Virginias Health 2018

Marissa J. Levine, MD, MPH, FAAFPVirginia State Health CommissionerThe Virginia Department of Health

House Appropriations Health & Human Resources Subcommittee

Overview

VDH Overview and Updates

Virginias Health Status

Using a Population Health Improvement Approach

VDH Budget

2

2018 Introduced VDH Budget

3

4Data Source: Virginia Department of Health Plan for Wellbeing

www.virginiawellbeing.com

http://www.virginiawellbeing.com/

VDH: 110 Years YoungMission: To protect the health and promote the well-

being of all people in Virginia.

Strategic Goals: Maintain a competent and valued workforce

Foster healthy, connected, and resilient communities

Be a trusted source of public health information and services

Assure the conditions that improve health opportunity

Provide internal systems that deliver consistent and responsive support

Essential Public Health Services

Communicable Disease

Investigation and

ControlChronic

Disease and Injury

Prevention

Environmental Public Health

All Hazards Preparedness and Response

Maternal, Child and Family

HealthAccess to and Linkage with Clinical Care

Essential Public Health

Services

Foundational Areas

Oversight of Healthcare

Facilities = 9,226Vital Records Issued = 418,388

Deaths Investigated = 7,185

Screened For Sexually Transmitted Infectious

Disease = 108,523

Unique Clients Served Through WIC = 243,521 Restaurant

Inspections = 72,823

Newborns Screened

= 100,431

Summer Food Program Meals Served = 3,268,208

Long Term Services Screenings =

17,039

Vaccines Administered

= 287,625

Home Visits Conducted =

28,734

Served By Family Planning Services

= 53,645

Preventive Dental Screenings= 11,091

8Data Source: Virginia Department of Health 2017 and Federal Fiscal Year 2017

Lifespan Public Health Services

Source: Virginia Department of Health Syndromic Surveillance

Expenditures in the Local Community

88%

State-Level Support

12%

88% Percent of VDH Budget Spent in Local Communities

10Data Source: Virginia Department of Health, Office of Financial Management, FY16 Budget

Virginia is a National Leader in Preparedness

National Health Security Preparedness Index Top 3 States

Trust for Americas Health: Ready or Not Report Top 5 States

NACCHO Project Public Health Ready Only state with all local health districts recognized

Statewide Hospital Preparedness Program

Regional Healthcare Coordinators develop their regional plans, policies and governance structure under the oversight of their Regional Healthcare Coalition

Regions operate Regional Healthcare Coordination Centers

VDH provides the framework for statewide administration of HPP

VDH works through the Virginia Hospital and Healthcare Association (VHHA) to coordinate governance and initiatives to 6 Healthcare Coalitions with 300+ participating facilities

Virginia Medical Reserve Corps

Volunteers Protecting Virginias Health

25 Units

9,750+ Volunteers

4,000+ Health Care Volunteers

$ 1,000,000 in volunteer time for 2016

AMONG ALL STATES, VIRGINIA RANKED 19TH IN HEALTH STATUS

2016

Data Source: Americas Health Rankings, United Health Foundation Scorecard-2016 and 2017

15

AMONG ALL STATES, VIRGINIA RANKED 19TH IN HEALTH STATUS

2017

2017 RWJF County Health Rankings:Health Outcomes

A composite measure comprised of 13 indices that reflect a broad array of social determinants of health

Air Quality Population Density Population Churning Walkability Affordability Education Food Access Material Deprivation Employment Income Inequality Job Participation Segregation Access to Health Care

Virginia Health Opportunity Index

Source: VDH, Office of Health Equity

TOP 3 METHODS OF UNNATURAL DEATH

2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017*

Motor Vehicle Related 1124 928 841 823 878 877 832 808 879 890 940Gun Related 836 818 843 868 863 835 852 901 940 1057 1020Fatal Drug Overdose 721 735 713 690 819 799 913 994 1028 1428 1515

0

200

400

600

800

1000

1200

1400

1600

Num

ber

of F

atal

itie

s

1 Top 3 methods of death (motor vehicles, guns, and drugs) include all manners of death (accident, homicide, suicide, and undetermined)

Source: VDH OCME

ALL DRUGS: TOTAL NUMBER OF FATAL DRUG OVERDOSES BY QUARTER AND YEAR OF DEATH

2007-2017

2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017*Q4 205 195 183 179 232 240 248 263 262 375Q3 152 180 157 170 191 199 217 257 270 359 369Q2 188 162 172 159 215 190 230 246 243 332 372Q1 176 198 201 182 181 170 218 228 253 362 396Total Fatalities 721 735 713 690 819 799 913 994 1028 1428 1515

0

200

400

600

800

1000

1200

1400

1600

Num

ber

of F

atal

itie

s

1At the time of this analysis, approximately 32 cases from Q3 2017 were open and therefore not included in the calculated total of Q3 2017. These open cases may or may not be fatal drug overdoses.

