Kentucky’s health departments are working on changes, to adapt to changing times

By Melissa Patrick
Kentucky Health News

Health departments across Kentucky come in all shapes and sizes, and typically work independently from each other to serve the specific needs of their community within their budgets. But to deal with changes in the health-care system, the Kentucky Health Department Association is working on a strategic plan that will bring even more changes to the departments and the people they serve.

The plan will either “succeed or health departments will be privatized; this is our choice,” said
Georgia Heise, district director of Northern Kentucky’s Three Rivers Health Department and current president of the National Association of County and City Health Officials.

She discussed the plan and the state’s health needs at the recent fall meeting of the Friedell Committee for Health System Transformation in Lexington.

One of the biggest changes in Kentucky’s health departments is a move away from clinical care toward population health, Heise said. Departments are funded for clinical care, but they were never intended to take care of the sick, contrary to public perception; and Kentucky’s shift to managed-care Medicaid no longer makes it feasible for health departments to provide clinical services, she said.

Heise noted that Kentucky’s health status is 45th in the nation, so the first priority of the plan is to improve it. She told the Friedell Committee that this goal is timely, since it coincides with Gov. Steve Beshear’s “kyhealthnow” goals for 2019.

Prevention through population health is the key, but prevention takes more than just educating the public; there must be political and social will, Heise said. There are also organizational obstacles.

She said local health departments have spent lots of money just being told what to do, while the health of Kentuckians just got worse. A new strategy will use a data-driven approach toward solutions and require smart goal statements, attaching responsibility to tasks and measuring everything.

The health departments want to develop a shared vision with the state Department for Public Health, which oversees them. “It does us no good to be at odds,” Heise said.

Other goals include serving as a communication tool for private and nonprofit public-health partners, and to assist with local public-health advocacy for all branches of Kentucky government.

The plan also calls for changing laws that govern health departments. “Current statutory obligations do not represent the purpose and scope of public health,” Heise said, calling the laws dated, vague and hard to understand. She said that often there is no consensus about the requirements for a health department, but they are working on that.

Heise said there are limited resources to fulfill the required mandates, and there will be no new money. “We have to do better with what we have,” she said. Kentucky already ranks 15th in per-capita spending for health care among the states.

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