The document discusses Virginia's health and human services programs and delivery system. It provides an overview map of the various state agencies and programs involved, including Medicaid, social services, behavioral health, public health, and more. It emphasizes moving from a program-focused model to a more coordinated, customer-centric model to better serve individuals and families. Key challenges discussed include demographic changes, technological shifts, workforce issues, balancing specialization and integration, and coordinating complex federal, state and private systems and requirements.
Ricardo Colon and Sebastian Branca of the Philadelphia AIDS Activities Coordinating Office presented on Client Services and Quality Management in Philadelphia at the March 2017 meeting of the Ryan White Planning Council.
Carisa Magee, Manager, Medicaid/CHIP Program Policy Texas Health and Human Services Commission, presented an overview of Medicaid at the "Designing Healthcare in Texas" conference hosted by One Voice Texas, Harris County Healthcare Alliance and Kinder Institute on June 3, 2014.
Yvonne Hughes – 2014 nominee for Modern Healthcare's Community Leadership AwardModern Healthcare
Yvonne Hughes – 2014 nominee for Modern Healthcare's Community Leadership Award.
The success of the healthcare industry depends on leaders who define themselves by leading efforts to change lives and contribute to their communities through their work. But many go above and beyond commitments central to their roles, reaching out to support causes that may be wholly unrelated to healthcare, but which build and sustain strong communities and the quality of life within them. Modern Healthcare's Community Leadership Awards was established to recognize these leaders while bringing attention to the worthy causes they support. Modern Healthcare's Community Leadership Awards was established to recognize these leaders while bringing attention to the worthy causes they support.
http://www.modernhealthcare.com/section/community-leadership
Because everyone matters.
IBM Health and Social Programs Summit, October 2014
Craig Rhinehart’s Blog
Insights from NASHP Conference in Atlanta
Trick or Treating for State Healthcare Innovation Treats
http://craigrhinehart.com
Virginia AFP's lobbyist Hunter Jamerson's presentation from the 2013 SLC on the unique Medicaid reform approach being followed in the state of Virginia.
Presentation 90-10-funding-opportunity-for-health-infomation-exchangesOrion Health
How can HIEs access 90/10 and Federal funding and expand their exchange
We examined the opportunities to capture funding from CMS to develop core HIE services, public health infrastructure, electronic Clinical Quality Measurement (eCQM) infrastructure, and provider onboarding.
This webinar demonstrated how to some innovative HIEs are leveraging these grants and have elected multiple funded activities to boost growth, expand regional interoperability, and upgrade to higher performing technology stacks.
George Beckett, Chief Business Development Officer at the Cedar Bridge Group and Orion Health’s Director, Laura Young, about the process to request funding for health information exchange (HIE) infrastructure.
In this webinar, we explained:
1. The CMS 90/10 funding opportunities for private and public HIEs
2. The funding strategy used by NDHIN and their 5-year business plan
3- How NDHIN has created a solid data foundation for their data strategy and how they are expanding their infrastructure
Ricardo Colon and Sebastian Branca of the Philadelphia AIDS Activities Coordinating Office presented on Client Services and Quality Management in Philadelphia at the March 2017 meeting of the Ryan White Planning Council.
Carisa Magee, Manager, Medicaid/CHIP Program Policy Texas Health and Human Services Commission, presented an overview of Medicaid at the "Designing Healthcare in Texas" conference hosted by One Voice Texas, Harris County Healthcare Alliance and Kinder Institute on June 3, 2014.
Yvonne Hughes – 2014 nominee for Modern Healthcare's Community Leadership AwardModern Healthcare
Yvonne Hughes – 2014 nominee for Modern Healthcare's Community Leadership Award.
The success of the healthcare industry depends on leaders who define themselves by leading efforts to change lives and contribute to their communities through their work. But many go above and beyond commitments central to their roles, reaching out to support causes that may be wholly unrelated to healthcare, but which build and sustain strong communities and the quality of life within them. Modern Healthcare's Community Leadership Awards was established to recognize these leaders while bringing attention to the worthy causes they support. Modern Healthcare's Community Leadership Awards was established to recognize these leaders while bringing attention to the worthy causes they support.
http://www.modernhealthcare.com/section/community-leadership
Because everyone matters.