1

+38.9%

+6.1%

Source: VDH OCME

http://www.vdh.virginia.gov/surveillance-and-investigation/syndromic-surveillance/drug-overdose-surveillance/

ED Visits for Unintentional Overdose by Opioid or Unspecified Substance - Virginia

http://www.vdh.virginia.gov/surveillance-and-investigation/syndromic-surveillance/drug-overdose-surveillance/

0.91.4

2.9

6.7

0.0

1.0

2.0

3.0

4.0

5.0

6.0

7.0

1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016

Neonatal Abstinence Syndrome DischargesRate per 1,000 Live Births: Virginia, 1999-2016

*

*2016 rate is provisional, pending final 2016 count of Virginia live, resident births

6.7

6.3

6.2

5.7

6.2

5.2

5.4

5.6

5.8

6.0

6.2

6.4

6.6

6.8

2011 2012 2013 2014 2015

Infa

nt M

orta

lity

per 1

,000

Sing

leto

n Liv

e bi

rths

22

Infant Mortality Rate, Virginia 2011-2015

Data Source: VDH Division of Health Statistics, compiled by the Division of Population Health Data, Office of Family Health Services. Infant mortality is defined as the death of an infant before his/her first birthday. Rate of infant deaths per 1,000 live births.

Chart1

2011

2012

2013

2014

2015

Series 1

Infant Mortality per 1,000 Singleton Live births

6.68

6.32

6.2

5.73

6.22

Sheet1

Series 1

20116.68

20126.32

20136.2

20145.73

20156.22

To resize chart data range, drag lower right corner of range.

A Population Health Approach:

Data-Informed, Community-Led, Intentional Actions

Designed to Impact Key Health Determinants

23

www.vdh.virginia.gov

http://www.vdh.virginia.gov/

Improving Health and Well-Being in Virginias Communities

Local

Steps to Assuring a Strong Start for Children in Virginia

Improve Maternal Risk Screening for All Women of Reproductive Age In 2015, 40% of pregnancies in Virginia were non-

marital Ensure Quality of Care for All Women and Infants

Comprehensive tobacco prevention and cessation Enhance Service Integration for women and infants

Medical home Home visiting for high risk families

Ensure access to quality family planning Preconception, Prenatal, Interconception Care Access to highly effective contraception

Impact of Reducing Unintended Pregnancies

*Rates of decrease observed in Colorado Initiative to Reduce Unintended PregnanciesPew Charitable Trust, February 12, 2015 A Pregnancy Prevention Breakthrough . Numbers of teen pregnancies, unintended pregnancies, and abortions from Virginia Department of Health, Health Statistics.

47,869 Teens & Women

28

69.8%

30.2%

VDH Family Planning Clients, 2016

UninsuredInsured

HB 888: Transition of Onsite Sewage System Evaluations and Designs

SW Virginia Cooperative Agreement

VIRGINIA DEPARTMENT OF HEALTH BUDGET

31

VDH Funding & Staffing FY 2008 to FY 2020

32

FTEsGF: 1,664NGF: 2,107Total : 3,771

FY2008Total $535,427,423

FTEsGF: 1,503NGF: 2,195Total: 3,698

FY2020Total $737,084,516

Virginia Department of HealthAppropriation by Fund 2008 - 2020

33

The increase in federal funds in FY17 is largely due to AIDS/HIV grants and is not new funding , but a technical appropriation increase, as these funds increased in the last biennium (FY19 increase is also Ryan White related and just a technical).

The increase in federal appropriation in FY2013 is attributable to funding for the Child and Adult Special Feeding Programs. The federal appropriations illustrated above do no include ARRA or H1N1 funding.

Federal Funding UncertaintySCOPE: Federal funding = 50% of VDH budget and 69% of local budgets Immediate Concern:

Federal Shutdown: VDH federal spending = $5M+/week statewide Shutdown of more than 1 week results in local/statewide service interruptions

and payroll impacts 2018-20 Biennial Concern:

Proposed Federal FY19 Budget Reductions: Impact to ALL local health departments; other key statewide service Proposal impacts to date have ranged from $24M-$50M (or more) for VDH This tentative range is from proposals before the federal tax package

Core Public Health Funding Potentially at Risk: Childhood immunizations (Vaccines for Children) Opioid, chronic disease and other prevention efforts (PHHS block) Food and nutritional assistance programs (WIC) HIV/AIDS and other communicable disease prevention/treatment

(multiple grants) Rural and other community health services (multiple grants)

2018 Introduced VDH Budget

35

Budget Amendments

Provide general fund support to develop an Electronic Health Records System

System is a critical addition to Virginias health safety net organizations, which provide patients with free or low cost health services. This system will allow the agency to efficiently and effectively operate its preventive health clinics, collect standard demographic information, and provide the capacity for electronic orders for laboratory tests, results, and prescriptions.

FY19 - $1,801,500 GF 1 FTEFY20 - $4,201,500 GF 1 FTE

36

Environmental Health Services

Increase in costs associated with the contract for the Virginia Environmental Information System (VENIS)

Migrate the current database to a more sophisticated application, which will provide improved flexibility for creating and deploying changes in response to changing business needs.

