Public Health - Executive Summary

Office of Organizational Development and Performance Improvement

The Department of Health seeks to continuously improve the quality and responsiveness of its services. The Office of Organizational Development and Performance Improvement (ODPI) has as its primary mission to serve as an internal consulting group to assist programs in the Department to meet and exceed standards for sustainable excellence. The Office has eight primary areas of focus: 1) leadership and management development, 2) workforce engagement and development, 3) strategy development, 4) value anchoring and listening to the voice of the customer, 5) performance measurement and analytics, 6) process and performance improvement, 7) public health accreditation efforts, and 8) the Governor's SUCCESS initiative participation.

Some of the specific activities of ODPI include providing the Management and Leadership Training program, facilitating the Department's Strategic Planning processes, managing the Utah Public Health Improvement Initiative, facilitating the Statewide Health Improvement Plan, training and supporting teams conducting quality improvement projects, and working the ODPI Team which provides broad-based representation of program needs to the Office in a steering and advisory capacity.

Division of Medicaid and Health Financing

Ninety percent of Utah's public health budget goes to patient care for Utahns who require assistance paying for their health care. The various health care financing programs are funded largely by federal dollars. The Division has recently completed its first full year of the Accountable Care Organization (ACO) payment reform initiative. At the end of the year, the State was able to deposit $17.1 million into the Medicaid Stabilization Account as a result of these savings.

The Medicaid program currently covers an average of 276,000 Utahns each month. The Children's Health Insurance Program (CHIP) covers 17,000 children. The Primary Care Network (PCN) covers over 20,000 adults. The Utah Premium Partnership (UPP), a health insurance premium subsidy program, covers nearly 750 adults and children.

Division of Family Health and Preparedness

Utahns who come in contact with health care systems are protected by public licensing and regulation. Facilities as diverse as nursing homes, hospitals, radiology units, emergency medical responders, and child care providers are inspected and licensed by the Division of Family Health and Preparedness through the Bureau of Emergency Medical Services and Preparedness; the Bureau of Health Facility Licensing, Certification, and Resident Assessment; and the Bureau of Child Development that includes the Child Care Licensing program. The Bureau of Emergency Medical Services and Preparedness also provides staff support for the Department's Bioterrorism and Disaster Response activities.

Besides child care licensing, the Bureau of Child Development includes the early childhood programs, such as the Baby Watch/Early Intervention program that provides critical services to at-risk children with developmental delays to improve their school-readiness, the Office of Home Visiting and early childhood systems development.

The Division's Bureau of Primary Care includes several programs focusing on health care for some of our most vulnerable populations.

• The Clinical Services Program (the Health Clinics of Utah and the Family Dental Plan) is designed to assure adequate access to needed health care services for Utah's citizens served by the Medicaid program, which includes the Primary Care Network (PCN). This is done through three medical clinics (Ogden, Salt Lake, and Provo) and three dental clinics (Ogden, Salt Lake, and St. George) plus a mobile dental clinic which serves rural areas throughout our state.
• The Patient Safety initiative, begun in 2001 and coordinated with the Utah Hospital Association and HealthInsight, provides monitoring of numerous health outcomes in an effort to improve the safety of our health care delivery systems.
• The Office of Primary Care and Rural Health provides grants to safety net clinics and rural hospitals so that rural and underserved areas of our state can maintain adequate medical facilities, equipment, and trained personnel to care for our state's medically underserved populations.
• The Office of American Indian/Alaska Native Health Affairs in cooperation with the Division of Medicaid and Health Financing supports efforts to improve the health status of this vulnerable population in our state and assure that we properly address consultation requirements for these government-to-government relationships.
• The Office of Health Disparities Reduction is involved in numerous activities that support the delivery and improvement of health care services for vulnerable populations in our state that face disparities in health outcomes.

The Division's Bureau of Maternal and Child Health programs reduce illness, disability, and death among women of childbearing age, infants, children, and youth in the state. This Bureau does this work through continuous review and analysis of numerous data sources that staff use to identify health concerns, determine priorities, and establish program strategies and plans that improve the health of mothers, infants, and children. The Bureau provides leadership for many maternal and child health efforts in the state through its programs, contracts with local health departments for services, and federal grant opportunities. The Bureau is responsible for most maternal and child health issues, such as promotion of health among women of childbearing age, access to health care before, during, and after pregnancy, healthy weight and nutrition, and oral health. The Bureau, along with the Bureau of Children with Special Health Care Needs, is responsible for oversight of the federal Maternal and Child Health Block Grant (Title V) and as such, is responsible for 18 National and 10 State Performance Measures related to the health of mothers, infants, children, and youth, including those with special health care needs and their families. This Bureau also includes the federally funded (USDA) Women, Infants and Children (WIC) program that provides critical, nutritional support to pregnant and breastfeeding women, and to infants and small children up to age five. This program is administered through contracts with local health departments throughout the state.