IBM Health and Social Programs Summit, October 2014
Craig Rhinehart’s Blog
Insights from NASHP Conference in Atlanta
Trick or Treating for State Healthcare Innovation Treats
http://craigrhinehart.com
Virginia AFP's lobbyist Hunter Jamerson's presentation from the 2013 SLC on the unique Medicaid reform approach being followed in the state of Virginia.
Presentation 90-10-funding-opportunity-for-health-infomation-exchangesOrion Health
How can HIEs access 90/10 and Federal funding and expand their exchange
We examined the opportunities to capture funding from CMS to develop core HIE services, public health infrastructure, electronic Clinical Quality Measurement (eCQM) infrastructure, and provider onboarding.
This webinar demonstrated how to some innovative HIEs are leveraging these grants and have elected multiple funded activities to boost growth, expand regional interoperability, and upgrade to higher performing technology stacks.
George Beckett, Chief Business Development Officer at the Cedar Bridge Group and Orion Health’s Director, Laura Young, about the process to request funding for health information exchange (HIE) infrastructure.
In this webinar, we explained:
1. The CMS 90/10 funding opportunities for private and public HIEs
2. The funding strategy used by NDHIN and their 5-year business plan
3- How NDHIN has created a solid data foundation for their data strategy and how they are expanding their infrastructure
In search of a digital health compass: My data, my decision, our powerchronaki
Knowledge is power. Despite extensive investments in digital health technology, navigating the health system online is challenging for most citizens. Also for eHealth, the “Inverse Care Law” proposed by Hart in 1971, seems to apply. Availability of good medical or social care services and tools online, varies inversely with the need of the population. The low adoption of eHealth services, and persistent disparities in health triggers a call for multidisciplinary action.
Barriers and challenges are not to be underestimated. Culture, education, skills, costs, perceptions of power and role, are essential for multidisciplinary action. This comes together in digital health literacy, which ought to become an integral part to navigate any health system. Patients living with an implanted device or coping with persistent, chronic disease such as diabetes, as well as citizens engaged in self-care, caring for an elderly relative, a neighbor, or their child with illness or deteriorating health, need a digital health compass.
The panel will engage the audience to elaborate on a vision for this personal, digital health compass and drive advancement in health informatics and digital health standards. The transformative power of health data fueled by targeted digital health literacy interventions can be leveraged by open, massive, and individualized delivery. This way, digital health literate, confident patients and citizens join health professionals, researchers and policy makers to address age-related health and wellness changes to shape the emerging precision medicine and population health initiatives.
From a panel in the eHealthweek 2016. http://www.ehealthweek.org/ehome/128630/hl7-efmi-sessions/
The Practical Playbook
National Meeting 2016
www.practicalplaybook.org
Bringing Public Health and Primary Care Together: The Practical Playbook National Meeting was at the Hyatt Regency in Bethesda, MD, May 22 - 24, 2016. The meeting was a milestone event towards advancing robust collaborations that improve population health. Key stakeholders from across sectors – representing professional associations, community organizations, government agencies and academic institutions – and across the country came together at the National Meeting to help catalyze a national movement, accelerate collaborations by fostering skill development, and connect with like-minded individuals and organizations to facilitate the exchange of ideas to drive population health improvement.
The National Meeting was also a significant source of tools and resources to advance collaboration. These tools and resources are available below and include:
Session presentations and materials
Poster session content
Photos from the National Meeting
The conversation started at the National Meeting is continuing in a LinkedIn Group "Working Together for Population Health" and Twitter. Use #PPBMeeting to provide feedback on the National Meeting.
The Practical Playbook was developed by the de Beaumont Foundation, the Duke University School of Medicine Department of Community and Family Medicine, the Centers for Disease Control and Prevention (CDC), and the Health Resources & Services Administration (HRSA).
