HomeMy WebLinkAboutPublic Works November 20 20121
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WHATCOM COUNTY COUNCIL
Public Works, Health, and Safety Committee
November 20, 2012
CALL TO ORDER
Committee Chair Barbara Brenner called the meeting to order at 1:30 p.m. in the
Council Chambers, 311 Grand Avenue, Bellingham, Washington.
ROLL CALL
(1:31:32 PM)
Present: Barbara Brenner, Ken Mann and Pete Kremen.
Absent: None.
Also Present: None.
COMMITTEE DISCUSSION
1. DISCUSSION REGARDING THE POSSIBILITY OF ALLOWING GOLF CARTS ON
LUMMI ISLAND ROADS (AB2012 -355)
Brenner stated she doesn't know what the problem is. She needs to know all the
information.
Joe Rutan, Public Works Department, submitted a handout (on file). Staff has done
a lot of information on this issue and what other jurisdictions have done.
Knutzen asked if they looked at other islands, such as Blakely Island.
Mike Donahue, Public Works Department, referenced the handout and stated the
Revised Code of Washington (RCW) says a posted speed has to be 25 miles per hour. On
Lummi Island, most roads have a speed limit of 35 miles per hour, which would conflict with
the RCW.
Mann stated they could lower the speed limit on the Lummi Island roads. Rutan
stated that is an option if they want to allow golf carts island -wide.
Donahue stated Grant County and Island County have islands that allow golf cart
zones. He didn't find a golf cart zone in San Juan Island. The City of Sumas allows golf
carts because they posted a 25 mile per hour speed limit citywide.
Knutzen asked what is required for licensing. Rutan stated that information is in
RCW 46.08.175(6). The County has the authority to regulate and license the golf carts.
Mann asked if the City of Sumas has a designated golf cart zone
does.
Donahue stated the City of Sumas adopted an ordinance in 2009
limits of Sumas is a designated golf cart zone.
Rutan stated it
The entire city
Public Works, Health, and Safety Committee, 11/20/2012, Page 1
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Rutan stated there is some operation that ferries people back and forth from the
border.
Brenner stated she wanted to know what counties do to make it legal and what the
rules are.
Rutan stated another area discussed for a golf cart zone was Birch Bay Drive.
However, the issue was that the roads getting to Birch Bay Drive are 35 miles per hour.
Islands are nicely contained, but an issue in another area of a county is how one would get
to a golf cart zone.
Mann asked the downside of making a golf cart zone. Rutan stated they have
electric motors, so they don't have power to get up hills, according to the Sheriff. There are
already speeding issues on Lummi Island. There's more potential for conflict and people
could get stuck behind a golf cart on a hill.
Brenner stated they are stuck because of State law, but it would be nice for golf
carts to go on shoulders.
Knutzen stated the majority of the carts will probably be gas - powered. They may
need some kind of horsepower restriction and special licensing, just like scooters. Some
golf carts will do 80 miles per hour.
Mann asked why this came to the agenda.
Brenner stated people have asked her about it in the past, and she didn't have any
information.
Knutzen asked how Birch Bay Village allows it. Rutan stated the Birch Bay Village
roads are private.
Knutzen asked if Sudden Valley could have golf carts on their roads. Rutan stated
they could.
Brenner stated it's nice that Sumas allows it.
Knutzen stated Sumas allows it for a different purpose. There is a service that will
transport someone from across the border.
Brenner stated she will send the information to the residents of Lummi Island.
COMMITTEE DISCUSSION AND RECOMMENDATION TO COUNCIL
1. UPDATE REGARDING WHATCOM COUNTY'S PARTICIPATION IN
WASHINGTON STATE HEALTH PATH STRATEGY 2 DEMONSTRATION
(AB2012 -368) (1 :44:52 PM)
Regina Delahunt, Health Department, gave a staff report and stated last June, staff
presented information about the State's strategies for the dual - eligible population, folks
eligible for both Medicaid and Medicare. During that meeting, the Board approved strategy
two and directed staff to enter into discussions with the State to see if strategy two would
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work for this community. As a result of many discussions, staff now recommends not
proceeding with strategy two. It became clear that negotiations would be very complicated.
Also, the State decided that strategy two communities would not be allowed to have
strategy one, which would result in some of the dual - eligible population not receiving
benefits. They would also have to have two administrative structures in place. Staff said it
would not recommend moving forward if they don't all recommend it. There wasn't
consensus agreement that it is the best option for dual eligible people in the community,
particularly because the State and federal government are unwilling to move long -term care
out of the strategy two option. The Council doesn't have to take action.
Brenner asked if the bigger counties are going to participate. Delahunt stated King
and Snohomish Counties will probably go forward with strategy two.
Kremen stated he compliments everyone in their wisdom in deciding not to pursue
strategy two.
Delahunt stated the County still plans a pilot project to test the new system. They
haven't decided which population will be in the pilot. Strategy one will happen in Whatcom
County. Strategy one is also rather complicated. It will take a lot of community and
regional collaboration to determine how strategy one will work best. They will work on it
over the next year. Strategy one takes affect November 2013.
Mann stated he gives Ms. Delahunt credit for putting the time in to decide not to do
it. He asked about the County becoming its own accountable care organization (ACO).
Delahunt stated an ACO will be developed in this community.
Mann asked how the ACO impacts strategy one or strategy two. Delahunt stated it's
a separate track. This community is moving toward a different system. They will hold the
payers and providers accountable for care availability, quality, and outcomes. This is a pilot
project.