FY19 - $165,000 GF FY20 - $223,000 GF

Establish new fees for voluntary upgrades, repairs, and reviews of onsite sewage systems

HB888 Phases out onsite sewage system evaluation and design services that are available from the private sector. Redeploy existing staff to other high priority environmental health services with greater impact on the publics health and not available from the private sector. New fees enable agency to maintain resources to retain our staff.

37

Budget Amendments

Environmental Health Services

Long-term Plan to fund Food Safety and Restaurant Inspection Program The VDH and the Department of Agriculture shall collaborate to

develop a long-term plan to adequately fund the food safety and restaurant inspection program. Shall seek input from local governments, private sector organizations, and the public. The plan shall be submitted no later than October 1, 2018 to the Governor and Chairmen of the House Appropriations and Senate Finance Committees.

38

Budget Amendments

Community Health Services

Supports local health districts that are expecting significant rent increases in FY17 and FY18 due to moving to new facilities or rent increases in existing facilities.

FY19 - $345,304 GF $230,959 NGF FY20 - $345,304 GF $230,959 NGF

Increase education and expand access to womens reproductive health Increases federal support for education and expanded access to women's reproductive health. Temporary Assistance for Needy Families (TANF) funding.

FY19 - $6,000,000 NGF 1 FTEFY20 - $6,000,000 NGF 1 FTE

39

Budget Amendments

Licensure and Certification

Support for Cooperative Agreement in Southwest Virginia The Code currently allows VDH to seek reimbursement of up to

$75,000, which is insufficient to adequately support the monitoring of the cooperative agreement. With legislative proposal VDH will be able to recoup the actual costs from the health system.

FY19 - $624,518 NGF 6FTEFY20 - $624,518 NGF 6FTE

Epidemiology

Require meningococcal vaccine prior to entering sixth grade Adds a requirement for one dose of meningococcal conjugate (MCV4)

vaccine prior to entering the 6th grade. FY20 - $520,745 GF $1,562,236 NGF

40

Budget Amendments

Medical Examiner Supports additional staff for the Office of the Chief Medical Examiner,

which performs comprehensive death investigations for citizens and families in all applicable cases.

FY19 - $1,472,900 GF 12 FTE FY20 - $1,472,900 GF 12 FTE

Increases general fund support to allow the Office of the Chief Medical Examiner to increase the decedent transport rate from $100 to $250 to secure transport services that remove decedents from the scene of death.

FY19 - $700,000 GFFY20 - $700,000 GF

Provide general fund to support mandated autopsy services for sudden unexpected infant deaths (DCLS laboratory testing)

FY19 $102,923 GF FY20 $102,923 GF

41

Budget Amendments

NGF Spending Authority Increases Increases the federal appropriation for the Emergency Medical Services

Trauma Center fund based on current spending levels.FY19 - $1,500,000 NGFFY20 - $1,500,000 NGF

Increases the federal appropriation for the Ryan White Program. Grant funding is distributed to each state based on a needs-based formula.

FY19 - $12,500,000 NGFFY20 - $12,500,000 NGF

Increases the federal appropriation for the Drinking Water State Revolving Fund, which provides low interest loans, as well as some grants, for drinking water projects to local governments and privately organized water suppliers.

FY19 - $2,500,000 NGFFY20 - $2,500,000 NGF

42

Budget Amendments

State Health Services

Transfer positions and federal appropriation for the CACFP At-risk and Summer Food Service Program to the DOE

FY19 ($14,999,176) NGF 5 FTE FY20 ($14,999,176) NGF 5 FTE

Financial Assistance to Community Human Services Organizations

Increase support for the Virginia Association of Free and Charitable Clinics

FY19 $500,000 GF FY20 $500,000 GF

43

Budget Amendments

Summary and Questions

Thank You!

44

Virginias Health 2018Overview2018 Introduced VDH BudgetSlide Number 4VDH: 110 Years YoungMission: To protect the health and promote the well-being of all people in Virginia. Essential Public Health Services Slide Number 7Slide Number 8Slide Number 9Slide Number 10Virginia is a National Leader in PreparednessStatewide Hospital Preparedness Program Virginia Medical Reserve CorpsSlide Number 14AMONG ALL STATES, Virginia RankED 19Th IN HEALTH STATUS20162017 RWJF County Health Rankings:Health Outcomes Virginia Health Opportunity IndexTop 3 Methods of Unnatural DeathAll drugs: Total Number of Fatal Drug Overdoses by Quarter and Year of Death2007-2017ED Visits for Unintentional Overdose by Opioid or Unspecified Substance - VirginiaSlide Number 21Slide Number 22A Population Health Approach:Slide Number 24Improving Health and Well-Being in Virginias CommunitiesSlide Number 26Steps to Assuring a Strong Start for Children in VirginiaImpact of Reducing Unintended PregnanciesHB 888: Transition of Onsite Sewage System Evaluations and DesignsSW Virginia Cooperative AgreementVirginia department of health budgetSlide Number 32Slide Number 33Federal Funding Uncertainty2018 Introduced VDH BudgetBudget AmendmentsSlide Number 37Slide Number 38Slide Number 39Slide Number 40Slide Number 41Slide Number 42Slide Number 43Summary and Questions