Health Equity Investments: Opportunities and Challenges in 2023Health Catalyst
Trudy Sullivan and Dr. Melissa Welch will discuss how to establish mechanisms using data you already have for ongoing health equity evaluation and how to drive data-informed decisions. Trudy Sullivan and Dr. Melissa Welch will discuss how to establish mechanisms using data you already have for ongoing health equity evaluation and how to drive data-informed decisions.
How do medicaid waivers expand the possibilities of whole person care 032117Jennifer D.
With the changing landscape in healthcare right now it's important to know how Medicaid Waivers and Whole Person Care can help secure positive outcomes.
Universal Health Coverage (UHC) Day 12.12.14, NepalDeepak Karki
This presentation is made on the first ever Universal Health Coverage (UHC) Day 12.12.14 celebration in Nepal by Nepal Health Economics Association (NHEA).
Well Care Health Plans, Inc.
Presentation to Georgia House Children's Mental Health Study Committee
October 20, 2015
Dauda Griffin, MD
Behavioral Health Medical Director
Remedios Roderiguez, Senior Director
Behavioral Health Operations
Veterinary Diagnostics Market PPT 2024: Size, Growth, Demand and Forecast til...IMARC Group
The global veterinary diagnostics market size reached US$ 6.6 Billion in 2023. Looking forward, IMARC Group expects the market to reach US$ 12.6 Billion by 2032, exhibiting a growth rate (CAGR) of 7.3% during 2024-2032.
More Info:- https://www.imarcgroup.com/veterinary-diagnostics-market
INFECTION OF THE BRAIN -ENCEPHALITIS ( PPT)blessyjannu21
Neurological system includes brain and spinal cord. It plays an important role in functioning of our body. Encephalitis is the inflammation of the brain. Causes include viral infections, infections from insect bites or an autoimmune reaction that affects the brain. It can be life-threatening or cause long-term complications. Treatment varies, but most people require hospitalization so they can receive intensive treatment, including life support.
Empowering ACOs: Leveraging Quality Management Tools for MIPS and BeyondHealth Catalyst
Join us as we delve into the crucial realm of quality reporting for MSSP (Medicare Shared Savings Program) Accountable Care Organizations (ACOs).
In this session, we will explore how a robust quality management solution can empower your organization to meet regulatory requirements and improve processes for MIPS reporting and internal quality programs. Learn how our MeasureAble application enables compliance and fosters continuous improvement.
PET CT beginners Guide covers some of the underrepresented topics in PET CTMiadAlsulami
This lecture briefly covers some of the underrepresented topics in Molecular imaging with cases , such as:
- Primary pleural tumors and pleural metastases.
- Distinguishing between MPM and Talc Pleurodesis.
- Urological tumors.
- The role of FDG PET in NET.
Navigating Challenges: Mental Health, Legislation, and the Prison System in B...Guillermo Rivera
This conference will delve into the intricate intersections between mental health, legal frameworks, and the prison system in Bolivia. It aims to provide a comprehensive overview of the current challenges faced by mental health professionals working within the legislative and correctional landscapes. Topics of discussion will include the prevalence and impact of mental health issues among the incarcerated population, the effectiveness of existing mental health policies and legislation, and potential reforms to enhance the mental health support system within prisons.
About this webinar: This talk will introduce what cancer rehabilitation is, where it fits into the cancer trajectory, and who can benefit from it. In addition, the current landscape of cancer rehabilitation in Canada will be discussed and the need for advocacy to increase access to this essential component of cancer care.
Stem Cell Solutions: Dr. David Greene's Path to Non-Surgical Cardiac CareDr. David Greene Arizona
Explore the groundbreaking work of Dr. David Greene, a pioneer in regenerative medicine, who is revolutionizing the field of cardiology through stem cell therapy in Arizona. This ppt delves into how Dr. Greene's innovative approach is providing non-surgical, effective treatments for heart disease, using the body's own cells to repair heart damage and improve patient outcomes. Learn about the science behind stem cell therapy, its benefits over traditional cardiac surgeries, and the promising future it holds for modern medicine. Join us as we uncover how Dr. Greene's commitment to stem cell research and therapy is setting new standards in healthcare and offering new hope to cardiac patients.
