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2019-216-Minutes for Meeting May 14,2019 Recorded 6/18/2019��UT ES �oG2 44J� -� BOARD OF o COMMISSIONERS 1300 NW Wall Street, Bend, Oregon (541) 388-6570 1:00 PM Recorded in Deschutes County CJ2019-216 Nancy Blankenship, County Clerk Commissioners' Journal 06/1$/2019 9:56:36 AM G��res.co� II I l l II II ILII II l I ll I ll II (() I'll 2019-216 FOR RECORDING STAMP ONLY BARNES & SAWYER ROOMS Present were Budget Committee Members Mike Maier, Bill Anderson, and Bruce Barrett. Commissioners Phil Henderson, Patti Adair, and Anthony DeBone. Also present were Tom Anderson, County Administrator; Erik Kropp, Deputy County Administrator; Wayne Lowry, Finance Director; Andrea Perkins, Budget Analyst; and Sharon Keith, Board Executive Assistant. Several staff and no identified representatives of the media were in attendance. This meeting wos audio recorded. CALL TO ORDER: Chair Bruce Barrett called the meeting to order at 1:02 pm This meeting is a preparation for this year's budget hearing. Due to the complexity of the Health Services Department, there have been two additional budget preparation meetings for the Health Services Department. Health Services Department Budget Presentation (materials are attached to the record): A presentation was made on the Administrative Services Division of the Health Services Department. There are 42.50 FTE in the Administrative Services Division. Dave Inbody gave a historical summary of the division regarding staffing and operations. The division will be requesting a staff position to monitor the BOCC BUDGET MEETING MAY 14, 2019 PAGE 1 OF 2 department's grant process. Commissioner DeBone asks for documents explaining the purposes of grants when they are presented to the Board for consideration of approval. A presentation was made on the Public Health Division by Hillary Saraceno. The services provided by the public health department was reviewed including community health, healthy people & families and public health advancement & protection. The division will be requesting two prevention specialist staff as well as an environmental health specialist along with a fee increase. The Health Service Department reported on the facility needs to accommodate space for staff. gu�,Lgmv dal Being no further items to come before the Board, the meeting was adjourned at 4:00 p.m. DATED this Day of 2019 for the Deschutes County Board of Commissioners. k ANTHONYf `;COMMISSIONER BOCC BUDGET MEETING MAY 14, 2019 PAGE 2 OF 2 Deschutes County, Oregon Budget Committee Meeting May 14, 2019, 1:00PM Second of Two Health Department Briefings Agenda 1. Call to Order 2. Introductory Comments 3. Health Department Discussion • Public Health Bruce Barrett, Budget Committee Chair Tom Anderson, County Administrative George Conway and Health Managers • Administration • Wrap-up — Preparation for formal budget meeting on Tuesday, May 28 4. Questions/Adjourn co j ra Health Services Administrative Services Division Y. FY 2020 Budget Committee Presentation Agenda • Categories of Administration • How Has Administrative Services Changed? • Administrative Services Programs • FY 2020 Budget and Beyond 5/14/2019 1 5/14/2019 Is This Administration? 2 5/14/2019 5/14/2019 0 Categories of Administration I i 5/14/2019 Health Services Expenses Overhead, Director's 14.7% Office, 1.4% c Admin Services, 9.4% j"�, (�z•: {{Y�4 �. /s"�. a: ~ '�f r.�2.. Z7 kT. k.11 "1.. 5 Overhead Health Services Administration 5/14/20`9 FTE j J X 5/14/2019 7 5/14/2019 N. 5/14/2019 Admin of Health Services FTE Declining 350.00 300.00 250.00 200.00 z - � S `1 .J � � � tcV �.