HomeMy WebLinkAboutBoard of Health June 27 20061 WHATCOM COUNTY COUNCIL
2 Board of Health
3
4 June 27, 2006
5
6 Council Chair Laurie Caskey- Schreiber called the meeting to order at 5:30 p.m. in
7 the Council Chambers, 311 Grand Avenue, Bellingham, Washington.
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9
10 Board of Health Present: Absent:
11 Barbara Brenner None
12 Dan McShane
13 Sam Crawford
14 Seth Fleetwood
15 Carl Weimer
16 L. Ward Nelson
17
18 Public Health Advisory Board Present: A
19 Lavern Lane - Oreiro Jenny Shuler
20 Andy Byrne Diana Quinn
21 John Worlund
22 Mary Ellen Shields
23 David Davidson
24 L. Ward Nelson
25 Chris Phillips
26
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28 1. PUBLIC SESSION
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30 No one spoke.
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33 2. COMPREHENSIVE PUBLIC HEALTH PLAN
34
35 Regina Delahunt, Health Department Director, introduced Kristen West.
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37 Kristen West, CHOICE Regional Health Network Executive Director, gave a
38 presentation and background on the CHOICE Regional Health Network. What each
39 community can do for health care is unique. However, until there is a framework for
40 community -led health care reform efforts, they won't be able to influence State and federal
41 policy and attract larger resources. She has put together a framework for how communities
42 can help themselves. There is now a well - defined technical assistance component to
43 community health care collaborative work nationwide.
44
45 Many strategies for solving health care crises have been focused on consolidating
46 government and employer purchasers to create incentives in the marketplace. However,
47 it's been proven that many of those things don't work well. Community -led efforts is about
48 doing things differently through looking at how the healthcare system works at the point of
49 transaction between the provider and patient, and having that lead to changes in the health
50 care system and health care policy.
51
52 Approximately 600 communities nationwide have realized they won't see
53 comprehensive solutions from the federal government or state governments. They have
Board of Health, 6/27/2006, Page 1
defined what they can do in the absence of those solutions to create better health for
everyone at less cost.
Her positive deviance theory is that they spend a lot of time focusing on the 80
percent that is the problem, without looking at the 20 percent that is the solution. For
example, rather than focus on 80 percent of the children in Vietnam who are malnourished,
look at the 20 percent who aren't malnourished to see what they are doing differently.
Then, use that as a best practice. They took that approach to community health care
access. They are looking at communities with successful pieces of a solution, and
replicating those pieces as best practices. Many communities have achieved 100 percent
access. The positive outcomes is to improve health outcomes, save billions of dollars, and
leverage existing funds to raise more money.
A study has shown that about 30 percent of healthcare expenditures nationwide are
unnecessary and wasteful, as a result of fragmentation in the healthcare system. In
Washington State, that rate is slightly better, at about 24 percent. Compared to other
countries, they spend a significantly higher amount on health care, but the outcomes are
significantly poorer. They have poor health status but are paying a lot of money. Seventy -
five percent of every dollar that goes into the healthcare system is from a government
source. They believe they have a private healthcare system, but it's really a government -
funded system. An increasing number of people don't have access to this poorly organized
system of care, which they spend too much money on.
The vision is to get back in balance and have an improved health status. They must
fully fund primary care and prevention. They need to have a comprehensive definition of
primary care and prevention that includes dental care, mental health, and chemical
dependency services. They won't need to capture all 24 percent of those unnecessary costs
to cover everyone who is uninsured. They would only need to capture about ten percent of
those unnecessary expenditures. At the same time, they would reduce the amount of
uncompensated care that the hospitals and physicians provide.
There is a process to get from the small, community projects that are often grant -
funded to better health for everyone in the nation at a lesser cost. The first step in the
process is to identify the local early initiatives, including outreach programs. Get people
connected to the programs and services that exist, but that they aren't using. Eliminate
duplicative infrastructure and separate funding sources. They must be actively involved in
the three -tier chess game, which is at the local, state, and national levels. At the local
level, know how the community power is harnessed. Then, turn to other like- minded
colleagues at the state level and create state frameworks. Washington State has done that
through the Communities Connect program. They must also be actively involved at the
national level to change the way healthcare is financed. Communities Connect has been
successful during the last two legislative sessions in getting legislation passed that allows
community initiatives to flourish. Through Communities Joined in Action, talk about the
outcomes they've been able to achieve nationwide to attract large, private funding.
After increasing primary care capacity and getting people enrolled in government -
funded health plans, the next step is to get people access to affordable pharmaceuticals,
organize donated specialty care, and reduce inappropriate emergency room use. Make it
affordable for small employers to provide coverage. Initiatives are often developed around
those types of activities.
