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

Indiana State Department of Health

Kris Box, MD, FACOG State Health Commissioner

State Budget Committee Biennium Budget Presentation December 10, 2018

ISDH Mission & Vision

• ISDH Mission

– To promote, protect, and improve the health and safety of all Hoosiers

• ISDH Vision

– A healthier and safer Indiana

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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

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• Dr. Kristina Box

State Health Commissioner

• Dr. Melissa Collier

Chief Medical Officer Miranda Spitsnagle Tobacco Prevention & Cessation Antoniette Holt Health Disparities & Minority Wellness Pam Pontones Deputy Commissioner & State Epidemiologist Eden Bezy Public Health Performance Eric Hawins Epidemiology Resource Center Dennis Stover HIV, STD and Viral Hepatitis Trent Fox Chief of Staff Jeni O'Malley Deputy Chief of Staff & Office of Public Affairs Aaron Atwell Chief Financial Officer Preston Black Office of Legal Affairs Scott Zarazee Healthy Hoosiers Foundation Mohan Ambaty Office of Technology & Compliance Matt Foster Consumer Services & Health Care Regulation Commission Brenda Buroker Long Term Care Randy Snyder Acute Care HIlari Sautbine VItal Records Burton Garten Program Development & Quality Initiative Jan Kulik Survey Supports & Guidance Eldon Whetstone Health & Human Services Commission Shirley Payne Children's Special Health Care Services Laura Chavez Women, Infant, & Children

• Dr. James Miller

Oral Health Ann Alley Chronic Disease, Primary Care & Rural Health Martha Allen Maternal & Child Health Gretchen Martin Fatality Review & Prevention Lindsey Bouza Nutrition & Physical Activity Terri Lee Womens' Health Bethany Colson Center for Deaf & Hard of Hearing Education Katie Hokanson Trauma & Injury Prevention

• Dr. Judy Lovchik

Public Health Protection & Laboratory Services Commission

• Dr. Katlyn

Wainwright Deputy Lab Director Mike Mettler Environmental Public Health Krista Click Food Protection Lee Christenson Emergency Preparedness Paul Krievins Lead & Healthy Homes Dave McCormick Immunizations

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ISDH Priorities

• Infant Mortality
• Opioid Epidemic
• Smoking Cessation
• Obesity/Chronic Disease

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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

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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

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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

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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

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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

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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

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Smoking Cessation

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

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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

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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

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Other Top Priorities

• Ensure preparedness for infectious disease outbreaks and
• ther public health emergencies
• Strategic partnerships
• Quality improvement

– PHAB Accreditation – ISDH Strategic Plan – State Health Improvement Plan

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Agency Updates

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

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SFY 20-21 Budget Request

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ISDH Funding Sources

$33,956,414 9% $83,333,156 23% $249,623,348 68%

SFY 20 - 21

General Fund Dedicated Funds Federal Funds

$31,761,440 9% $79,747,633 23% $232,111,972 68%

SFY 19

General Fund Dedicated Funds Federal Funds

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ISDH Budget Request

State Fiscal Year

SFY 2018 Base Budget Requested for SFY 2020 Requested for SFY 2021

Total State Appropriation (General & Dedicated)

$111.5 million $107.9 million $117.3 million $117.3 million

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General Fund Request

$31,761,440 $33,956,414 $33,956,414

$5,000,000 $10,000,000 $15,000,000 $20,000,000 $25,000,000 $30,000,000 $35,000,000 FY19 FY20 FY21

General Fund Portion of ISDH Budget

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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.

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Questions