� 3 .� �� 3 t. Derr z t < s S 150.00 i s t 4 d t r fiu .r MIN" Se 100.00t,gNE- y r s > t RREM NNM IN 1 INEM 0.00 MMM M N N N N N N N N N N N p O O O O O O O _p O ON W J� Ln ®. V W �O O 1 9 Admin Less than Comparable Counties 500.00 450.00 400.00 350.00 �. 300.00 250.00 200.00 s tx 150.00 4 100.00 50.00 0.00 Marion Lane Deschutes Linn YamhIII FTE: 455.38 436.25 300.40 256.00 131.25 9 5/14/2019 How did Admin Services Adjust? I, Integration 2. Reallocation 3. Innovation 10 5/14/2019 3. Innovation: Expanded Services 1 11 5/14/2019 Administrative Services Programs Compliance & Quality Assurance Workforce Development Operations Business Intelligence 12 Compliance & Quality Assurance Jillian Weiser - Quality & Performance Manager �0 Strategic Planning Compliance Client Grievances Policies and Procedures HIPAA/Privacy Medical Records 8.00 HE 1.00 Manager 1.00 Compliance 6.00 Med Records 5/14/2019 Compliance & Quality Assurance Highlight PROBLEM: Significant loss of revenue from claim invalidations SOLUTION: More auditing and training RESULT: Strong correlation between compliance positions and reduction in claim invalidations 7ACTS: IBM '�Sa a 3"� w4....�.;...,.,a..=.._�.� 2015 3,155 <$445,124 One` Compliance' position conducting audits 2016 1,200 $220,618 Supervisor position converted to Coding & Data Analyst position 2017: 683 $101,620 Additional compliance position added through CCBHC 2018 1,244 $229,460 CCBHC Compliance position vacated and not refilled REQUEST: Retain Quality Improvement Analyst 13 5/14/2019 Workforce Development Dianne Capozzola - Human Resources Analyst Personnel Issues Workforce Development Committee Welcome Week Core Competencies - Employee Evaluations Exit Interviews �d�n3" � 2' 2 0.00 FTE 1.00 FTE �� sm _ � y Workforce Development Highlight PROBLEM: High employee turnover in first year of employment SOLUTION: Welcome Week (established Sep 2016) s, RESULT: Resignations in first year of employment reduced by 2/3 FACTS: � u -.._ - -..... �".;.�sa�'d%m 010- �a'. '`ak�u, r�a�f w +T..i�: WE!. .. '��•1-.L �,G. � In two years prior to Welcome Week: 18.9% In two years since Welcome Week: 4.7% am REQUEST: None in FY 2020 14 Operations Chris Weiler - Operations Manager Billing Electronic Health Records Front Office Facilities Fleet Management Safety 22.10 FTE 23.20 FTE 1.00 Operations Manager 14.40 Front Office 12.00 Front Office 6.70 Billing 6.20 Billing 1.00 EHR 4.00 EHR 5/14/2019 Deschutes County Population Projection 500,000 __ __ __.__ _.._..-.... _-_- _.__.._ 450,000 __. _ ___. __4321930 400,000 . _..._...... ___ _....... ..... -_ 385,803...... 350,000 _ _334,042.._. 300,000 _. ___. ___ _ __ 289,22.5_... 4. t 250,000 244,018 __. _._. x .4 200,000 199, 793 187,6221 _ 157,x11 '� 150,000 _..... 115,367 ,.. _._ 100,00062 142 --74 958........ _ ..... _.. 50,000 23,100 30,442 , _ 1960 1970 1980 1990 2000 2010 2018 2020 2030 2040 2050 2060 2068 Population Projections provided by Portland State University- Population Research Center 15 w I I I I I Operations Highlight PROBLEM: Current facilities not adequate to meet growth in services RESULTS: Facilities ill-equipped to provide needed services Less cost effective solutions used, such as rental property fi./"SOLUTi ®N: Long term strategy to address future service needs FACTS: PSU projects Deschutes County population at 244,018 (+30%) by 2030 Community need for services increases with population growth REQUEST: Development of long term facility