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HomeMy WebLinkAboutBoard of Health October 3 20061 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 WHATCOM COUNTY COUNCIL Board of Health October 3, 2006 Council Chair Laurie Caskey- Schreiber called the meeting to order at 5:30 p.m. in the Council Chambers, 311 Grand Avenue, Bellingham, Washington. Present: Barbara Brenner Dan McShane Sam Crawford Seth Fleetwood Carl Weimer L. Ward Nelson Public Health Advisory Board Present: Diana Quinn Jenny Shuier L. Ward Nelson Chris Phillips 1. PUBLIC SESSION No one spoke. Absent: None Absent: Mary Ellen Shields Lavern Lane - Oreiro David Davidson John Woriund Andy Byrne 2, WHATCOM ALLIANCE FOR HEALTHCARE ACCESS UPDATE Regina Delahunt, Health Department Director, stated it's been two to three years since the Board of Health has had an update on the Whatcom Alliance for Healthcare Access (WAHA). Chuck Beard, Whatcom Alliance for Healthcare Access President, stated they are grateful to the County Executive and Council for their support. Without funding, WAHA couldn't have implemented the access coordination services. It's an effective program that helps people find health insurance. There are many community access programs throughout the State, but they are not like WAHA, with a unique blend of partners and funding. Sue Sharpe, Whatcom Alliance for Healthcare Access Co- Director, submitted a visual presentation (on file). She read the presentation. They now have a formal non - profit organization. A number of groups around the state have organized to improve health care access. WAHA is unique due to its public /private alliance. She read the presentation on the leadership, outcomes for 2006, programs and initiatives, and access services. Chris Phillips, Whatcom Alliance for Health Care Access Co- Director, stated they want to make sure children eligible for Medicaid get Medicaid. It has very good benefits for children. The Medicaid income limit is $45,000 for a family of four. A considerable number of families are eligible for Medicaid, but do not receive benefits. Make it easy for school districts to participate in this program. Until recently, to participate in sports, students and families were told about insurance programs that costs hundreds of dollars to get limited Board of Health, 10/3/2006, Page 1 coverage. Usually, sports students are uninsured. That's one small example of where they can systemize the approach to educate people about Medicaid. He read the presentation on the Ferndale Schools Pilot Project. They are now working with five school districts, with another two to follow. Put the information in a format and make it available to school administrators and teachers. There is considerable support from school districts, school boards, and parents. They have also gotten some recognition from local media. Sharpe stated WAHA also implemented another program called Whatcom Project Access. It's a model used throughout the country. Locally, they have a partnership with the Whatcom County Medical Society. Medicaid doesn't cover uninsured adults. The fastest growing group of uninsured people are the working poor. She read the presentation on Access Services. The Whatcom Project Access asks specialists to see these people for free. The Alliance will do the pre -work, do all the screening, and make sure the patient has a primary care physician. If they participate, can guarantee a fair distribution of the uninsured cases. There is a standard eligibility process. WAHA is capturing the value of the care the physicians are donating. The doctors fill out a form just like with an insured patient. To date, -over 90 percent of the specialists in the community have committed to participate. They started seeing patients in September. The program is well - received by the patients and community. She read the slide on the Physician Recruitment and Retention. A question is whether the community has enough physicians and, if not, which specialties are needed. The community must also hold on to the physicians the community has. The Small Business Development Center helps keep those people in the community by providing help with business practices. The community partnership with the State and federal government will make the changes they need. She read the slide on healthcare policy education. Many communities around the state are collaborating to improve health care access at the State level. A number of initiatives can accomplish effective access improvement. There are eight things a community can do to make changes, as presented to the Board of Health at it's July meeting. WAHA is doing many of those eight things. To the end of the year, WAHA will look at other areas of focus, such as getting insurance access to small businesses, working on prevention and wellness, and many other activities. They are assessing what they are doing well and what they need to do next. Fleetwood asked how they recruit doctors to the community. Sharpe stated they can't use public funds or hospital resources unless they can document the community's shortage of particular specialties. There is a study showing which physician specialties are needed. Within that need, they identify the most critical needs. They post advertisements electronically, work with existing physicians to recruit