Letter to MREC - application to conduct studyAzreen Aj
Application to conduct study on research title 'Awareness and knowledge of oral cancer and precancer among dental outpatient in Klinik Pergigian Merlimau, Melaka'
DECODING THE RISKS - ALCOHOL, TOBACCO & DRUGS.pdfDr Rachana Gujar
Introduction: Substance use education is crucial due to its prevalence and societal impact.
Alcohol Use: Immediate and long-term risks include impaired judgment, health issues, and social consequences.
Tobacco Use: Immediate effects include increased heart rate, while long-term risks encompass cancer and heart disease.
Drug Use: Risks vary depending on the drug type, including health and psychological implications.
Prevention Strategies: Education, healthy coping mechanisms, community support, and policies are vital in preventing substance use.
Harm Reduction Strategies: Safe use practices, medication-assisted treatment, and naloxone availability aim to reduce harm.
Seeking Help for Addiction: Recognizing signs, available treatments, support systems, and resources are essential for recovery.
Personal Stories: Real stories of recovery emphasize hope and resilience.
Interactive Q&A: Engage the audience and encourage discussion.
Conclusion: Recap key points and emphasize the importance of awareness, prevention, and seeking help.
Resources: Provide contact information and links for further support.
The dimensions of healthcare quality refer to various attributes or aspects that define the standard of healthcare services. These dimensions are used to evaluate, measure, and improve the quality of care provided to patients. A comprehensive understanding of these dimensions ensures that healthcare systems can address various aspects of patient care effectively and holistically. Dimensions of Healthcare Quality and Performance of care include the following; Appropriateness, Availability, Competence, Continuity, Effectiveness, Efficiency, Efficacy, Prevention, Respect and Care, Safety as well as Timeliness.
Deep Leg Vein Thrombosis (DVT): Meaning, Causes, Symptoms, Treatment, and Mor...The Lifesciences Magazine
Deep Leg Vein Thrombosis occurs when a blood clot forms in one or more of the deep veins in the legs. These clots can impede blood flow, leading to severe complications.
Deep Leg Vein Thrombosis (DVT): Meaning, Causes, Symptoms, Treatment, and Mor...
Hazel
1. Virginia Rural Health Association 2015
Conference
The Honorable William A. Hazel, Jr., M.D.
Virginia Secretary of Health and Human Resources
2. Program and Services Map
VA Health and Human
Resources Secretariat
SSA DOL AOA NIH
ACL ACF FNS CDC SAMHSA EPA CMS
DARS DBHDS DHP DMAS VDSS OCS VBPD VDBVI VDDHH VDH VFHY
• Vocational
Rehabilitation
• Disability
Determination
• Community
Rehabilitation
for Disabled
• Aging Services
• Adult Protective
Services
• Developmental
Disability
Services
• Mental Health
Services
• Substance Abuse
Treatment
Services
• Behavioral
Health
Emergency
Response
Services
• Provider
Licensing
• Licensing and
Health
Profession
Regulation
• Prescription
Monitoring
Program (PMP)
• Health
Practitioners
Data Center
• Medicaid
• Family Access
to Medical
Insurance
Security
(FAMIS)
• Medicaid
Analytics and
Reform
• Supplemental
Nutrition
Assistance
Program
• Temporary
Assistance for
Needy Families
• Child Care
• Energy and
Cooling
Assistance
• Eligibility
Determination
• Foster Care and
Adoption
Services
• Child Support
Enforcement
• Child and Adult
Protective
Services
• Licensure
• Community
Policy and
Management
Teams (CPMT)
• Family
Assessment
and Planning
Teams (FAPT)
• At-Risk
Youth and
Families
• Policy
Setting
• Grants for
Innovation
• Leadership and
Advocacy
Training
Programs
• Disability
Services
Assessment
• Vocational
Rehabilitation
• Randolph-
Sheppard
Vending
Program
(RSVP)
• Virginia
Industries for
the Blind
• General Library
Services and
Education
Services
• Technology
Assistance
Program (TAP)
• Virginia Relay
• Outreach and
Community
Services
• Interpreter
Services
• Family Health
Services
• Emergency
Preparedness
and Response
• Environmental
Health Services
• Licensure and
Certification
• Epidemiology
• Virginia
Certificate of
Public Need
(COPN)
• Minority Health
and Equity
• Drinking Water
• Youth Programs
• Youth Tobacco
Use Prevention
• Youth Obesity
Prevention
IRS
A Focus on Value
What do we do? How well do we do it? How much does it cost?
