Today we hear an important conversation about the role of local government in population health and wellness. Scott LaVigne, Public Health Director of the Franklin County Health Department in North Carolina, talks with CHESS vice president, Josh Vire, about the broad scope of work his team is responsible for and how they are successfully tackling numerous initiatives, including managed Medicaid, to be a safety net provider for community health needs.

Scott LaVigne, welcome to the Move to Value podcast.

Oh, it's great to be here.

We're we're really excited and looking forward to the conversation. Scott, as a public health director, you're responsible for all aspects of the Franklin County Health department from the clinical to environmental services and you balance state mandated services. So for the audience that things like vaccines, basic health screenings, environmental services, and with the expectations of Franklin County government, all while dealing with the critical workforce shortages. Health departments are considered safety net providers in most of North Carolina's counties. Can you share how your team is addressing the specific healthcare needs of the Medicaid population in the county?

Sure. Well, after hearing all that, I'm, I'm getting tired. Yeah. That that is a we have a lot on our plate here at the health department and a lot of they're, they're not very often competing interests. But you know, I think what we look at when we talk about healthcare services in general and the overall health of the county, we don't break it up into per SE Medicaid population, although we do focus on that as part of the work that we do. But we, we have 2 broad missions and one is obviously population health and that it cuts across all payers and everyone in the community. And then the other role, which you correctly identified as we're a safety net provider. So in addition to putting out a lot of population health initiatives, we're also a provider and we're involved in a lot of the initiatives that all the providers in the community are involved in. So, you know, that gives us a unique position and we get to tailor some of our initiatives as a healthcare provider based on what we know the community health needs are. So it's, it's, I'm going to be honest, it's not very easy to do all of that. I would say we, as I said, we don't just focus on the Medicaid population, but we do have a lot of initiatives that cut across all of that.

Great. What are the specific issues that that I think you have a lot of experience in close to 30 years of behavioral health experience with much of that coming in New York. Can you describe the changes in public health that you see in your career and maybe also for the audience contrast the differences between the public health in New York and North Carolina. What are the differences you've seen?

Sure. Well, when I was in New York, I was a a mental hygiene director for a county and, and when I came to North Carolina, I became a public health director. But we were actually in the same building in New York with our public health programs and we had a very close relationship with that program. But there are some significant differences, but a lot of similarities. You know, the some of the big differences though relate to some of what we're talking about. Medicaid managed care being a big one in New York. Medicaid managed care started first with medical care and then they brought behavioral health and IDD into the picture. In North Carolina, they did it the exact opposite. And so that that was a, a big difference. When I came down here, we had a mental hygiene system that had already made the conversion and was and, and medical care, which is what I was now in, we had to make that shift. So, I would say that was a, a big difference. But in New York, most of the public health agencies had gotten out of...