HomeMy WebLinkAboutBOH agenda 112917ORANGE COUNTY BOARD OF HEALTH
MEETING AGENDA
DATE: November 29, 2017
TIME: 7:00 P.M.
PLACE: Whitted Building, 3rd Floor Meeting Rooms
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 November 29, 2017 Agenda
7:10 – 7:15 IV. Actions Items (Consent)
A. Minutes of October 25, 2017 Liska Lackey
B. 2018 Board of Health Schedule Liska Lackey
7:15 – 8:05 V. Educational Sessions
A. Food Deserts/OC Food Council Collaboration Marcie Ferris
Molly De Marco
(relative to BOH Strategic Plan Priority: Physical Activity & Nutrition)
B. Tobacco Prevention Efforts April Richard (relative to BOH Strategic Plan Priority: Mental Health & Substance Abuse)
C. Advisory Board Update Beverly Scurry
(relative to BOH Strategic Plan focus on Engagement)
D. Medicaid Transformation Dorothy Cilenti/
Rebecca Crawford (relative to BOH Strategic Plan Priority: Access to Care)
8:05 – 8:10 VI. Action Items (Non Consent)
A. Elections (Chair & Vice-Chair) Liska Lackey
8:10 – 8:25 VII. Reports and Discussion with Possible Action
A. Periodic Review of Drinking Water Fluoridation Dorothy Cilenti
B. Health Director Report Dorothy Cilenti
C. Media Items Dorothy Cilenti
8:25 – 8:55 VIII. Closed Session to Discuss Health Director Appointment
Closed Session (ref. NCGS 143-318.11(a)6) to consider the qualifications, competence
performance, fitness, conditions of appointment, of an individual public officer or
employee, or prospective public officer or employee; or to hear or investigate a complaint,
charge, or grievance by or against an individual public officer or employee.
8:55 – 8:55 IX. Adjourn to Open Session
8:55 – 9:00 X. Board Comments
9:00 XI. 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.
MINUTES-Draft
ORANGE COUNTY BOARD OF HEALTH
October 25, 2017
S:\Managers Working Files\BOH\Agenda & Abstracts\2017 Agenda & Abstracts/ October 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 October 25, 2017, at the Orange
County Health Department, 300 West Tryon Street, Hillsborough, NC.
BOARD OF HEALTH MEMBERS PRESENT: Liska Lackey – Chair, Susan Elmore – Co-Chair,
Bruce Baldwin, Johanna Birchmayer, Commissioner Mia Burroughs, Barbara Chavious, Paul
Chelminski, Jennifer Deyo, Jessica Frega, Sam Lasris and Timothy Smith.
BOARD OF HEALTH MEMBERS ABSENT: None.
STAFF PRESENT: Dr. Dorothy Cilenti, Interim Health Director; Cheryl Bono-Zenia,
Environmental Health Specialist; Rebecca Crawford, Financial and Administrative Services
Director; Victoria Hudson, Food, Lodging & Institutions Supervisor; 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; Beverly Scurry,
Board of Health Strategic Plan Manager; Angela Sowers, Food, Lodging & Institutions Plan
Review Specialist; and La Toya Strange, Administrative Assistant II.
GUESTS PRESENT: Anna Hoffmeyer, UNC Student, Chelsea Perfect, UNC Student, Shreya
Shah, UNC Student and Mary Tucker.
I. Welcome New Employees
Liska Lackey, Chair, called the meeting to order. Dr. Cilenti welcomed new employees, Cheryl
Bono-Zenia and Angela Sowers, in attendance.
II. Public Comment for Items NOT on Printed Agenda: None
III. Approval of the October 25, 2017 Agenda
Motion was made by Mia Burroughs to approve the agenda, seconded by Johanna
Birckmayer and carried without dissent.
IV. Action Items (Consent)
A. Minutes of September 20, 2017 Meeting
Motion was made by Susan Elmore to approve the minutes of September 2017, seconded
by Bruce Baldwin and carried without dissent.
V. Educational Sessions
A. Customer Satisfaction Survey
MINUTES-Draft
ORANGE COUNTY BOARD OF HEALTH
October 25, 2017
S:\Managers Working Files\BOH\Agenda & Abstracts\2017 Agenda & Abstracts/ October Page 2
Dental Health, Personal Health and Environmental Health Services reported their results of
patient and client input surveys as well as their improvement plan.
The Dental Health Services patient satisfaction survey in September 2017 reflects patient
satisfaction with staff friendliness, dental provider listening skills and explanations of care.
There were 61 respondents. Some of their results included:
• 100% rated staff friendliness and courteousness as good, very good, or excellent
• 95% rated their trust in the providers as very good or excellent
• 95% rated the providers listening and explanation of condition as very good or
excellent
A key area for improvement was how long it takes to get an appointment which is currently 9
months for a hygiene appointment. The Dental Health Services’ strategies to improve this
include:
• Adding UNC Dental School hygiene students on Tuesdays and Thursdays
• For cancellations, begin using Solutionreach to send text and email message to all
patients waiting for hygiene appointments
• Requesting a 3rd hygienist position
Environmental Health Services has used the same feedback tool since 2007. Their survey
consisted of 18 questions with 2 questions that allow for free form comment on services and 2
questions that provide opportunity for staff recognition. It was collected from September 2016 to
September 2017. There were 131 responses collected. Some of their results include:
• Food and Lodging Feedback – 93% of clients felt they were kept well informed and/or
had a chance to ask questions
• Well and Septic Permitting Feedback – 94% of clients reported an overall satisfaction
with their services
• General Feedback – 97% of clients felt that office staff was professional and courteous
Personal Health Services also collected paper patient satisfaction surveys from mid-December
to mid-January. There were a total of 114 surveys collected at SHSC and 309 surveys at WHSC
respondents. The response rate to interpreter questions was 37 at WHSC and 63 at SHSC.
Not all respondents answered all of the questions. The results included:
• Satisfaction with location convenience was 99% at both locations
• The ease of making an appointment was 97% at WHSC and 100% at SHSC
• Overall satisfaction was 91% at WHSC and 96% at SHSC
• Satisfaction with interpreter services was extremely high at both clinical sites with 98%
at WHSC and 100% at SHSC
Positive feedback included:
• Everything is good
• Everyone is very friendly and courteous
• Great service
Constructive feedback included:
MINUTES-Draft
ORANGE COUNTY BOARD OF HEALTH
October 25, 2017
S:\Managers Working Files\BOH\Agenda & Abstracts\2017 Agenda & Abstracts/ October Page 3
• Have more options for mental health. A psychologist would be more beneficial than a
social worker
• Be available more days
• Need more staff to reduce wait time
Personal Health Services’ plan for improvement includes:
• Continue to refine clinic flow to reduce wait times
• Discuss adding clinic hours on Friday afternoon
• Provide additional suggestion boxes in exam rooms
The BOH had questions that were addressed by Ms. Julian, Mr. Kase and Ms. McCall.