4. The Virginia Health and Human Resources Secretariat is focused on six strategic issues.
Virginia Health and Human Resources
Virginia Health and Human Resources Secretariat
Healthy and Productive Virginians
Eliminating Intergenerational Poverty
Thriving Children and Families An Aging and Diverse Population
Integrating Individuals with
Disabilities in the Community
Supporting and Valuing Our
Veterans and Volunteers
Financial Sustainability Performance Management
Customer- Centric
Data Aware
Promoting Pathways to the 21st Century Economy for All Virginians While Maximizing the Value of Commonwealth Resources
Cultural Competence Trauma Informed Systems of Care
5. An interaction in one domain may only be measured by impact in another domain.
Coalition Partners
Fiscal Impact Data
Outcome Measures Data
Citizen Census Data
Population Health
Data
Specific At-Risk
Population Data
Social
Program Data
Health
Care
Data
DMAS
DSS,
OCS
DBHDS, DHCD,
DOC, DJJ
VDH
DMV, Elections
Education,
DOC, DJJ,
State Police
Tax, DPB,
Trade & Commerce
6. Virginia is shifting from a ‘program-focused’ model to a more ‘Customer-Centric Coordinated Care’ model.
‘Customer-Centric Coordinated Care’ Model
Agency
Traditional Program-Focused
Model
‘Customer-Centric Coordinated
Care’ Model
Agency
Agency
Agency
Agency
Service
Delivery
Partner
Service Delivery
Partner
Agency
Agency
Agency
Services driven by individual, family, or community needs
Agencies recognize and consider the full range of services provided by other agencies, partners and
organizations
Services are considered more broadly factoring in role of social determinants
7.
8.
9.
10. System Transformation, Excellence and Performance (STEP Virginia) – The Path
to a Healthy Virginia
• Establishes Certified Community Behavioral Health Clinics (CCBHCs)
• There are two phases:
• Phase 1: Virginia granted $982,000 for 1-year planning grant for CCBHC
• Phase 2: Up to 8 CCBHC Planning Grant states will be selected to
participate in the demonstration program.
• This grant opportunity from SAMHSA arose from the Excellence in Mental
Health Act.
CCBHCs
11. Other recent grants
• With help from the Center for Health Care
Innovation, VHQC recently received a $5.7
million grant from CMS as a Practice
Transformation Network. Only such grant
awarded in Virginia.
• In May, VCU received a $10 million grant
to establish a statewide consortium to help
small-to-medium-sized primary care practices
in Virginia.
12. METRICS ALONE ARE INSUFFICIENT
• We also require:
• Vision – Where we want to be
• Process – How to get there
• Accountability – Who does what and by
when
• Will – A commitment to move forward
• Much of the above will be addressed as we
collectively create Virginia’s Plan for Well-
Being
13. What is DSRIP?
• Medicaid waiver to access federal dollars to
invest in transformation of the Medicaid
delivery system
• CMS has approved seven DSRIP programs to
date (CA, NM, TX, KS, NJ, MA, NY)
• Helping states move from Fee-for-Service to
Value-Based Reimbursement
14. DSRIP program is an opportunity
for transformation
• The future is a Medicaid delivery system that
reimburses based on high-value care
• Ensure that even the most medically complex
enrollees with significantly behavioral,
physical, and developmental disabilities can
live safely and thrive in the community
• To accomplish either of these, significant
investment in data infrastructure at the
provider and state level is imperative
15. DSRIP program is an opportunity for
Virginia to transform
The future is a Medicaid delivery system that reimburses based
on high-value care
Ensure that even the most medically complex enrollees with
significantly behavioral, physical, and developmental disabilities
can live safely and thrive in the community
To accomplish either of these, significant investment in data
infrastructure at the provider and state level is imperative
16. Certificate of Public Need
• Study group required by 2015 legislation
• Evaluating whether Virginia’s COPN process,
needs, and relationship with charity care
• Has met 3 times, has 2 more meetings; next is
Oct. 27
• Final report due Dec. 1, 2015
• http://www.vdh.state.va.us/Administration/COPN.