partners, recruit the physicians' families, and help with financing and real estate issues. Delahunt stated there wasn't a single point of contact in the past for physicians to connect. This program serves as that point of contact and works with the State Department of Health, which has connections with physicians who want to move to communities in Washington. Brenner asked if Medicaid is just for kids or all the family. Phillips stated it is just for kids and pregnant women. Board of Health, 10/3/2006, Page 2 Brenner asked how they can keep the costs down for small business insurance. Sharpe stated they have ideas, but haven't implemented them yet. Activities around the country are similar. For instance, an employer contribution, employee contribution, and public subsidy can together provide the insurance. Another example is using health savings accounts to cap health care expenditures. There is a way to use the accounts for low income people for catastrophic coverage. Brenner stated low income people can't put much money into a health savings account. It would be just for catastrophic insurance. Phillips stated that's why the Alliance has served the community well. It has varied opinions on the value of service strategies. They are getting people with varying opinions, looking at data and practices, and then deciding where they want to go and how they will do that. It's a dialog the community must have and is having. There will probably be a mixed solution. Brenner asked if they are talking about universal healthcare. Sharpe stated they talk about 100 percent access. There are many ways to get there. Most successful models have a public /private partnership. They use the tools and work with people, government,.and the private sector to make the plan work. Phillips stated the Alliance puts out a newsletter every other month. Project Access looks at charity and donated care to deal with the policy issue that they don't have universal coverage. They must look to structural solutions as well. There is a policy group and a group looking at on- the - ground solutions. Brenner asked what percentage of general practitioners are participating, and why retention is difficult. Sharpe stated most of the primary care is provided through community health centers. Any private family physician or general internal medicine physician can participate in Project Access. If there is a referral from a private provider for specialty care, they may accept the patient as a Project Access patient. They provide the service for free. Family physicians participate through referral. A number of physicians were being recruited to the community, but aren't staying. That started to happen about five years ago. There is research about why they left. Delahunt stated they found that many physicians are good physicians, but not good business people. That's why the Small Business Development Center partnership will help. Nelson asked about the Small Business Development Center's shortage survey. Sharpe stated the Center just completed the survey and presented results to the Whatcom County Medical Society. It was helpful in showing what the shortages are. The greatest shortage now is in obstetricians /gynecologists (OB /GYN). Vascular surgery and general surgery are other needed specialties. Phillips stated Whatcom County, through WAHA's efforts, qualified as an underserved area. For any area outside of Bellingham, physicians can set up rural health centers and get enhanced reimbursements. The county area is underserved. Physicians are responding and beginning to set up practices in the rural areas. Caskey - Schreiber thanked Ms. Sharpe and Mr. Phillips for their presentation. The Council appreciates their hard work. This is very important for the community. Board of Health, 10/3/2006, Page 3 I Delahunt stated the County has a lot to be proud of. The governor put together a 2 Blue Ribbon Commission. There are a lot of references at that Commission to what 3 Whatcom County has done. 4 5 Sharpe stated many of the things they are doing are being done in other parts of the 6 country and state, but not with local support. When federal dollars come and go, the 7 programs come and go. With local support, the programs are more viable, responsive, and 8 sustainable. 9 10 3. HEALTH DEPARTMENT 2007/2008 WORK PLAN 11 12 Regina Delahunt, Health Department Director, stated this is a two year plan. The 13 Board is familiar with the format. She is available for questions. 14 15 Nelson asked why they are seeing numbers decrease, and if their programs 16 contribute to the decrease. Delahunt stated there are decreases in certain areas. The 17 change in the numbers is so small that it's difficult to say whether the changes are 18 attributable. 19 20 Nelson asked if they are not seeing any real changes in programs. Delahunt stated 21 they aren't. 22 23 Nelson asked about routine food service inspections. Delahunt stated that has gone 24 down a lot, due to staff turnover. There is quite a bit of turnover with the environmental 25 health specialists. They are working on hiring two positions now. 26 27 Crawford stated Medicaid eligible adults and children who receive mental health 28 services dropped by 1,000. Delahunt stated that is a typo. 29 30 Crawford stated detoxification admissions dropped by about 20 percent. He asked if 31 that was the same year St. Joseph's stopped doing detoxification. Delahunt stated the 32 unduplicated category doesn't look as different. 