Transcript Document

DEPARTMENT OF
HEALTH
House Health and Human Services Finance
House Health and Human Services Reform
Edward P. Ehlinger, MD, MSPH
Commissioner of Health
January 13, 2015
“Prevention first,
cure if you must;
capacity to do in
both directions.”
Charles Nathaniel Hewitt
Secretary, MN State Board of Health
1872-1897
“Public Health is what we, as a
society, do collectively to assure
the conditions in which people
can be healthy.
Institute of Medicine
Determinants of Health
Genes and
Biology
10%
Physical
Environment
10%
Social and
Economic Factors
40%
Clinical Care
10%
Health Behaviors
30%
Determinants of Health Model based on frameworks developed by: Tarlov AR. Ann N Y Acad Sci
1999; 896: 281-93; and Kindig D, Asada Y, Booske B. JAMA 2008; 299(17): 2081-2083.
• Necessary conditions for health (WHO)
Peace
Shelter
Education
Food
Income
Stable eco-system
Sustainable resources
Health Care
Equity
World Health Organization. Ottawa charter for health promotion. International Conference on Health Promotion: The Move Towards a New Public Health, November 17-21, 1986
Ottawa, Ontario, Canada, 1986. Accessed July 12, 2002 at <http://www.who.int/hpr/archive/docs/ottawa.html>.
Public health = longer lives
Life Expectancy
(Years)
80
70
60
50
40
Life Expectancy at Birth,
United States, 1900 - 1996
30
1900
1910
1920
1930
1940
1950
1960
1970
1980
1990
Year of Birth
25 of the 30 years of life gained in the 20th
Century resulted from public health
accomplishments
Our investments in health
Distribution of Resources
Medical Care
Public Health
95
0
20
40
5
60
80
100
Minnesota’s Health Care Spending
Source: Minnesota Health Care Spending and Projections, 2012, Feb. 2014
Minnesota 48th nationally in per capita public health spending
Healthy Healthcare System
Balances Treatment and Prevention
Deaths Prevented And Change In Health Care Costs Plus Program Spending, Three
Intervention Scenarios, At Year 10 And Year 25.
Milstein B et al. Health Aff 2011;30:823-832
Deaths Prevented And Change In Health Care Costs Plus Program Spending, Three
Intervention Scenarios, At Year 10 And Year 25.
Milstein B et al. Health Aff 2011;30:823-832
©2011 by Project HOPE - The People-to-People Health Foundation, Inc.
Cost Benefits of Treatment and Prevention
Milstein B et al. Health Aff 2011;30:823-832
MDH Mission
• To protect, maintain and improve the health of all
Minnesotans
One of first 5 State Health Departments to be Accredited
MDH
District
Offices
State and Local Public
Health Partnership
Infectious Disease
• Around-the-clock
monitoring of infectious
diseases, like Ebola
• Investigation into novel
illnesses through close
work with partners
• A swift, effective
response to disease
outbreaks and public
health emergencies
Acknowledgements
(MPR photo/Mark Steil)
Environmental Health
• Assurance that the
water you drink is
clean and the food
you eat is safe
• Advice about
reducing risks
Emergency Preparedness
• Statewide preparations for
responding to public health
emergencies, including a
possible pandemic
• Planning with hospitals and
health care systems to
rapidly care for large
numbers of injured or ill
victims
Office of Medical Cannabis
• 2014 law creates a new process to allow 5,000 seriously-
ill Minnesotans to acquire and use medical cannabis to
treat certain specified conditions
• Registered two manufacturers by 12/1
• Development of a patient registry
• Published review of medical
Cannabis studies
• Adopted administrative rules
Rural Health, Workforce, & Vulnerable Adults
• Planning to help ensure
rural Minnesotans have
access to care
• Assuring adequate
health/health care
workforce
• Assurance that abuse
or neglect in nursing
homes, hospitals and
other care facilities will
be corrected
Health Economics
Trends in health care costs and economic indicators
Cumulative Percent Change
140%
120%
100%
80%
60%
40%
20%
0%
2000
2001
Health Care Cost
2002
2003
MN Economy
2004
2005
2006
Per Capita Income
2007
Inflation
2008
2009
Wages
Health care cost is MN privately insured spending on health care services per person, and does not include enrollee out of
pocket spending for deductibles, copayments/coinsurance, and services not covered by insurance.
