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Home My WebLink AboutPresentation- #08 1 11-111 " s I All E 01 �N UF SX,,,i A A FEA III WIUI �N X',,,J,,D RISCAL SHI,�,VIICES A PLIBUIC �1,'-",IIEX� AGE","iCY UF,"DA"rED RU,,",,c,1ii ro Q ry COUjll`,,.jjGL J UJI 1I % 2022 yy IIIIIIIIIFeasibility AnalysisFiscal Evaluation h „w. V ou uGUVUVuVVVV VVVVVVV VUVVu��Vu J �fIJl1 ,� Illlllr��f�� Comparative Cost, Staffing, Revenue Analysis minterviewed City mldentified GReviewed and ✓Provide high- Council Members significant trends summarized level cost GMapped input OProvide mandated and summaries for comparison to statutory comparable County data responsibilities organizations ✓Provide estimated range of cost for City of Santa Ana Public Health and other options ✓Preview draft State process Completed Tasks vllll,,,,, ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, ,,,,,,,,,,,,,,,,, Tod ay's Focus s , �� *, Final Deliverable IIIIIIIIIPublic Healthi ili iDomains `1 �1 dial 1�l � ti lip \u �,�ii 1 1,,� , ions death records) investigation and • investgation (food, • Public health laboratory • Public health health • Reportable disease vector,tattoo, • Communicable disease education conditions recreational water, control and • Public health nursing •Assessment of water,solid waste,jails, investigation(including • Tobacco prevention hazardous waste, STDs and TB morbidity,mortality and hazardous materials) ) and control health risks • Communicable disease • Vector-borne disease outbreak response • Lead poisoning, • Largely mandated monitoring,and responsibilities •All mandated reporting responsibilities with • Mandated and • State and grant specific reportable discretionary funding diseases, methods and res • Specific inspections p Discretion on the responsibilities timeframes requirements by facility . Specialized staffing for level of services • Subsidized by State type and/or material public health labs provided funds • Mandated and discretionary • Fees/State funding responsibilities • Fees/State funding Executionlic Health responsibilitiesitmobilizing a IIIIIIIII coordinated, i multaneous response �o Disease Investigation/ ' ' Public Health Lab • Conduct/confirm Epidemiology ` i testin g • Receive case reports �.enori a°' (.Yyc(.Yr � center r p rt5 �� t • Identify strain of • Determine control ��lti ple children hove exhibited thot ��171��o disease/strain-typing • Investigate level of risk oy h, measures connected t o food borne fllfl 55 • Explore whether any health officer orders are necessary .......1 ..... � Public Health Nursing ® - �//, • Interview and index Environmental Health ;ii�� all contacts • Provide guidance to parents and facility I workers • Assess food handling procedures and food access r • Assess facility conditions Health Education • Alert the public, as , appropriate ,,,,, ;,,,,,,,,,,,,, . Provide proactive ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, education, as appropriate IIIIIIIIIProject Updates February 15 Presentation Today"s Discussion J ��U��u�f��J��IIIIf��11IIj��J1�J��lf ll�l��'Iltltll��lb��l��l�l�il''I,1I1�1 �� blllll ll �I Ujl�111111II((�),1�� Ill 1Jll�Jl�I��uJl�l�l f �� ......................................................................................................... Gty F"'U"J'k �'�« Ut� �l l ��U�a�� ' ��,� iiiii��1111.. ....................... �lllllllllljjjjjl��f�tt�l�l�l��ifif il��iiii� il�flii�liii�ii��liiiii�l�iiii��ill�l�llllllllf IIII�� ............... ...............I �� U1111111�I1I�I1I,1,1,II11��JI"I�I'11JJ11111)�� W['i�A �s est�mAed cost �,',md potent��,',d revenLje? M-i�,'A �,',we O"ie necess�,',wy steps? a�a�, �� ,�� 1�� IIIIIIIII'll �� >>.>>..�� I f 1�1III1111 ............................................................................................................ r�111111111111111jjjhi�iil�iiiiiiiiiioilii iiii�illliiiliflil�lllf f f f f f f f f f f Illlf lll� f;, C o rf"i rf"i u ri�i ty ............................. t g�st a�a�I1��y1Y�1»i�>>��;��ip�ai��11i��i�111��l�L�i��ll�iilii i��llllllllllllllllll��,,;,�, Il��i»��lli»�i��i�l�»»»>11��»»>l��»111»>11»��»>�ll»r»>��I�»»»>l�»�1�»»�>»»»�»»>�11�lllllllllll ...................................................................................... I M A., Public Health Cost Analysis .......... Methodology and Cost Estimates IIIIIIIII Fiscal Approach and Limitations Objective: Provide fiscal evaluation of a City of Santa Ana public health agency 111111II,111111Relied upon the experience of the County of Orange and two peer municipalities that provide full-scope public health services, Long Beach and Pasadena 111111IIII111111Discretion afforded local health jurisdictions creates challenges and limitations in developing budget comparisons: Local health jurisdictions are not required to meet a fiscal maintenance of effort requirement Local health jurisdictions can provide a higher level and additional services beyond mandates Budgets are not tied to independent benchmarks or community conditions Local health jurisdictions can organize the function and related responsibilities in a variety of ways ............................................ I I M A...' IIIIIIIIIPublic Healthi Analysis u oo»uu�uuuuuu iu��. �uiuuiu�uuuuoo� �uu»�iiiii�iiu. i��iii��u�u�a»�uu�u�� uuiu iiiiiiiii. u��uu�uuu �uui�uu�uu�� 1 1 u 0 Total Population (2021 Census Data) 3,167,809 138,699 466,742 Public Health Department within OC Health & Human Services Public Health Organization Structure Health Care Agency (OCHCA) Department Department Total Public Health $214.3 mil $15.2 mil $34.1 million Budget Based on 19/20 Budget* Total Per Capita Spending $68 $110 $73 Examples of Non-Public • Correctional Health Homeless Services Housing Authority Health Functions within Services and Homeless Agency or Department 0 Mental Health Services Services • Medical Health Services • Special Services Notes: County of Orange excludes costs associated with other departments within OCHCA Long Beach excludes all costs associated with Housing Authority and Homeless Services ............................................ I I M A..., IIIIIIIIIPublic Healthi l i 111111IIjiiiiii Developed a comparative cost analysis of the public health functions at County of Orange and Cities of Pasadena and Long Beach Captured cost, revenue, and workload data Organized cost into a comparable format based on the four domains of public health and administrative costs Health Assessment & Epidemiology Health Protection - Environment Health Prevention - Communicable Disease Health Promotion 111111II,111111 Adjusted public health budgets to account for nonpublic health functions and/or discretionary services, to the degree identifiable ............................................ IIIIIIIIIPublic HealthAnalysis � 0 m m 11 0 1 1 \ 111�1111 11 111��\ 11010101111011 � 0001�� 011�� 1101�11110 111101110111 Administration $583,000 $3,981,000 $2,189,000 Health Assessment & Epidemiology Embedded in Other Cost Units Health Protection - Environment* $37,949,000 $3,389,000 $7,177,000 Health Prevention -Communicable Disease $141,221,000 $3,564,000 $12,074,000 Health Promotion $28,260,000 $2.064,000 $12,691,000 Reduction (non-core PH programming) ($6,332,000) ($2,251,000) Net (Budget for Comparative Purposes $214,345,000 $12,998,000 $34,131,300 ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- (Vet Per Capita Public Health Costs 66 94 7 ............ et...Pe r.. ....... ... . .......Public W Health... . . . ..........................._.,.,.,.,.,.,.,.,.,.,.,.,.,.,.,.,.,.,.,.,.,.,.,.,.,.,.,.,.,.,.,.,.,.,.,.,.,.,.,.,.,.,.,.,.,..,.,.,.,.,.,.,.,.,.,.,.,.,.,.,.,.,.,.,.,.,.,.,.,.,.,.,.,.,.,.,.,.,.,.,.,.,.,.,.,.,.,.,.,.,.,.,.,.,.,.,.,.,.,.,.,.,.,.,_,.,.,.,.,.,.,.,.,.,.,.,.,.,.,.,.,.,.,.,.,.,.,.,.,.,.,.,.,.,.,.,.,.,.,.,.,.,.,.,.,.,..............................., Capita (Excluding Environmental Health* 54 69 58 *Since Environmental Health costs are largely cost neutral and dependent on the number of facilities requiring inspections such as restaurants, the budget excluding environmental health provides an indication of the public investment. ............................................ I M A 1.0 IIIIIIIII City of Santa Ana PublicIEstimated 111111II111111 Employed different costing methodologies and the adjusted peer agency budgets to estimate annual costs for the City of Santa Ana Administration Direct cost with applied Estimated the level of staffing required and projected costs based overhead on Santa Ana's demographics Health Assessment Direct cost with applied Estimated the level of staffing required and projected costs based and Epidemiology overhead on Santa Ana's demographics Health Protection— Workload factors Used the productivity rates of comparable peer agencies and Environmental applied to the City of Santa Ana's estimated workload Health Prevention— Per Capita Estimated costs based on per capita ratios and applied ratios to Disease Control the City of Santa Ana's population Health Promotion Per Capita Estimated costs based on per capita ratios and applied ratios to the City of Santa Ana's population 111111II111111Additional Assumptions 11111I11111 Applied an overhead rate to total direct cost budget to estimate citywide overhead for finance, HR, procurement, IT, etc. 11111I11111 Estimate position costs based on the City of Santa Ana's FY 2021-22 Master Salary Schedule midpoint salaries for selected classifications 11111I11111 Excludes start-up or one-time capital requirements See,giic r� ac„for detailed listing of assumptions . .... IIIIIIIII City of Santa Ana PublicIEstimated 111111IIj,11111 Identify revenue estimates for each domain by major source Fees based revenue Allocated state/federal revenue Discretionary grant revenue Estimated potential revenue return based on peer agency experience Assumes that the City would be eligible recipient of all applicable federal grants 111111II,111111 Potential resources to offset required City funding include: State Realignment Funding - Per the State/County Realignment Agreement counties receives sales and vehicle licensing fees (VLF) taxes; a portion of which supports public health ,,ill, Santa Ana could seek proportionate share of funding County Property Tax City General Fund ............................................ IIIIIIIII City of Santa Ana Public ProjectedI Costs and Revenue Offsets w________________________________________________ _____________________________________________ Estimate Annual Costs Net Local Cost ._._._.____Low_______ _______High________ Est Earned ----------------------------------------------- Low _____High______ Estimate Estimate RevenueOffset Estimate Estimate Administration -$392,�305wW -$392,�305W -25% -$294,229wW -$294,229 Health Assessment and Epidemiology $735,202 $880,992 25% $551,401 $660,74 Health Protection -- Environmental $4,163,422 $5,152,246 90% $416,342 $515,225 Health Prevention -- Disease Control $7,971,572 $13,829,924 33% $5,314,381 $9,219,949 Health Promotion $4,616,533 $8,435,245 75% $1,154,133 $2,108,811 __.__ Subtotal PH Budget $17,879,034 $28,690,71 $7,730,487 $12,798,958 Estimated Citywide OH Costs* $1,787,903 $2,869,071 55% $804,557 $1,291,082 _._ _ ,._ ___ TOSAL PROJECTED BUDGET $166693 $3155978 $8 535➢04 $14,090,04 Capita"dotal Cost Per Ca ita $63 $1. Peer agencies ranged from $66 to$94 per capita Note: Citywide OH costs are anticipated to be proportionately captured through fees and earned revenue through a cost allocation plan. See giic r� ac„for detailed listing of assumptions ,,,,, .... 1. Preliminary CDPH Guidance for Creating Municipal Public Health Department .......... Proposed Process and Requirements IIIIIIIIICalifornia Department of Public Preliminary Guidance (December 2021) 111111II,111111 CDPH proposing amendments to California Code of Regulations (CCR) to designate CDPH as the regulatory authority to develop and enforce and a review process for new local health jurisdictions 111111II,111111 CDPH Proposed Guiding Principles for Approval New health department must meet public health statutory and regulatory requirements in order to receive funding Applicant must demonstrate clear understanding of community health needs Applicant must prove ability to address community health needs through the provision of high-quality public health services Source: CDPH New Health Department Application and Regulations ,;;",";°';"""'; ""';;"';',' """""" Details and Status Update,December 2021 IIIIIIIIIProposed CDPH Two-Staged Approval Process Stage : Provisional Approval Provide only specific services that CDPH has approved p p Required Services. Communicable disease prevention, emergency preparedness, environmental health and three other aligned with Applicant's Community Health Assessment Possibly apply for CDPH funding MEN== Stage : Full Approval Ensure provision of all required services Authority for local mandates and regulations ............................................ IIIIIIIIICDPHI Applicationit (Preliminary) ............................................................................................................................................................................................................................................................................................................................................................................... Proof of meeting baseline requirements ............................................................................................................................................................................................................................................................................................................................................................................... Letter of intent that describes rationale and need ............................................................................................................................................................................................................................................................................................................................................................................... Feasibility study ...................