htm
17. Provider Assessment
• Workgroup mandated by 2015 legislation
• Will analyze options for creating a provider
assessment program
• Prompted in part because of struggles of rural
hospitals, about half of which are operating in the
red
• Group has met twice – next meeting Oct. 28
• http://www.dmas.virginia.gov/Content_pgs/paw
g.aspx
18. Intersection of SIM and DSRIP
27 SIM projects from 8
workgroups and three
subgroups
1) Population Health,
Quality, Payment, HIT
2) Care Transitions
3) Workforce
4) Medicaid Innovation
5) VBID/Choosing, Wisely
6) Telehealth
7) Integrated Care
(Behavioral Health, Oral
Health, Complex Care)
Possible SIM project
funding via DSRIP
19. Rates of Opioid Overdose Deaths, Sales, and
Treatment Admissions, United States, 1999–2010
0
1
2
3
4
5
6
7
8
1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
Rate
Year
Opioid Sales KG/10,000 Opioid Deaths/100,000 Opioid Treatment Admissions/10,000
CDC. MMWR 2011. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm60e1101a1.htm?s_cid=mm60e1101a1_w.
Updated with 2009 mortality and 2010 treatment admission data.
Rates of Opioid Overdose Deaths, Sales,
and Treatment Admissions, United States, 1999–2010
20. 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013
Motor Vehicles 1037 1035 1052 1070 1124 928 841 823 878 877 831
Guns 799 824 884 812 838 818 843 868 863 830 848
Drug/Poisons 595 498 545 669 721 735 713 690 819 799 912
0
200
400
600
800
1000
1200
NumberofFatalities
OCME's Top 3 Methods of Death by Number
and Year of Death, 2003-2013
21. Deaths from Heroin and Rx Opiates in Virginia
0 4
19
100
89
107
48
100
135
213 210
0
50
100
150
200
250
NumberofDeaths
Year
Number of Fatal Heroin Overdoses by Year,
2004-2014*
1 Fatal heroin overdoses may have one or more drug or poisons contributing to
death.
2 The number of fatal heroin overdoses in 2014 is estimated based upon data for
January 1, 2014 to June 30, 2014.
389
422
398
415
487
414
468
508
0
100
200
300
400
500
600
2007 2008 2009 2010 2011 2012 2013 2014
NumberofDeaths
Year
Number of Fatal Prescription Opioid
Overdoses by Year, 2007-2014*
1 Heroin and prescription drug deaths are tallied separately. Where heroin and
prescription opioids caused or contributed to death, decedents will be counted twice.
2 Prescription opioid deaths are drug/poison deaths where one or more prescription
opioids caused or contributed to death.
3 The number of fatal heroin overdoses in 2014 is estimated based upon data for
January 1, 2014 to June 30, 2014.