The Division's Bureau of Children with Special Health Care Needs (CSHCN) programs reduce preventable death, disability, and illness due to chronic and disabling conditions by providing access to affordable high-quality health screening, specialty health care, and coordination/case-management of health services. The Bureau encompasses eight programs serving children and youth with chronic or disabling conditions for whom there are no other developmental or diagnostic services in their community. Services are provided along the Wasatch Front as well as in rural communities. Bureau programs try to improve the system of care for Utah children and youth with special needs through direct clinical services or population-based services, such as newborn blood spot and newborn hearing screenings, and the promotion of system infrastructure building. These services are provided by Bureau staff or through contractual agreement with community providers.

Division of Disease Control and Prevention

The Division of Disease Control and Prevention (DCP) includes the Bureau of Epidemiology (BOE), Bureau of Health Promotion (BHP), Office of the Medical Examiner (OME), and the Utah Public Health Laboratory (UPHL). This Division is charged with critical public health functions including detection of outbreaks and emerging public health problems (UPHL, OME, BOE), tracking and assessing causes of diseases (All), and prevention of important causes of disease and disability (BOE, BHP). A current Division priority is to identify approaches to reduce the impact of the obesity epidemic, improve immunization rates and track and prevent deaths from prescription drug overdoses.

The Bureau of Epidemiology (BOE) tracks communicable diseases, works to prevent and control infectious diseases, detects and investigates outbreaks, assesses the health impacts of environmental hazards, manages a statewide immunization program, supports treatment of HIV/AIDS for those unable to afford it, and coordinates a statewide environmental sanitation program including 15 rules that protect Utahns from environmental threats. Important current priorities include: 1) increasing vaccination rates to protect all Utahns from preventable threats such as measles, influenza, and pertussis; and 2) converting from manual methods of disease reporting to electronic laboratory reporting to improve timeliness and reduce both public and private reporting burden. The Bureau of Epidemiology is a critical component in the Department's efforts to prepare for emerging infectious disease threats and bioterrorism.

The Bureau of Health Promotion works to reduce the leading causes of illness and death of Utahns through prevention, early detection, and management of injuries and chronic diseases and conditions, and promotion of early prenatal care. Unintentional injury is the primary cause of death for Utah children, adolescents, and young adults. The Violence and Injury Prevention Program seeks to improve safety for pedestrians, cyclists, and drivers. Chronic diseases, such as cancer, diabetes, and heart disease, account for 70 percent of all U.S. deaths. Three modifiable health behaviors addressed by the Bureau of Health Promotion, including unhealthy eating, lack of physical activity, and tobacco use, are responsible for much of the illness and death related to chronic diseases. The Tobacco Prevention and Control Program has helped Utah achieve the lowest rate of adult tobacco use of any state in the U.S. However, tobacco remains the leading cause of preventable death and disability in Utah and remains a top public health priority. Obesity is one of the most important emerging public health problems in Utah. The Healthy Living through Environment, Policy and Improved Clinical Care Program (EPICC) is continuing to coordinate the implementation of the Utah Nutrition and Physical Activity Plan 2010-2020.

The Utah Public Health Laboratory provides essential laboratory testing to detect and investigate causes of outbreaks of infectious diseases, assure safe drinking and surface waters, certify clinical and environmental laboratories that serve Utah, and support death and criminal investigations that involve toxic substances including licit and illicit drugs and alcohol. The most important priorities for the UPHL this year are to: 1) identify resources and/or process improvements allowing reduced turn-around times for toxicology testing in support of Medical Examiner and law enforcement investigations and 2) continue to improve the use of electronic laboratory reporting.

The Office of the Medical Examiner investigates deaths to support law enforcement investigations of homicides, public health efforts to track important health problems such as suicide, injury, and causes of child mortality, and detect emerging public health problems such the epidemic of deaths due to prescription pain medication overdose.