Sources: Health care cost data from Minnesota Department of Health, Health Economics Program; per capita personal
income from U.S. Department of Commerce, Bureau of Economic Analysis; inflation data from U.S. Bureau of Labor Statistics
(consumer price index); workers’ wages from MN Department of Employment and Economic Development
Health Care Homes & State Innovation Model
Health reforms to:
• Reward value, not volume of
services (Health Care Homes)
• Care coordination
• Quality incentive
payments
• Create transparency of quality
and cost (State Innovation
Model)
• Quality measurement
and reporting
• All Payer Claims
Database
Health Promotion and Chronic Disease
Firearms
Tobacco 42%
Diet/Physical Activity 35%
Alcohol 9%
Tobacco
Diet/Physical
Activity
Microbial Agents 7%
Toxic Agents 5%
Firearms 2%
Attributable Causes of Death
Statewide Health Improvement Program (SHIP)
Locally-controlled, research-based
strategies include:
• “Farm to School” - kids get healthy
produce while benefiting local farmers
• Support employers with comprehensive
workplace wellness (ROI up to 6:1)
• “Complete Streets” - sidewalks and
crosswalks for to physical activity
• Healthier eating and physical activity in
childcare settings
• Colleges and apartment buildings
going tobacco-free
Schools
Businesses
SHIP
Communities
Providers
Community & Family Health
• An immunization program
for preventable diseases
• WIC Services providing
access to nutritious food.
250
200
Pneumococcal
Vaccine
Licensed
150
100
50
0
1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008
Advancing Health Equity
50 years of growing diversity
Percent Of Color
1960-2010
50%
45%
40%
35%
30%
25%
20%
15%
10%
5%
0%
U.S.
MN
Twin Cities
36%
24%
17%
1960
Source: mncompass.org
1970
1980
1990
2000
2010
The Center for Health Equity
A focus on Health Equity
Vital Records and Mortuary Science
Birth and death certificates
Assurance that the dead are
disposed of safely
MDH Budget
FY 2016-17 Base
$1.059 billion
General Fund
14%
HCAF
5%
Federal
44%
SGSR
9%
TANF
2%
Special Revenue
12%
MERC
14%
How the General Fund Budget is Spent
FY 2016-17 Base $149 million
Payroll
19%
Lease/Rent
9%
Other
Operating
4%
Grants
67%
IT Services
1%
Staffing
Base FY 2016-17 MDH Staffing Levels
• Total FTEs: 1,309
• General Fund FTEs: 128 (9.8%)
Largest Sources of Federal Funding
2016-17
Federal Agency
Amount
US Department of Agriculture (WIC)
$240 million
Centers for Disease Control (CDC)
$119 million
Centers for Medicare and Medicaid Services (CMS)
$41 million
Health Resources and Services Administration
(HRSA)
$38 million
Department of Health and Human Services (other)
$34 million
Environmental Protection Agency (EPA)
$20 million
MDH Sections Most Reliant on
Federal Funds
Section
% of Funding
from Federal
Sources
Office of Emergency Preparedness
98%
Infectious Disease Epidemiology Prevention
and Control
85%
Community and Family Health
81%
Health Promotion and Chronic Disease
63%
“Public health is what we, as a society, do
collectively to assure the conditions in
which (all) people can be healthy.”
-Institute of Medicine (1988), Future of Public Health
Edward P. Ehlinger, MD, MSPH
Commissioner, MDH
P.O. Box 64975
St. Paul, MN 55164-0975
[email protected]