10th Annual PH Finance Roundtable

November 16, 2014Abby Dilley, Vice President of Programs

Chrissie Juliano, Senior Program Manager

Rachel Nelson, Program Associate

Defining Foundational Public Health Services1

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Develop a cogent, compelling national case for ensuring provision of FPHS, and for securing necessary, sustainable funding to support them

Aspirational and prospective At the level needed, not what is currently being done or spent

Foundational - Identify cross-cutting skills and areas essential to assure the public’s health, and on which other critical services are dependent and built

Supports Cost Estimation – Foundational skills and areas described to estimate cost effectively Specific enough to cost out Avoid “double counting”

Project Goal and Principles

Public Health Leadership Forum PH Finance Roundtable – November16, 2014

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April 2012 For the Public’s Health: Investing in a Healthier Future: recommends minimum package of PH services“The committee believes that it is a critical step to develop a detailed description of a basic set of public health services that must be made available in all jurisdictions. The basic set must be specifically defined in a manner that allows cost estimation to be used as a basis for an accounting and management framework and compared among revenues, activities, and outcomes. The committee developed the concept of a minimum package of public health services, which includes the foundational capabilities and an array of basic programs no health department can be without.”  

Background – IOM Recommendation

Public Health Leadership Forum PH Finance Roundtable – November16, 2014

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“…built on the well-known and long-established concepts of the Three Core Public Health Functions and the Ten Essential Public Health Services, it is intended to make more specific the services that every community should receive from its state and local health departments and to inform public health funding decisions. …a framework for program and financial management, including the development of charts of accounts. …enhance people’s understanding of the critical nature of population-based approaches (what communities get for their investment), and their understanding of the package as an instrument to ensure a standard level of health protection for all communities.” (IOM For the Public’s Health, April 2012)

Why a “New” Framework?

Public Health Leadership Forum PH Finance Roundtable – November16, 2014

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Jan 2013, PH leaders approached RWJF and RESOLVE – could the PHLF help move the IOM work forward?

April 2013, convened PH leaders to determine: Is there universal need/desire to clarify/establish

foundational capabilities at state/local levels? If so, what is comprehensive strategy for achieving

development, implementation, adequate funding? July to December 2013: PHLF work to articulate FPHS 2014: Produced “V1”; gathering feedback; adding

funding pieces and moving towards a “V-2” early 2015

Background –FPHS Project

Public Health Leadership Forum PH Finance Roundtable – November16, 2014

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Working Group Members/Others

PH Associations/Orgs APHA ASTHO* NACCHO* TFAH

CDC* Other HHS offices

PHAB* RWJF*Public Health Leadership Forum PH Finance Roundtable – November16, 2014

Researchers Glen Mays* and

colleagues at UKY Cost estimation WG

Public Health Officials Terry Allan* Terry Cline David Fleming* + others

*Denotes WG Member

FoundationalPublicHealthServices

CommunicableDiseaseControl

ChronicDisease &

Injury Prevention

Environmental Public Health

Access to and Linkage

w/Clinical Care

Foundational AreasMaternal,Child, &

Family Health

Programs/Activities Specific to an HD and/or Community NeedsMost of an HD’s Work is “Above the Line”

• Assessment (Surveillance, Epidemiology, and Laboratory Capacity)• All Hazards Preparedness/Response• Policy Development/Support• Communications• Community Partnership Development• Organizational Competencies (Leadership/Governance; Health Equity,

Accountability/Performance Management , QI; IT; HR; Financial Management; Legal)

Foundational Capabilities

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Provide timely, statewide, and locally relevant and accurate information to the HC system and community on CD and injury prevention/control.

Identify statewide and local CD and injury prevention community partners and their capacities, develop and implement a prioritized prevention plan, and seek funding for high priority initiatives.