B.& C. 1st Quarter Financial and Billing Dashboard Reports
Rebecca Crawford, Financial and Administrative Services Director, gave a report on the 1st
quarter revenue and billing accuracy. Her report is as follows:
• Total Health Department Revenue: Average YTD monthly revenue in FY18 after the first
quarter is $208k/month or $642k YTD, representing 18.7% of our overall budgeted
revenue for the year. The total first quarter revenue is slightly skewed down due to the
majority of state funds not eligible to be drawn in July (this is typical) and allocations of
Medicaid Max funds are not transferred into our budget until the end of the fiscal year.
Expenses are slightly higher than revenues at 19.1% of the total, overall budget.
• Total Billing Accuracy: Continuing with the goal of 90% billing accuracy set in FY14-15,
the average billing accuracy rate for medical after the first quarter is 88% as compared
to 95% in FY 16-17.
• Dental Earned Revenue by Source: The FY 17-18 average monthly revenue
($42.9k/month) for the first quarter is very close to our budget projection ($43.4k/month)
and above our FY 16-17 average of $39.8k/month and is tied to our new, automated
patient reminder system, which has decreased the no show rate in the dental clinic from
an average of 19% in FY 16-17 to an average of 15% so far in FY 17-18. FY 17-18
dental earned revenue totaled $129k at the end of the first quarter.
• Medical Earned Revenue by Source: Medical earned revenue is currently below the
budgeted projection for FY 17-18 ($58k/month) at $48.2k/month since we have a
provider on maternity leave. Medical clinic revenue totals $145k for first quarter FY 17-
18.
The BOH had questions that were addressed by Ms. Crawford.
VI. Reports and Discussion with Possible Action
A. Budget Amendments
MINUTES-Draft
ORANGE COUNTY BOARD OF HEALTH
October 25, 2017
S:\Managers Working Files\BOH\Agenda & Abstracts\2017 Agenda & Abstracts/ October Page 4
Dr. Cilenti discussed the recommended changes to the FY 17-18 Health Department budget as
the Department is required to bring changes to the overall budget appropriation to the Board of
County Commissioners for approval before they can be entered officially in the county’s
financial system, Munis.
The three amendments were:
BCCCP (Breast and Cervical Cancer Control Program)
The Health Department has received notification of an increase in state BCCCP funds of
$5,610, which will be used for providing an increased number of breast and cervical
cancer x-rays for qualifying patients.
Family Planning Program
The Health Department has received notification of a decrease of $20,095 in funding for
the Family Planning program due to a federal decrease in Maternal and Child Health
funds. These funds would have been used for pharmacy supplies for the Family
Planning program. The Health Department will continue to provide the same level of
service within the Family Planning program and will offset this loss in funding by utilizing
savings from other programs, savings from General Fund funded expenses, and by
seeking additional revenue sources.
MDPP (Minority Diabetes Prevention Program)
This technical amendment reduces funding to the Minority Diabetes Prevention Program
by a net of $9,000. In the FY2017-18 Budget Ordinance Amendment #1, revenues
related to the Minority Diabetes Prevention Program were erroneously increased by
$12,050. The Department’s original budget already accounted for this revenue, as the
Department was notified in time to include in its original budget request. Since the
adoption of the FY2017-18 Budget and the approval of Budget Ordinance Amendment
#1, the Health Department has received notification of an additional $3,050 in Minority
Diabetes Prevention Program grant revenues. This technical amendment reverts the
revision that was approved in Budget Ordinance Amendment #1 and includes the
addition of the $3,050 in new funding, which will be used to provide additional training
and supplies to members of the program.
The BOH had questions that were addressed by Dr. Cilenti.
B. Elections (Chair and Vice-Chair)
Liska Lackey, Chair, stated that the positions of Chair and Vice-Chair are open. She also
prefaced that by stating that it is customary for the current Vice-Chair to occupy the Chair
position because of the experience gained as Vice-Chair. Ms. Lackey informed the BOH
members that interested persons should contact her or current Vice-Chair, Susan Elmore. BOH
members will vote to select the Chair and Vice-Chair at the November meeting.
The BOH had questions that were addressed by Ms. Lackey.
C. Health Director Report
MINUTES-Draft
ORANGE COUNTY BOARD OF HEALTH
October 25, 2017
S:\Managers Working Files\BOH\Agenda & Abstracts\2017 Agenda & Abstracts/ October Page 5
Dr. Cilenti briefly elaborated on the Health Department’s activities that occurred in October that
were in her Health Director’s Report as well as answered all follow up questions asked by the
BOH members.
D. Media Items
Media items were in the packet which focused on Orange County’s events and our
involvement in various efforts.
At 8:05pm, Sam Lasris motioned to move into closed session and Mia Burroughs
seconded.
VIII. Closed Session to Discuss Health Director Recruitment
During the closed session, the Board of Health discussed the recruitment process with
Mr. Chuck Rohre, Springsted Waters and Brenda Bartholomew, Human Resources
Director.
IX. Adjourn to Open Session
Sam Lasris motioned to move from closed to open session and Jessica Frega seconded.
X. Board Comments.
None.
XI. Adjournment
Susan Elmore moved to adjourn the meeting at 8:50pm and Mia Burroughs seconded.
The next Board of Health Meeting will be held November 29, 2017 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: November 29, 2017
Agenda Item Subject: 2018 Board of Health Schedule
Attachment(s): Proposed 2018 Board of Health Schedule
Staff or Board Member Reporting: Liska Lackey
Purpose: __X_ Action
_ __ Information only
____ Information with possible action
Summary Information:
Attached is the proposed meeting schedule for the Board of Health in 2018.
It is recommended that the Board of Health approve the schedule.
Recommended Action: _X_Approve
___Approve & forward to Board of Commissioners for action
___Approve & forward to ___________________________
___Accept as information
___Revise & schedule for future action
___Other (detail):
2018 BOARD OF HEALTH MEETING SCHEDULE
Whitted Human Services Center
Board of Health Conference Room
Building 3rd Floor Room A 305
7:00 p.m. – 9:00 p.m.
Contact Person La Toya Strange 919-245-2411
January 24, 2018
February 28, 2018
March 28, 2018
April 25, 2018
May 23, 2018
June 27, 2018
August 22, 2018
September 26, 2018
October 24, 2018
November 28, 2018
All meetings are held on the fourth Wednesday of the meeting months and at the
Whitted Human Services Center, Hillsborough unless noted otherwise.
Agenda Item Number:
ORANGE COUNTY BOARD OF HEALTH
AGENDA ITEM SUMMARY
Meeting Date: November 29, 2017
Agenda Item Subject: Orange County Food Council Presentation – Strategic Plan
Collaboration with BOH
Attachment(s): PowerPoint Presentation
Staff or Board Member Reporting:
Molly De Marco, PhD MPH
Research Assistant Professor, Dept. of Nutrition, Gillings School of Global Public
Health, UNC-CH
Research Fellow and Project Director
Center for Health Promotion & Disease Prevention (a CDC Prevention Research
Center), UNC-CH
Marcie Cohen Ferris, Ph.D.