There are critical activities common to any community program. Knowing what
those activities are, they can jump -start a community's efforts to create a critical, local
Board of Health, 6/27/2006, Page 2
1 infrastructure. They need someone in the community to put these activities together in an
2 integrated way. There must be a common client- tracking and referral system. Track the
3 services people are using and identify gaps to plan for the next phase. She asked if this is
4 the type of work they are doing in this community.
5
6 Phillips stated they start out concentrating on Medicaid outreach, working through
7 the school system. Make sure that every child eligible for Medicaid gets Medicaid. They are
8 beginning to implement Project Access, for uninsured access who need specialty care. They
9 are implementing strategies for emergency room redirection, to reduce the inappropriate
10 use of the emergency room. Those are three they are concentrating on at the moment.
11 They've begun to develop the prescription drug program.
12
13 West stated this community is active on four of the eight critical activities.
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15 Nelson stated they have also done work on a survey of medical homes.
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17 West read the eight critical activities from the presentation (on File).
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19 Phillips stated many of these things are related to finding savings in the system. If
20 they can redirect people from the emergency room to medical homes, there is tremendous
21 savings.
22
23 Fleetwood asked where a subsidy for small employers to cover low wage workers
24 would come from.
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26 Nelson stated that's what they are working on.
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28 West stated a community in Michigan pays the cost of low wage health care equally
29 from the employer, employee, and the hospital disproportionate share dollars. In
30 Washington, they may have access to basic health plan dollars to be their one -third share.
31 There are also local taxing options.
32
33 Nelson stated that locally, they've talked about using medical savings accounts as a
34 tool for employers.
35
36 Brenner stated she's not convinced the health accounts will work. They work great
37 for healthy people. When people aren't healthy, they aren't working and don't have an
38 account.
39
40 West stated she has information on that issue. Medical health accounts cannot be
41 the only solution. However, they can be part of the solution. There could be a community
42 health savings account for primary care and prevention, if it were tied to some kind of
43 catastrophic insurance product. There is some innovative ways to use them that have not
44 been explored. Employers love them because they are pre -tax. If they get employers into
45 the conversation, it's worth it to get them thinking about coverage for their workers.
46
47 Regarding the process to get from the small, community projects that are often
48 grant- funded to better health for everyone in the nation at a lesser cost, people in Whatcom
49 County are working the three tiers very effectively. In the legislature, Whatcom County
50 efforts are innovative, talked about a lot, and are seen as community collaboratives that
51 should be replicated throughout the state. She talks a lot about Whatcom County's work
52 nationally. Whatcom County is in the phase of working to implement and integrate the
53 eight critical activities.
Board of Health, 6/2712006, Page 3
Once the community healthcare collaborative movement matures, they build the
local capacity around the eight critical activities, and the activities are integrated, then they
will have the leverage to influence policy at the state and federal levels. They can look at
sustainable ways to organize the delivery system. Begin to track health outcomes and
status in the community. That's when they will see a larger savings in the system and can
begin to advocate at the state and federal levels for changing the way health care is
financed to support this newly organized healthcare delivery system. It will fully fund
expanded primary care and blend funding from Medicaid, Basic Health Plan, employers, and
other sources in a community pot of funds to pay for primary care and prevention.
Insurance is a great mechanism for catastrophic, unpredictable events. They don't need
insurance for regular, routine, planned care. There are savings that can be had by carving
that out of the insurance financing mechanism and keeping those dollars local.
Brenner stated the local community, through the hospital, has a program to do
different kinds of screenings that are very inexpensive rather than going to several different
doctors. She understands they are getting ready to broaden that program. West stated
that is a great example.
A State bill before the legislature is before the Blue Ribbon Commission on
Healthcare. They are interested in hearing from communities about what kind of health
policy is needed to increase access, improve quality, and reduce cost. Community
healthcare collaboratives will have significant influence on the recommendations of the Blue
Ribbon Commission. Community -led initiatives are finally getting visibility.
Move to the community level the decision about which healthcare services should be
covered and prioritize within available financing. Pooling funds requires changes in state
and federal statutes, which seems really difficult. To begin moving the decisions to the local
level within existing statutes, public health services districts may be formed. They can
create a governance body and taxing authority to finance things like a determining how to
finance an electronic health record, set up a plan to cover everyone who is uninsured, or
many other things. There is a lot they can do within existing statute and with the vote of
the people.
In summary of the process, start with small projects, plan to implement the critical
activities, designate an organization to be a neutral convener to implement the activities in
an integrated way, drive policy decisions about how healthcare is organized and financed,
and then move financial and delivery decisions to the local communities.
Davidson asked about evidence -based medicine and driving decisions locally. That
runs counter to his notion that what they know is best has to do with epidemiologic things
such as big samples, best practices, and recommendations from the Centers for Disease
Control (CDC). He asked how those mesh. West stated her collaborative uses the U.S.
