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Virginia Department of Health

Presentation to West Virginia

October 28, 2015

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Outline

• VDH Structure

• VDH Communication Methods

• VDH Overview & Budget Highlights

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The mission of VDH is to protect

and promote the health of ALL

people in Virginia

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Vision:

Virginia Will Become The

Healthiest State In The Nation

§ 32.1-2. Finding and purpose.

The General Assembly finds that the protection,

improvement and preservation of the public health and

of the environment are essential to the general welfare

of the citizens of the Commonwealth. For this reason, the

State Board of Health and the State Health Commissioner,

assisted by the State Department of Health, shall

administer and provide a comprehensive program of

preventive, curative, restorative and environmental

health services, educate the citizenry in health and

environmental matters, develop and implement health

resource plans, collect and preserve vital records and

health statistics, assist in research, and abate hazards

and nuisances to the health and to the environment,

both emergency and otherwise, thereby improving the

quality of life in the Commonwealth.

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VIRGINIA DEPARTMENT OF HEALTH Office of the Commissioner

November 10, 2015

State Health Commissioner Marissa Levine, MD, MPH

Office Manager

Nancy Glasheen

Adjudication Officer

Douglas Harris

Director of

Process

Improvement vacant

Director of Strategic Planning

and Evaluation

vacant

Director of Governmental

and Regulatory Affairs

Joseph Hilbert

Director of Internal Audit

Alvie Edwards

Office of Information

Management

Debbie Condrey, CIO

Chief Deputy

Commissioner David Trump, MD, MPH,

MPA

Deputy Commissioner

for Administration

Richard Corrigan

Deputy Commissioner for

CHS

Robert Hicks

Operations

Director for

Public Health &

Preparedness

Kim Allan

Operations

Director for

Public Health &

Health Equity

Chris Gordon

Office of Risk

Communication and

Education

Suzi Silverstein

Office of Emergency

Preparedness

Bob Mauskaupf

Office of Emergency

Medical Services

Gary Brown

Office of Licensure and

Certification

Erik Bodin

Office of the Chief

Medical Examiner

William Gormley, MD

Office of Epidemiology

Laurie Forlano, DO,

MPH

Office of Radiological

Health

Steve Harrison

Office of Drinking

Water

John Aulbach

Operations

Director for

Administration

Mike McMahon

Office of

Financial

Management

Elizabeth Franklin

Office of Human

Resources

Rebecca Bynum

Office of

Purchasing and

General Services

Steve VonCanon

Operations Director for

CHS

Jennifer Mayton

Director for Process and

Evaluation Oversight

CHS

Bill Edmunds

35 Health Districts

Director of the

Office of Family

Health Services

vacant

Director of the

Office of Minority

Health and

Health Equity

Adrienne McFadden,

MD, JD

Office of Environmental

Health Services

Allen Knapp

Operations Director for

CHS

Chris Gordon Business

Manager

Steve Murman

Deputy Commissioner

for Population Health

Lilian Peake, MD, MPH

Director for Public

Health Nursing

Joanne Wakeham

Operations Director

for Population

Health

Chris Gordon

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Management of Health Districts

• Deputy Commissioner directly supervises 33 of

35 district directors and serves as reviewer for

300 district managers

• Each district is led by a physician director and

managed by team that includes nursing,

environmental, and business managers

• District directors also supervise clinicians,

pharmacists, dentists, and laboratorians where

those services still exist

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Role of District Directors

• Medical and public health resource for private sector, local government officials, and public utility operators.

• Manage operations for local health departments within their district.

• Carry out authority delegated by the Commissioner and Deputy Commissioner

• 75% of directors have MPH and 66% are board certified in preventive medicine

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Communication

Event Notifications:

Release Information

Situation and/or Problem

Immediate Impact or Required Action

Background

Discussion

Recommendation or Action Taken

Conclusion

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Community Health Services Network of Health Districts & Local Health Departments

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Community Health Services

• 134 cities and counties are organized into 35 Health Districts

• District boundaries usually follow planning districts and include as few as 1 and up to 10 cities and/or counties

• There is at least one service delivery site in every city and county

• Services vary among localities within a district and between districts based on local needs, funding, and private sector capacity

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Alternatives for LHD Operation

