TRIBALFOUNDATIONAL PUBLIC HEALTH SERVICES PROJECT

May 21, 2015 – Informal Consultation with Tribes

Marilyn Scott, Vice Chairperson (Upper Skagit Indian Tribe)John Wiesman, Secretary of Health (Washington State)

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PURPOSE

We are seeking…

Your general approval of a project: The Tribal Foundational Public Health Services

(FPHS) Project

Your interest and willingness to have your health directors engage with the Tribal FPHS Project

What Defining foundational public health services Estimating the cost to deliver them and the

gap in funding Recommending who should pay for them

Why? May bring additional funding or services to

tribes to make them available Could free up other funds that are currently

being spent on them to be redirected to more clinical or contract care

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PURPOSE (Cont.)

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CONTEXT: Health Spending

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CONTEXT: The difference between medical care and public health (examples)

Clinical/Medical Care Public Health (Prevention/Population Health)

Diagnose and treat an adult with food poisoning

Contact people with food poisoning, compare what they ate and when, identify the source of the food poisoning and work with the vendor to eliminate the problem.

Administer immunizations to patients

Review immunization data, identify groups with low immunization rates, find out why and help solve the problem.

Diagnose and treat a child with pertussis (whooping cough)

Contact people who may have been exposed to the child during the three week infectious period, tell them they may have been exposed, check for symptoms and get them tested and treated.

Provide pre-natal and maternity care

 

Promote programs that foster development of healthy relationships, link pregnant women to pre-natal care and work with hospitals, employers and the community to promote breastfeeding friendly policies.

Screen and test patients for hypertension and diabetes and provide treatment.

Promote healthy eating and active living to reduce obesity and prevent hypertension and diabetes

CONTEXT: Medical care and public health are funded differently in tribal and non-tribal jurisdictions

Medical Care Public Health

Tribal Tribal & Federal Government

Tribal & Federal Government

Non-tribal

Insurance purchased by employers, groups or individuals, out of pocket, Federal & State Govt. for Medicare/Medicaid

Grants, Donations, Community Benefit Funds from Non-profit Hospitals, Community Based Organizations

County, State, Federal and Some City Governments

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THE PROBLEM: Much Public Health Funding is Categorical (only for specific programs)

THE GOAL: Develop a long-term strategy for predictable and appropriate levels of

core public health funding

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Current StatusFunding for Categorical

ProgramLimited Core Funding

Desired StatusFunding for Categorical Programs

Core Funding to Support, Coordinate & Integrate Programs

FOUNDATIONAL PUBLIC HEALTH SERVICES (FPHS)National Workgroup 2013 - 2015

Define a ‘minimum package’* of public health services

Estimate the cost of a ‘minimum package’* of public health services

Develop a chart of accounts for use by public health at all levels

Discuss the Federal role in funding a ‘minimum package’* of public health

service

* Later changed to ‘foundational’

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FOUNDATIONAL PUBLIC HEALTH SERVICES (FPHS)National Draft Framework 2014

Across all Programs• Assessment (surveillance and epidemiology)• Emergency preparedness and response (all hazards)• Communications• Policy development and support• Community partnership development• Business competencies

Foundational

Capabilities

ChronicDisease& Injury Preventi

on

Communi-cableDiseaseControl

MaternalChild

FamilyHealth

Environ-mentalPublic Health

Access to

Clinical Care

VitalRecords

Foundational

Programs

Additional

Important

Services

FOUNDATIONAL PUBLIC HEALTH

SERVICES

WASHINGTON STATE FPHS PROJECT: Framework

Changed the terminology to: Foundational Public Health Services (FPHS)

Defined what is included in FPHS Estimated the cost of

delivering FPHS statewide what is currently spent on FPHS statewide any funding gap for FPHS statewide

A FPHS Policy workgroup recommended a new vision for the governmental public health network and funding model

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FOUNDATIONAL PUBLIC HEALTH SERVICES (FPHS)Washington’s FPHS Work 2012 - 2014

Key Recommendations from the FPHS Policy Workgroup Endorsed the FPHS framework and

definitions Recommended a new funding model for

state and local governments Recommended a tribally lead process to

define how the Foundational Public Health Services funding and delivery framework will apply to tribal public health, and how tribal public health, the Department of Health, and local health jurisdictions can work together to serve all people in Washington

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WASHINGTON’S FPHS WORK:A New Vision for Washington state (December 2014)

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A TRIBALLY LEAD PROCESS TO

What Define foundational public health services Estimate the cost to deliver FPHS, current

spending, and any gap in funding FPHS Recommend who should pay for FPHS

Why? May bring additional funding or services to

tribes for FPHS Could free up other funds that are currently

being spent on FPHS to be redirected for more clinical or contract care

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WE ARE SEEKING

Your general approval of a project: The Tribal Foundational Public Health Services

(FPHS) Project

Your interest and willingness to have your health directors engage with the Tribal FPHS Project