utilization plan suited to evolving deparirrnenf needs Business Intelligence Cheryl Smallman - Business Manager Fiscal Services Contracts Grants Data Analytics Quality Improvement Project Management Ell UNION 5/14/2019 5.00 FTE 8.00 FTE 1.00 Manager 1.00 Manager 3.00 Fiscal 2.00 Fiscal 1.00 Contracts 1.00 Contracts 1.00 Project Management 1.00 Quality Improvement 2.00 Data Analytics 16 Business Intelligence Highlight PROBLEM: Chronic fiscal instability SOLUTIONS: • Fully leverage data analytics to better inform decision making • 'Commit resources to grant seeking, application and management RESULT: Greater fiscal stability & More efficient use of resources FACTS: CCBHC PPS rates set at $286 revised to $294, resulting in additional $800;000+ in revenue Grant funding increased from $7.8M (2010) to $18.OM (2019) REQUEST #1: Retain Accounting Technician _- REQUEST #2: Add a position to coordinate grant activities Future of Administration - Integration _= Identify links between root causes and outcomes to inform service delivery T Leverage expertise and successes from other jurisdictions - Reallocation * Use automation to continue transition from clerical to analytical focus Make information more accessible to leadership and staff - Innovation Find solutions for cybersecurity challenges Explore options for workspace alternatives 5/14/2019 17 5/14/20'9 FY 2020 Budget Considerations r "w Long Term Facility Utilization Plan 0.00 Cost effective investment in p facilities suited to long term service needs Retain Quality Improvement Analyst 0.00 Reduction in claim invalidations and lost revenue Retain Accounting Technician0.00 More effectively drive data -based decision making - Greater fiscal stability Add Grant Manager +0.80 Increased revenue from grants - Greater fiscal stability er V, Q) O cr a) af 'U a) LZ Ln m Ln v a•� Lv U C iF 0 a c =3 N O � O O +, U Q) U fl7 > to � Q) Q) O I t0 :L- Q O L U , m LIQ N Q) U Fl0 Caj Ol H L 7 4J N `L' . 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N t� � `� � � •O N � lD c f6 U a) N c }' E O a) L O O N N N Y t > U aJ V) U Q -O_ U o y� a) E V1 ,y,,, = O M a) aJ L U u aJ O U 'O E 01 c II U OL +' E L O M N ONOD CL aj O 00 c 0 N M OO O_ U O vi 0A ¢ U N 76 N �O' U 0A OD m 00 oN O +� 00 O O O� tNif R 3 ` O S Q c oA c c r1 O O E L- -C ++ a •> QJ U c toLL N V\f O = H 00 N U L O L a) , +J O N — c-1 _ m O f6 +1 m a) l0 c'1 I� O L a .N F- TH .F." U -, L N N _ a o 0 0 c o C O 0 o Ln co co 0 O �o LnQ O M rH � of N c -I ci TH e"'1 al Q1 e-•1 r -I t0 C1' c N � ch a1 M a+ 0 'a\ + 0 + 0 o a O o a s a o 0 0 o o cr) �1 z z z rn 0 v v v 1, 01 00 V Ln c L a) ++ a) N > m E L o v *= C Q c ai °° (D cr O O Ln _ as 'O Lc > a) a) m G O O 3 O 0 Y =3c a.; U a) c Q Q a+ O c a) E L o }? U m O ai aJ -o U > O> v a E `° E C i Q 'N two COA O c �- aJ to a; a1 a O O vi CL -1 i' i+ O a m p O O U O E p Q6 U_ VI v -p L � va) L v OM= 0a e W c c U co u m a) E U a) Y In U +-" 4 �- w c U U � 4.- 1 m O O O O O bA a) L 00 cn p 0 0 O p to p O O E to O O 4-1 }' c >" C (O ++ c o L ++ a) co L v L >. a) L a) v> L v N O E aJ ++ aJ >. O VI c N ++ N-0 7 � a) ,= O lC C: O .E '- f- O U L U c L U� L c U� L E U c L U L E a) E U c L U L E C E c CL ' E = �••" v O v v c a) _ O a) L v a) a) c 0 a 3 a E a m a w L a LL a Z m z a +, a Z to Z +, z George Conway, MD, MPH Deputy Public Health Hillary Saraceno, MS To Promote and Protect the Health and Safety of Our Community What We Do Public Public Health Public health promotes and protects the health of everyone who lives in or visits Deschutes County by: ® Preventing, investigating and protecting people from diseases ® Making sure our food and water are safe ® Promoting health and countering the harmful impact of chronic disease of budget supported and injuries by General Funds ® Preparing for and responding to natural or human caused emergencies and emerging health threats 67 FTE ® Ensuring equitable access to preventive health services Local Public Health Delegations of Authority - L HA (OAR 333-094-0530) Fulfilled by 77 Public Health employees - Local Public Health Authority: County Commissioners - BoCC - Local Public Healthy Agency: Deschutes County Public Health Division is authorized by the BoCC to perform Public Health requirements and Healthcare is vital to all of responsibilities on behalf of the county (Public Health is a division of Health us some of the time, but public health is vital to all of Services) us all of the time." - Local Public Health Administrator: DOHS Director, authorized by the BoCC to -C. Everett Koop, Former oversee the Local Public Health Agency US Surgeon General Responsibility of the Local Public Health Authority (BoCC) - Receive and investigate all Deschutes County reports of communicable NEa�rH OFA diseases, outbreaks or epidemics ��o - Issue or petition for isolation and quarantine orders 3� Q - Review immunization records and issue school exclusion orders ® - Assure access to family planning, birth control services, and immunizations ® -� C - Perform duties and activities related to enforcing the Indoor Clean Air Act Advancing Q public health o � - Licensure and inspections of tourist accommodations, pools and spas, yperformance � 4'TyACrmance restaurants, mobile food units, and some public water systems ��`O� - Enforcement of public health laws under ORS 431.150 - Assure meeting of PH service requirements in ORS 431.413 (PH Modernization minimum required programs and capabilities) George Conway, MD, MPH Deputy Public Health Hillary Saraceno, MS C iF O O ?y y C > C p .2; t�i� p C s. N C C O N u E Z i1 ;c6 C bA 0 O E O L- GJ p U p Q a p �, u Q1 O + y y+' w 4-' c .� a' O > b4+ c Q F► C Z3 N (a 4-+ N O m u O p a- g N O i^ p QOJ Ln O C 0 .0 O �, u 06 0 >- -CC -0 � �, � � a o E -0 a E n � N O � � 4- y H o u - N C M C; 0 i C -C +-' E— E ca w p O � a ., v- - + O y, O bA O N �' Q „ V �' •� Vi7i U 0a v V Q b0 LU �ti (6 C L' U1 ru aJ v >> 00 Q1 Oi i1 bo O Z; y � Vl u U ... c6 �=+ � Oi u v > +�+ r6 Zz; C u is (V E- u n C >, > •_ -a -6a Oji s.. in <C v v E Ln�' W o W vui °' vi > >fa a o v '' a (A v ® v x �n ��.. n - r- -r- �°. i O 'G O H >` r w. v = Q v CL 4� Q i a C H Q to Q i .— u p v W v C Z C T ra a a_;o Promoting & protecting the health and safety of Deschutes County FM i "Health is a state of complete physical, social, and mental well-being, and not merely the absence of disease or infirmity." Public health is what we, as a society, do collectively, to assure the conditions in which people can be healthy. Our mission: To promote and protect the health & sofety of our e Public health and prevention programs in your community: Immuma pMbren �� R Screen peWe foe IDVIAIDS6 PrWO people lmm tllpasleB .(, .a. kovbe MaDh O BDtl tlbxisp'WlEredkS Yi T SeiviCet lO Nldldttas� o sueepnewbwns � d u��;�la� Sfo IM h4aDA DrDDkmt r O DMwaneR. @ � Anp Wrii4 waur gwnaruranlapr. fi � z ;. � ene eNpnoan000s ckana OReduca Wb.- ufa A Pro-I—twMftM".f* We all benefit Nne,ican PubncH Ihhssociotion Agenda 1) The unique role of public health 2) Why invest in public health? 