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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??
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