Professor, American Studies Dept., UNC-CH
Co-Chair, UNC FOOD FOR ALL
Purpose: ____ Action
_ X Information only
____ Information with possible action
Summary Information:
The Orange County Food Council will present information regarding their organization
and what they do. They will also address the BOH Strategic Plan and the collaborative
efforts between the BOH and OCFC. They will address topics such as food deserts in
Orange County and underserved areas.
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):
Promoting A Strong Food System in
Orange County
Marcie Ferris, Professor, UNC-CH American Studies Department UNC FOOD FOR
Molly De Marco, Research Assistant Professor, Department of Nutrition, Gillings
School of Global Public Health, UNC-CH
Presentation to the Orange County Board of Health - November 28, 2017
Food Insecurity: An Overview
Defined by the U.S. Department of
Agriculture (USDA) as a condition when:
“the availability of nutritionally
adequate and safe foods, or the ability
to acquire such food, is limited or
uncertain for a household”
How is food insecurity measured?
US Census’s Annual Current Population Survey
Surveys range from 6, 10, or 18 items
Example questions:
Q1: The food that (I/we) bought just didn’t last, and (I/we) didn’t
have money to get more.
Q2: (I/we) couldn’t afford to eat balanced meals.
Q3: In the last 12 months, did (you/you or other adults in your
household) ever cut the size of your meals or skip meals because
there wasn't enough money for food?
Response options: Often true, Sometimes true, Never true
Different Levels of Food Insecurity
High food security: No reported indications of food-access problems or
limitations. Raw score of 0-1.
Marginal food security: 1 – 2 reported indications—typically of anxiety over
food sufficiency or shortage of food in the house. Little or no indication of changes
in diets or food intake. Raw score of 0-1.
Low food security: Reports of reduced quality, variety, or desirability of diet.
Little or no indication of reduced food intake. Raw score of 2-4.
Very low food security: Reports of multiple indications of disrupted eating
patterns and reduced food intake. Raw score of 5-6
2014 North Carolina Food Insecurity
Rates
Orange County
specifics:
•Overall 14.6%
•Child 19.1%
SNAP (Food Stamp) use
in Orange County –
2013
Respondents were asked if one or more
of the current household members
received food stamps or a food stamp
benefit card during the past 12 months.
This map reflects the percentage of
individuals with SNAP Benefits per
Census Tract.
The green areas represent low-income
census tracts where a significant share
of residents is more than 1 mile (urban)
or 10 miles (rural) from the
nearest supermarket.
The orange areas represent low-
income census tracts where a
significant share of residents is more
than 1/2 mile (urban) or 10 miles (rural)
from the nearest supermarket.
(from USDA Food Desert Map generator)
Orange County food deserts
Close-up View
Orange County food deserts
Key Food Access Terms
Food Access – Food access is defined as a household’s means to procure an adequate
amount of food on a regular basis through a combination of purchases, barter, borrowings,
food assistance or gifts.
Food Retailer – A food retailer is defined as any place (supermarket, fast food restaurant,
convenience store, etc.) that one can buy food. Food retailers are ranked on a spectrum from
healthy to unhealthy using an indicator known as the modified retail food environment index
(mRFEI).
Food Desert – A food desert refers to a section or zone (census tract) that is classified as
both low income and low access as measured by different distance demarcations.
Food Swamp – A food swamp is a census tract where unhealthy foods are way more
accessible than healthy foods. For example, food swamps have lots of fast food restaurants
and corner stores rather than supermarkets and grocery stores. Food swamps can also exist
within food deserts, where healthy food is out of range.
Consequences of Food Insecurity
Under-nutrition and over-nutrition with the wrong foods.
Under-nutrition is particularly serious during certain vulnerable periods: infancy, childhood, and pregnancy.
Over-nutrition with the wrong foods: high in starch/carbohydrates, high in fat (fast food, snack foods that are often cheap and available).
Poorer self-reported health status.
Increased incidence of chronic disease.
Increased incidence of depression.
Consequences of Food Insecurity
Effects on Health and Well-being in children
Related to babies born at low weight, shown to be correlated with chronic disease later in life such as heart disease.
Failure to thrive, iron and other micronutrient deficiencies in infants and children.
Physiological, cognitive and behavioral developmental delays in infants and children.
Social implications
Lack of concentration and low productivity in adults.
Stress at home.
Inability to participate fully in social life such as sharing meals, potlucks, providing meals for ill friends, etc.
Consequences of Food Insecurity
The Hunger-Obesity Paradox
Individuals experiencing food insecurity are more likely to be obese or overweight than those who are not.
Holds for adults and children.
This is especially true for low-income women, who often restrict their food intake to protect their children
from hunger
Why does this occur?
Stretching food budgets by purchasing cheap, energy-dense foods that are filling (maximizing
calories/dollar)
Overeat when food does become available, resulting in chronic ups and downs in food intake
When available, healthy food – especially fresh produce – is often of poorer quality in lower income
neighborhoods, which diminishes appeal.
Fewer opportunities for physical activity in low-income neighborhoods
High levels of stress
Greater exposure to marketing of obesity-promoting products
Limited access to health care
Causes of Food Insecurity
Racial Oppression
The ways in which history, culture, ideology, public policies, institutional practices, and personal behavior and
beliefs interact to maintain a hierarchy that over-advantages dominant identities and over-burdens or under-
advantages ‘otherness.”
This cumulative impact of disparities in power over time leads to unequal access to resources such as food.
Poverty & Low Income
Minimum wage does not allow for an adequate diet
Unemployment or seasonality of work
Homelessness
Isolation
Lack of a social support network
Lack of access to public and private assistance
Low educational attainment
Lack of skilled labor
Low Literacy
Causes of Food Insecurity
Poor Health
Acute or chronic illness or injury
Mental Illness
Substance Use
Language barriers
Stigma - discourages people from applying for aid, seeking help or using their benefits
High fixed costs of other needs vs. elastic cost of food
Housing, child-care, health care including prescriptions, utilities
Lack of cooking, shopping, and budgeting skills
Rising food prices due to changes in economy
Lack of transportation
Lack of grocery stores
Orange County Food Council Goals:
1. Action Plan development: Create plan to focus, guide, and prioritize the council’s work.
2. Outreach: Increase knowledge of available resources for those with low food access.
3a. Work with the Orange County Board of Health Strategic Plan Manager to research
successful models and policies that address food access issues through healthy corner
store and grocery store initiatives to improve healthy food access in "food deserts”. Assist in
drafting policies with the BOH Strategic Plan Manager and the BOH Physical Activity and
Nutrition Sub-Committee if a policy proposal is deemed to be the next step.
3b. Provide this presentation
3c. Research successful "soda tax" and healthy eating incentive programs and policies with the
Board of Health Strategic Plan Manager and, if deemed appropriate, help draft a policy
proposal.