3) County General Fund PH investment 4) FY20 budget, knowns & unknowns 5) Programs, services, outcomes, ROI 6) Needs & Policy Options 7) Q&A 5/14/2019 •a�e,mo� P�baeeeotrn assoc arm„ Promote and protect the health and safety of our community Work is statutorily defined (OARS & ORS) & regularly reviewed Unable to bill for all of our work and services Impacted by population growth, yet required to provide services Rely on grants to address unmet needs & gaps Safety net for vulnerable populations Unique Role Public Public Health is primarily focused on the population, NOT the individual Unique Role: Statutory Requirements ` BOARD OF COMMISSIONERS �`' HEALTH SERVICES -11 in 5/14/2019 Unique Role Of Public Health �yPublicHealthcare Health Provider a, g 3. p i:ders and b t q ed by aw w report cettxd nd and t-. ns to'.o<a. neat, e departments 11111333-18-0000} O Am Unique Role: Programs & Services Communicable Disease (CD) ; ; ;,,o o & on.rr Tuberculosis Case Management j—camp rx VOC Program Perinatal Care Continuum = Emergency Health Preparedness & Response Vital Records (birth & death records) Tobacco Prevention & Community -Systems change Prevention Environmental I lealth Services (licensing & inspections Since 1900 ave, lifespan increased by 30 years 25 of those 30 years due to advances in public health, not healthcare Vaccinations Safer food and water S�AT� IAW,` Cont— or commu^'cao' cd;.... SEAT OUT > Healthier mothers and babies I USE REOWREO , ",1111111111i Tobacco prevention and control { . Motor vehicle & workplace safety 2 For each 10 percent Increase In local public health spending: Inlenideads CM161 a4CWa( plabetes deans cancer deans • decrease deaths d-- d-- deaese '. Seaibett use redact 4 serious M7udes rd doalhl carerasbesby 50% € ,d gi y mt(4Cenhnit Me US L��`1av:' d "" meralomaadn PAWS eonenuototlmp— mzolo,le%oiawns�- ;J" vdwanokelrom42%In. 1ecsWru, n, 1997. � � smoked >S k� tgg5 2010 of every $1 spent on healthcare in the US goes towards preventable chronic disease conditions such as obesity, heart disease, and diabetes O of every $1 spent on health care goes towards public health and prevention 5/14/2019 �." r M d E-3-4 E E21 1. Funding PH is a smart investment Protects our community, saves lives, saves money 2. PH is primarily focused on whole population Benefits everyone: where we live, learn, work & play 3. Most PH programs & services: Not provided by anyone else in Deschutes County 4. Q&A 3 Ten Year CGF Investment Trend P: FY19 CGF Investments & Supports 1) Off -set loss of 5.60 FTE (FV19 FTE only decreased by 1.50) 2) Kept County health clinics open in Redmond & Bend 3) FY19 investment provided capacityfor: r S-1 D/CD investigation & response WIC Program o Clinical Preventive Health Services (without asking for $200K) 4) Good news: Investment outcomes in program reviews 5/14/2019 FY 19 PUBLIC HEALTH RESOURCES - Braided & Blended PH Reserves. Vital Records Other Federal Grans. 3% 2% 1% 3% State Mise. /F FY20 PH Budget: - Kn®wns - Unknowns Promoting and protecting the health and safety of our community —r i 12 Local Per Capita Investment (CGF) in Public Health — FY18 s 60.00 MORROW, $ 50.39 $5000 Average: $16.27 $ 40.00 CROOK, $ 31.88 $ 30.00 DESCHUTES $ 20.19 $ 20.00 `4 $ 10.00 � v POLK,$3.541 S000 Per Capita Total Local lnvestrnenl FY19 CGF Investments & Supports 1) Off -set loss of 5.60 FTE (FV19 FTE only decreased by 1.50) 2) Kept County health clinics open in Redmond & Bend 3) FY19 investment provided capacityfor: r S-1 D/CD investigation & response WIC Program o Clinical Preventive Health Services (without asking for $200K) 4) Good news: Investment outcomes in program reviews 5/14/2019 FY 19 PUBLIC HEALTH RESOURCES - Braided & Blended PH Reserves. Vital Records Other Federal Grans. 