HomeMy WebLinkAboutBoard of Health February 4 20141
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Whatcom County Council
Board of Health
February 4, 2014
CALL TO ORDER
Council Chair Carl Weimer called the meeting to order at 10:30 a.m. in the County
Council Chambers, 311 Grand Avenue, Bellingham, Washington.
ROLL CALL
(10 :32:06 AM)
Present: Barbara Brenner, Ken Mann, Sam Crawford, Carl Weimer, Pete
Kremen, Rud Browne and Barry Buchanan.
Absent: None.
1. PUBLIC SESSION
No one spoke.
2. PUBLIC HEALTH ADVISORY BOARD UPDATE
Regina Delahunt, Health Department Director, welcomed two new Board of Health
members Barry Buchanan and Rud Browne.
Doug Benjamin, Public Health Advisory Board Chair, described his background and
the relationship between the Board of Health and Public Health Advisory Board. The Public
Health Advisory Board looks at a broad range of issues, including the Group B septic system
regulations, public health issues in the Comprehensive Plan process and public health
policies. Today they will hear about issues surrounding substance abuse.
Weimer asked the pros and cons of having a separate Board of Health and why
Whatcom County chose this process. Delahunt stated it's generally related to Home Rule
Charter counties, in which the council generally acts as the Board of Health.
Kremen stated health districts skew the funding percentage that goes to criminal
justice. Whatcom County actually funds the Health Department. In other counties, a higher
percentage of their budget is attributed to other mandated services. In Whatcom County,
this system works better. There is only one administration, which is more efficient and
accountable. Whatcom County's Health Department is a model for the entire state.
Delahunt stated one reason for a separate advisory board is that members with expertise
can look more in -depth at issues and advise the Board. The Board will be confident that
issues were discussed by people with expertise.
Brenner stated she likes the Council being the Health Board so they better
understand health problems in the community. All elected officials need to have a better
understanding of public health problems. Health issues are scarier than criminal justice
issues, because they are often a cause. Being the Board of Health makes elected officials
understand health issues better. The advisory committee is extremely helpful.
Board of Health, 2/4/2014, Page 1
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Weimer stated that this is a budget year, and asked that the advisory committee
make budget recommendations on things that need more attention.
3. CHEMICAL DEPENDENCY TREATMENT AND ITS FUTURE
(10: 44: 07 AM)
Ann Deacon, Health Department, introduced this program, which is complicated,
confusing, and broken as it is. Changes are underway. Major changes are coming related
to the Affordable Healthcare Act and Governor Inslee's initiatives. Many chemical
dependency dollars come from the federal government, through the State, to the County.
There are also local funds for more specific, targeted needs. Chemical dependency staff
also work in the jail. She introduced Jackie Mitchell.
Jackie Mitchell, Health Department, stated the broken infrastructure is mostly related
to low rates of reimbursement that the providers receive. With healthcare reform and other
issues, they're experiencing a higher than normal volume and need for treatment. She read
from the presentation in the Board packet.
Deacon continued the presentation on what's next. Today they ask the Board to
contact local legislators about their complex needs and make sure chemical dependency is
adequately funded. A major transformation of healthcare reform is to integrate mental
health treatment, chemical dependency treatment, and general medical care. Like the
regional support network that gets a per member per month rate for all Medicaid eligible in
the region, an idea is to set up the same system for chemical dependency to replace the
fee - for - service. The County would be part of a regional entity. A concern is that programs
and services must have some level of county oversight and a method for holding the
regional entity accountable if they're providing ineffective services. The Association of
County Human Services is pushing for some level of county governance over those dollars.
Health insurance plans must take a more active role in delivering Medicaid services.
That results in for - profit agencies doing work that government has typically done. The
Association has a concern with that. When working with people who have serious and
persistent mental illness and serious addiction, the people need supportive social services
also. If the health insurance companies take on the healthcare services for these complex
patients, there are questions about whether the companies know how to do that, whether
they know who the critical partners are, and whether they have accountability for treatment
delivery outcomes.
The current system, although broken, should not become any more compromised.
Don't harm the current system, which is all they have. Don't rush into health plans without
good planning and coordination with communities. She referenced the two actions
requested shown on the discussion form in the board packet. Talk to legislators about
making sure chemical dependency is adequately funded and maintaining the County's role
in the governance and oversight of behavioral health services.
Delahunt stated that in the future weeks and months, there will be more discussion
with the different agencies about the integration of substance abuse and mental health.
There is risk to the counties if the system isn't properly funded. They can't take on both
without additional funding for substance abuse. The legislative bills moving forward have
very short timeframes. The ultimate goal is to integrate all services. This region works well
Board of Health, 2/4/2014, Page 2
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together, but things will be very different. Medicaid procurement will be done on the
regional basis.
