VIRGINIA






 

VIRGINIA
Office of Minority Health and Public Health Policy
Prepared by National Association of State
Offices of Minority Health (NASOMH)
 
Michael O. Royster, MD, MPH, FACPM
Director, Office of Minority Health & Health Equity
Virginia Department of Health
109 Governor Street
Richmond, VA 23219
Phone: (804) 864-7435
Fax: (804) 864-7440
Email:michael.royster@vdh.virginia.gov
 
Organizational Structure/History
 
Inception History - In 1992 the Commissioner of Health established the Virginia Office of Minority Health (VAOMH). The VAOMH has served as the primary unit in the Department of Health to determine the extent to which policies, programs, and services of the agency appropriately address the needs of minority populations. Eventually, VAOMH became a part of the Office of Health Policy and Planning, which also included the State Office of Rural Health and the State Primary Care Office.
 
Current Organizational Structure – Over the years, as Virginia’s minority population increased, the VAOMH expanded its staff to address culturally and linguistically appropriate health care services, minority health, and healthcare workforce. In 2007, the Office of Health Policy and Planning was named the Office of Minority Health and Public Health Policy (OMHPHP) to demonstrate the Governor’s commitment to minority health.  OMHPHP was reorganized into two Divisions, the Division of Primary Care and Rural Health (DPCRH), and the Division of Health Equity (DHE). The rural health and primary care functions are carried out within DPCRH and the minority health functions are carried out in DHE. The Office strives to integrate the two Divisions in order to comprehensively promote health equity among rural, medically underserved, low income, and racial/ethnic minority populations.
 
Minority Health Advisory Committee - Virginia established a Minority Health Advisory Committee (MHAC) in 1990 to advise the State Health Commissioner on issues related to the priorities and strategies for reducing disease, disability and death among minorities in the state. The MHAC includes representatives from local, state, and federal public health agencies, educational institutions, private and public, profit and non-profit organizations. The MHAC’s mission is topromote and advocate for the elimination of health inequities among all racial and ethnic minorities, as well as other disadvantaged populations in Virginia.  
 
The duties and responsibilities of the MHAC are to: (1) serve racial and ethnic minority communities; (2) advise and make recommendations to the Commissioner of the Virginia Department of Health; (3) identify limitations associated with existing laws, regulations, programs, and services; (4) identify and review health promotion and disease prevention strategies; and (5) support policies and legislation to improve accessibility and delivery of health services.
 
Program Focus/Activities
 
The mission of the OMHPHP is to identify health inequities, assess their root causes, and address them by influencing policy, establishing partnerships, providing resources and educating the public. Central to this mission is the recognition that inequities in health stem from social inequities that lead to unequal access and exposure to social determinants of health (e.g. income, economic opportunity, quality education, quality and affordable housing, healthy living environments, favorable working conditions, access to health care and providers, social support and social capital, and transportation). These and other social determinants of health (SDOH) influence behaviors, chronic stress, and exposure to environmental risks; and they affect health throughout the life span and across generations. SDOH have been termed fundamental causes of disease because their distribution is strongly associated with the distribution of the major causes of morbidity and mortality (e.g. heart disease, cancer, unintentional injuries, HIV/AIDS, asthma). Fulfilling the Office’s mission requires addressing the SDOH in partnership with disadvantaged and underserved communities, health professionals, advocacy groups, policy makers, and others to:
·         Develop the health care workforce, including the management of scholarship and loan repayment programs and other initiatives aimed at the recruitment and retention of health care providers;
·         Target the social and economic policies, practices, and conditions that create disproportionate barriers to health among low income, racial and ethnic minority, and rural populations; and
·         Assist socially disadvantaged and medically underserved communities and populations with the development of resources, establishment of partnerships and identification of programs to promote health and prevent disease.
 
