HomeMy WebLinkAboutBOH agenda 012418ORANGE COUNTY BOARD OF HEALTH
MEETING AGENDA
DATE: January 24, 2018
TIME: 7:00 P.M.
PLACE: Whitted Building, 3rd Floor Meeting Room
300 West Tryon Street
Hillsborough, NC 27278
TIME ITEM
7:00 p.m. I. Welcome New Employees
7:00 – 7:05 II. Public Comment for Items NOT on Printed Agenda
public Comment for Items ON Printed Agenda will be
handled during that agenda item
(Please sign up for both on sheet near the entrance to room.)
Please limit your comments to 3 minutes.
7:05 – 7:10 III. Approval of January 24, 2018 Agenda
7:10 – 7:15 IV. Actions Items (Consent)
A. Minutes of November 29, 2017 Susan Elmore
7:15 – 8:15 V. Educational Sessions
A. Recycling Muriel Williman
(relative to BOH Strategic Plan Priority: Social Determinants of Health)
B. Immigration Updates Susan Clifford
(relative to BOH Strategic Plan Priority: Social Determinants of Health)
C. Workplace Safety Carla Julian
D. 2nd Quarter Billing Dashboard Reports Rebecca Crawford
E. 2nd Quarter Financial Reports Rebecca Crawford
8:15 – 8:20 VI. Reports and Discussion with Possible Action
A. Health Director Report Quintana Stewart
B. Media Items Quintana Stewart
8:20 – 8:25 VII. Board Comments
8:25 VIII. Adjournment
BOARD MEMBERS: To ensure a quorum, SEND E-MAIL to lstrange@orangecountync.gov advising her of your
attendance at this meeting OR CALL 919-245-2411.
Compliance with the “Americans with Disabilities Act” and Title VI - Interpreter services and/or special sound equipment are available on
request. Call the Immigrant and Refugee Health Program Manager at 919.245.2387 to request an interpreter or other accommodation.
Conforme a la “Ley sobre Estadounidenses con Discapacidades” (ADA) y el Título VI – los servicios de intérprete y/o equipo de sonido
especial están disponibles a solicitud. Llame a la Administradora del Programa de Salud para Inmigrantes y Refugiados al 919-245-2387 para
solicitar un intérprete u otros arreglos o adaptaciones.
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ORANGE COUNTY HEALTH DEPARTMENT MISSION STATEMENT: To enhance the quality
of life, promote the health, and preserve the environment for all people in the Orange County
community.
THE ORANGE COUNTY BOARD OF HEALTH MET ON November 29, 2017, at the Orange
County Health Department, 300 West Tryon Street, Hillsborough, NC.
BOARD OF HEALTH MEMBERS PRESENT: Liska Lackey – Chair, Bruce Baldwin, Johanna
Birchmayer, Commissioner Mia Burroughs, Barbara Chavious, Paul Chelminski, Jennifer Deyo,
Sam Lasris and Timothy Smith.
BOARD OF HEALTH MEMBERS ABSENT: Susan Elmore – Co-Chair and Jessica Frega.
STAFF PRESENT: Dr. Dorothy Cilenti, Interim Health Director; Rebecca Crawford, Financial
and Administrative Services Director; John Kase, Interim Environmental Health Director; Donna
King, Health Promotion & Education Services Director; Carla Julian, Dental Clinic Practice
Manager,HIPAA Privacy and Security Officer; Pam McCall, Personal Health Services Director;
Kristin Prelipp, Communications Manager; Thais Ramirez, Temporary Community Health
Specialist; April Richard, Tobacco Prevention and Control; Beverly Scurry, Board of Health
Strategic Plan Manager; and La Toya Strange, Administrative Assistant II.
GUESTS PRESENT: Commissioner Penny Rich, Cliff Bellamy, Herald Sun reporter; and Ed
Kerwin, OWASA Executive Director.
I. Welcome New Employees
Liska Lackey, Chair, called the meeting to order. Dr. Cilenti welcomed new employee, Thais
Ramirez.
II. Public Comment for Items NOT on Printed Agenda: Chris Harlan, UNC School of
Nursing. Amongst giving her thanks to the OCHD for the accepting of new students placed at
the OCHD over the last 20 years, Ms. Harlan added that its been a valued experience by those
students. Currently in the process of retiring, Ms. Harlan also expressed gratitude for all of the
support received from the BOH and the OCHD.
III. Approval of the November 29, 2017 Agenda
Motion was made by Mia Burroughs to approve the agenda, seconded by Jennifer Deyo
and carried without dissent.
IV. Action Items (Consent)
A. Minutes of October 25, 2017 Meeting
Motion was made by Sam Lasris to approve the minutes of October 2017, seconded by
Barbara Chavious and carried without dissent.
B. 2018 Board of Health Schedule
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Motion was made by Paul Chelminski to approve the 2018 Board of Health schedule,
seconded by Mia Burroughs and carried without dissent.
V. Educational Sessions
A. Food Deserts/OC Food Council Collaboration
Molly De Marco, Research Assistant Professor, Department of Nutrition, Gillings School of
Public Health, and Marcie Ferris, Professor, American Studies Department, UCH-CH, presented
information on the OC Food Council (OCFC) including food deserts and insecurity. Below is a
brief summary of the information presented:
OC Food Council
o Goals
• Action plan development
• Outreach
• Reach successful models and policies
• Collaborate with other food councils
o Strategic Priority Areas
• Outreach to elected officials; creation of a local food economy.
• Increase new market, wholesale and institutional buying opportunities for low-
resource and farmers of color.
• Support diversity of food producers and business owners.
Food Deserts
o Defined as a section or zone that is classified as both low income and low access to
grocery stores as measured by different distance boundaries.
o Food access is defined as a household’s mean to procure an adequate amount of food
on a regular basis through a combination of purchases, barter, borrowings, food
assistance or gifts.
o Food swamp is where there are unhealthy foods that are far more accessible than
healthy foods.
Food Insecurity
o Defined as the inability of nutritionally adequate and safe foods, or the ability to acquire
such food, is limited or uncertain for a household.
o Measured yearly via questions on the U.S. Census
o Four levels of food insecurity
• High – no reported indications of food access problems/limitations
• Marginal – 1-2 reported indications – typically of anxiety over food sufficiency or
shortage of food in the house. Little or no indications of changes in diet or food
intake.
• Low – reports of reduced quality, variety or desirability of diet. Little or no
indications of reduced food intake.
• Very low – reports of multiple indications of disrupted eating patterns and
reduced food intake.
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o 2014 NC Food Insecurity rates (most recent presenters were able to find) –
• Orange County has a child rate of 19.1% and the county overall has a rate of
14.6%.
o Highest usage of food stamps (SNAP) use in Orange County is in downtown
Carrboro/Chapel Hill areas.
o Causes of food insecurities include
• Racial oppression
• Poverty and low income
• Lack of transportation/grocery stores
• Poor health/mental illness/acute or chronic illness or injury
o Consequences of food insecurities include
• Under-nutrition (especially during vulnerable periods of life) and over-nutrition
with the wrong foods (such as foods high in starch, carbohydrates and fat)
• Increased incidence of chronic disease and depression
• Effects on health and well-being in children and social implications (such as lack
of concentration and low productivity in adults).
