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WHATCOM COUNTY COUNCIL
Joint Board of Health and Public Health Advisory Board
June 12, 2012
CALL TO ORDER
Board of Health Chair Kathy Kershner called the meeting to order at 5:30 p.m. in the
Council Chambers, 311 Grand Avenue, Bellingham, Washington.
ROLL CALL
Council
Present: Barbara Brenner, Ken Mann, Sam Crawford, Bill Knutzen, Kathy
Kershner, Carl Weimer and Pete Kremen
Absent: None
Public Health Advisory Board
Present: Douglas Benjamin, Bill Knutzen, Ben Scholtz, Laura Ridenour, Steve ]ilk,
and Rachel Lucy
Absent: Emily Gibson and Laverne Lane
1. PUBLIC SESSION
No one spoke.
2. DUAL ELIGIBLE PILOT PROJECT
Regina Delahunt, Health Department Director and Whatcom Alliance for Healthcare
Access (WAHA) Board President, stated this joint meeting is an annual requirement. Usually
it is a strategy session for the Board of Health and Public Health Advisory Board (PHAB).
This year, they decided to present this important topic and discuss how the PHAB can help
the Board of Health.
She described the history of the dual eligible pilot project and read from the
presentation in the Board packet (on file).
Mann asked for the definition of the word "capitation."
Larry Thompson, Whatcom Alliance for Healthcare Access Executive Director, stated
capitation is a way of paying for care. The provider or group of providers get paid per
person, rather than per service. A health plan would pay the provider a fixed amount of
money per month, for example, in exchange for all the care needed, regardless of how often
the patient seeks care.
Delahunt continued the presentation on the dual eligible pilot project, which target
the group of people who are eligible for both Medicare and Medicaid. That is elderly people
and people with disabilities. They are a complex and expensive population. The care
provided now is not efficient. The project is a State proposal to the federal government to
Board of Health and Public Health Advisory Board, 6/12/2012, Page 1
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better - coordinate care for this population. She described strategy two of the proposal,
which is the full capitation concept. The Council will have to give final intent to the State if
the County wants to participate in the dual eligible project. The County would negotiate
with the State on the terms and conditions for local implementation of the pilot project in
Whatcom County. If the County can't negotiate favorable terms with the State, the County
won't have to participate. Give approval to WAHA to negotiate with the State on these
terms and conditions.
Thompson continued the presentation regarding identifying who the duals are, the
pilot project, and better care received through the pilot project.
(6:25:07 PM)
Delahunt concluded the presentation on the impact to County government.
Mann asked and there was discussion of how the financial incentives would improve
the system for both the health care provider and health care patients. Providers will have
an incentive to withhold care, and patients will have an incentive to seek care daily.
Knutzen stated and there was discussion of taking advantage of recent uncertainties
due to the Affordable Healthcare Act. There needs to be an information technology (IT)
based care coordination system, or it won't work.
Kershner asked and there was discussion of whether the developmentally disabled
and long term care dollars will be used to fund the dual eligible pilot project and the
experience that the health plans, accountable care organization (ACO), and other providers
have in dealing with those populations. The WAHA Board needs to have representation
from the developmental disability and long -term care community.
Brenner asked and there was discussion of how they are going to deal with the lack
of federal healthcare funds for Medicare and changing federal healthcare requirements.
Jilk stated the reason for the project seems to be cost control. He asked and there
was discussion of how they determine what quality control and oversight is at a local level.
Ridenour stated it's great to see attention on fragmented healthcare issues. She
asked and there was discussion of how the ACO might intersect with WAHA and the County
Health Department and whether the ACO is different from the community organization.
Scholtz asked and there was discussion of why the ACO and oversight organization
are not on the flow chart in the presentation.
Mann stated he supports moving ahead, depending on the terms and conditions. He
asked and there was discussion of how they envision handling a patient with a major
medical issue, such as an organ transplant.
Knutzen asked there was discussion of how the State Department of Social and
Health Services (DSHS) and pharmacies fit into the equation.
(7:09:58 PM)
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Weimer stated he supports going forward. He asked and there was discussion about
forming a strong community oversight organization with paid staff and the how they will
measure outcomes for people who have end -of -life issues.
Kershner asked and there was discussion of why Whatcom County, as a smaller
community, wants to do this project instead of learning the lessons from other counties and
incorporating those lessons locally. She is concerned that ACO, WAHA, and an oversight
group don't have experience dealing with the dual eligible population. She would like to see
the complete data on the existing outcomes for this population and how a pilot program
would change that data.
Kremen stated the presentation was compelling. He stated and there was discussion
about reduced staff and services in the Health Department and allowing King and
Snohomish Counties to blaze the trail with these pilot programs.
Scholtz asked and there was discussion of whether pursuing this project would take
County resources from some other worthy service.
Crawford moved for the Council to provide direction to continue to explore with the
State the possible implementation of Option 2 in Whatcom County.
Kershner stated that a final recommendation on Whatcom County participation in
Option 2 will be made to the Council within 2 months.
Crawford stated he has a concern about direct costs. He would like information in
the future about those costs.
Kershner stated she supports the motion. She still has many questions for staff.
Mann stated he supports the motion. He asked for an update in a month or six
weeks. He's curious about the terms and conditions as they're negotiated.
Weimer stated he supports the motion. Healthcare will change significantly in the
next few years. Locally, they should steer that change as much as possible through a
community- driven effort.
The motion carried by the following vote:
Ayes: Kremen, Crawford, Brenner, Weimer, Knutzen, Mann and Kershner (7)
Nays: None (0)
Kershner stated the PHAB asks about how they can best advise the Health Board on
this issue and other aspects of health care transformation in the community.
Knutzen stated the PHAB can communicate through him, as he's the Council's
representative on the PHAB.
Kershner stated she will forward her list of issues and concerns to the PHAB. Other
councilmembers are also welcome to do that. The Health Department Director will also
work with the PHAB on issues.
Delahunt stated the PHAB is happy to look deeper into particular aspects of the
issues and concerns that come up with the Board.
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Weimer stated he would like more information on what the community oversight
group will be.
Ridenour stated there has been a lot of discussion by the PHAB on how best to
communicate with the Board of Health.
Kershner stated communicate through Councilmember Knutzen and at the Council's
Public Works, Health, and Safety Community.
ADJOURN
The meeting adjourned at 7:33 p.m.
The Council approved these minutes on August 7, 2012.
ATTEST:
WHATCOM COUNTY COUNCIL
WHATCOM COUNTY, WASHINGTON
Please contact the Council Office to obtain an
official, signed copy:
360- 676 -6690 or council@�omhatcomma.us
Board of Health and Public Health Advisory Board, 6/12/2012, Page 4