Brenner stated this was extremely depressing. They should all be sending angry
letters to the federal and state governments. People won't get what they really need from
the federal level. She's very upset with all of this. Having a decent mental health system,
which should include substance abuse, will save money and lives. Hiring trainees right out
of school may do a better job than long -time employees who may be burned out. They can
be very beneficial. She recommends that people working in the public sector should receive
free training. She referenced the statistic about healthcare savings exceeding costs by a
ratio of 12 to 1 and whether they can reduce costs. Mitchell stated they need to fund the
system better so they can reduce costs in other areas. They can deliver more effective and
efficient services with best practices. They will get better at providing services in
conjunction with primary care physicians to streamline services. Many folks in the
healthcare industry don't know how to handle people with substance abuse issues.
Brenner asked which agencies have closed or downsized. Mitchell stated Advanced
Choices was a small agency that closed and Whatcom Counseling downsized.
Weimer asked if that was due to Medicaid rates. Mitchell stated it largely was. The
smaller agency also saw all the healthcare reform changes and decided to close. Agencies
with a larger infrastructure tend to manage better.
Mann asked how they define the need of adults who need alcohol or illicit drug
treatment and if the comparisons are equal. Mitchell stated the data comes from the
national household survey study. They call people and ask specific questions about use and
treatment.
Mann referenced the Medicaid reimbursement rates and asked what people are doing
to change the problem of low reimbursement rates. It's such a prevalent issue. Deacon
stated everyone should play a role, but it's a national challenge. She doesn't know what it
would take to make changes.
Mann asked who sets the Medicaid rates. Deacon stated the Center for Medicare
Services (CMS), which is under the Health and Human Services umbrella, sets the rates.
Mann asked if some states are happy with the rates. Mitchell stated they are. At a
recent State of Reform conference, she spoke with Amerigroup Insurance representatives.
They told her that their providers make it work with Medicaid rates because they can set the
rates higher. They don't have the ability to do that here with the State partner.
Kremen stated Medicaid rates for Washington State are historically low. The State of
Florida gets paid much more than Washington State. Other states have more political clout
or an older constituency. They have better reimbursement rates. Whatcom County has a
very low reimbursement rate. The cost of living is 113% of the average. Wages are 80 to
85 percent of the average. That creates a huge disparity problem for the community. The
current federal administration was derelict in addressing healthcare reform in a system-
wide, holistic way. They must expand the number of people who are served. The cost of
healthcare is too high. The administration did not address health cost containment,
pharmaceuticals, insurance companies, or tort reform. Both political parties must address
the issue of inmates losing their health insurance. It's a way for the federal government to
shift costs to local governments. He doesn't know how these issues will be addressed. The
mental health sales tax gave the State the false impression that it would adequately
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address mental health issues. It generates one -tenth of what is needed to adequately
address mental health issues in the community. The State believes funding mental health is
no longer their problem. It used to be exclusively a State - funded issue. Most of the State's
focus now is on adequately funding education. That's where limited State dollars will go.
He's not optimistic they will make any meaningful progress toward getting adequate funding
for these services.
Browne referenced the initial training costs and asked how retention rates would
change if salaries were brought up to average. Mitchell stated people stay longer when
they're paid well.
Browne asked for an analysis of salary versus tenure in other jurisdictions. Deacon
stated that analysis hasn't been done in this State, because no one can provide a larger
salary. The system is too underfunded. They can look into the statistics for the Lummi
Tribe.
Browne asked if there is anything they should do to encourage smaller agencies to
consolidate to lower administrative costs and be efficient. Mitchell stated the small agency
that closed was the only small agency.
Browne asked how to improve how they provide immediate help and access upon
first contact. Mitchell stated the State and Brandeis University are doing a study to look at
how to incentivize agencies for engaging people sooner than the 14 -day period.
Browne stated people who've gotten to a crisis point need to get into the system
before reaching another crisis point. He would like to know what they can do to accelerate
that initial contact rate. Deacon stated they try to allow the agencies to bill for more
services that aren't Medicaid allowable, and then pay for the service with local taxes. It will
infuse more dollars into the agencies to pay them for the work they're really doing, so they
can get a bigger workforce to engage in first contact.
Mitchell stated they are also considering ways to fund someone to do assessments so
treatment agencies can focus on treatment.
Browne asked how the County engages with Alcoholics Anonymous (AA) and
Narcotics Anonymous (NA). Mitchell stated the treatment agencies refer people to them as
part of the support component. Some agencies may have folks from AA come into the
treatment center. All of the agencies are very supportive of AA.