• Hunger-Obesity Paradox
The BOH had questions that were addressed by Ms. Ferris and Ms. De Marco.
B. Tobacco Prevention Efforts
April Richard, Senior Public Health Educator, Tobacco Prevention and Control, presented a
brief overview of the tobacco related efforts completed over the last year. The presentation will
include sections on prevention, control, and treatment efforts.
Prevention
o Tobacco. Reality. Unfiltered. (T.R.U.)
• One of few counties in NC that supports TRU and also supports TRU financially
• TRU groups meet at the following high schools:
Chapel Hill/Carrboro City Schools
Carrboro High School, Chapel Hill High School, East Chapel Hill High
School
Orange County Schools
Cedar Ridge High School, Orange High School
• Hosts Tobacco 101 for the youth.
• Participated in the the national movement, The Great American Smokeout, which
occurred on November 16th .
o FreshStart
Classes provided at Whitted Building and Seymour Center.
New partnerships with Freedom House and UNC Horizons .
7 Classes completed with 44 participants.
o New Employee Orientation
• Opportunity to inform new employees about the tobacco related policies that
affect them and the opportunity to connect tobacco users to treatment.
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Control
o HUD Smoke Free Public Housing
• Effective July 31, 2018, all Public Housing Agencies must comply with the rule and
implement smoke-free policies.
• Policy assistance to private tenants/landlords.
• Provided technical assistance for the lease addendum development and
enforcement protocol.
• Completed 3 tenant listening sessions.
• Discussed strategies to increase compliance including signage.
Treatment
o Nicotine Replacement Therapy (NRT)
• 143 boxes of NRT were dispensed to employees, Quitline participants and
FreshStart participants.
o Quitline
• $5000 contract was received to support NRT for all OC residents and employees.
• There were approximately 190 Quitline participants in 2017.
C. Advisory Board Update
Beverly Scurry, Board of Health Strategic Plan Manager, gave a brief summary of the Orange
County advisory boards’ activities as they pertained to the BOH. Ms. Scurry added that just
about every advisory board was working on some type of racial equity work. She also stated
that the full advisory report is available online. Below are some highlights as it relates to BOH
priorities in the Strategic Plan:
o Family Success Alliance (FSA) –
• The FSA will be attending a national racial equity summit next year.
• Currently have 7 new navigators which has increased their capacity to serve
more families and family members.
o Healthy Carolinians of Orange County (HCOC) –
• HCOC will be hosting a Poverty Simulation Exercise next month on January 19th.
Community residents, committee members and service providers will be invited
to participate in the simulation to help bridge the gap from misconception to
understanding through this interactive immersion experience to help participants
fully understand the realities of poverty.
D. Medicaid Transformation
Dr. Cilenti began by stating that the presentation was adopted from the NCALHD. Below is a
summary of the presentation that incorporated information also related to the OCHD.
Background
o In September 2015, the NC General Assembly enacted Session Law 2015-245, which
directed the transition of Medicaid from a fee-for-service structure to a managed care
structure. This past August, NC Department of Medical Assistance (DMA) issued a
position paper detailing the proposed vision for what has been coined “Medicaid
Transformation”. According to the proposed schedule, DMA will issue white papers this
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fall, which will provide further information around program design, Requests for
Information (RFI’s) this winter, which will gather information from experts to flesh out the
program design, and Requests for Proposals (RFP’s) in the summer of 2018 to engage
providers and candidates for managed care organizations; with the goal of beginning
services under the new model in July 2019.
Medicaid facts
o Medicaid is administered by states, according to federal requirements. The program is
funded jointly by states and the federal government.
o About 68.5 million people in the U.S. were covered by Medicaid as of July 2017. Two
million in NC are insured by Medicaid. About 5.8 million additional children were
covered by the Children’s Health Insurance Program (CHIP) as of July 2017.
o About 20% of the U.S. population (319 million) are covered by Medicaid/CHIP. One
dollar out of every $6 spent in healthcare in the U.S. is Medicaid.
Medicaid and CHIP in NC
o Medicaid is a health and long-term care coverage program that was enacted in 1965.
The Children’s Health Insurance Program (CHIP) was established in 1997 to provide
new coverage opportunities for children in families with incomes too high to qualify for
Medicaid, but who cannot afford private coverage.
o 2,030,268 million people in North Carolina were covered as of July 2017.
o Total State Fiscal Year 2016 Medicaid expenditures were $13.9 billion.
o State appropriations for Medicaid were $3.5 billion of that $13.9 billion.
o Federal dollars make up the majority of the remaining Medicaid budget.
o State Medicaid dollars were about 15.7% of the total $22.3 billion state budget.
Medicaid Managed Care
o Managed care is a health care delivery system organized to manage cost, utilization,
and quality. Medicaid managed care provides for the delivery of Medicaid health benefits
and additional services through contracted arrangements between State Medicaid
agencies and managed care organizations (MCO’s) that accept a set per member per
month (capitation) payment for these services.
o Over 55 million Medicaid enrollees covered under some form of Medicaid managed care
as of July 2014 (77% of total enrollment).
o As of July 2011, over 80% of Medicaid beneficiaries in NC were enrolled in some form of
managed care.
Medicaid Managed Care in the future
o Session Law 2015-245 – An act to transform and reorganize North Carolina’s Medicaid
and NC Health Choice Programs. Session Law 2016-121 – An act to … Modify certain
provisions of the Medicaid transformation legislation. Additional legislation will further
define the scope and expectations association with Medicaid managed care.
o The intent of the legislation is to expand and connect the majority of remaining Medicaid
expenditures to a managed care model that would capitate or limit those expenditures.
o The state will issue a request for proposals for 3 statewide commercial managed care
organizations and up to 12 regional provider-led entities in 6 regions to manage
Medicaid expenses based on a per member per month capitated model.
Why does this matter to public health?
o Care Management
• Role could be removed from health departments (Eliminated or given to MCO’s).
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• Health departments have exceptional expertise in managing these high risk
populations at a local level with our medical community.
• Reduces our capacity and staffing, which supports other critical community
needs like preparedness and communicable disease outbreaks.
o Clinical Services and Cost Settlement
• Higher costs per service for health departments since we are also complying with
federal and state program requirements.
• Cost settlement could end; the role with clinical services would be compromised
• Unclear if all health departments will qualify for that designation (Primary Care).
o Medicaid revenue streams have become critical funding for local health departments.
o Local health departments rely on Medicaid funding in part to provide essential and
mandated services required in the NC General Statutes (for all populations).
Timeline for Medicaid Transformation
o February 2018 – Estimated CMS Approval of Amended 1115 waiver application
o June 2018 – Requests for proposals released by state
o March 2019 – Contracts awarded and executed
o July 2019 – Prepaid Health Plans (PHP) go live
o July 2020 – Statewide rollout complete
Challenges for Public Health
o Uncertain about qualifying as an Advanced Medical Home – Primary care role.
o Questions about Medicaid dollar being able to follow the patient for services.
o Questions regarding how health departments would get paid for social determinants of
health initiatives and chronic disease prevention.
o Won’t be a level playing field.