4. Collaborate with other food councils: Collaborate with other North Carolina food councils to
learn new strategies to strengthen the Orange County food system.
*The Race Equity and Social Justice Toolkit fwill be used for 3a and 3 c to identify any racial disparate impacts of proposed policies.
Food
Access
Workgroup
Monthly Education Campaign Themes
●October/November Schools/Youth/"After The School Day"
●December Cooking Education/Wellness/Physical Activity
●January Seniors
●February Transportation
●March Language/Accessibility
●April Living Wage
●Spring and ongoing: Tie in with Farmers' Markets and the new growing season,
and highlight summer food insecurity for youth
Local Food
and Farm
Economy
Strategic priority areas
1.Outreach to elected officials; creation of a local food economy Fact
sheet.
2.Increase new market, wholesale, and institutional buying opportunities
for low-resource and farmers of color.
3.Support diversity of food producers and business owners
Agenda Item Number:
ORANGE COUNTY BOARD OF HEALTH
AGENDA ITEM SUMMARY
Meeting Date: 1/29/2017
Agenda Item Subject: 2017 Tobacco Efforts
Attachment(s): PowerPoint
Staff or Board Member Reporting:
Purpose: ____ Action
_ X_ Information only
____Information with possible action
Summary Information:
April Richard is excited to share a brief overview of the tobacco related efforts
completed from November 2016- November 2017. The presentation will include
sections on prevention, control, and treatment efforts.
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):
2017
Tobacco Prevention,
Control, and
Treatment Efforts
April Richard, MPH
Senior Public Health Educator, Tobacco Prevention and Control
PREVENTION-
TOBACCO. REALITY. UNFILTERED.
Tobacco 101
Tobacco. Reality. Unfiltered
•Content
Great American Smoke Out
CONTROL-
POLICY TECHNICAL ASSISTANCE
HUD Smoke Free Public Housing
•Developed policy planning and implementation timeline with Housing Manager
•Provided technical assistance for the lease addendum development and enforcement protocol
•Discussed strategies to increase compliance
–Signage options
–Neighbor complaints
•Completed 3 Tenant Listening Sessions
–Only 2 had resident attendance
–Reach to 10 residents
•Will provide treatment opportunities on housing sites
TREATMENT
Freshstart
•7 Classes completed
–Reached 44 participants
•1 Class running currently at UNC Horizons
–9 participants
•New partnerships with our recovery
community
–Freedom House
–UNC Horizons
Nicotine Replacement Therapy
•Dispensed 143 boxes of NRT to:
–Employees
–Quitline participants as starter kits
–Freshstart participants
•Provide NRT to individuals to support every
quit attempt they make
Freshstart Live
•Programming provided to UNC Carolina Association of Pharmacy Students
–Understand the progression of the Freshstart Series
–Navigating tobacco treatment and motivational interviewing with people who are in varying stages of change
–Become familiar with typical responses from tobacco users
–Increase the number of community supports who understand tobacco use as an addiction
•Reach to 75 pharmacy students over two interventions
Quitline
•$5000 contract to support nicotine
replacement therapy for all Orange County
residents and employees
•2017: ~190 Quitline Participants
New Employee Orientation
•Opportunity to inform new employees about the
tobacco related policies that affect them
–Tobacco free government grounds
–County employee policy against using tobacco
products in or on property
–Smoke Free Public Places
•Opportunity to connect tobacco users to
treatment!!!
–Freshstart
–Quitline
Certified Tobacco Treatment Specialist
Training
•Completed training Nov 1-4
•Must complete 240 hours of document
tobacco treatment
•Working to develop new programming
protocols to implement evidence based
innovative strategies to treatment
–Individual treatment opportunities
–Nicotine matching
–Encouraging the use of prescription medications
Questions?
April Richard
arichard@orangecountync.gov
919-245-2424
www.OrangeCountyNC.gov/Health
2017
Tobacco Prevention,
Control, and
Treatment Efforts
April Richard, MPH
Senior Public Health Educator, Tobacco Prevention and Control
PREVENTION-
TOBACCO. REALITY. UNFILTERED.
Tobacco 101
Tobacco. Reality. Unfiltered
•Content
Great American Smoke Out
CONTROL-
POLICY TECHNICAL ASSISTANCE
HUD Smoke Free Public Housing
•Developed policy planning and implementation timeline with Housing Manager
•Provided technical assistance for the lease addendum development and enforcement protocol
•Discussed strategies to increase compliance
–Signage options
–Neighbor complaints
•Completed 3 Tenant Listening Sessions
–Only 2 had resident attendance
–Reach to 10 residents
•Will provide treatment opportunities on housing sites
TREATMENT
Freshstart
•7 Classes completed
–Reached 44 participants
•1 Class running currently at UNC Horizons
–9 participants
•New partnerships with our recovery
community
–Freedom House
–UNC Horizons
Nicotine Replacement Therapy
•Dispensed 143 boxes of NRT to:
–Employees
–Quitline participants as starter kits
–Freshstart participants
•Provide NRT to individuals to support every
quit attempt they make
Freshstart Live
•Programming provided to UNC Carolina Association of Pharmacy Students
–Understand the progression of the Freshstart Series
–Navigating tobacco treatment and motivational interviewing with people who are in varying stages of change
–Become familiar with typical responses from tobacco users
–Increase the number of community supports who understand tobacco use as an addiction
•Reach to 75 pharmacy students over two interventions
Quitline
•$5000 contract to support nicotine
replacement therapy for all Orange County
residents and employees
•2017: ~190 Quitline Participants
New Employee Orientation
•Opportunity to inform new employees about the
tobacco related policies that affect them
–Tobacco free government grounds
–County employee policy against using tobacco
products in or on property
–Smoke Free Public Places
•Opportunity to connect tobacco users to
treatment!!!
–Freshstart
–Quitline
Certified Tobacco Treatment Specialist
Training
•Completed training Nov 1-4
•Must complete 240 hours of document
tobacco treatment
•Working to develop new programming
protocols to implement evidence based
innovative strategies to treatment
–Individual treatment opportunities
–Nicotine matching
–Encouraging the use of prescription medications
Questions?
April Richard
arichard@orangecountync.gov
919-245-2424
www.OrangeCountyNC.gov/Health
Submitted November 29, 2017
O RANGE C OUNTY
A DVISORY B OARD
S UMMARY
M ARCH 2017 – S EPTEMBER 2017
Board of Health Engagement
4/19/17
1
Biannual Report
Board of Health Engagement
B OARD BOH
P RIORITY
S UMMARY
Orange County
Schools Board
of Education
Social
Determinants of
Health, Physical
Actvity
• The Board of Education formed an Equity Committee
composed of community members, parents, and staff.
• The Board is working with OpenSource to facilitate racial equity
conversations. This is the same company OCHD is using.