33 34 Crawford asked about the rabies rates that increased. Delahunt stated there were 35 quite a few groups of campers who were in cabins, there was a bat, so everyone had to be 36 treated. They just had bad luck that year. 37 38 Crawford asked if things are steady overall. Delahunt stated the numbers are similar 39 to what they were overall. 40 41 Caskey - Schreiber asked about a -coli rates. She asked how those are reported to the 42 Health Department. Delahunt stated it is a reportable disease. Labs and physicians have to 43 report it. 44 45 Caskey- Schreiber stated the number of a -soli cases for 2005 seems low. She is 46 aware of a number of cases due to an outbreak at the fair. There were three cases she 47 knew of, and 12 cases were reported. Delahunt stated the information shows the number 48 of cases that were reported. One of the departments initiatives is to work with physicians 49 offices to ensure they really do understand the reporting requirements. Labs are good 50 about reporting. This year, the State started a new reporting system that will help get the 51 reports quicker and. more accurately. 52 53 Brenner stated she's disappointed to see the number of teen births going up. Board of Health, 10/3/2006, Page 4 Janet Davis, Community Health Manager, stated that as the population goes up, they will see larger numbers. The information given doesn't show the rate. Brenner stated the rate is probably the same. Delahunt stated that at the next Board of Health meeting, the Board will see that the staff completed the communicable disease section of the County Health Status Report. The Public Health Advisory Board helped. They can get into more in -depth discussion on communicable disease rates at that time. Crawford moved to approve the work plan as presented. Caskey - Schreiber asked if the department's added staff for OSS implementation is not included here, and whether it will be included in the budget. Delahunt stated the plan includes a summary of budget additional services requests (ASR's) (on file). She read the list of requests. (Clerk's Note: End of tape one, side A.) Delahunt stated one ASR is for a human services coordinator to work with housing and with the contracts. It would relieve the contract specialists from doing so much contract work, who can then go to work with the service providers on quality control. Make sure they really are providing all in the community with needs. Caskey- Schreiber asked if the positions are on- going. Delahunt stated the onsite septic (OSS) position and human services coordinator are on- going. The other requests are one -time expenses. Brenner asked how hard it will be to hire these positions in addition to the vacant positions in the environmental health division. They are having the same problem in other departments. Delahunt stated it is really hard to attract experienced people. Brenner stated this will be very sensitive and difficult for a lot of people. McShane asked if those employees leaving are moving up to another location or going to another organization. Delahunt stated the employees are generally younger people who are just transitioning through their lives. No one has left because they are dissatisfied with the County or their job. Some people have left for what they perceive as better opportunities. When there are younger employees, she hopes to get five years from people in their 20's. McShane asked if these jobs will be considered transitional jobs in these positions. Delahunt stated she tries to steal people from other counties as much as she can. Caskey - Schreiber stated the OSS operations staff could make much more money if they start their own businesses. The administration will have to be aware of that. Delahunt stated every county in the state will be trying to fill these positions. McShane stated the amount of work available is tremendous. It will be a struggle no matter what they do. The positions will remain transitional. Board of Health, 10/3/2006, Page 5 1 Caskey- Schreiber asked who will train these OSS specialists. Delahunt stated there 2 is a statewide program for OSS training. 3 4 Caskey - Schreiber stated engage the Bellingham Technical College. 5 6 John Wolpers, Environmental Health Services Manager, stated the department hasn't 7 engaged anyone locally yet to provide training for the specialists. The Washington Onsite 8 Sewage Association operates near Puyallup, Washington. Many designers, installers, 9 pumpers, and health officials use this facility. They do a traveling show through the State 10 Department of Health. Approaching Bellingham Technical College is a good idea. 11 12 Delahunt stated they could develop a regional program that includes Skagit and 13 Island counties. 14 15 Motion carried unanimously. 16 17 18 ADJOURN 19 20 The meeting adjourned at 6:27 p.m. 21 22 23 24 Jill Nixon, Minutes Transcription 25 26 The Council approved these minutes on October 24 , 2006. 28 A- JA'T Y IC JA 'T WHATCOM COUNTY COUNCIL 29 ��`� �i' • • • •.�'�0 ,��ii WHATCOM COUNTY, WASHINGTON C r 31 [' 33 S • • 34 Da*,y r i*vis,,,CoLlflcil Clerk Laurie Caskey -Sc reiber, Council Chair •• �� Board of Health, 10/312006, Page 6