3% 2% 1% 3% State Mise. /F FY20 PH Budget: - Kn®wns - Unknowns Promoting and protecting the health and safety of our community —r i 12 LIMITED RESOURCES INCREASING DEMAND As population size increases, our work increases Deschutes County Population $ize and Total Number of CD/STD Cases investigated by the Communicable Disease Team, 2013.2018 ?ww0 I� 1.100 IHpwO 1z0`v Iv+coo lcowo Iwo cc- Iwwo eww �w s �, odyw Between2013-2018: tw '`- 4ww 14% increase in population 39% increase in total CD/STD cases zw zww a o zo;3 _c.l� zou ..mo 2012 zole MIM 1) State & Fed. PH funding is restricted 2) Several pending grants also restricted 3) —$200K reduction in grant funds Action: positions eliminated 4) $26K increase in state EHS remittance fees Action: SB 27 Water Legislation 5/14/2019 As population size increases, our work increases Deschutes County Populatlon Si,e and Total Number of Facilities Inspected by the Environmental Health Team, 2013-2018 180000 EifS.4l.Y 8 sm IEoao 6Nd'!d4 tna:l �_ lacwo lzowe lxoo �1wwo eww coon M Between2013-2018: Iran 0 14% increase in population 20% increase in total facilities inspected o I,00 mis zmo zou zm� zon nota +-Oezz Futez Cou�ny Populatlon Size +—Total (�nlities inspecteA Public Health Division I Three Year Trend V\/hat lnie knov,, is also what concerns us'. 68.90 68.90 67.40 63.35 I ME ild (No change) (1.50) (3.95) Phi FY20 Budget: What we don't know County 1) Level of CGF for PH? i 2) Marijuana Tax Revenue? 3) Environmental Health supplemental funding? State 1) Budget may not be approved until July or August 2) $250K CD Modernization Funding , 3) If SB 27 Water Legislation will pass Federal 1) Uncertainties about funding1 5 Other Unknowns: Potential Future Challenges Contingencies that may need policv direction County: Reserves for health emergency response State: $26K for state fee increase if SB27 for water bill does not pass Declining Medical Marijuana Tax revenue i- Tobacco prevention funding formula changes (-$58K) Federal: Title X (RH clinic) & 340B (discounted meds) PREP - Teen pregnancy prevention Unique role of public health: PH 101 I -P -.moa t ,F<<rp, It -nI Rfa ). $1 1.5M Wh We Do U t� 33% 67 FTE 5/14/2019 Ivey Fake -Away Points � 1) FY 20 Budget: Many unknowns 2) All counties contribute CGF CGP covers 33% of PH costs for 100% of the benefit 3) Most PH funding is categorical & restricted Therefore NOT interchangeable 4) Primary Challenges: Population increase = increase demand for services PH capacity (FTE) is declining despite growth 5) Q&A Public Health Division Who are we? Budget = $11.51M ti FTE = 67 F1E s. # Employees = 77 R ��o Hearts pip o7t I eMENy yap �Pr I ME P rvz INE e 'TFq�ni ACCREO.tP.. Community Health Section I Overview L Foodborne illness costs Oregon $229 million each year in health care, lost productivity and premature death. Resources not keeping pace with need: 21% increase in number food, pool, and lodging facilities since 2010 107% increase in the number of mobile food units since 2014 Current EHS case load exceeds FDA Program Standards 5/14/2019 Achievements ➢ 400+ Temporary Restaurants inspected at county events ➢ 92% overall approval client survey(2019) ➢ 97% of licensed facilities are inspected annually 61 plan reviews & pre -opening inspections on new Mobile Food Units z The ability to provide better and more timely customer service More thorough inspections, including prevention, education, & support Being able to respond more quickly to urgent situations and outbreaks Capacity to respond to Public Health concerns apron ., a,mu<nenim �o��e�n 7 5/14/2019 Prevention & Health Promotion .services Offered ✓ * Alcohol, tobacco & other drugs prevention tet„ �• Suicide & bullying prevention *Youth Engagement Program Chronic disease self-management l z t * Diabetes prevention Oki * Tobacco prevention -.,3>.,,. a gym.., P rt.. lw..,/ , ^!