• The Board approved FSA conducting a Kindergarten readiness
program at New Hope Elementary
• Grant approvals include:
o Voya Unsung Heroes Grant to expand Action-Based
learning kinesthetically in classroom
• Youth Tobacco Use Prevention Program was approved to work
with OCHD on tobacco cessation for youth
• Orange County Rape Crisis Center Safe Touch Program
approved to provide students with safety curriculum topics by
grade level
• Juvenile Court/School Liaison approved to provide a liaison the
for school year
• The Board approved for Duke University College Advising
Corps to insert an advisor at Orange County High School
• The Board approved a revision of the dress code in August
Chapel
Hill/Carrboro
City Schools
Board of
Education
Social
Determinants of
Health; Substance
Abuse & Mental
Health
• CHCCS has seen an increase in sexual violence in schools and
will be taking appropriate steps to education students
• The Board revised the Policy Against Discrimination,
Harassment, and Bullying to prevent further learning disruption
as a result of flags and other symbols of racism
4/19/17
2
Board of County
Commissioners
Social
Determinants of
Health, Physical
Activity
• The Board approved funding requests for immigrant and
refugee support services and approved utilization of the
Social Justice Fund. There was an immediate need for
agencies that use these funds.
• Proclamation passed designating May as Older Americans
Month to honor older adults
• The Board accepted the 2017-2022 Orange County Master
Aging Plan
• Awarded the RFP for $2.5 million of the 2016 Affordable
Housing Bond for affordable housing projects proposed by
Habitat for Humanity, CASA, and EmPOWERment.
• The Board entered into operating agreements with Cedar
Grove Neighborhood Association and United Voices of
Efland Cheeks for the operation of the Cedar Grove
Community Center and Efland Cheeks Community Center,
respectively
• Received a presentation from FSA’s new Impact Report
• Adopted a Resolution in Support of a State and National
Goal of 100% Clean Energy by 2050 and the Creation of
Green Jobs
• Received a report on the Mountains-to-Sea trail from
Hillsborough to Alamance County
Chapel Hill
Town Council
N/A
Carrboro Board
of Aldermen
Physical Activity
and Nutrition;
SAMH
• Passed a Resolution in Support of a State and National Goal of
100% Clean Energy by 2050 and the Creation of Green Jobs
• Proclamation passed designating October 2017 as Carrboro
Walk/Bike to School Month and October 4, 2017 as Carrboro
Walk/Bike to School Day
• Passed a resolution in support of a NCDOT Bicycle Planning
Grant Application that will update Carrboro’s Comprehensive
Transportation Bicycle Plan
• Resolution passed for the Town Manager to identify funds and
to take other steps to assist Carrboro residents who are
beneficiaries of Deferred Action for Childhood Arrivals (DACA)
• Resolution passed in solidarity with Charlottesville
counterprotestors condemning and calling for action against
racism and white supremacy
• Ordinance implemented authorizing the sale of malt beverages,
unfortified wine, fortified wine, and mixed beverages beginning
at 10 am on Sundays
4/19/17
3
Hillsborough
Board of
Commissioners
Physical Activity
• The Town of Hillsborough hosted a Mountains-to-Sea event
in September
• Passed a Resolution in Support of a State and National Goal
of 100% Clean Energy by 2050 and the Creation of Green
Jobs
Orange Unified
Transportation
Board
(OUTBoard)
Physical Activity
• The OUTBoard endorsed both the Safe Routes to School
Implementation Plan and Bicycle Safety Task Force Draft
Report, both of which were presented by Abigaile
Pittman. Additionally, a Bicycle Safety Taskforce was
created to implement recommendations in the report.
• Members of OUTBoard are being encouraged to get
involved in the Mountain-to-Sea bike trail
• OUTBoard participated in Try Transit Week with Healthy
Carolinians
Healthy
Carolinians of
Orange County
All
Social Determinants of Health - Access:
• In October, the Access committee hosted 2 transportation
academies, targeted at human service providers, to educate,
share and explain the components of public transportation,
with the intent to increase rider usage. Presenters
represented Go Triangle, Chapel Hill Transit and Orange
Public Transportation and provided thorough overviews of
major routes, trip planning, transit apps, ADA/paratransit,
non-medical options, responding to LEP (Limited English
Proficient) residents, and new routes coming to rural Orange
County. There were 37 participants present for both
Academies. Of the 37 present, 5 expressed interest in
housing an information kiosk at their individual
agencies/organizations and 3 of those expressed interest in
bringing the academy to their agency/organization. The
Academies are in preparation for a Try Transit Week that will
be held from October 23rd – 29th.
Mental Health & Substance Abuse
• In September, during Suicide Prevention, the MH&SA
committee hosted events to bring awareness to suicide
prevention. By adopting the campaign “Be the 1 to”, the
committee is working to encourage residents to Ask, Keep
them Safe, Be there, Help them Connect, and Follow
Up. The kickoff event included the introduction of the
campaign, the reading of “A Prayer of Understanding” and a
4/19/17
4
personal testimony from a committee member who shared
her 3-generation family history of mental illness and suicide.
• Be the Light suicide prevention awareness walk was held on
the campus of UNC and was intended to bring awareness to
the younger age population around suicide. The speaker,
who is a licensed professional counselor, UNC alum, a
member of a Greek organization, was an athlete, and a 3-time
suicide survivor, shared his personal story of dealing with
mental illness and how that encouraged him to become a
counselor. The event reached 50-100 individuals who
included students, community members and professionals.
• The month ended with a community focused QPR
(Question, Persuade, Refer) training to train community/lay
people 3 simple steps that can be used to help save a life
from suicide.
Physical Activity & Nutrition
• The PAN committee is implementing a 6-month Eat Smart
Move More Consistent Messaging Campaign that focuses
increasing knowledge and influencing behavior change
related to eating smart and moving more. The campaign will
run October 2017 through March 2018 and will target one
message a month for 6 months. The PAN committee has
partnered with 15 agency/organizations that will each
implement and promote this campaign through a variety of
strategies with the goal to reach thousands of OC residents
over the 6-month timeframe.
HCOC
• The annual celebration for HCOC will be in January with
implementation of a Poverty Simulation. 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.
4/19/17
5
Family Success
Alliance
Access
• 2nd Annual End of School Year celebration was held in June at
New Hope Camp and Retreat Center in Hillsborough
• Family Fun Day was held in June at Estes Park Apartments in
Chapel Hill and Gateway Village Apartments in Hillsborough
• Ready for K Camp began in July with its 3rd cohort of scholars.
This program helps children prepare for the first day of
kindergarten!
• New FSA Navigators were welcomed to the team. An expanded
teams means that FSA can serve more families and family
members!
o Brittany Bullock
o April Oo
o Antonia Cortes Sanchez
o Claudia Yerena
o Erika Cervantes
• FSA was honored with several media features including the
Durham Herald Sun and Daily Tar Heel.
Orange County
Advisory Board
Summary Report
March 2017 - September 2016
Beverly Scurry
Board of Health Strategic Plan Manager
•Orange County Schools Board of Education
–Formed an Equity Committee and working with OpenSource Inc. to
facilitate racial equity conversations.