22. The systems of care are constantly evolving due to some key challenges in Virginia.
Key Challenges in Health and Human Services Delivery
Population demographic changes
including aging and ethnicity
Key
Challenges
Keeping
pace with technological and political
shifts
Developing and retaining a skilled
health and human services
workforce
Balancing the requirement for specialization
with need for integration
Addressing the role of social
determinants of health
Coordinating with complex federal, state
and private structures and requirements
Managing funding instability
and inflexibility
23. An interaction in one domain may only be measured by impact in another domain.
Coalition Partners
Fiscal Impact Data
Outcome Measures Data
Citizen Census Data
Population Health
Data
Specific At-Risk
Population Data
Social
Program Data
Health
Care
Data
DMAS
DSS,
OCS
DBHDS, DHCD,
DOC, DJJ
VDH
DMV, Elections
Education,
DOC, DJJ,
State Police
Tax, DPB,
Trade & Commerce
24. The illustration below provides spending overlaps of individuals served by Medicaid, SNAP, and TANF in Virginia.
Program Overlaps – Spending
NOTE: Costs for each program have been derived by using population overlap data from SFY 2014 and program spending from SFY 2013
SOURCES: SFY 2014 VDSS Clients Served Annually , SFY 2013 VDSS Annual Statistical Reports
• Majority of the state and federal HHR
spending focuses on individuals receiving
Medicaid only followed by individuals
receiving both Medicaid and SNAP benefits
• Spending on individuals receiving TANF is
accompanied by Medicaid and SNAP
spending as well
Program
Annual Program
Spending
(in Millions)
Annual
Per-
Capita
Spending
Medicai
d
$7,600 $6,138
SNAP $1,625 $1,251
TANF $105 $655
Medicaid
Only
$5,100 M
Medicaid &
SNAP
$2,100 M
Medicaid,
SNAP &
TANF
$997 M
SNAP
Only
$572 M
TANF Only
$0.88 M
Medicaid &
TANF
$36 M
SNAP &
TANF
$30 M
Editor's Notes
DSRIP proposals in Virginia are currently just that – proposals, not done deals.
DMAS is in the stakeholder public comment process, DMAS has put together a framework/ strawman and is on the road describing the proposal and gathering feedback from stakeholders.
Virginia Health Information database of fiscal 2013 financial results for the hospitals. It lists 36 rural hospitals, 17 of which had a negative operating margin. That comes to 47 percent. In this database, the hospitals were allowed to determine for themselves whether they should be classified as rural or urban.
In a second batch of data, hospitals were sorted as rural or urban based on definitions from the federal Centers for Medicare & Medicaid Services. This grouping listed 25 rural hospitals in 2013, 16 of which ran in the red. That comes to 64 percent.
By comparison, of the 60 urban hospitals in Virginia under the federal definition, 13 had operating losses. That means nearly 22 percent of urban hospitals in the commonwealth had an operating loss in 2013.
A clear genesis of the abuse and overdose epidemics. Important to note that often these addictions begin with legitimate prescriptions.
A primary contributor to the increase in opioid overdose deaths is an abundance of supply of these very powerful drugs.
A recent analysis by CDC looked at the relationship between the sales of opioids and the number of deaths from them. What the study found was alarming:
As the amount of opioids sold increased, so did the number of deaths.
In fact, the supply of opioid pain relievers is larger than ever. The quantity sold in 2010 was four times that sold in 1999.
Enough opioids were sold in 2010 to give every American adult a 5mg Vicodin tablet every 4 hours for a month.
When you look at substance abuse treatment admissions for opioids and emergency department visits related to their misuse or abuse, you also see increases consistent with the increases in sales of these drugs.
Of the 912 poisoning deaths in 2013, 468 of those involved prescriptions opioids and 213 involved heroin. The street value of oxycontin is about $1/milligram (5-120mg available). Heroin is about $10 a dose (1/10 gram). An active heroin user may spend about $100 daily, much cheaper than the same amount of pills it would take to get high.
New 2014 numbers, not out as graphics yet, separate out opioid and heroin deaths, and show that in 2014, 728 Virginians died from heroin and prescription drug overdoses, up from 661 in 2013. In the last five years, fatal overdoses have increased by 57% and nearly 3,000 Virginians have lost their lives.
There is no reason to assume that these numbers will reverse course without significant, coordinated efforts.
Funding Stability and Flexibility
Flat federal funding and limited state funds for ongoing programs
High dependency of certain programs and agencies on federal grants/one-time grants and silo-ed funding approach
Workforce Development and Retention
Specialization vs Integration
Focusing on specialized issues sometimes results in siloes
Gaps in services due to inconsistent eligibility requirements
Complex Federal Structure and Interaction
Significant and wide-ranging federal oversight
Complicated regulations and requirements
Requirements not always current with modern service delivery
Addressing Social Determinants in Health
Limited usage of social determinants in designing, measuring and implementing policies and programs
Limited infrastructure to support social determinants in health
Legislative and Political Direction Changes