Our Steps Forward/What’s Next
o Electronic Health Record (HER) implementation.
o Large scale focus on improvement with clinical quality measures.
o Strong role with community and social determinants of health.
o NC Association of Local Health Directors is advocating for Local Health Departments.
o Consultant hired by NCALHD to provide capacity and expertise.
o Ongoing responses to additional legislation, 1115 waiver application amendments and
changes to managed care plan.
o There’s a monthly Medicaid Transformation digest that will assist in the understanding of
this process.
The BOH had questions that were addressed by Ms. Crawford and Dr. Cilenti.
VI. Action Items (Non Consent)
A. Elections (Chair and Vice-Chair)
The Board members shall elect a Chair and Vice-Chair by majority vote each year at the last
meeting of the calendar year.
Motion to elect Susan Elmore to Chair for the 2018 calendar year was made by Jennifer
Deyo, seconded by Sam Lasris and carried without dissent.
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Motion to elect Timothy Smith to Vice-Chair for the 2018 calendar year was made by
Jennifer Deyo, seconded by Barbara Chavious and carried without dissent.
VII. Reports and Disccussion with Possible Action
A. Periodic Review of Drinking Water Fluoridation
Dr. Cilenti began by acknowledging Ed Kerwin, OWASA’s Executive Director. She referred to
the November 3rd letter from OWASA requesting feedback and recommendation regarding a
County-wide process for periodic review of fluoridation. The letter was sent following public
input and discussion at OWASA’s meeting held on October 26th. Our Communications
Manager, Kristin Prelipp, was also in attendance at that meeting. Dr. Cilenti stated that a
discussion needs to be had to develop a process about how the OCHD/BOH is going to address
key concerns from those opposed to fluoridation, the oral health benefits and risks, and make
sure it’s communicated to the public in a clear way.
Suggestions by BOH members included creating a subcommittee with the new health director,
hiring an outside party to give the OCHD/BOH a recommendation and possibly having an
expertise in toxicology be involved. As a response was needed to the OWASA letter, it was
suggested that this topic be a future agenda item. It was determined that this would occur in
February 2018. Mr. Kerwin thanked the Board for all of its help and stated that he will pass the
information on to his Board of Directors.
The BOH had questions that were addressed by Dr. Cilenti and Mr. Kerwin.
B. Health Director Report
In addition to the report, Dr. Cilenti invited all to the meet and greet taking place on December
19th at the Whitted Building Room 230 from 2-4pm to welcome the new health director,
Quintana Stewart. Speakers are to include the county manager as well Vice-Chair, Susan
Elmore and Commissioner Mia Burroughs.
The newly hired health director has also been invited to attend the OCHD All Staff meeting on
December 15th at 2:30pm at the SHSC. Dr. Cilenti stated that it’s an opportunity for staff to
meet her before she starts on December 18th. Lastly, she expressed that it’s been a great
privilege to work at the OCHD again and that she will be available during Quintana’s transition.
On behalf of the BOH, Chair Liska Lackey conveyed how thankful and appreciative the Board
was for Dr. Cilenti and for the space she gave to the Board that allowed them to conduct the
health director search eventhough it took longer than expected.
C. Media Items
Media items were in the packet which focused on Orange County’s events and our
involvement in various efforts.
At 8:55pm, Paul Chelminski motioned to move into closed session and Sam Lasris
seconded.
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VIII. Closed Session to Discuss Health Director Appointment
During the closed session, the Board of Health discussed the appointment process with
Brenda Bartholomew, Human Resources Director.
IX. Adjourn to Open Session
Bruce Baldwin motioned to move from closed to open session and Mia Burroughs
seconded.
X. Board Comments.
None.
XI. Adjournment
Timothy Smith moved to adjourn the meeting at 9:20pm and Jennifer Deyo seconded.
The next Board of Health Meeting will be held January 24, 2018 at the Orange County
Health Department, 300 West Tryon Street, Hillsborough, NC at 7:00 p.m.
Respectfully submitted,
Dorothy Cilenti, MSW, MPH, DrPH
Orange County Interim Health Director
Secretary to the Board
Agenda Item Number:
ORANGE COUNTY BOARD OF HEALTH
AGENDA ITEM SUMMARY
Meeting Date: January 24, 2018
Agenda Item Subject: Recycling
Attachment(s): PowerPoint
Staff or Board Member Reporting: Muriel Williman, Education and Outreach
Coordinator
Purpose: ____ Action
_X Information only
____ Information with possible action
Summary Information:
The Orange County Solid Waste Management Department will inform the Board of the
process of recycling in the county. Muriel will give facts on waste in the county and the
improvements cycling has made. Muriel will cover how recycling works in county
government buildings as well as in the community. The different materials that can be
recycled will also be explained as well as visual demonstrations.
Recommended Action: ___Approve
___Approve & forward to Board of Commissioners for action
___Approve & forward to ___________________________
_X_Accept as information
___Revise & schedule for future action
___Other (detail):
Recycling Rules in Orange County
Waste Diversion Basics
for your office and beyond!
Where Does Your Garbage Go?
Tons MUNICIPAL SOLID WASTE by origin in FY 13-14
Carrboro 6,489
Hillsborough 3,311
Chapel Hill 14,746
Orange County 10,710
UNC 5,660
UNC Hospital estimated 2,900
Subtotal 40,916
"Other" OC, origin unknown 9,989
OC MSW Total (from NC DENR) 53,805
40,000 gallons of diesel
fuel.
2017 Composition & Tonnage Orange County NC 2017
Orange County Waste Audit (Fall 2016)
Plastics Perplexion!
Unlock the resin identification code…
Curbside, Apartment, School, Government and
Commercial Collections
•Place your cart at the curb with 3feet clearance from cars, trees and other objects. •Place cart with the cart lid opening toward the street. •Line up the front of the cart so it is flush along the curb.
TWIN YOUR BINS!
CHOICES
Corrugated Cardboard
Shredded Paper
PURCHASING
RECYCLED PRODUCTS
•Products are available
•Quality is as good or better
•Cost is competitive
•https://vimeo.com/190005789
BUYING RECYCLED
PLASTIC
•Apparel
•Carpeting and floor tile
•Office accessories
•Outdoor furniture
•Lumber
•Waste receptacles
•Traffic barricades/speed bumps
•Plastic Clamshells
BUYING RECYCLED
PAPER
•Cardstock
•Notebooks
•Office Paper
•Parchment for Brochures
•Greeting Cards
•Boxes/Packaging Products
•Toilet Paper and Paper Towels
Events that serve food
•No single-use disposable items
•Durable utensil loan-------Fork it Over
•Compostable serving ware
•Recycling and compost collection=
virtually waste free.
•Online guides
Why Recycle?
•Save $$ in reduced disposal costs
•Reduce carbon footprint
•Enhance image= Walk the Talk!
•Good for the economy
–17,000 recycling related jobs in North Carolina
•Provide re-manufacturers with feedstock
•Purchasing products made from recycled
materials supports recycling businesses in
North Carolina and beyond
Thank you!