–Has worked with FSA on the Kindergarten readiness program as well
as our tobacco specialist to implement tobacco cessation for youth
•Chapel Hill/Carrboro City Schools Board of Education
–Has seen an increase in sexual violence and working to educate
their students
–Revised their Policy Against Discrimination, Harassment, and
Bullying to take away disruptive flags and symbols of racism.
•Board of County Commissioners
–Approved funding requests for immigrant and refugee support and utilization of the
Social Justice Fund
–Awarded an RFP for $2.5 million of the 2016 Affordable Housing Bond to housing
projects proposed by Habitat for Humanity, CASA, and EmPOWERment
•Carrboro Board of Alderman
–Working to update their Comprehensive Transportation Bicycle Plan
–Working to identify funds and other steps to assist Carrboro resident who are
beneficiaries of Deferred Action for Childhood Arrivals (DACA)
•Hillsborough Board of Commissioners
–Involved in the Mountain-to-Sea efforts from Hillsborough to Alamance County
–Passed a Resolution in Support of a State and National Goal of 100% Clean Energy by
2050 and the Creation of Green Jobs
•Orange Unified Transportation Board (OUTBoard)
–Has endorsed the Safe Routes to School Implementation Plan and Bicycle Safety Task
Force Report
–Participated in Healthy Carolinian’s Try Transit Week
•Family Success Alliance
–Check out their new website at familysuccessalliance.org
–Currently have 7 new navigators which has increased their capacity to serve more
families and family members
–Has been featured in several major newspapers over the summer in Durham and
Chapel Hill
•Healthy Carolinians of Orange County
–Conducted a major Suicide Prevention Campaign in September
–To come – Poverty Simulation coming at the annual celebration in January – This
simulation helps bridge the gap from misconception to understanding through
interactive immersion experience to help participants understand the realities of
poverty.
Questions?
Beverly Scurry
bscurry@orangecountync.gov
919-245-2405
www.OrangeCountyNC.gov/Health
Agenda Item Number:
ORANGE COUNTY BOARD OF HEALTH
AGENDA ITEM SUMMARY
Meeting Date: November 29, 2017
Agenda Item Subject: Orange County Advisory Board Update
Attachment(s): Update Advisory Board Summary
Staff or Board Member Reporting: Beverly Scurry
Purpose: ___ Action
_X_ Information only
___ Information with possible action
Summary Information:
The Board of Health identified action steps related to engagement in the 2016-2018
Strategic Plan. One of these action steps is to receive biannual updates on actions of
other Orange County advisory boards that relate to the BOH strategic plan priorities.
The summary provided is of pertinent actions or information from Orange County
advisory boards from March 2017 to August 2017, as available from the boards. Beverly
will highlight a number of these activities and their connection to the BOH.
Some boards being tracked do not have updates included because they do not pertain
to the BOH’s priorities or they were not available at the time of the report.
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):
Agenda Item Number:
ORANGE COUNTY BOARD OF HEALTH
AGENDA ITEM SUMMARY
Meeting Date: November 29, 2017
Agenda Item Subject: Medicaid Transformation Update
Attachment(s): Medicaid Transformation Presentation
Staff or Board Member Reporting: Dorothy Cilenti and Rebecca Crawford
Purpose: ___ Action
_X_ Information only
___ Information with possible action
Summary Information:
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
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.
There are many unknowns in this process to combine primary care and behavioral
health into “whole person” care, including how local health departments will play a role
in the new managed care environment. However, the NC Association of Local Health
Directors has retained a consultant to help vouch for the importance of health
departments as a service provider and to help health departments navigate the change
process.
Our role over the next 18 months will be to monitor and educate ourselves about the
new processes, policies, and regulations and stay nimble as an organization so we can
adjust to change. We will need to stay relevant as a Medicaid provider in North Carolina
and provide the best, coordinated care to our clients in Orange County.
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):
PUBLIC HEALTH &
MEDICAID MANAGED CARE
NOVEMBER 29, 2017
The information contained in this presentation is intended to be general in nature and
does not represent the perspective of any particular health department. The Association
encourages all public health stakeholders to remain engaged with the Medicaid
transformation process and to advocate for a meaningful managed care plan that
supports the optimal delivery of essential public health services to meet the needs of
every community.
- Jim Bruckner, President
NCALHD
MEDICAID IN THE UNITED STATES
•Medicaid provides health coverage to millions of Americans,
including eligible low-income adults, children, pregnant women,
elderly adults, and people with disabilities. Medicaid is administered
by states, according to federal requirements. The program is funded
jointly by states and the federal government.
•About 68.5 million people in the United States were covered as of
July 2017.
CHILDREN’S HEALTH INSURANCE PROGRAM
(CHIP)
IN THE UNITED STATES
•The Children’s Health Insurance Program (CHIP) provides health coverage
to eligible children, through both Medicaid and separate CHIP programs.
CHIP is administered by states, according to federal requirements. The
program is funded jointly by states and the federal government.
•About 5.8 million additional children in the United States covered as of July
2017.
•For the purposes of this presentation, Medicaid & CHIP will be considered
as one.
NATIONAL SIGNIFICANCE
•319 million people in the United States
•About 20% of the U.S. Population is covered by Medicaid/CHIP
•$1 out of every $6 spent in healthcare in this country is Medicaid
•$545 billion of national health expenditures (about 17% of total)
MEDICAID MANAGED CARE IN THE
UNITED STATES
•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.
•Over 55 million Medicaid enrollees covered under some form of Medicaid
managed care as of July 2014 (77% of total enrollment).
•Managed care is the norm, not the exception.
MEDICAID MANAGED CARE IN THE
UNITED STATES
MEDICAID & CHIP IN NORTH CAROLINA
•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.
•2,030,268 million people in North Carolina were covered as of July 2017.
MEDICAID & CHIP IN NORTH CAROLINA
•Total State Fiscal Year 2016 Medicaid expenditures were $13.9 billion.
•State appropriations for Medicaid were $3.5 billion of that $13.9 billion.
•Federal dollars make up the majority of the remaining Medicaid budget.
•State Medicaid dollars were about 15.7% of the total $22.3 billion state
budget.
MEDICAID MANAGED CARE
IN
NORTH CAROLINA TODAY
As of July 2011, over 80% of Medicaid beneficiaries in NC were enrolled in
some form of managed care.
Primary Examples include:
•Community Care of North Carolina – Primary Care Case
Management
•LME’s/MCO’s – Mental Health, Developmental Disabilities &
Substance Abuse
•Care Coordination for Children (CC4C) and OB Care Management
(OBCM)
MEDICAID MANAGED CARE IN THE FUTURE
•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.
MEDICAID MANAGED CARE IN THE FUTURE
•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. Some exceptions are in the law like
individuals that are dually eligible for Medicaid and Medicare and certain
carve out services (like communicable disease and immunizations for health
departments.)
•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.