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................... Timeline, budget and staffing information for service provision (including credentials, job descriptions for all staff and Local Health Officer) ............................................................................................................................................................................................................................................................................................................................................................................... MOU or contract with county/other organization for contracted services/staff ............................................................................................................................................................................................................................................................................................................................................................................... Community Health Assessment & Community Health Improvement Plan ............................................................................................................................................................................................................................................................................................................................................................................... Site Visit ............................................ IIIIIIIIIPotentiall l i i I'llr» CDPH Proposed Steps Conduct community health needs assessment Develop proposed staffing model Assess which functions in-house vs. contracted Negotiate and develop agreement with the County I'llr» If approved, the proposed process would likely require the City to invest in infrastructure prior to application submittal without assurances of application approval ............................................ (IIIY jllll II ff111 ',,. I II I JfII �� ll�+Y„�I,>(��III;;Il,��11�11111»I11!'k111��1�11�111111�1�11)�IJ,IJIJ��I lu`„�III ;f I Ir,,DI III I ;I ff III I (,`,�b� IIIII U �� II�II�I��I��J�i�liiilllllll �lil rr�o ul�;;�,rt��f 111 UIo��l llll� �IUll�lllll �U11��Illllllll IIIIIIII,II�I,,,II II�� I��IIIV I� V" (lff)ilUl u;�'� Alternative Public Health Models .......... Methodology and Cost Considerations IIIIIIIII Alternative li I Is: Chief HealthStrategist 1111111IIIII11111 Santa Ana's priorities align most strongly with providing limited public health responsibilities focused on Health Promotion 1111111IIIII111111 Chief Health Strategist provides an alternative model 111111II111111 Newly envisioned role leadership as system-level, strategic player in local communities, responding to changing health needs and priorities IIIII Enabling factors Leadership and accountability Technology and infrastructure supports Community partnerships ............................................ i interest on healthi ligns with most ChiefStrategist IIIIIIIIIresponsibilities Proposed Role of Health Strategist 1\\\ 11 1111 1 01 1 \\\\\ 1111110\\11�`1 00��1�»010�0111 Understand Develop Identify, Collaborate Build Establish Modeii,uilize and adapt strategies secure, with federal collaboratio effective R...f Il a ad,Jces strategies to for health analyze and and state In with partnerships an address promotion disseminate partners to clinical with apa[i llfl:fes leading real time meet needs providers, agencies causes on data sources of public and illness, for community health and stakeholders injury and forecasting payers to who can premature and optimize make a death decision- population difference in making health the outcomes community's health °°.. °°°°°°° Source: Public Health 3.0: A Call to Action to Create a 21s'Century Public Health Infrastructure, Office of the Assistant Secretary for Health,US Department of Health and Human Services . u ° .°°°°° hrtt s: nrnw.health eorrlr xoysltes �rfa.ult (Ilr; II>.ukrlc;-I(°Ilr:.alth-S.G.)- hltr-II'a r:. . f 21 ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, p........ /.............................................................y.p.............t.............. ........... ....................../.................................. .................../....................................................................................................................................�................p........... Ana'sSanta ides an example of potential future IIIIIIIIImodel Two-year, $4 million federal grant to address health disparities in communities hardest hit by COVID-19 HEAL OC alignment with public health Created collaborative structures with strategic partners provides platform for growth Provides opportunity to embed change and advancing equity in organizational culture and practice Builds and continues strong track record of success with grants IIIr»»»> Lessons Learned Staff capacity is vital Necessity of data infrastructure investments Benefiting from richness of CBO partners requires assessment and support to ensure readiness to partner and respond ............................................ IIIIIIIIIChief Strategist/CommunityI I: Estimated Assumes following responsibilities: Active pursuit of federal and state grants Monitoring and reporting on community conditions Internal strategy development related to community services and land use Advocacy with county public health Community and philanthropic cultivation and partnership ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ Projected Fully Comparable City of Number of Salary Burdened Proposed New City Staff Position Santa Ana Position FTEs Midpoint Cost(+40%) _ _ _ __ __________Principal Planner � ____________ ____________ _ ______ _____________ Chief Strategist Position Position 1 $11,295 $190,000 Grant Manager/Analyst Senior Budget Analyst 1 $8,718 $146,000 Data Analyst Budget Analyst 1 $6,538 $110,000 Subtotal 3 $446,000 Estimated Infrastructure (30%) $133,800 , l I I I1 l ��llll�� II��Vllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllll��. Notes: ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, Estimated year 1 costs, costs may increase over time • All position cost estimates based on City of Santa Ana Salary Schedule " ;;,,,,,;;,,,,,,,;;, Salaries based on midpoint salary plus 40%fringe rate 23 IIIIIIIIINext Steps for the City'sConsideration Plilr�°° Monitor CDPH guidance 1111111IIIII1111,Additional guidance from CDPH anticipated 11111111l1l�°° Assess options for local funding 1111111IIIII11111Opportunities to access property tax and alignment funding 1111111IIIII1111, Grant and/or philanthropic funding opportunities 11111111l1l�°° Explore potential County collaborations 1111111IIIII1111,What responsibilities would the County be open to the City assuming a greater leadership role in? 11111111l1l�°° Consider alternative public health models as interim ste p ............................................ Appendix .......... IIIIIIIIIDetailed Cost AssumptionsPublic ,u m m a, a aoiw m „m ,. rv�m mu »v m u w n n „m�mnnmw v. rv�m mu »v m u w n n „m�mnnmw 1 1 1 4 411111 \\.11. 10 1011 111111. ? \1 P1. 11111 11 I 111 011 I \I 111N Il 11111 11 I 111 011 I \I 111N Il 1 111.\.1 9 1�\Q.1111 11 1 6 1110 I l ll \11� .11 111 141� 1...1111 I l ll \11� .11 111 141� 1...1111 u P �p 1 �p 1 u � V..� .. a .. u . Direct Cost Assumes 3 FTEs Public Health Registrar(5-10 Assumes 5 FTEs Public Health Registrar(5-10 Calculation records per day);plus 1 Supervisor records per day);plus 1 Supervisor 2 FTEs for morbidities and special studies 2 FTEs for morbidities and special studies 1 senior analyst for special studies 1 senior analyst for special studies Workload factors Calculated the number of inspectors required for Calculated the number of inspectors required for Santa Ana based on comparable productivity rates Santa Ana based on comparable productivity rates and estimated volume: and estimated volume: - Used workload data from Pasadena and - Used workload data from Pasadena and Long Beach to determine the number of Long Beach to determine the number of inspections per inspector(productivity rate) inspections per inspector(productivity rate) - Determined the number of inspections - Determined the number of inspections required in Santa Ana based on the number required in Santa Ana based on the number of inspectable facilities and annual of inspectable facilities and annual inspections required by facility. inspections required by facility. - Applied the productivity rate to the - Applied the productivity rate to the estimated 4,603 annual inspections required estimated 4,603 annual inspections required in Santa Ana to determine the number of in Santa Ana to determine the number of inspectors required. inspectors required. - Assume 4:1 ratio of staff to supervisor. - Assume 4:1 ratio of staff to supervisor. - Used midpoint salaries to calculate costs. - Used midpoint salaries to calculate costs. Per Capita Calculate the per capita cost of this function from Calculate the per capita cost of this function from peer agencies and apply the per capita cost to peer agencies and apply the per capita cost to Santa Ana based on Santa Ana population Santa Ana based on Santa Ana population 1`111��1\\\111111�'1»V°4!,�01u»111111141\11111111p11�111�\�tisiq»p11111p11 1 Per Capita Calculate the per capita cost of this function from Calculate the per capita cost of this function from peer agencies and apply the per capita cost to peer agencies and apply the per capita cost to Santa Ana based on Santa Ana population Santa Ana based on Santa Ana population O,m,vl!'