Muriel Williman
muriel@orangecountync.gov
(919) 968-2788
Agenda Item Number:
ORANGE COUNTY BOARD OF HEALTH
AGENDA ITEM SUMMARY
Meeting Date: January 24, 2018
Agenda Item Subject: Immigration Updates
Attachment(s): PowerPoint
Staff or Board Member Reporting: Susan Clifford, Immigrant and Refugee Health
Program Manager
Purpose: ____ Action
_X Information only
____ Information with possible action
Summary Information:
As a result of changes in federal administration policies and practices affecting
immigrants and refugees in 2017, OCHD’s Immigrant and Refugee Health Program and
an OCHD interdivisional task force took steps to: 1) inform immigrant and refugee
OCHD clients and community members of their rights and access to services, 2) inform
OCHD staff of resources to share with clients, and guidelines regarding their rights and
responsibilities when law enforcement is on County property, and 3) review OCHD
forms and documentation practices to ensure that they do not create any unnecessary
barriers to services for immigrant and refugee clients. Currently the IRH Program
Manager is exploring new ways to collaborate and integrate with community partners to
support the health and well-being of immigrants and refugees in 2018.
Recommended Action: ___Approve
___Approve & forward to Board of Commissioners for action
___Approve & forward to ___________________________
_X_Accept as information
___Revise & schedule for future action
___Other (detail):
BURMA
Orange County Health Department
Supporting
Immigrant & Refugee
Access to Care
Susan Clifford, MSW, MPH,
Immigrant & Refugee Health Program Manager
OC Board of Health Presentation- January 24, 2018
Immigrant & Refugee Health
Program
OCHD Language Services Policies & Coordination
OCHD Immigrant/Refugee Health TA
3 Staff Medical Interpreter/Translators, 18 Contractors, Telephonic & Video Interpretation
IRH Community Liaison
OC Latino & Refugee Health Interagency Coalitions
•Termination of DACA & DAPA
•End of TPS designations
•Refugee Admission Reduction
•Travel Ban & Extreme Vetting
•Expansion of Enforcement
Priorities
•Expansion of 287(g) partnerships & restoration of
Secure Communities program
Big Changes: 2017- now
Fear: Impact on Health Care
Isolation
Reluctance to seek health
care or other services
Deferred health care
Hesitation about federal
programs
Mental Health
New York Times: June 26, 2017
2017 Activities
Community Forums for
Latino Immigrants &
Refugees
“IRH Update” Emails to
Partners & Staff
OC Social Justice Funds
for Immigrant/Refugee
Agencies
OCHD Task Force
Task Force
•Forms Review
•Documentation
Guidance for Staff
•Know Your Rights
“Red Cards”
•Guidance for Staff
when LE on Site
“Yellow Cards”
•2017: Staff Trainings
•2018: New Staff
Orientation
2018: Forward Together
•Identifying more Collaboration Opportunities
•Coalition Co-leadership & Visioning
•Triangle Refugee Integration Workgroup
•UNC/TOC Building Integrated Communities
•Trauma-Informed Interpreter Training
Agenda Item Number:
ORANGE COUNTY BOARD OF HEALTH
AGENDA ITEM SUMMARY
Meeting Date: January 24, 2018
Agenda Item Subject: Health Department Workplace Safety Activities
Attachment(s): PowerPoint Presentation
Staff or Board Member Reporting: Carla Julian
Purpose: ____ Action
_ X Information only
____ Information with possible action
Summary Information:
Maintaining an effective Workplace Safety Program is one of the best ways to create
productive work environments and protect our most valuable asset – the employees.
OCHD has engaged in a number of safety activities to meet these goals including new
employee and annual training, classroom de-escalation training, an active assailant
tabletop exercise, and installation of panic buttons in the clinics and environmental
health. Efforts will continue through the work of the Safety Committee throughout the
coming year and beyond.
Recommended Action: ___Approve
___Approve & forward to Board of Commissioners for action
___Approve & forward to ___________________________
_X_Accept as information
___Revise & schedule for future action
___Other (detail):
Workplace Safety Program
Safety Training for OCHD Employees
Orange County New Employee Orientation
Workplace Harassment Prevention
Workplace Violence Prevention
Presentation by County Risk Manager
•Initial Orientation
•Basic Safety
Orange County Risk Manager Training Includes
OCHD New Employee & Annual Training
Emergency Action Plan and Fire Plan
Workplace Violence Prevention
Incident reporting
Respiratory Protection Plan Training
Bloodborne Pathogens and Personal
Protective Equipment for staff with exposure
risk
Hazardous Chemical Communication for staff
with exposure risk
Emergency Action Plan
The Departmental EAP details the actions
personnel in a department will take in response
to an emergency situation.
Evacuation
Shelter-in-Place
Workplace Violence / Active Assailant
Weather Emergencies
Fire
Etc.
What We Did in 2017
February – Panic Buttons installed in the medical and dental clinics
March 3 – Active Assailant Training at SHSC by Troy Comar with the Sheriff's Dept.
June 16 – Classroom de-escalation training for Personal Health Services
Aug 22 – Active Assailant Tabletop with Troy Comar for Personal Health Services
Sept 27 – EAP Training conducted by County
What’s Next
At least quarterly Safety Committee meetings
Quarterly Workplace Safety assessments
Address Incident Reports, look for trends
Additional safety tabletop or functional
exercises
Encourage participation in county-offered
active assailant and Emergency Action Plan
training
Agenda Item Number:
ORANGE COUNTY BOARD OF HEALTH
AGENDA ITEM SUMMARY
Meeting Date: January 24, 2018
Agenda Item Subject: 2nd Quarter Financial Report FY 17-18
Attachment(s): 2nd Quarter Financial Report
2nd Quarter Billing Dashboard
Staff or Board Member Reporting: Rebecca Crawford
Purpose: ___ Action
_X_ Information only
___ Information with possible action
Summary Information:
Total Health Department Revenue: Average YTD monthly revenue in FY18 after the
second quarter is $211/month and totals $1.3M YTD, representing 39.7% of our overall
budgeted revenue for the year. The total second quarter revenue is slightly skewed
down due to the majority of state funds not eligible to be drawn in July (this is typical)
but we are trending higher than we were at this time last fiscal year ($1.2M). Expenses
are higher than revenues at 44.3% of the total, overall budget.
Total Billing Accuracy: Continuing with the goal of 90% billing accuracy set in FY 14-
15, the average billing accuracy rate for medical after the second quarter is 91% as
compared to 95% in FY 16-17 and the average rate for dental for second quarter FY 17-
18 is 103% as compared to 104% in FY 16-17. Dental billing accuracy data for
December is unavailable while we are going through a system upgrade.
Dental Earned Revenue by Source: The FY 17-18 average monthly revenue
($38.1/month) for the second quarter is below our budget projection ($43.4k/month) and
our FY 16-17 average of $39.8k/month. FY 17-18 dental earned revenue totaled $234k
at the end of the second quarter.
Medical Earned Revenue by Source: Medical earned revenue is currently below the
budgeted projection for FY 17-18 ($57.1k/month) at $54.1k/month since we had a
provider on maternity leave until the end of December. Medical clinic revenue totals
$325k for second quarter FY 17-18.
Recommended Action: ___Approve
___Approve & forward to Board of Commissioners for action
___Approve & forward to ____________________
_X_Accept as information
___Revise & schedule for future action
___Other (detail):
BOH GOVERNANCE DASHBOARD Q2 FY17-18
* NOTE :FY17-18 Billing Accuracy no longer combines dental and medical paid claims & unpaid claims. Because two different accounting systems are being used (Medical: Accrual; Dental: Cash) the two clinics are shown separately.