MEDICAID MANAGED CARE
LEGISLATIVE GOALS
•Ensure budget predictability through shared risk and accountability.
•Ensure balanced quality, patient satisfaction, and financial measures.
•Ensure efficient and cost-effective administrative systems and structures.
•Ensure a sustainable delivery system.
MEDICAID MANAGED CARE BASICS
•Shifts fee for service model to value based reimbursement
•Capitated model based on per member per month (PMPM) rates
•Managed care organization is an insurance company (Prepaid Health
Plans)
•Managed care organization accepts risk and needs scale
ORANGE COUNTY PUBLIC HEALTH
&
MEDICAID
MEDICAID REVENUE IN FY 17:
•PRIMARY CARE & OBCM/CC4C CARE MANAGEMENT $ 40,873
•CLINICAL SERVICES (MATERNAL HEALTH, CHILD HEALTH, etc.) $411,437
•DENTAL (not impacted by Medicaid Transformation so far) $228,318
•COST SETTLEMENT $879,421
TOTAL $1,560,050
ORANGE COUNTY PUBLIC HEALTH
&
MEDICAID
MEDICAID REVENUE IN FY 17:
•PERSONAL HEALTH BUDGET REVENUES EQUAL $4,341,214
•MEDICAID REVENUE OF $680,629 REPRESENTS 11% OF TOTAL REVENUES
•MEDICAID REVENUE OF $680,629 REPRESENTS 16% OF NON-COUNTY
REVENUES
ORANGE COUNTY PUBLIC HEALTH
&
MEDICAID
COST SETTLEMENT EXPENDITURES IN FY 17:
•Capital Renovations: $358,702
•Finance and Administrative Services: $23,500
•Dental: $18,000
•Health Promotion and Education Services: $56,072
(Family Success Alliance - $27,720)
•Personal Health: $30,000
Total $486,274
WHY DOES THIS MATTER TO PUBLIC HEALTH?
CARE MANAGEMENT
•Role could be removed from health departments (Eliminated or given to
MCO’s)
•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
•Single largest Medicaid revenue for local health departments today (other
than Orange County)
WHY DOES THIS MATTER TO PUBLIC HEALTH?
CLINICAL SERVICES & COST SETTLEMENT:
•Required role with clinical services through mandated services
•Higher costs per service for health departments since we are also
complying with federal and state program requirements
•Cost settlement offsets that additional expense for local health departments
•Cost settlement could end; the role with clinical services would be
compromised
WHY DOES THIS MATTER TO PUBLIC HEALTH?
CLINICAL SERVICES & COST SETTLEMENT
•DHHS envisions that “Advanced Medical Homes” will coordinate services
for Medicaid patients
•Unclear if all health departments will qualify for that designation (Primary
Care)
•Barriers for seeing Medicaid patients and achieving historical revenues,
including cost settlement, would again compromise capacity and staffing
(particularly for uninsured patients)
WHY DOES THIS MATTER TO PUBLIC HEALTH?
CLINICAL SERVICES & COST SETTLEMENT:
•Billing and accountability for services today is tied to one entity (the State)
•Under Managed Care, there will be 3 statewide MCO’s and up to 12
Provider-Led Entities (PLE’s) in 6 regions – additional administrative
burdens for local health departments
•Future payment models will likely include a blend of contracted fee for
service arrangements and/or additional per member per month programs
WHY DOES THIS MATTER TO PUBLIC HEALTH?
BIG PICTURE:
•Medicaid revenue streams have become critical funding for local health
departments
•In NC, state funding for public health is ranked 44th; lowest in the Nation
($14.16 per capita; $27.40 per capita is the median)
•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
•February 2018 – Estimated CMS Approval of Amended 1115 waiver
application
•June 2018 – Requests for proposals released by state
•March 2019 – Contracts awarded and executed
•July 2019 – Prepaid Health Plans (PHP) go live
•July 2020 – Statewide rollout complete
PUBLIC HEALTH’S ROLE IS BEING DEFINED
NOW
•Managed care networks are soliciting LHD’s with contracts
•DHHS is defining the role for essential community providers (safety net)
•Carve-outs have been established for communicable disease,
immunizations, and family planning
•Cost settlement and care management roles are critical considerations
CHALLENGES FOR PUBLIC HEALTH
•Provider of last resort – inability to discharge patients, complex patients
•Uncertain about qualifying as an Advanced Medical Home – Primary care
role
•Questions about Medicaid dollar being able to follow the patient for services
•Questions regarding how health departments would get paid for social
determinants of health initiatives and chronic disease prevention
CHALLENGES FOR PUBLIC HEALTH
•Won’t be a level playing field
•Navigation resources for people to choose Prepaid Health Plans is lacking
•Public health services not particularly cost effective due to federal
requirements
•Additional federal and state decisions are looming - uncertainty
OUR STEPS FORWARD
•Electronic Health Record (HER) implementation
•Meaningful use of HER
•Large scale focus on improvement with clinical quality measures
•Practice transformation initiative
•Strong role with community and social determinants of health
WHAT NEXT?
•NC Association of Local Health Directors is advocating for Local Health
Departments
•Consultant hired by NCALHD to provide capacity and expertise
•Ongoing responses to additional legislation, 1115 waiver application
amendments and changes to managed care plan
PUBLIC HEALTH OBJECTIVES
•Play a valid role in Medicaid reform and clinical services without
compromising our broader public health mission
•Maintain public health capacity and expand role with initiatives beyond
traditional health care
•Continue to meet community needs for all families individuals
SOURCES
•Medicaid In the United States & North Carolina – Kaiser Family Foundation
http://files.kff.org/attachment/fact-sheet-medicaid-state-NC
•CMS NHE Fact Sheet
https://www.cms.gov/research-statistics-data-and-systems/statistics-trends-and-
reports/nationalhealthexpenddata/nhe-fact-sheet.html
•Medicaid and NC Health Choice (CHIP) SFY 2016 Annual Report
https://files.nc.gov/ncdma/documents/files/Medicaid-Annual-Report-State-Fiscal-Year-2016.pdf
•Trust for America’s Health – Key Health Data About North Carolina
http://healthyamericans.org/states/?stateid=NC#section=1,year=2017,code=undefined
Agenda Item Number:
ORANGE COUNTY BOARD OF HEALTH
AGENDA ITEM SUMMARY
Meeting Date: November 29, 2017
Agenda Item Subject: Elections (Chair & Vice-Chair)
Attachment(s): None
Staff or Board Member Reporting: Liska Lackey
Purpose: __X_ Action
_ __ Information only
____ Information with possible action
Summary Information:
Per the Board of Health Policies and Procedures, the Board shall elect a Chair and
Vice-Chair by majority vote each year at the last meeting of the calendar year.