 
Eliminating Health Disparities Statewide Initiatives
 
Health Care Access and High Priority Target Areas
As the Primary Care Office of Virginia, OMHPHP is federally mandated to oversee the Health Professional Shortage Area (HPSA) and Medically Underserved Area and Population (MUA/MUP) designation process. OMHPHP proactively reviews for HPSA and MUA/MUP designation each of Virginia’s 206 Census Tracts (2000 Census) with over 20 percent of their population below the Federal Poverty Level (FPL). The OMHPHP facilitates new primary care, dental and mental HPSA and MUA/MUP designations in all qualified areas. In addition, the Office developed a new methodology for identifying specific neighborhoods and communities that could benefit from public health interventions and policy change. These “High Priority Target Areas” are identified using geospatial informational system analysis of multilevel spatial data associated with social determinants of health.
In addition to developing systems to identify areas of need, the OMHPHP is also working to insure more Virginians. In partnership with Community Health Resource Center, Inc., the OMHPHP supported the development of InsureMoreVirginians.net, a Web site designed to expand health coverage by educating Virginia citizens and small employers about the value of health coverage, their health insurance coverage options and how to acquire health coverage.
Developing the Health Care Workforce
Recruitment and Retention Initiatives
The OMHPHP educates practitioners and employers about the online recruitment resource, PPOVA.org as well as the loan repayment and scholarship programs that are designed to attract and retain primary care practitioners in Virginia’s rural and medically underserved areas. During FY2008, the OMHPHP produced a health care workforce video, Choose Virginia: A Healthy Place to Live and Work. This video has been showcased on the Office web site, conferences, and YouTube.
Incentive Programs and Placement of Practitioners in Virginia’s Underserved Areas
The OMHPHP administers the Virginia Physician and the Virginia State Loan Repayment Programs. These programs offer financial incentives to physicians, physician assistants and nurse practitioners who are committed to serving the needs of underserved populations and communities in the Commonwealth of Virginia. During FY2008, the OMHPHP provided awards to 22 eligible applicants.
In addition to loan repayment programs, the OMHPHP administers four nursing scholarship programs. Recipients of the scholarship awards agree to provide service in Virginia after completing their educational programs. The OMHPHP awarded a total of 121 nursing scholarship awards during this fiscal year.
The OMHPHP also administers the J-1 Visa Waiver (Conrad 30) program. This federally authorized program enables international medical graduates to remain in the country after completing their residency if they agree to work in medically underserved areas. The OMHPHP assisted in the placement of 19 physicians who were granted J-1 Visa Waivers during FY2008.
Rural Health
The OMHPHP serves as the State Office of Rural Health. In this capacity, it manages the Small Rural Hospital Improvement (SHIP) Grant Program and the Medicare Rural Hospital Flexibility (Flex) Program. The SHIP program supports rural hospitals in developing network systems to enhance the quality of care in the hospitals, promoting implementation of the Medicare prospective payment system and the Health Insurance Portability and Accountability Act (HIPPA). The Office partnered with the VDH Office of Emergency Medical Services (EMS) to assess EMS capacity in rural regions and participated in a Multi-state Performance Improvement Project as well as several telehealth educational programs.
 
In collaboration with over 40 statewide rural partners, The State Office of Rural Health leads an action plan for the advancement of health and healthcare services in rural Virginia. This plan provides an analysis of rural health and will aid in the development of practical strategies that will lead to health improvements in rural Virginia. It can be found at http://www.va-srhp.org/. In addition to the plan, OMHPHP has continued to leverage its resources to support the development of rural health systems of care. As a recipient of the Critical Access Hospital - Health Information Technology Network Implementation Grant (CAHHITN), the OMHPHP has partnered with institutions of higher education, rural communities, organizations and hospitals to implement, design, develop, test and evaluate a model stroke network across the central Shenandoah region.
Health Equity and Minority Health
The OMHPHP leverages partnerships with community leaders, institutions of higher education and government agencies to increase awareness of health inequities and provide technical assistance and training for partners to address their root causes and contributing factors.
·         The Health Commissioner’s Minority Health Advisory Committee embraces this vision and implemented a systematic plan to educate and mobilize members of their communities through presentations, workshops, forums and literature.
·         The OMHPHP partners with California Newsreel and other partners to promote health equity, using the series Unnatural Causes: Is Inequality Making Us Sick? as a catalyst for research, discussion, public engagement, and community mobilization.
·         The OMHPH has developed and facilitated a training program to provide individuals and organizations with the information and tools to lead discussions and action planning to promote health equity.
·         The CLAS Act initiative continues to enhance its award-winning resource, CLASActVirginia.org and also provided VDH employees with telephonic interpretation and translation services and cultural sensitivity training.
·         OMHPHP is currently engaged in community-based participatory partnerships with communities in the Norfolk and Richmond areas and in southwest Virginia.  These partnerships engage community residents as equal partners and build on community strengths and the resources present among organizations serving those communities to identify and address community health concerns.  The partnerships use the World Health Organization definition of health to guide their work (WHO defines health as the presence of complete physical, mental, and spiritual well-being and not merely the absence of disease).
 