Clinical Preventative Services guidelines and the State Board of Health expanded work on
primary care and prevention. They work with the State agencies on developing best
practices. They tried to apply the best science available to the services that should be
covered. They also use what they know about the health outcomes of other countries that
do things differently. The State health care authority donated their actuaries to her
collaborative to see if is remotely affordable. They found that it was affordable. Evidence_
based medicine means having some kind of a distribution mechanism in the community
where sole or small -group practice providers have access to the best information available
and know how their practice compares. They can extract the savings and cover everyone
who is uninsured within five years.
Board of Health, 6/27/2006, Page 4
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2 The Community Health Care Collaborative grant program is to create six
3 collaboratives in the state and give them $250,000 per year to implement those eight
4 critical activities to extract these savings. The State legislature approved and funded the
5 legislation because they were able to show the outcomes communities are achieving. Once
6 they begin to organize the donated care, get small employers financially participating,
7 everyone is enrolled in existing resources, and have a highly organized system for
8 interacting with the healthcare system, there will be a common infrastructure. When
9 hospitals and practitioners, public and private health organizations, community
10 collaboratives, and employers operates together without duplication, there will be an
11 integrated infrastructure.
12
13 The involvement of county government is exciting. It can be a bully pulpit for these
14 types of initiatives. County governments plays a wonderful role in health care access and
15 quality, through the comprehensive plans. Counties can also monitor annually how well the
16 community is doing on the eight critical activities and outcomes. They can provide subsidies
17 to support efforts and provide seed capital.
18
19 Nelson stated a jurisdiction in Oregon included a health component in their
20 comprehensive plan. There is more this community can do. There are many organizations
21 that make efforts to have a healthy community, but there is no plan. The County should
22 facilitate a collaborative effort within the community to provide a comprehensive health care
23 plan. It will take some time to put together a plan the community can help develop and
24 support.
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26 Delahunt stated this goes beyond the Whatcom Alliance for Healthcare Access
27 (WAHA). It is about developing a real plan for having a healthy community. There are
28 many good ideas and projects to make the community healthier.
29
30 (Clerk's Note: End of tape one, side A.)
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32 Delahunt continued to state that they need a plan and goals for the next five or ten
33 years to evaluate funding requests, the County's public health work, and all the community
34 collaborative work. The Public Health Advisory Board can assist in putting together this
35 vision.
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37 Brenner stated she is involved in the Pandemic Flu Task Force. They can use the
38 same protocol and organization. It's important to have a comprehensive plan, but the
39 County shouldn't do it. The plan should be community -based and pull together all the
40 elements of healthcare in Whatcom County.
41
42 Dr. Greg Stern, County Health Officer, stated a comprehensive county health care
43 plan should not be run by the County. The pandemic flu planning process involved many
44 people, and is not a County government process. It is a community process. Coming up
45 with a comprehensive health plan should be the same thing.
46
47 There is a difference between coverage and insurance. There are alternatives to
48 health insurance. Consider treating preventive care as a public utility. Pool money through
49 taxes, donations, or other methods to save on preventive services and benefit all. It will
50 save money by preventing the expense of catastrophic care. (Inaudible.)
51
52 Nelson stated government is not an entity on its own. It is comprised of everyone.
53 People will look to the government in situations of pandemic crises. Government facilitates
Board of Health, 6/27/2006, Page 5
and gets the discussion going, then formalizes a community plan. That doesn't mean that
government, as an individual entity, does it by themselves. Get people talking about ideas
and thoughts. The Council should ask the Public Health Advisory Board to begin considering
a plan process and subjects to go into a public health comprehensive plan. Begin
discussions. Reach out to the business community, schools, and other interest groups. A
lot of work has already been done. Bring that work together. If many of these community
groups throughout the nation do this, it will send a message to the federal government that
the communities can do a better job of using the dollars.
Caskey - Schreiber stated she supports going forward with this kind of plan. The local
government needs more control to fix its own problems with healthcare access. This will be
a big project. She asked if the Public Health Advisory Board has time to take this on. She
may be willing to consider adding staff to work on it. Use the Board's recommendations as
a framework for developing a comprehensive plan. Delahunt stated that is how it would
work. After they decide on the framework and community partners, find someone to
facilitate the entire thing. Take the time to be thoughtful and deliberate, and it won't be a
big burden. The process may take a couple of years to get through. In the end, there
would be a really good product.
McShane stated he likes the idea of adding it to the County Comprehensive Plan.