Billing Accuracy Formulas: Medical = Paid claims/(# encounters minus no charge claims). Un-claimed appointments are no longer factored in; Dental = Paid Claims/# kept appointments.
Claims can take a quarter to realize payment - billing accuracy for all months increases with time as claims are finalized and errors are reworked.
Due to application updates, December Dental billing accuracy data is not available
42
50
42 42
38
20
0
20
40
60
J A S O N D J F M A M J
Th
o
u
s
a
n
d
s
DENTAL EARNED REVENUE BY SOURCE
vs. budget projection & prior year
MEDICAID INSURANCE
SELF PAY Total Earned Revenue ($234k YTD)
Budget Projection ($43.4k/m, $521k/y)YTD Month Avg ($39.k/m, ~$467k/y est)
FY16-17 D Revenue ($478k/y)FY16-17 D Revenue - Avg ($39.8k/m)
48 50 50
74
69
34
0
20
40
60
80
J A S O N D J F M A M J
Th
o
u
s
a
n
d
s
MEDICAL (PH) EARNED REVENUE BY SOURCE
vs. budget projection & prior year
MEDICAID INSURANCE
SELF PAY Total Earned Revenue ($325k YTD)
Budget Projection ($57.1k/m, $686k/y)YTD Month Avg ($54.1k/m, ~$649k/y est)
FY16-17 M Revenue ($660k/y)FY16-17 M Revenue - Avg ($55.k/m)
209
236
180
252 259
130
-
50
100
150
200
250
300
350
400
J A S O N D J F M A M J
Th
o
u
s
a
n
d
s
TOTAL HEALTH DEPARTMENT REVENUE
vs. budget projections & prior year
Personal Health Dental
Environ Health Grants
State Other
Total OCHD Revenue ($1.3M YTD)YTD Month Avg ($211k/m, ~$2.5M/y)
Prior: FY16-17 Total OCHD Revenue ($2.9M/y)Prior: FY16-17 Revenue - Avg ($240k/m, $2.9M/y)
FY17-18 Budget Projection ($278k/m, $3.3M/y)
105%102%105%96%105%
J A S O N D J F M A M J
Dental Billing Accuracy*
vs previous year & goal
D FY18 Total Accuracy (YTD avg 103%)D FY17 Accuracy - Avg (98%)Accuracy Target (90%)
94%94%93%92%92%81%
J A S O N D J F M A M J
Medical Billing Accuracy*
vs previous year & goal
M FY17 Total Accuracy (YTD avg 91%)M FY16 Avg Accuracy (96%)Accuracy Target (90%)
Orange County Health Department
Second Quarter Financial Report
FY 2017-2018
TOTAL HEALTH Q2
YTD
ACTUAL
ANNUAL
BUDGET
% OF ANNUAL
BUDGET
Revenue
Donations
Finance and Admin Services 0 (74)0 0.00%
Health Promotion & Edu (1,715)(3,301)(13,886)23.77%
Personal Health 0 (338)(18,000)1.88%
Donations Total (1,715)(3,712)(31,886)11.64%
Internal Allocations
Finance and Admin Services 0 0 (37,144)0.00%
Dental Health 0 0 (18,000)0.00%
Health Promotion & Edu 0 0 (244,756)0.00%
Personal Health 0 0 (30,000)0.00%
Internal Allocations Total 0 0 (329,900)0.00%
Service Revenue
Dental Health (100,081)(234,270)(520,734)44.99%
Environmental Health (139,901)(299,650)(576,100)52.01%
Personal Health (177,137)(325,047)(684,386)47.49%
Service Revenue Total (417,120)(858,967)(1,781,220)48.22%
State Allocations
Finance and Admin Services (8,301)(20,213)(42,921)47.09%
Health Promotion & Edu (18,352)(30,528)(90,674)33.67%
Environmental Health (1,027)(2,118)(41,324)5.13%
Personal Health (95,211)(228,210)(525,202)43.45%
State Allocations Total (122,892)(281,069)(700,121)40.15%
Grants Project Revenues
Piedmont Hlth Srv - Nutr (5,237)(8,658)(33,800)25.61%
CC4C Accesscare (37,027)(74,638)(149,624)49.88%
PCM Accesscare (40,474)(80,813)(147,651)54.73%
FIT Grant 0 (9,500)(45,093)21.07%
MDPP 0 0 (10,175)0.00%
Community Health Grant (9,174)(9,174)(122,065)7.52%
Wolfe Mini Grant (8,000)(8,000)(8,000)100.00%
Grants Project Revenues Total (99,913)(190,783)(516,408)36.94%
Revenue Total (641,639)(1,334,531)(3,359,535)39.72%
Orange County Health Department
Second Quarter Financial Report
FY 2017-2018
TOTAL HEALTH Q2 YTD ACTUAL ANNUAL BUDGET
% OF ANNUAL
BUDGET
Expenditures
Salaries 1,508,876 2,675,416 5,719,659 46.78%
Benefits 507,121 963,136 2,003,119 48.08%
Travel 808 5,312 18,430 28.82%
Training 9,786 19,148 44,264 43.26%
Certifications & Licensing 1,227 4,087 11,276 36.25%
Mileage 8,708 13,613 31,593 43.09%
Telephone 18,131 42,837 86,084 49.76%
Postage 1,594 5,461 14,015 38.97%
Motor Pool 6,909 19,052 53,014 35.94%
Equip Repairs 2,996 3,851 9,921 38.82%
Equip Rent 145 748 1,200 62.33%
Duplicating 2,340 4,992 13,350 37.39%
Printing 1,024 2,915 11,849 24.60%
Advertising 934 6,570 24,483 26.84%
Dues 300 2,792 5,100 54.74%
Subscriptions 228 228 1,500 15.20%
Dept Supplies 4,480 8,997 44,045 20.43%
Edu Supplies 963 1,129 26,762 4.22%
Office Supplies 3,334 8,193 30,435 26.92%
Medical Supplies 34,154 53,451 123,042 43.44%
Bloodborn Path Supplies 240 398 2,750 14.46%
Pharmacy Supplies 40,359 75,247 172,155 43.71%
Comp Supp/Software 191 1,328 7,444 17.84%
Contracted Srv 387,216 516,487 1,516,709 34.05%
X-Ray 2,994 7,726 30,235 25.55%
Lab Srv 15,583 50,308 123,840 40.62%
Bonds & Insurance 0 0 10,815 0.00%
Uniforms 1,395 4,183 7,014 59.64%
Community Proj 14,068 16,872 67,812 24.88%
Innovations Project 4,009 4,737 20,000 23.68%
Accreditation Project 0 2,750 2,750 100.00%
Credit Card Exp 1,989 4,078 6,000 67.96%
Capital Exp Under $500 1,453 1,938 4,635 41.81%
Nicotine Replacement Therap 17,034 17,034 18,000 94.63%
Capital Expenditures
Equipment 0 0 5,156 0.00%
IT Equipment 660 4,570 11,172 40.90%
Expenditures Total 2,601,250 4,549,582 10,279,628 44.26%
Health Director’s Report
January 2018
My first 30 days on the job have been great! My days have been filled with lots of warm
welcomes and a good bit of cold weather and snow! Health Department Staff and
County Staff have all been extremely helpful in answering my questions and helping me
get settled. To date, I’ve had the opportunity to meet with all Division Directors at least
twice and several program staff once.