• Locality may enter into a contract with VDH to

operate (130 of 134 localities)

• Administer their LHD under contact to VDH (4 of

134 localities)

• Operate an independent LHD with no state funding (no locality has chosen this option)

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Philosophy Behind Local Health

Districts (LHDs) in VA

• LHDs are a partnership between state and local governments

• LHDs work closely with private sector health care providers and systems

• Array of LHD services varies based on local need

• Preserve flexibility for LHDs on “how” to improve community health while assuring compliance with policy, regulation, and law

• Partnership is the key

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Strengths of Virginia’s Public

Health System

• Local health districts in every city and county that

provides basic public health services

• Joint state and local funding of local health districts

• Interdisciplinary management of districts

• Flexibility to adapt to local needs

• Public-private partnerships to improve health

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Local Health District Services

• Services provided in every LHD include

communicable disease control, family

planning, inspection of public establishments

that serve food, permitting of onsite sewage

disposal and well construction, emergency

preparedness and response.

• Limited number of districts provide

pharmacy, lab, and general medical services

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Service Delivery Models

• Most districts have more than one of the following models depending on service and community capacity: LHD staff provide services directly to clients

LHD provides services with individual provider contracts or through agreements with non-profits

LHD provides initial service then hand-off to private sector

LHD collaborates with private sector to assure service

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Evolution of Modern Public Health System

• Prior to the creation of the existing system, all parts of

Virginia did not have access to basic public health

services throughout the state, including control of

communicable diseases and immunizations

• Cities tended to have more established, better funded

public health services

• Rural areas had a limited tax base and could not afford

to establish more comprehensive public health services

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Expenditures

in the Local Community

88%

State-Level Support

12%

88% Percent of VDH Budget

Spent in Local Communities

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VDH Funding & Staffing – FY 2008 to FY 2016

FTEs

GF: 1,664

NGF: 2,107

Total : 3,771

General $169,123,124

32%

Special $128,723,905

24%

Dedicated Special

$15,844,925 3%

Federal $221,735,469

41%

FY2008 Total $535,427,433

FTEs

GF: 1,481

NGF: 2,191

Total: 3,672

General 152,085,583

24%

Special 144,959,042

23%

Dedicated Special

28,839,230 4%

Federal 312,721,600

49%

FY2016

Total $638,605,455

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Virginia Department of Health

Appropriation by Fund 2008 - 2016

$169M $169M

$153M $151M $147M

$156M $154M

$160M $152M

$145M

$161M

$164M $170M $166M $161M $161M

$167M $174M

$222M

$251M $250M $247M

$251M

$304M

$312M $313M $313M

$100

$150

$200

$250

$300

$350

2008 2009 2010 2011 2012 2013 2014 2015 2016

Millio

ns

General Fund Special Fund Federal Fund

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Virginia Department of Health

General Fund 2008 - 2016

$135

$140

$145

$150

$155

$160

$165

$170

$175

2008 2009 2010 2011 2012 2013 2014 2015 2016

Millio

ns

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LHD Funding Streams

• State Funds Appropriated by General Assembly

• Local matching funds appropriated by local government based on ability to pay formula developed by JLARC

• 100% Local funds above the match requirement

• Revenue earned from services delivered

• Federal grant funds that are primarily categorical in nature

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Locality State General

Fund Share %

Local Government

Share %

Self Generated

Revenue %

Clarke County 60.386% 39.614% 11.8%

Frederick County 55.744% 44.256% 19.9%

Page County 61.073% 38.927% 13.8%

Shenandoah County 58.031% 41.969% 19.9%

Warren County 57.234% 42.766% 16.3%

Winchester City 56.958% 43.042% 18.3%

District Average % 58.237% 41.763%

Cooperative Budget Percentage of Shared Cost Between State and

Locality Funding, Excluding Self Generated Revenue

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Cooperative District Budget Totaling $5,021,704 Breakdown

$2,173,440 43%

$1,618,764 32%

$1,229,500 25%

State Funds

Local Funds

Revenue

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$2,173,440 35%

$1,618,764 26%

$1,227,615 19%

$1,229,500 20% State Funds

Local Funds

Grants

Revenue

Total Funding Of The District Budget Breakdown

Including Federal Funds $6,249,319

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Questions??