•1/ Local Youth Marijuana Prevention r Focus on youth is important as they are significantly more likely to become substance dependent in adulthood if they begin use in adolescence Grant funding often has limitations to how the funds can be used and for what area (geographically and/or topically) Current focus of youth marijuana prevention is in Bend, leaving La Pine, Sisters, and Redmond with minimal prevention service Return on Investment Cost Benefit studies indicate that $1 spent on substance abuse prevention can result in $10 of long-term savings i W Service Data Accomplishments >1,299RHclients and 2,173visits 1 95.8% of clients use effective contraceptive method 5,652 women, infants & children Increased WIC outreach through partnerships and new on-line access 600 billable in-home visits xlnDeveloped RN extender model ➢ 2,323 perinatal clients received Served 53% of all pregnant clients coordination se vices 10K birth and death certificatestr Creating on-line portal for faster birth processed certificate processing ✓RH Clinic was able to set-up new cost-effective staffing model expand safety services to a under -served population. ✓WIC was able to expand Nutritionist Education capacity in Bend & Redmond Public Health * Client Providin timely access to clinical preventive services or our community through: Safety net clinics in Bend & Redmond WIC clinics in Bend, Redmond & La Pine Family Support services throughout county Birth and Death certificate processing for the county Every $1.00 invested in publically funded family planning, creates $7.09 in health and early childhood care savings ECONOVK BE UITS OF CC M L✓2l KIC fAFk RSR£Gi Nlfi Ff ilQY PiFGAAM 5/14/2019 WE Is, MMIMMMIMUM Good News: Gonorrhea cases down Percent fall g—n-he—ase report that were completed within 7 or fewer (Jays and number of total case,, Deschutes Coudty, ORPHEUS 2012-2018. 7, M M I hankyou for Your 1! i to investment! i ti 30 40 30 Mut 2013 201a 2015 20)1 lot, 1- -d .(cases Epidemiology Informs Risk Communicati 1.. Collect &monitor local data Provide timely health info to detectemerging health & recommendations to the public threats and health care providers j: Flu lases on the rise in Central Oregon 5/14/2019 Service Data &Accomplishments Disease investigation and response �e- 1,178 communicable disease reports 12 outbreak investigations Emerging & seasonal health threats: measles exposure, ft DETECT GENERATE SOLVE CONIROL Service Data &Accomplishments Prevention, outreach, and education Offered 260 free flu vaccines in Deschutes County to vulnerable lations Provided education on healthy relationships, STDs, and teen pregnancy prevention to -5900 students (18-19 school vagi Conducted 130 HIV tests and 86 Hepatitis C tests at 32 outreach testing events ()un -Dec 2018) PREVENT o DETECT ® RESPOND CD e Emergency Prep a Epidemiology o Risk Communication Public health mobilized to Deschutes County offers head off measles outbreak wildfire smoke health tips Hantavirus HIS Deschutes County woman What to expect for this Deschutes County flu year's mosquito season