I attended my first County Department Director’s Meeting on 1-8-18; had the opportunity
to meet all the other Department Directors and hear the County Manager’s FY 18-19
Budget Guidelines. As a result, I’ve also had 1-on-1 meetings with the Finance Director,
HR Director, Planning Director and an upcoming meeting with the Animal Control
Director.
Rebecca and I attended the Annual Budget Kickoff Workshop on 1-10-18. The process
will mirror last year’s process; key budget request guidelines include:
o No New General Fund Positions without 100% offsetting revenues or reallocation
of existing funds
o Any request not legally mandated must be supported with new revenue or
reallocation of existing funds
o Minimal Recurring Capital – Request Replacement items only
On 1-7-18, I had an opportunity to attend a presentation facilitated by Racial Equity
Institute (REI), “Measuring Racial Equity: A Groundwater Approach.” This event was
co-sponsored by Orange Against Racism (OAR) and our Health Department. The
presentation was very insightful on the impact of institutional racism on our society. I
look forward to attending the Phase I training offered by REI.
I attended the Annual Public Health Leaders Conference (formerly known as the State
Health Director’s Conference) January 17 – 19, 2018 in Raleigh. The theme of the
Conference this year was “Public Health 3.0….Where Will You Be?” The Conference
focused on five premises:
o Role of Chief Health Strategist
o Deliberate Collaboration
o Health Equity Success
o Timely Data
o Innovative Funding Models
Despite the snow and low attendance, this was still a good conference. It was great to
have the opportunity to network with several other Health Directors from across the
State.
Interim Environmental Health Director, John Kase submitted his resignation effective
January 18, 2018. John accepted a position with Wake County. The Environmental
Health Director position has been posted for applicants. In the interim, two EH
Supervisors, Phil Vilaro and Victoria Hudson, have agreed to lead the Environmental
Health Division until the position is filled.
Program Updates
Communicable Disease/Preparedness
o Pertussis - CD Team is actively investigating multiple pertussis cases in the
County. Everyone involved has been made aware. The State is aware and they are
working with us to monitor the situation. Letters have been sent out to parents,
close contacts and the entire school (Principal’s discretion). Most cases are fully
immunized and other contacts have been notified and given information about
prevention, symptoms and vaccinations.
o TB Update (Follow-up from November Report) – A total of 109 contacts have
been tested, 106 negative and 3 positive. One positive case is currently receiving
LTBI treatment and the other 2 had a previous history of TB.
o Preparedness Coordinator, Daniel Kashdan, organized a tabletop exercise for
County Stakeholders. Participants included Communicators and Public
Information Officers (PIOs) from Town of Chapel Hill, Town of Hillsborough,
Sheriff’s Office, UNC Campus, Health Department, Office of Aging,
Hillsborough Fire and Police and Emergency Management. The exercise scenario
was a flu pandemic. Successful exercise with a lot of lessons learned. Participants
requested more of these communication type exercises a little more frequently so
all partners stay ready and engaged.
Family Success Alliance - invited to complete Phase II of the Robert Wood Johnson
Culture of Health Prize award process.
Tobacco Prevention and Control Coordinator, April Richard is working with both school
systems to provide updated Tobacco free Schools signage for 32 schools (youth tobacco
funding).
Community Health Grant Update:
In collaboration with UNC Family Medicine, OCHD received funding for a
Community Health Grant from the Office of Rural Health (9/1/17 to 6/30/18) and
will submit the midpoint performance report February 7, 2018. The goal of this
funding is to increase access to primary and preventive care as well as self-
management support services for vulnerable patient populations living with
chronic disease in Orange County. OCHD is using part of the funding for a
voucher program created to cover the costs of the minimum fee for nutrition
services and have already seen a significant increase in the number of primary
care and family planning patients using nutrition services compared to previous
years. The grant is also covering costs for diabetes testing supplies for the
uninsured as this is a significant cost barrier in managing diabetes.
Through the grant, UNC Family Medicine and OCHD initiated a community
partnership of medical providers and local agencies with the goal of increasing
community awareness of services and linking residents to care through formal
referral systems. We hired a community health worker who will establish
relationships with residents and offer them support to better manage their disease.
We plan to apply for additional funding (March 2018) with the information
learned through this pilot programming period.
Upcoming Events
Kiana Redd, Healthy Homes Coordinator, is hosting Healthy Homes overview & Asthma
Medications training; January 29th for Headstart/ Early Headstart in Hillsborough; February
2nd for Family Home Visiting staff, Community Services staff, and partners.
Poverty Simulation Exercise was cancelled due to inclement weather. A rescheduled date is
forth coming. Contact Ashley Rawlinson, Healthy Carolinians Coordinator if you have
questions. All Board of Health Members are Welcome to participate as your schedule
allows.
January 25, 2018 – Health Director to meet with UNC Director of Emergency Management
& Planning
January 26, 2018 – Board of County Commissioners Retreat
January 29, 2018 – Health Director to meet with Ed Kerwin, OWASA Director
January 31, 2018 – Regional Health Advisory Meeting (UNC Family Medicine)
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ORANGE COUNTY BOARD OF HEALTH
November 29, 2017
S:\Managers Working Files\BOH\Agenda & Abstracts\2017 Agenda & Abstracts/ November Page 1
ORANGE COUNTY HEALTH DEPARTMENT MISSION STATEMENT: To enhance the quality
of life, promote the health, and preserve the environment for all people in the Orange County
community.
THE ORANGE COUNTY BOARD OF HEALTH MET ON November 29, 2017, at the Orange
County Health Department, 300 West Tryon Street, Hillsborough, NC.
BOARD OF HEALTH MEMBERS PRESENT: Liska Lackey – Chair, Bruce Baldwin, Johanna
Birchmayer, Commissioner Mia Burroughs, Barbara Chavious, Paul Chelminski, Jennifer Deyo,
Sam Lasris and Timothy Smith.
BOARD OF HEALTH MEMBERS ABSENT: Susan Elmore – Co-Chair and Jessica Frega.
STAFF PRESENT: Dr. Dorothy Cilenti, Interim Health Director; Rebecca Crawford, Financial
and Administrative Services Director; John Kase, Interim Environmental Health Director; Donna
King, Health Promotion & Education Services Director; Carla Julian, Dental Clinic Practice
Manager,HIPAA Privacy and Security Officer; Pam McCall, Personal Health Services Director;
Kristin Prelipp, Communications Manager; Thais Ramirez, Temporary Community Health
Specialist; April Richard, Tobacco Prevention and Control; Beverly Scurry, Board of Health
Strategic Plan Manager; and La Toya Strange, Administrative Assistant II.
GUESTS PRESENT: Commissioner Penny Rich, Cliff Bellamy, Herald Sun reporter; and Ed
Kerwin, OWASA Executive Director.
I. Welcome New Employees
Liska Lackey, Chair, called the meeting to order. Dr. Cilenti welcomed new employee, Thais
Ramirez.
