Department of Powers and Duties of Public Health Agencies Summary Human Resources BUREAU FOR PUBLIC HEALTH • Authority • Structure • State and Local Public Health Relationships 28