immunization rate tops state Heat wave could reach triple digits in Central Oregon 10 Cost of DCHS staff time Cost to Clark County PH Inpatient charges from responding to a local for the recent measles a tetanus case in an measles exposure outbreak unvaccinated OR child $52,000 $1.5 M Cost of a LHD response Hospital charges for a to a pertussis outbreak i .. in a school severe pertussis case m an infant Issues: 0) Marijuana use in last 30 days among youth increasing 7 , 2) Unable to provide needed prevention efforts In La Pine, Redmond & Sisters<..` Options: 1) Fund 1.0 FTE Prevention Specialist (CHS II) with Marijuana Tax or CGF funds to serve La Pine and Sisters 2) Add: 2nd Prevention Specialist (CHS II) for Redmond? 3) Leave La Pine, Sisters &/or Redmond underserved 5/14/2019 Nearly 60% of outbreaks in Central Oregon occur in Long Term Care Facilities 60+ infection prevention trainings Created an outbreak prevention & response team Recommendation(s): 1) 1.0 FTE Prevention Specialist (CHS II) for La Pine and Sisters $114,968 (request marijuana tax funds) .. J) Add: $114,968 (CGF) option for Redmond if CGF resources Total: $229,936 for 2.0 FTE Benefits: 1) Increase capacity for needed marijuana prevention services 2) Would bring Prevention program FTE to FYI levels 3) County control of decisions, priorities & activities 11 Policy Option ° Environmental Health Issues: 1) Resources needed for current service level ($88K deficit) 2) EH Specialist caseloads well above FDA best practices Options: 1) 3% fee increase with $61,500 additional CGF 2) 8.5% fee increase with no additional CGF 3) RIF Policy Option ° CD Modernization Issues• . ,. ,�s �E� � , . ,.,,�� . , �� ,.w,. ,. , . , . _a, . , 1) Funding ends June 30th and not in proposed DCHS budget It 2) Funding is in CHA proposed budget- may know until July August and may be a reduction in funding 3) Two limited duration staff impacted & require 30 day notice Options: 1) RIF now and hope staff remain when budget is confirmed 2) Extend limited duration status three more months 1) 1.0 FTE La Pine & Sisters Prevention Specialist (CHS II) Requesting marijuana tax funds 2) 3% fee increase & CGF for Env. Health to off -set shortfall 3) One time bridge funding to stabilize CD r Requesting Co. General Funds & 3 mo. ext. for limited duration staff 4) 1.0 FTE Redmond Prevention Specialist (CHS II) o- Additional option request for County General Funds 5/14/2019 Policy Option ® Environmental Health Recommendation: 1) 3% fee increase with added $61,500 CGF �r Benefits: 1) Prevents further reductions in staff 2) Preserves capacity for effective inspections and education 3) Minimizes increase in fees to businesses Policy Option ° CID Modernization Recommendations: 1) Extend limited duration status three more months r- 2) Requires $62,500 CGF to extend program three months Benefits: 1) Provides funding to either stabilize program or allow transition 2) Helps retain staff during the uncertainty 3) Assures continuity of program if funded and staff retained 4) If funding received but reduced, provides bridge funds to make adjustments Policy Option Requests ® Costs In Summary' Marijuana Tax Revenue. 1) $114,968 for 1.0 FTE La Pine & Sisters Prev. Specialist (riff) County General Fund - Option 1: 1) $61,500 with 3% fee increase for Environmental Health 2) $62,500 one time bridge funding to stabilize CD $124,000 TotaICGFRequest County General Fund -- Option 2: ^ 1) Option 1 plus: 2) $114968 for 1.0 FTE Redmond Prev, Specialist rcnsm $238,968 Total CGF Request 12