II. Public Comment for Items NOT on Printed Agenda: Chris Harlan, UNC School of
Nursing. Amongst giving her thanks to the OCHD for the accepting of new students placed at
the OCHD over the last 20 years, Ms. Harlan added that its been a valued experience by those
students. Currently in the process of retiring, Ms. Harlan also expressed gratitude for all of the
support received from the BOH and the OCHD.
III. Approval of the November 29, 2017 Agenda
Motion was made by Mia Burroughs to approve the agenda, seconded by Jennifer Deyo
and carried without dissent.
IV. Action Items (Consent)
A. Minutes of October 25, 2017 Meeting
Motion was made by Sam Lasris to approve the minutes of October 2017, seconded by
Barbara Chavious and carried without dissent.
B. 2018 Board of Health Schedule
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Motion was made by Paul Chelminski to approve the 2018 Board of Health schedule,
seconded by Mia Burroughs and carried without dissent.
V. Educational Sessions
A. Food Deserts/OC Food Council Collaboration
Molly De Marco, Research Assistant Professor, Department of Nutrition, Gillings School of
Public Health, and Marcie Ferris, Professor, American Studies Department, UCH-CH, presented
information on the OC Food Council (OCFC) including food deserts and insecurity. Below is a
brief summary of the information presented:
OC Food Council
o Goals
• Action plan development
• Outreach
• Reach successful models and policies
• Collaborate with other food councils
o Strategic Priority Areas
• Outreach to elected officials; creation of a local food economy.
• Increase new market, wholesale and institutional buying opportunities for low-
resource and farmers of color.
• Support diversity of food producers and business owners.
Food Deserts
o Defined as a section or zone that is classified as both low income and low access to
grocery stores as measured by different distance boundaries.
o Food access is defined as a household’s mean to procure an adequate amount of food
on a regular basis through a combination of purchases, barter, borrowings, food
assistance or gifts.
o Food swamp is where there are unhealthy foods that are far more accessible than
healthy foods.
Food Insecurity
o Defined as the inability of nutritionally adequate and safe foods, or the ability to acquire
such food, is limited or uncertain for a household.
o Measured yearly via questions on the U.S. Census
o Four levels of food insecurity
• High – no reported indications of food access problems/limitations
• Marginal – 1-2 reported indications – typically of anxiety over food sufficiency or
shortage of food in the house. Little or no indications of changes in diet or food
intake.
• Low – reports of reduced quality, variety or desirability of diet. Little or no
indications of reduced food intake.
• Very low – reports of multiple indications of disrupted eating patterns and
reduced food intake.
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o 2014 NC Food Insecurity rates (most recent presenters were able to find) –
• Orange County has a child rate of 19.1% and the county overall has a rate of
14.6%.
o Highest usage of food stamps (SNAP) use in Orange County is in downtown
Carrboro/Chapel Hill areas.
o Causes of food insecurities include
• Racial oppression
• Poverty and low income
• Lack of transportation/grocery stores
• Poor health/mental illness/acute or chronic illness or injury
o Consequences of food insecurities include
• Under-nutrition (especially during vulnerable periods of life) and over-nutrition
with the wrong foods (such as foods high in starch, carbohydrates and fat)
• Increased incidence of chronic disease and depression
• Effects on health and well-being in children and social implications (such as lack
of concentration and low productivity in adults).
• Hunger-Obesity Paradox
The BOH had questions that were addressed by Ms. Ferris and Ms. De Marco.
B. Tobacco Prevention Efforts
April Richard, Senior Public Health Educator, Tobacco Prevention and Control, presented a
brief overview of the tobacco related efforts completed over the last year. The presentation will
include sections on prevention, control, and treatment efforts.
Prevention
o Tobacco. Reality. Unfiltered. (T.R.U.)
• One of few counties in NC that supports TRU and also supports TRU financially
• TRU groups meet at the following high schools:
Chapel Hill/Carrboro City Schools
Carrboro High School, Chapel Hill High School, East Chapel Hill High
School
Orange County Schools
Cedar Ridge High School, Orange High School
• Hosts Tobacco 101 for the youth.
• Participated in the the national movement, The Great American Smokeout, which
occurred on November 16th .
o FreshStart
Classes provided at Whitted Building and Seymour Center.
New partnerships with Freedom House and UNC Horizons .
7 Classes completed with 44 participants.
o New Employee Orientation
• Opportunity to inform new employees about the tobacco related policies that
affect them and the opportunity to connect tobacco users to treatment.
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Control
o HUD Smoke Free Public Housing
• Effective July 31, 2018, all Public Housing Agencies must comply with the rule and
implement smoke-free policies.
• Policy assistance to private tenants/landlords.
• Provided technical assistance for the lease addendum development and
enforcement protocol.
• Completed 3 tenant listening sessions.
• Discussed strategies to increase compliance including signage.
Treatment
o Nicotine Replacement Therapy (NRT)
• 143 boxes of NRT were dispensed to employees, Quitline participants and
FreshStart participants.
o Quitline
• $5000 contract was received to support NRT for all OC residents and employees.
• There were approximately 190 Quitline participants in 2017.
C. Advisory Board Update
Beverly Scurry, Board of Health Strategic Plan Manager, gave a brief summary of the Orange
County advisory boards’ activities as they pertained to the BOH. Ms. Scurry added that just
about every advisory board was working on some type of racial equity work. She also stated
that the full advisory report is available online. Below are some highlights as it relates to BOH
priorities in the Strategic Plan:
o Family Success Alliance (FSA) –
• The FSA will be attending a national racial equity summit next year.
• Currently have 7 new navigators which has increased their capacity to serve
more families and family members.
o Healthy Carolinians of Orange County (HCOC) –
• HCOC will be hosting a Poverty Simulation Exercise next month on January 19th.
Community residents, committee members and service providers will be invited
to participate in the simulation to help bridge the gap from misconception to
understanding through this interactive immersion experience to help participants
fully understand the realities of poverty.
D. Medicaid Transformation
Dr. Cilenti began by stating that the presentation was adopted from the NCALHD. Below is a
summary of the presentation that incorporated information also related to the OCHD.
Background
o In September 2015, the NC General Assembly enacted Session Law 2015-245, which
directed the transition of Medicaid from a fee-for-service structure to a managed care
structure. This past August, NC Department of Medical Assistance (DMA) issued a
position paper detailing the proposed vision for what has been coined “Medicaid
Transformation”. According to the proposed schedule, DMA will issue white papers this
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fall, which will provide further information around program design, Requests for
Information (RFI’s) this winter, which will gather information from experts to flesh out the
program design, and Requests for Proposals (RFP’s) in the summer of 2018 to engage
providers and candidates for managed care organizations; with the goal of beginning
services under the new model in July 2019.
Medicaid facts
o Medicaid is administered by states, according to federal requirements. The program is
funded jointly by states and the federal government.
o About 68.5 million people in the U.S. were covered by Medicaid as of July 2017. Two
million in NC are insured by Medicaid. About 5.8 million additional children were
covered by the Children’s Health Insurance Program (CHIP) as of July 2017.
o About 20% of the U.S. population (319 million) are covered by Medicaid/CHIP. One
dollar out of every $6 spent in healthcare in the U.S. is Medicaid.
Medicaid and CHIP in NC
o Medicaid is a health and long-term care coverage program that was enacted in 1965.
