Indiana State Department of Health State Budget Committee Biennium - PowerPoint PPT Presentation

Indiana State Department of Health State Budget Committee Biennium Budget Presentation December 10, 2018 Kris Box, MD, FACOG State Health Commissioner

ISDH Mission & Vision • ISDH Mission – To promote, protect, and improve the health and safety of all Hoosiers • ISDH Vision – A healthier and safer Indiana 2

Agency Structure • State Health Commissioner – Deputy Health Commissioner – Chief of Staff – Chief Medical Officer – Assistant Commissioners (3) • Three Commissions – Health and Human Services – Consumer Services & Health Care Regulation – Public Health Protection and Laboratory Services 3

Dr. Kristina Box State Health Commissioner Matt Foster Dr. Judy Lovchik Pam Pontones Eldon Whetstone Dr. Melissa Collier Trent Fox Public Health Protection Consumer Services & Health Deputy Commissioner & Health & Human Chief of Staff Chief Medical Officer & Laboratory Services Care Regulation State Epidemiologist Services Commission Commission Commission Miranda Spitsnagle Eden Bezy Shirley Payne Laura Chavez Jeni O'Malley Dr. Katlyn Brenda Buroker Tobacco Prevention Public Health Children's Special Women, Infant, & Wainwright Deputy Chief of Staff Performance Health Care Services Children & Cessation & Office of Public Long Term Care Deputy Lab Director Affairs Antoniette Holt Eric Hawins Ann Alley Dr. James Miller Mike Mettler Health Disparities & Epidemiology Aaron Atwell Randy Snyder Chronic Disease, Environmental Public Oral Health Resource Center Minority Wellness Primary Care & Rural Acute Care Chief Financial Health Health Officer Dennis Stover Martha Allen Krista Click HIV, STD and Viral HIlari Sautbine Maternal & Child Gretchen Martin Preston Black Food Protection Hepatitis Health VItal Records Fatality Review & Office of Legal Affairs Prevention Lee Christenson Lindsey Bouza Burton Garten Scott Zarazee Emergency Terri Lee Nutrition & Physical Program Preparedness Healthy Hoosiers Activity Development & Womens' Health Foundation Quality Initiative Bethany Colson Paul Krievins Katie Hokanson Center for Deaf & Lead & Healthy Mohan Ambaty Jan Kulik Hard of Hearing Trauma & Injury Homes Office of Technology Survey Supports & Education Prevention & Compliance Guidance Dave McCormick Immunizations 4

ISDH Priorities • Infant Mortality • Opioid Epidemic • Smoking Cessation • Obesity/Chronic Disease 5

Infant Mortality • The 2016 infant mortality rate was 7.5 deaths per 1000 live births – that means 623 babies didn’t make it to their first birthday • Indiana has lost nearly 3,000 babies in the past five years • 7th highest infant mortality in the nation • 3rd highest maternal mortality in the nation 6

Infant Mortality: Roadmap to 2024 Perinatal Levels of Care • • OB Navigator for at-risk populations through Medicaid Investment in APRN or CNM for rural areas, care closer to home • Identify mothers with prior preterm birth/IM progesterone • Hypertension Pilot to decrease the risk of severe preeclampsia • Decrease maternal smoking • • Maternal Mortality Review Committee/IPQIC Hemorrhage Committee Safe Sleep Campaign • Perinatal Substance Use/NAS • 7

Opioid Epidemic • 785 opioid-involved overdose deaths in 2016 – 52% of drug overdose deaths involve opioids – 1,518 total drug overdose deaths in 2016 • 1,138 opioid-involved overdose deaths in 2017 – 63% of drug overdose deaths involve opioids – 1,809 total drug overdose deaths in 2017 • 6,934 people treated in ED for opioid overdose in 2016 • 8,169 people treated in ED for opioid overdose in 2017 8

Opioid Epidemic • Naloxone distribution and training • Faith-based Outreach • Overdose Response Project/Toolkit • Coroner Toxicology Program • IU Hospital pilot to analyze drug trends • Overdose Fatality Review • Syringe Service and Harm Reduction Sites • Fresh Start Recovery Centers 9

Smoking Cessation: Impact • 10th highest smoking rate in the nation - 21% adults • 13.5% pregnant women smoke (2x the national average) • 24% Medicaid moms smoke • 2018 data shows 45% increase in high school seniors vaping 10

Smoking Cessation: Cost • Single most preventable cause of death and disease • 11,100 Hoosier lives lost due to tobacco use every year • Everyone shares in the costs for smoking – over $900 per Hoosier household per year • Nearly $3 billion annually in medical expenditures/$3.1 billion annually in lost productivity • For every pack of cigarettes sold in Indiana, the state spends $15.90 in health care costs, lost productivity and premature death related to tobacco 11

Smoking Cessation • Indiana Tobacco Quitline • Baby & Me Tobacco Free • Medicaid coverage for FDA-approved smoking cessation treatments • Community-based tobacco control partnerships 12

Obesity/Chronic Disease • 12th most obese state in the nation • 2/3 adults overweight or have obesity • 1/3 children overweight or have obesity • Obesity increases risk for hypertension and diabetes, thereby increasing heart disease and stroke • $3.5 billion in obesity related health care costs per year – 37% of these costs are covered by Medicaid or Medicare 13

Obesity/Chronic Disease • Help fund bicycle and pedestrian master plans in selected communities • Fund physical activity trainings for child care program staff • Help schools find creative ways to incorporate more physical activity, including physical activity ideas for students with disabilities • Increase access to healthy foods through SNAP education and encouraging farmers market managers to accept SNAP/WIC benefits • Train employers on worksite wellness best practices • Train community wellness coordinators on best practices for obesity prevention • WIC collaboration with hospitals • National Diabetes Prevention Program 14

Other Top Priorities • Ensure preparedness for infectious disease outbreaks and other public health emergencies • Strategic partnerships • Quality improvement – PHAB Accreditation – ISDH Strategic Plan – State Health Improvement Plan 15

Agency Updates • Hepatitis A Outbreak Response • Vital Records System Upgrade • Cervical Cancer Strategic Plan • Maternal Mortality Review 16

SFY 20-21 Budget Request 17

ISDH Funding Sources SFY 19 SFY 20 - 21 $31,761,440 $33,956,414 9% 9% $83,333,156 $79,747,633 23% $232,111,972 $249,623,348 23% 68% 68% General Fund Dedicated Funds General Fund Dedicated Funds Federal Funds Federal Funds 18

ISDH Budget Request Total State Appropriation State Fiscal Year (General & Dedicated) SFY 2018 $111.5 million Base Budget $107.9 million Requested for SFY 2020 $117.3 million Requested for SFY 2021 $117.3 million 19

General Fund Request General Fund Portion of ISDH Budget $33,956,414 $33,956,414 $35,000,000 $31,761,440 $30,000,000 $25,000,000 $20,000,000 $15,000,000 $10,000,000 $5,000,000 FY19 FY20 FY21 20

Change Packages 1. OB Navigator Program – $6.6 million ($3.3M/Year) • Establish an obstetric (OB) navigator program to connect pregnant women on Medicaid with a community health worker, targeting the state’s highest risk zip codes and counties for infant mortality. 2. Youth Risk Behavior Survey (YRBS) - $2.2 million ($1.1M/year) • Administer the YRBS in all Indiana high schools (public and nonpublic) to provide schools and communities with better data to monitor and implement informed responses to risks and threats facing our children in school. 21

Questions