!bu;i61141111w`II11110 Ipp puuu,lp 1119111111 V�VAA\VAA�!11111 r OH Applied Rate 10%OH rate applied to calculated operating 10%OH rate applied to calculated operating budget to support related city support costs such budget to support related city support costs such as HR,finance,IT, purchasing,etc. as HR,finance,IT, purchasing,etc. IIIIIIIIIPublic Healthi IAssumptions � I � o I r� �I .. I I M ila I I o,„�l;,' ,,,Ilk ,u��, ,�„II,�II,,,�,41„ ,��;@I�11,9,ii �mllt h a��,��tin�11�u�,�,111�h,�,ll� ill 1�1��,�� u�1��@1�,: ,�I, '��V,NI �I ,NIA nll.Ill,��t�1�Ad,�4 011 Birth/Death Records Supervisor Police Records Supervisor Epidemiology $6,021 $101,153 Birth/Death Records Clerk Police Records Specialist Epidemiology $4,339 $72,895 Epidemiologist/Data Scientist Management Analyst Epidemiology $7,389 $124,127 Epidemiologist/Data Scientist Principal Management Analyst Epidemiology $9,947 $167,110 Public Health Officer ED, Planning and Building Safety Administration $17,878 $300,342 Administrative Support Position Administrative Secty Administration $5,474 $91,963 Public Heath Inspector Combo Building Inspector Environmental Health $6,903 $115,970 Public Heath Inspector Senior Combination Building Supervisor Inspector(Supervisor) Environmental Health $7,609 $127,831 Notes on Assumptions • 40% Benefit Assumption • PERS Normal Cost 11.23% ............................................................................ • Medicare 1.45% • Insurances on a $100k employee 25% Evolving lic Health Approaches and Drivers ■ Infectious disease model ■ Growth of knowledge and ■ Chronic disease model tools for medicine and public ■ Systematic development of ■ Life course, multifactorial health PH agency capacity across US model ■ Uneven access to care and ■ Focus on traditional PH ■ Engage multiple sectors and public health (PH) agency programs community g Y p g y partners to generate collective impact ■ Reduce risk of chronic disease by addressing social determinants of health Late 1800's 1988 IOM Future of Public Health Recession Affordable 2012 IOM For The Care Act Public's Health What's Driving This Evolution? Shifting health paradigm Inflexible(categorical)funding model Evolving healthcare needs of the population Revolution in data and information access, needs Changing population demographics Changing access to clinical care Recognized role of SDOH and non-clinical Fiscal constraints despite demand for increased solutions breadth of services Emerging health and related threats Demands for accreditation and professionalization I I M A 28 SOURCE: Graphic adapted from DeSalvo,Public Health 3.0;A Call to Action,2017. IIIIIIIII Alternative li I I Regional Public I'llr» Regionalization — Merging of departments, regional infrastructure, and/or regional efforts to partner across jurisdictional boundaries Networking Coordination Collaboration` SOURCE:Stoto,Public Health Reports,2008. I'llr» Benefits ■ Avoids duplication of efforts ■ Facilitates Mutual Aid agreements ■ Benefits bioterrorism and other ■ Provides assistance to each local responses requiring surge capacity health jurisdiction in region ■ Shares resources and sets priorities ■ Enables coordination of efforts across a region among state offices and regions ■ Achieves consistency among local, regional and state planning efforts ............................................ I A IIIIIIIII Alternative li I I Regional Public Washington State—went from 39 local health National Capital Region (NCR - D.C.) —effort to jurisdictions (LHJ) to 5 regional departments with organize for future preparedness goal of reducing antecedents of chronic disease • Historic inconsistency/variation in what constitutes ■ Community Transformation Grant (CTG) the NCR supported training and technical assistance to • Coordination groups established/rebooted (Health advance policy and system changes Operations Council, Bioterrorism Emergency ■ Establishing timely communication channels Preparedness Subcommittee) improved regular builds trust communication ■ Pre-existing LHJ governance ad inadequate • Essence Regional Surveillance Systems established time to understand local needs and build trust new regional data system slowed decision-making • Some progress, but continued tension and lack of clarity on who's in charge Massachusetts —went from 35148 regional Japan —Two-staged transformation from 460 • NACCHO funding helped establish the hokenjo during Covid-19 Advanced Practice Center for Emergency ■ Initially inflexible triage protocols and narrowly Preparedness—) Mutual Aid Agreements and held controls overwhelmed hospitals and honkejo multidisciplinary exercises staff • Regions are responsible for emergency ■ Later risk stratification, sharing gateway functions notification (Local Emergency Notification relieved bottlenecks and equalized hospital Systems [LENS]), alerts and mobilization capacity • Regional 4B Emergency Operations Plan (REOP) ■ Persistent need for investment in data and public health infrastructure ............................................ ............................................