Level of Funding Sources
Year                 Federal              State             Private               

FY 2006
$2,250,744
$1,063,274
   0
FY 2007     
$1,194,892   
$1,733,279
   0
FY 2008     
 $1,629,664   
 $2,274,129
   0
FY 2009
$1,487.669
$1,496,077
$ 69,232

 
Resources
 
  • Director, Office of Minority Health and Public Health Policy (1 FTE) - directs all activities of the Office of Minority Health and Public Health Policy, which includes the Offices of Minority Health, Rural Health, Primary Care;
  • Director, Division of Health Equity (1 FTE) - manages activities of Division;
  • Minority Health Specialist, Division of Health Equity - Position currently Vacant (1 FTE), provides day to day assistance with health equity initiatives statewide;
  • CLAS Act Coordinator, Division of Health Equity (1 FTE) - manages cultural and linguistic healthcare resources, develops policy, provides training, etc; and
  • Outreach Coordinator for Minority Health, Division of Health Equity (1 FTE) - Gubernatorial appointee who participates in and provides technical assistance for local health equity initiatives and provides leadership for marketing activities.
  • Director, Division of Primary Care and Rural Health (1FTE) – provides oversight, guidance and direction for the Virginia Department of Health Office of Minority Health and Public Health Policy Division of Primary Care and Rural Health and serves as the State’s Primary Care Officer.
  • Rural Health Manager/Flex Coordinator, Division of Primary Care and Rural Health (1FTE) – provides oversight, guidance, and direction for all Health Care Workforce and Flex initiatives and programs
  • Health Workforce Manager, Division of Primary Care and Rural Health (1FTE) – coordinates Health Care Workforce initiatives, programs,
  • Social Epidemiology and Shortage Designations Manager, Division of Primary Care and Rural Health (1FTE) –Manages the designation/redesignation processes and activities for Health Professional Shortage Areas (HPSAs), Medically Underserved Areas (MUAs), and Medically Underserved Populations (MUPs) in Virginia. Additionally, provides data analyses support for the purpose of program planning and policy development
  • Program Support Technician, Division of Primary Care and Rural Health (1FTE) – performs administrative/technical and fiscal support for all healthcare workforce incentive programs, these include but are not limited to the Virginia Nursing Scholarship and Loan Repayment Programs, Virginia Medical Scholarship Program, Loan Repayment Programs, the J-1 Visa Waiver Program, and the Practice Sights Software Program.
  • Business Manager, Office of Minority Health and Public Health Policy (1FTE) – manages all human resources and financial aspects of the office, to include the budget development and management of 10+ programs and manages and monitors the financial aspects of all contracts and memorandum of agreements pertaining to the division. 
  • Communications and Information Technology Specialist, Office of Minority Health and Public Health Policy (1FTE) – responsible for the planning and development of communications strategies for the Office of Minority Health and Public Health Policy (OMHPHP) in order to increase public awareness of health equity and social justice issues and promote Office programs, initiatives and accomplishments.
  • Program Support Technician, Office of Minority Health and Public Health Policy (1FTE) – provides organizational support, to include ensuring compliance with records retention policies, office files and records management and organization, maintaining inventories of office supplies and equipment, logging and tracking of requests and protocols, and ensuring the general orderliness of the office environment. Additionally, this position will provide meeting support for staff, to include scheduling, meeting preparation, and communications; as well as fiscal support, including generating simple reports, assisting with financial data reconciliation and thorough and accurate financial database management.
 
 
OMHPHP has developed a comprehensive website that highlights information on state, local and national health equity initiatives. The website is www.vdh.state.va.us/healthpolicy/about.htm
 
Recent Publications
The OMHPHP has revamped its newsletter called “Health Equity Matters.” Until recently, this newsletter was published quarterly and distributed to constituents to facilitate a common interest in advancing health equity in Virginia. This newsletter focuses on health inequities related to socioeconomic status, race/ethnicity, geography and living environment, and access to health care. The newsletter has been replaced with a blog to make information available to partners in a more timely manner. It can be found at  http://healthequitymatters.blogspot.com/.
The OMHPHP published the first Virginia Health Equity Report  - in the summer of 2008.   This report includes greater emphasis on statistical data reflecting the impact of social determinants of health on morbidity and mortality and health inequity. It can be found at http://www.vdh.state.va.us/healthpolicy/2008report.htm