Knutzen asked about an information technology- (IT) based care coordination
system for the Transforming Health Care in Whatcom County project. He asked where they
are in developing these strategies, and if they've reached out to family doctors. It seems
very valuable. Delahunt stated they are doing that. They haven't reached out to every
family doctor, but to the leaders of the major provider organizations and the specialists.
They've had several meetings with the medical community. They are still in the planning
stages. There will be more outreach in the next year.
Knutzen stated these people invest a lot of money in infrastructure. It would be nice
to be on the same page as they go forward. Delahunt stated IT and communication is not
something the providers would have to invest in. They are considering inter - operability at a
higher level. They must develop the concepts and have general agreement by the major
players before bringing in the general doctors.
Brenner asked for a summary of strategy one, where this County is with doctors
accepting Medicare patients, and the effect of the Affordable Healthcare Act.
Larry Thompson, Whatcom Alliance for Healthcare Access (WAHA), stated reform is
proceeding. There will be a lot of activity in 2013. The State is putting together a
healthcare exchange. In Whatcom County, they will see the development of a process to
link people to health insurance in 2013. There are about 25,000 uninsured in Whatcom
County. By 2014, that number should be down to about 10,000.
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Brenner asked how much this work will cost the taxpayers. Thompson stated that in
the initial years, expansion of the Medicaid program and the subsidies are funded by the
federal government through general taxation across the United States. The specific tax isn't
yet earmarked. Some would say that reductions in healthcare expense will pay for it.
Others say those reductions won't materialize, and there will be a net expense. They are
working on the cost of care locally. The Affordable Care Act is about access, not reducing
the cost of care. Someone will have to deal with the cost of care at some point.
Brenner asked for a summary of strategy one. Thompson stated it is a coordinative
strategy. It adds coordinators into the mix to help people better access their care and to
link together the different parts of the health care, long -term care, and behavioral health
care systems. There is a lot of coordination already. This strategy beefs up existing
activity. It will be implemented on a five - county basis. Whatcom will be in a region with
Snohomish, Skagit, Island, and San Juan counties. The State will enter into contracts with
several coordinative organizations, but they don't know who those organizations will be.
The coordinative entities will subcontract for case managers.
Brenner stated that sounds like another broad, new program. She asked how it will
be paid for. Thompson stated it's paid for through the federal government, an initiative to
deal with poor quality and high cost of dual eligible persons. If the State succeeds in
reducing the cost of care, the savings will be split between the federal and State
governments. There is a lot of wasted care that's not necessary and that happens because
of the lack of coordination in healthcare. The trick will be to implement it properly and
achieve those savings here.
Benner stated she's worried that the dual - eligible folks won't get better care, but it
will just look better on paper. Delahunt stated the community will have to work hard to
make sure that doesn't happen. They want better care for the dual eligible community
without wasting money from uncoordinated efforts. They will have to work hard to make
sure services aren't diminished.
Mann asked how they know the dual eligible population receives the worst care.
Thompson stated it is measured by various epidemiologic measures, including morbidity and
mortality. It can also be partly due to their underlying health status. The poor outcomes
are relative to mainstream populations. It's not a function of poor providers or ill intent.
It's more about getting lost in the cracks of the system. The system just doesn't work.
Brenner stated make sure everyone is connected electronically, rather than engage
in a complicated strategy one. Thompson stated that is a partial solution. Doctors don't
have time in one 15- minute appointment to deal with all the chronic conditions of a patient.
Delahunt stated a care coordinator would be an intermediary to coordinate all the
providers for each person.
Victoria Doerper, Northwest Regional Council, stated her organization works with
people who are on Medicaid and may also be on Medicare, who are eligible for nursing home
care, who choose to stay at home, and who receive home care. They have a pilot project
for chronic care management, which includes many of these functions proposed for strategy
one. It's a way to expand chronic care management beyond the currently- served
populations, which are Medicaid -only individuals. It includes a nurse case manager. It's
about more than healthcare. It has to do with housing, income and ability to get food,
ability to comply with a special diet, ability to get and take drugs, and ability to monitor
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their conditions. There must be someone to take the time to look at the big picture to help
folks with multiple chronic conditions. These are the folks who repeatedly end up in the
emergency room. There has been a pilot program that shows evidence of decreased
emergency room use and decreased mortality, with a cost that is about the same.
Brenner asked if a home healthcare person can be the coordinator. Doerper stated it
would not be the home healthcare provider. The coordinator is like a coach, and may
accompany a person to a doctor's office.
Mann asked how much a person can be responsible for themselves. Doerper stated
these are individuals who have many things going on. Sometimes people aren't aware.
Brenner stated some people can be completely overwhelmed by the system. The
medical structure in this community doesn't help the problem. People often see different
doctors. There will end up not being enough doctors in the new federal program.
Mann asked for an update of a young women using Women, Infant, Children (WIC)
services. Delahunt stated she will find out what happened with that person.
OTHER BUSINESS
There was no other business.
ADJOURN
The meeting adjourned at 2:16 p.m.
ATTEST:
WHATCOM COUNTY COUNCIL
WHATCOM COUNTY, WASHINGTON
Please contact the Council Office to obtain an
official, signed copy:
360- 676 -6690 or council &o.w hatcom .wa.us
Public Works, Health, and Safety Committee, 11/20/2012, Page 5