Center for Health Data and Informatics

Effective governance is fueled by strategic information. The Center for Health Data and Informatics collects, manages, analyzes, and provides appropriate access to large-scale information resources that support Utah public health programs and policies. Utah's premier web-based public health data resource, the Indicator-Based Information System for Public Health (IBIS-PH), acts as a central portal for much of this information. The heart of IBIS-PH is the Indicator Reports. Public health indicators are important measures of population health. IBIS-PH provides easily accessible, up-to-date data, graphs, and textual information for over 180 of these measures; 109 of which are priority measures for the Utah Department of Health and are included in this report. IBIS-PH users may access publications and can even directly analyze a variety of public health data sets. IBIS-PH provides "Community Snapshot Reports". The "Snapshots" are dynamic summary tables that use existing IBIS-PH Indicator Reports to display data for each of Utah's Local Health Districts, along with comparison data for Utah and the U.S. where available. In addition, the Center publishes monthly 'Health Status Updates' about the public's health and related initiatives.

In 2013, the UDOH continued the 30th year of Behavioral Risk Factor Surveillance System (BRFSS) data collection. The 2013 Utah BRFSS collected information from 12,769 adults and 4,447 children statewide on both landline and cellular telephones. This was the third year that BRFSS estimates included cell phone data. Information such as health-related behaviors and health status is gathered to support statewide collaborative initiatives including the Utah Partnership for Healthy Weight and the Utah Cancer Action Network (UCAN). Questions about health insurance and access were asked of 11,676 adults and 2,048 children. These data represent healthcare coverage in every local health district. The survey results are important to informing and assessing the Governor's Health System Reform initiative including providing estimates of the uninsured to guide development of the Governor's Healthy Utah Plan and to identify the number of children eligible for the Children's Health Insurance Program (CHIP). Data collection for the Asthma Callback Study was continued in 2013; information was gathered on 659 adults and 144 children with asthma throughout the state. The Survey Center also completed an ad hoc survey for the Utah Tobacco Prevention and Control Program to assess quitting behaviors and TPCP's recent media campaign. In total, Utah residents gave approximately 6,000 hours to public health data collection conducted by the UDOH Survey Center.

The Center registered 51,871 births and 16,793 deaths in 2013, preserving the facts of their births, deaths, and family formation. The Office of Vital Records and Statistics continues to move historical records to an electronic format which makes more records available for research, increases the speed and availability of records for issuance as well as preserving and protecting the information. Our staff archivist updated the retention schedules for all documents held by the Office, a project that was 20 years in the making. The Office began issuing Hemp Extract Registry Certificates on July 8, 2014 in accordance with legislation passed during the 2014 General Session. To date, there have been approximately 40 certificates issued to individuals with intractable epilepsy. The certification unit issued spproximately 93,000 certified copies of vital records for legal and other purposes.

The Center's Office of Health Care Statistics maintains three types of databases:

• The All Payer Claims Database: The Office collects claims data from various types of payers with the ultimate goal of reporting on cost and quality episodes of care. It currently receives data from 18 payers and continues to grow, with the addition of Medicaid fee-for-service data nearly complete and the possibility of receiving data from some self-pay clients. In July 2014, the Office released a public-use extract called DIADS that contains medical and pharmacy claims representing approximately 60% of the Utah population. In addition, data are being provided to other key stakeholder groups, such as the Department of Insurance for risk adjustment, to support their missions.
• Health Plan Quality: The Office currently produces to two reports: the Healthcare Effectiveness Data and Information Set (HEDIS) and the Consumer Assessment of Healthcare Providers and Systems - Health Plan Survey (CAHPS) for HMOs and PPOs in Utah.
• Health Care Facility: The Office collects data on multiple health care facilities, including hospitals, ambulatory surgical centers, and emergency departments. The Office publishes standard reports and makes data extracts available to qualified users for approved purposes. The emergency department data is co-managed through a collaborative agreement with the UDOH Bureau of Emergency Medical Services and Preparedness.

The Center's Health Informatics Program works with the Utah Health Information Network (UHIN), Utah Partnership for Value-Driven Healthcare at HealthInsight and several health professional/facility associations; leads Utah statewide strategic planning for health information exchange; coordinates public health's participation in the statewide clinical health information exchange (cHIE) in Utah; and promotes the development of a statewide Master Person Index for patient identity validation. The Center also collaborates with health informatics researchers at the University of Utah and Intermountain Healthcare to develop new informatics tools to better support public health practice.

The Office of Health Data Security also resides in the Center and provides privacy and security guidance and training to all agency programs and employees.