Nelson stated they can't add it to the Comprehensive Plan. According to the Growth
Management Act (GMA), the Comprehensive Plan must be a land use document. There is
no other comprehensive health plan in the state of Washington. They will be the first to do
this. There is no legal ground to tie it to the Comprehensive Plan. They can cite elements
from the health plan in the Comprehensive Plan. Randy Watts checked on it already.
McShane stated they can use the Comprehensive Plan as a skeleton for a health
plan. Define goals and action items. Define how the Council evaluates funding requests.
Delahunt stated the format of the Comprehensive Plan, with its policies, goals, and
actions, would work for a health plan. It could be a simple and straightforward document,
in the end.
Davidson stated don't have the health plan as a chapter of the Comprehensive Plan.
If it were a chapter, then all the legal requirements and challenges and controversies that
have to do with the land use plan would snarl up and delay the health plan. It may not
even be a plan the County Council has to formally adopt. There may be an advantage to
not having it be adopted. WAHA is in place. It can create a plan with staff and support
from the County. He worries about the extent to which it becomes a work plan of the Board
of Health, which will just slow down the process.
Nelson stated the County government includes everyone in the county. WAHA is an
element of everyone. County government does slow things down, but that's why it's
important. They take the time to make sure everyone has been heard and their concerns
have been addressed. If WAHA, which is a fine group, does the plan, the plan may not
include mental health issues, for example. It may not address dental issues. Those are
issues WAHA has not taken on. This plan process is an opportunity to address all the issues
of concern to the people of Whatcom County. They could put it out to the public as a vote.
There won't be 100 percent approval on anything related to healthcare. Therefore, reach
into the community to get as much information as they can. Include everyone, including
the tribes and small business, in this process. The County is the facilitator.
Board of Health, 6/27/2006, Page 6
1 Stern stated the County government may be new,to this, but the community has
2 been doing this for a long time. The County and Health Department is involved in these
3 community efforts. If the County rushes in too fast to develop a comprehensive plan, it
4 could interfere with what is becoming a community comprehensive planning process.
5 focusing on that final product may preclude developing relationships, new ideas, and new
6 partnerships. Step into this gently. Recognize the decades of work that has been going on
7 here. Offer County resources to the subtleties of an ongoing conversation rather than an
8 up -or -down vote.
9
10 Nelson stated many groups want to do things year after year. No one takes the role
11 to help them focus attention and find new ideas that work. He hopes any comprehensive
12 health plan would be a growing document that incorporates new ideas as they come
13 forward. There is no where for someone to see what is the community's plan for health
14 care. There are many groups, but they are not coordinated. Coordinating people isn't
15 telling people what to do. Put together written information on what the community has and
16 knows, as well as general goals and directions.
17
18 Phillips stated it seems like a lot of groups are doing a lot of things. A
19 comprehensive plan would address public health, traditional healthcare delivery, dental
20 health, and mental health. Begin from the County Board of Health and Public Health
21 Advisory Board to lay out an outline of what a comprehensive plan might look like. That
22 would be a tremendous step forward. Kristen West's message is that a community has
23 taken steps and made significant progress to ensure 100 percent access. They are facing a
24 healthcare crisis. They have begun to talk about rationing. What they should talk about is
25 sustainability. Stay focused on the possibility of ensuring 100 percent access.
26
27 Brenner stated she has confidence they can do both. It will take some time. It may
28 be an evolutionary document in the end, but they want to be confident that they have a
29 good start. What's most important is diverse community involvement in the process.
30
31 Worlund stated they are talking about two things, process and product. Keep them
32 separate. The process may be organic, too. It's not the County's job to tell people what
33 their roles should be any more than it is to tell them what the end product should be. The
34 most the County can do is come up with a position paper. Define the issues and invite
35 people to participate in a discussion on solutions. Leave open the issue of the County's role.
36 He doesn't know who owns the product. Part of the process will be to figure out who owns
37 the product.
38
39 Caskey- Schreiber stated everyone has a different vision. She will keep her mind
40 open to issues that are at the forefront of the county and how to prioritize them. She hopes
41 the Public Health Advisory Board begins moving in that direction. The Council can consider
42 incorporating this effort into its budget planning. She asked if there is consensus on doing
43 this project.
44
45 Delahunt stated the advisory board seems willing to take on this project to develop
46 an outline and framework, and then bring it back to the Board of Health.
47
48 The Council concurred.
49
50 West stated the National Association of County Officials (NACO) may have
51 discretionary seed funds to get this started. She will find out if anything is available for this.
52 The County is breaking new ground.
53
Board of Health, 6/27/2006, Page 7
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ADJOURN
The meeting adjourned at 6:50 p.m.
Jill Nixon, Minutes Traliscription
The Council approved these minutes on July 25 , 2006.
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Laurie Caskey - Schreiber, Council Chair
Board of Health, 6/27/2006, Page 8