Reduce statewide and community rates of tobacco use through a program that conforms to standards set by state or local laws and CDC’s OSH, including activities to reduce youth initiation, increase cessation, and reduce secondhand smoke exposure, as well as exposure to harmful substances.

Work actively with statewide and community partners to increase statewide and community rates of healthy eating and active living through a prioritized approach focusing on best and emerging practices aligned with national, state, and local guidelines for healthy eating and active living.

Coordinate and integrate categorically-funded CD and injury prevention programs and services.

Example FA: Chronic Disease & Injury Prevention

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Develop a cogent, compelling national case for ensuring provision of FPHS, and for securing necessary, sustainable funding to support them

Aspirational and prospective At the level needed, not what is currently being done or spent

Foundational - Identify cross-cutting skills and areas essential to assure the public’s health, and on which other critical services are dependent and built

Supports Cost Estimation – Foundational skills and areas described to estimate cost effectively Specific enough to cost out Avoid “double counting”

Project Goal and Principles

Public Health Leadership Forum PH Finance Roundtable – November16, 2014

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Through/in partnership with the PHLF: V-2(s) for targeted

audiences w/current information

Additional parts of the case(why, what, how) Cost Estimation WG Federal dollars and

assets currently in the system

Complementary Work Streams/Needs Chart of Accounts

project Alignment with PHAB

standards/measures, other frameworks

PH law analyses

Building the Case

Public Health Leadership Forum PH Finance Roundtable – November16, 2014

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RTI was subcontracted to ID whether/if federal funds are being (or could be) used for FCs/FAs

Reviewed dataset of federal dollars to state/local HDs, mostly through cooperative agreements, not inclusive of all PH funding. Included CDC, HRSA, HHS Office of Secretary, USDA (WIC)*

Core components of research: ID candidate programs and funding streams that could be

considered to fund a FC or FA in whole or in part; Conduct key informant (KI) interviews to help determine whether

funding was or could be directly linked to FPHS; and Bring analysis to core group of experts to review approach and

results.

RTI Funding Analysis: Bkgrd/Methods

Public Health Leadership Forum PH Finance Roundtable – November16, 2014

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KIs mostly federal staff, spoke with research team for approximately one hour Interviewer gathered info on if current dollars did or could fund

FCs/FAs and barriers to such funding as time allowed Conducted 25 interviews representing 35 programs and

included 34 programs deemed to fully support FCs/FAs (therefore not in interview pool) 100% includes included surveillance and preparedness funds

These 69 programs = ~80% of adjusted denominator based on 96 target programs ($4.6 billion)*

RTI Funding Analysis: Methods (Cont’d)

Public Health Leadership Forum PH Finance Roundtable – November16, 2014

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Majority of program funding supported assessment functions and community partnership development

About half funded policy development, communications, and organizational competencies

Less program funding supported FAs The overall percentage of funds to FCs/FAs among programs

participating in interviews was 38% ($1.1 billion/$3 billion) FCs are currently funded at $1.3 billion with the possibility of an

additional $35.5 million that could fund them (100% includes + interviews)

FAs are currently funded at $495.6 million, with additional $64.5 million that could fund them (100% includes + interviews)

RTI Funding Analysis: Findings

Public Health Leadership Forum PH Finance Roundtable – November16, 2014

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RESOLVE Health Team

Abby Dilley, VP Programs adilley@resolv.org

Chrissie Juliano, Sr Program Manager cjuliano@resolv.org

Rachel Nelson, Program Associate rnelson@resolv.org

Sherry Kaiman, Strategic Partner sherrykaiman@verizon.net et

Next Steps V2(s) Targeted policymaker outreach Communication/messaging work Moving towards advocacy/

implementation Resources/Feedback

Foundation PH Services websitewww.resolv.org/site-foundational-ph-services

Provide Feedback on the frameworkhttp://bit.ly/FPHSFeedback

Next Steps, Resources, Feedback

Public Health Leadership Forum PH Finance Roundtable – November16, 2014