The Children’s Health Insurance Program (CHIP) was established in 1997 to provide
new coverage opportunities for children in families with incomes too high to qualify for
Medicaid, but who cannot afford private coverage.
o 2,030,268 million people in North Carolina were covered as of July 2017.
o Total State Fiscal Year 2016 Medicaid expenditures were $13.9 billion.
o State appropriations for Medicaid were $3.5 billion of that $13.9 billion.
o Federal dollars make up the majority of the remaining Medicaid budget.
o State Medicaid dollars were about 15.7% of the total $22.3 billion state budget.
Medicaid Managed Care
o Managed care is a health care delivery system organized to manage cost, utilization,
and quality. Medicaid managed care provides for the delivery of Medicaid health benefits
and additional services through contracted arrangements between State Medicaid
agencies and managed care organizations (MCO’s) that accept a set per member per
month (capitation) payment for these services.
o Over 55 million Medicaid enrollees covered under some form of Medicaid managed care
as of July 2014 (77% of total enrollment).
o As of July 2011, over 80% of Medicaid beneficiaries in NC were enrolled in some form of
managed care.
Medicaid Managed Care in the future
o Session Law 2015-245 – An act to transform and reorganize North Carolina’s Medicaid
and NC Health Choice Programs. Session Law 2016-121 – An act to … Modify certain
provisions of the Medicaid transformation legislation. Additional legislation will further
define the scope and expectations association with Medicaid managed care.
o The intent of the legislation is to expand and connect the majority of remaining Medicaid
expenditures to a managed care model that would capitate or limit those expenditures.
o The state will issue a request for proposals for 3 statewide commercial managed care
organizations and up to 12 regional provider-led entities in 6 regions to manage
Medicaid expenses based on a per member per month capitated model.
Why does this matter to public health?
o Care Management
• Role could be removed from health departments (Eliminated or given to MCO’s).
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• Health departments have exceptional expertise in managing these high risk
populations at a local level with our medical community.
• Reduces our capacity and staffing, which supports other critical community
needs like preparedness and communicable disease outbreaks.
o Clinical Services and Cost Settlement
• Higher costs per service for health departments since we are also complying with
federal and state program requirements.
• Cost settlement could end; the role with clinical services would be compromised
• Unclear if all health departments will qualify for that designation (Primary Care).
o Medicaid revenue streams have become critical funding for local health departments.
o Local health departments rely on Medicaid funding in part to provide essential and
mandated services required in the NC General Statutes (for all populations).
Timeline for Medicaid Transformation
o February 2018 – Estimated CMS Approval of Amended 1115 waiver application
o June 2018 – Requests for proposals released by state
o March 2019 – Contracts awarded and executed
o July 2019 – Prepaid Health Plans (PHP) go live
o July 2020 – Statewide rollout complete
Challenges for Public Health
o Uncertain about qualifying as an Advanced Medical Home – Primary care role.
o Questions about Medicaid dollar being able to follow the patient for services.
o Questions regarding how health departments would get paid for social determinants of
health initiatives and chronic disease prevention.
o Won’t be a level playing field.
Our Steps Forward/What’s Next
o Electronic Health Record (HER) implementation.
o Large scale focus on improvement with clinical quality measures.
o Strong role with community and social determinants of health.
o NC Association of Local Health Directors is advocating for Local Health Departments.
o Consultant hired by NCALHD to provide capacity and expertise.
o Ongoing responses to additional legislation, 1115 waiver application amendments and
changes to managed care plan.
o There’s a monthly Medicaid Transformation digest that will assist in the understanding of
this process.
The BOH had questions that were addressed by Ms. Crawford and Dr. Cilenti.
VI. Action Items (Non Consent)
A. Elections (Chair and Vice-Chair)
The Board members shall elect a Chair and Vice-Chair by majority vote each year at the last
meeting of the calendar year.
Motion to elect Susan Elmore to Chair for the 2018 calendar year was made by Jennifer
Deyo, seconded by Sam Lasris and carried without dissent.
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Motion to elect Timothy Smith to Vice-Chair for the 2018 calendar year was made by
Jennifer Deyo, seconded by Barbara Chavious and carried without dissent.
VII. Reports and Disccussion with Possible Action
A. Periodic Review of Drinking Water Fluoridation
Dr. Cilenti began by acknowledging Ed Kerwin, OWASA’s Executive Director. She referred to
the November 3rd letter from OWASA requesting feedback and recommendation regarding a
County-wide process for periodic review of fluoridation. The letter was sent following public
input and discussion at OWASA’s meeting held on October 26th. Our Communications
Manager, Kristin Prelipp, was also in attendance at that meeting. Dr. Cilenti stated that a
discussion needs to be had to develop a process about how the OCHD/BOH is going to address
key concerns from those opposed to fluoridation, the oral health benefits and risks, and make
sure it’s communicated to the public in a clear way.
Suggestions by BOH members included creating a subcommittee with the new health director,
hiring an outside party to give the OCHD/BOH a recommendation and possibly having an
expertise in toxicology be involved. As a response was needed to the OWASA letter, it was
suggested that this topic be a future agenda item. It was determined that this would occur in
February 2018. Mr. Kerwin thanked the Board for all of its help and stated that he will pass the
information on to his Board of Directors.
The BOH had questions that were addressed by Dr. Cilenti and Mr. Kerwin.
B. Health Director Report
In addition to the report, Dr. Cilenti invited all to the meet and greet taking place on December
19th at the Whitted Building Room 230 from 2-4pm to welcome the new health director,
Quintana Stewart. Speakers are to include the county manager as well Vice-Chair, Susan
Elmore and Commissioner Mia Burroughs.
The newly hired health director has also been invited to attend the OCHD All Staff meeting on
December 15th at 2:30pm at the SHSC. Dr. Cilenti stated that it’s an opportunity for staff to
meet her before she starts on December 18th. Lastly, she expressed that it’s been a great
privilege to work at the OCHD again and that she will be available during Quintana’s transition.
On behalf of the BOH, Chair Liska Lackey conveyed how thankful and appreciative the Board
was for Dr. Cilenti and for the space she gave to the Board that allowed them to conduct the
health director search eventhough it took longer than expected.
C. Media Items
Media items were in the packet which focused on Orange County’s events and our
involvement in various efforts.
At 8:55pm, Paul Chelminski motioned to move into closed session and Sam Lasris
seconded.
MINUTES-Draft
ORANGE COUNTY BOARD OF HEALTH
November 29, 2017
S:\Managers Working Files\BOH\Agenda & Abstracts\2017 Agenda & Abstracts/ November Page 8
VIII. Closed Session to Discuss Health Director Appointment
During the closed session, the Board of Health discussed the appointment process with
Brenda Bartholomew, Human Resources Director.
IX. Adjourn to Open Session
Bruce Baldwin motioned to move from closed to open session and Mia Burroughs
seconded.
X. Board Comments.
None.
XI. Adjournment
Timothy Smith moved to adjourn the meeting at 9:20pm and Jennifer Deyo seconded.
The next Board of Health Meeting will be held January 24, 2018 at the Orange County
Health Department, 300 West Tryon Street, Hillsborough, NC at 7:00 p.m.
Respectfully submitted,
Dorothy Cilenti, MSW, MPH, DrPH
Orange County Interim Health Director
Secretary to the Board