Public Health Transformation Foundational Public Health Services Healthy

Public Health Transformation Foundational Public Health Services Healthy. Vital. Everyone. Everywhere. Orientation to DOH for LHJs & Tribes May 14, 2019

Washington State Population 7. 2 million people Governmental Public Health System • • • • 2 35 Local Health Jurisdictions (LHJs) State Board of Health (SBOH) State Department of Health (DOH) 29 Sovereign Tribal Nations and Urban Indian Health Programs (UIHP)

OBJECTIVES 1. Adopt a limited statewide set of core public health services, called Foundational Public Health Services (FPHS). FPHS are a defined, basic set of capabilities and programs that the government is responsible for providing and must be present in every community to efficiently and effectively protect all people in Washington. VISION A responsive and viable governmental public health system is essential for healthy and economically vital communities across Washington. 2. Fund FPHS primarily through state funds and fees that are predictable, sustainable and responsive to changes in both demand cost. 3. Provide and use local revenue-generating options to address local public health priorities. 4. Deliver FPHS in ways that maximize efficiency and effectiveness and are standardized, measured, tracked, and evaluated. GOAL 5. Complete a tribally-lead process, with support from the Department of Health, to define how the Foundational Public Health Services funding and delivery framework will apply to tribal public health, and how tribal public health, the Department of Health, the State Board of Health, and local health jurisdictions can work together to serve all people in Washington. Full funding and implementation of FPHS, statewide, using a long-term, building block, approach. 6. Allocate resources through a collaborative process between state, local, and tribal governmental public health system partners. 3

Why? £Lack of core funding for public health £Broken, irrational, and inequitable funding £Need to modernize how we do our work 4

Who? The Governmental Public Health System Steering Committee Participant: Washington State Association of Local Public Health Officials (WSALPHO) Steering Committee Participant: American Indian Health Commission (AIHC) 5

What? £Defined o Assumptions o The Governmental Public Health System o Criteria & the FPHS of the govt. public health system o Funding Roles £FPHS Assessment (2018) o Level of Implementation o Sharing – current, opportunities o Cost 6

What? (cont. ) £New Service Delivery Models o Three Demonstration Projects o WSALPHO Committees + DOH staff innovative proposals £Legislative Strategy o Policy bill o Building Block Approach to funding 7

Policy Bill 2 SHB 1497 £Repealed – most of the old PHIP/5930 law £Retained – “Protecting the public’s health…. is a fundamental responsibility of the state. ” £Added o This is accomplished through the govt. public health system o FPHS are a limited statewide set of services o FPHS should be delivered in ways that maximize the efficiency and effectiveness of the overall system o Funding must be restructured to reinforce capacity and implement new service delivery models o With any state funding, the state expects measurable benefits o Consultation with tribes and joint certification of agreement on use and distribution of state FPHS funds is required. o Report to the legislature due 10/1/20 8

Long-Term Building Block Approach Next Request $XXX Request for $296 M/bi EH, CD, Assessment $12 M/bi CD 20172019 Base Budget $450 M/bi Base Budget $XXX + $XXXM/bi Base Budget $XXXM/bi $22 M/bi 2019202120232025 -2027 -2029 Diagram is conceptual and not to scale 9 LT Goal: Additional funds needed from state gov’t. to fund FPHS statewide $450 M/bi ennium, in the base budget

Systemwide Accountability £How the funds were spent o Updating BARS expenditure codes £Impact Measures o # or % of disease cases investigated o infant and toddler immunization series completion rate £Level of Implementation – changes over time o 2018 FPHS Assessment & Annual Reporting 10

How the Funds Were Spent 2017 -2019 $12 Million Initial Investment: Year 1 ($6/M) Communicable Disease (CD) Investigation, 58% Public Health Lab, 7% Assessment & Emergency Preparedness, 4% Communications, Policy & Partnerships, 4% Business Competencies, 7% CD Data, 3% CD Planning, 6% Immunizations, 10%

Impact £Childhood immunization rates to prevent disease – the percent of children who have completed the standard series of recommended vaccination improved 4% for toddlers and 2% for school-aged children (up from 60% and 45%, respectively). £Disease investigation timeliness to reduce longterm and costly impact and prevent spread to others – the public health system investigated 625 more gonorrhea cases and assured that 582 more of those interviewed were on appropriate treatment. 12

Next Steps £Continue development of new service delivery models £ 2017 -2019 Initial Investment ($12 M/biennium) – Measure and report on impact (Summer-Fall 2019) £ 2019 -2021 Investment ($22 M/biennium) – Determine how the funds will be used, impact measures, distribution of funds, then monitor and report on progress Keep At It 13

Foundational Public Health Services Healthy. Vital. Everyone. Everywhere. Marie Flake Marie. flake@doh. wa. gov www. doh. wa. gov/fphs 14 14