Browne asked why the State legislature is encouraging that this work be transferred
into the private sector. Deacon stated Governor Inslee may be hoping to add competition
to the field, that insurance companies come in with deep pockets and bring forward
efficiencies, and that the State or other local governments are bulky in terms of
administering healthcare. Those are advantages. However, the concern is that patients
who need this work, which are typically funded with Medicaid, are very complex. Rarely do
they have just one issue.
Delahunt stated the primary driver of the State is to save money. Two other
secondary drivers are improved quality of care and improved patient experience. If they
can work with the health plans, negotiate rates, get bulk deals, that would be the primary
driver. Public health is concerned that even though they might save money, the complex
cases wouldn't get complete care and there would be no community accountability. Some
of the bills in the legislature set up accountable collaboratives of health, which are supposed
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to hold payers accountable for the types of services being delivered in the community.
However, the legislation doesn't include incentives in the accountable collaboratives of
health.
Weimer asked if anyone in the State is looking at reducing the training costs.
Mitchell stated King County has a program to support funding for folks who are going
through the education.
Weimer asked if that program has helped to retain staff. Mitchell stated it seems to
be helpful.
Deacon stated Whatcom County is offering to pay for some continuing education
credits.
Crawford moved that the Council draft a letter on both of these issues. The Health
Department could help draft the letter.
Kremen stated the Association of Counties can help County staff write the letter. He
will support the action items. The County must make a statement and request. In the past,
he's asked Senators Murray and Cantwell to close the Medicaid reimbursement rates, but
got nowhere. They have to continue and hope for the best.
Browne stated he's not automatically in favor of privatization of healthcare.
The motion carried by the following vote:
Ayes: Brenner, Mann, Crawford, Weimer, Kremen, Browne and Buchanan (7)
Nays: None (0)
(11: 53:20 AM)
Brenner stated don't set up another layer of regional infrastructure.
Greg Stern, County Health Officer, gave an update on the flu season. They're past
the peak time. The County puts out weekly updates. The flu season is predominantly the
H1N1 strain. Other strains may increase and extend the season. There were several
hospital admissions. Statewide, more people in the young to middle adult age range were
hospitalized than older folks.
Crawford stated he got the flu around Christmas, and his coworkers got the flu after
that, which created the discussion of flu shots. Many people have negative opinions of flu
shots. He asked about public education regarding flu shots. The public education efforts
must improve. He didn't get the flu shot this year, and he regrets it. Stern stated negative
information is out there. Certain people believe the science is conspiracy theory that
discounts expertise. They're left with a lot of mutual reinforcement of beliefs rather than
evidence. He used to think giving people information was sufficient, but it's not. They must
build trust and develop critical thinking. It's a very complex situation. There is a coalition
of public health and clinical groups with a project called the Immunity Community. It works
with parent advocates to develop peer discussions and build trust.
Crawford asked if there could be a mobile flu immunization clinic that employers
sponsor for their employees. It would save the business costs from sick and absent
employees. Stern stated there are immunization providers that do workplace
immunizations.
Board of Health, 2/4/2014, Page 5
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Crawford stated it may be good to educate the employers about the benefits.
Through the employer's encouragement or the ease of availability, people may take
advantage of an onsite clinic.
Delahunt stated Whatcom County did that for its employees.
Stern stated Peace Health St. Joseph Medical Center offered free vaccines to its
workforce for decades. Its immunization rate was approximately 65 to 70 percent. It
wasn't until there was mandatory vaccines that the rate rose to 90 or 95 percent. Some
people opted to wear masks. Even folks with the information still have concerns. There is
misinformation about influenza. The shot doesn't work against everything that makes
people sick. It works against influenza A and B.
Brenner asked if the older people are becoming informed about getting the flu shot,
and the younger people aren't. Stern stated it's more complicated. It has to do some with
immune memory from an H1N1 pandemic that started in 1918 and circulated until 1957.
People born before 1957 were exposed to that influenza. Influenza A is the type that can
cause worldwide pandemics. When there is a genetic shift, people are susceptible to the
new virus. H1N1 was the circulating influenza A that circulated from 1918 to 1957. He
described the history of the strains of influenza A that circulated.
Crawford stated he would like a presentation at a future Board meeting on tracking
sexually transmitted diseases (STDs). Stern stated that is an ongoing issue.
ADJOURN
The meeting adjourned at 12:05 p.m.
The Council approved these minutes on March 25, 2014.
ATTEST:
, Council Clerk
-, Minutes Transcription
WHATCOM COUNTY COUNCIL
WHATCOM COUNTY, WASHINGTON
Carl Weimer, Council Chair
Board of Health, 2/4/2014, Page 6