Recommended Action: _X_Approve
___Approve & forward to Board of Commissioners for action
___Approve & forward to ___________________________
___Accept as information
___Revise & schedule for future action
___Other (detail):
Agenda Item Number:
ORANGE COUNTY BOARD OF HEALTH
AGENDA ITEM SUMMARY
Meeting Date: November 29, 2017
Agenda Item Subject: Periodic Review of Drinking Water Fluoridation
Attachment(s): OWASA Water Fluoridation Letter
Staff or Board Member Reporting: Dorothy Cilenti
Purpose: ____ Action
_ _ Information only
__X_ Information with possible action
Summary Information:
Following public input and discussion at their meeting on October 26, 2017, the OWASA
Board of Directors would like to explore with the Orange County Health Department a
County-wide process for periodic review of drinking water fluoridation to evaluate the
latest scientific findings on the benefits for oral health and any harmful effects it may
have on any aspect of health.
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):
ORANGE WATER AND SEWER AUTHORITY
A public, non-profit agency providing water, sewer and reclaimed water services
to the Carrboro-Chapel Hill community.
400 Jones Ferry Road
Carrboro, NC 27510-2001
Equal Opportunity Employer
Printed on Recycled Paper
Voice (919) 968-4421
www.owasa.org
November 3, 2017
Dr. Dorothy Cilenti, DrPH
Interim Orange County Health Director
300 West Tryon Street
Hillsborough, NC 27278
Subject: Water Fluoridation
Dear Dorothy,
Following public input and discussion at their meeting on October 26, 2017 (meeting video), the
OWASA Board of Directors would like to explore with the Orange County Health Department a
County-wide process for periodic review of drinking water fluoridation to evaluate the latest
scientific findings on the benefits for oral health and any harmful effects it may have on any
aspect of health. While any future decision(s) on fluoridation for the Chapel Hill-Carrboro
community will remain the responsibility of the OWASA Board, we recognize that the Orange
County Health Department is a very important community resource for such health and safety
matters.
The OWASA Board discussed the following key components for review of fluoridation:
• Open and transparent process that has been communicated to the public and stakeholders.
• Individuals and organizations that both support and do not support fluoridation will be
invited to provide input.
• The latest science will be reviewed by dental and medical experts who have recognized
credentials in their fields of expertise including all aspects of human health that could be
affected by fluoridation.
• The review will specifically address key concerns raised by those who do not support
fluoridation.
• The observations and findings of the review will be communicated to the public and
stakeholders in a clear and understandable way.
As a next step, OWASA very much appreciates the Health Department’s timely feedback and
recommendations regarding a County-wide process for periodic review of fluoridation.
Thanks,
____________________
Ed Kerwin
Executive Director
c: OWASA Board of Directors
Water Fluoridation
November 3, 2017
Page 2
Mr. David Andrews, Carrboro Town Manager
Ms. Bonnie Hammersley, Orange County Manager
Mr. Eric Peterson, Hillsborough Town Manager
Mr. Roger L. Stancil, Chapel Hill Town Manager
Health Director’s Report
November 29, 2017
• Behavioral Health Consultant Update
A committee made up of staff from the Health department, the Criminal Justice
Resource department, representatives from both school systems, the DSS
Director, and a representative from Cardinal Innovations met October 9th to
review 6 proposals submitted in response to our Behavioral Health Consultant
RFP. While the proposals were for the most part excellent, the committee
unanimously chose to award a contract to NRI, Inc. (National Association of
State Mental Health Program Directors Research Institute.) NRI came highly
recommended by multiple references. NRI is headquartered in Falls Church,
Virginia, however they have contracted with Mark O’Donnell, who lives in NC,
and is a former employee of the North Carolina Division of Mental
Health/Developmental Disabilities/Substance Abuse Services to serve as a local
liaison. The key stakeholder group will meet in December to provide strategic
oversight and kick-off the project.
• Family Success Alliance Recognition
Each year GSK honors ten Triangle nonprofits that are making a positive
IMPACT on health outcomes. On November 16th, 2017 EmPOWERment, Inc.
won an IMPACT award on behalf of the Family Success Alliance’s Zone
Navigator program. Award winners will receive $40,000 each and were selected
by a panel of local and national community leaders through a competitive
process. The nonprofits needed to demonstrate innovative, measured and
sustainable approaches to addressing health factors.
EmPOWERment, Inc. employs four Zone 6 Navigators for the Family Success
Alliance (FSA). The Navigators are bilingual community leaders who partner with
economically disadvantaged families to assess their current needs, set goals and
pave a pathway toward success. FSA partners with almost a dozen community
nonprofits who collaborate to bring programs to FSA families, create common
measures of success, share data and assess impact, strategize to help families
achieve their goals, and commit to collective impact training and work
• Other Family Success Alliance Updates
Family Success Alliance submitted a Phase 1 application to the Robert Wood
Johnson Foundation for consideration as a Culture of Health prize winner. The
Culture of Health prize recognizes communities that have place a priority on
health and are creating powerful partnerships and deep commitments that will
enable everyone, especially those facing the greatest barriers to good health, the
opportunity to live healthy lives. In December, applicants will be selected to
submit Phase II applications. Site visits with finalist communities will be
conducted in Spring 2018.
• TB Update
Last month’s report contained information regarding the UNC undergraduate
student who was diagnosed with active TB after routine testing. It was later
determined that the student had volunteered at a local middle school. After letters
were sent to the parents advising that their children be tested, there were still
children who did not receive a skin test.
In order to eliminate testing barriers, the CD team arranged for onsite testing at
the school. All 13 children who had not yet been tested received skin tests with
consent forms signed by their parents. All 13 were read, resulting in a 100%
completion rate of first round testing.
The CD team is calling all parents again in preparation for the next round of
testing which will take place December 1. We are following guidance that states
that all contacts have to be tested twice, with the second test performed 8 – 12
weeks after last known exposure. Tests will be read on Monday Dec 4. The CD
team is going to the school again to make it easier for the children. If parents
choose to get the second round of testing done somewhere else, they have until
the winter break to return documentation to the school nurse.
• Staff Recognitions
Congratulations to Ashley Rawlinson for being voted in and awarded the 2017 -
2018 position of Vice - President for NC SOPHE (Society of Public Health
Education)! The Vice - President will also serve as the Chair for the Program
Committee, which is responsible for planning the 2018 NC SOPHE Annual
Meeting.
Donna King received her thirty year service pin from NCPHA in September.
• Public Health PHield Trip
On November 10, 2017, the health department hosted approximately 40 public
health students for the annual Practice Pathways PHIeld Trip. Donna King
recruited staff volunteers to pair up with teams of students and compete in a trivia
game, answering questions about various services of the health department.
Teams walked from West Campus to Whitted stopping in to see restaurant
grades, local media, smoke-free public places signage, and other examples of
public health practices. Teams toured the Dental and Medical clinics and learned
that just telling someone how to be safe and healthy isn’t as easy as it looks. By
competing in a condom relay, students learned a bit more about what it takes to
respond correctly and consistently under pressure—they struggled with being
shy, embarrassed, and unsure. They will have a lot to consider and reflect upon
when practicing public health in the future.
• Healthy Carolinians
Health Carolinians will not have a traditional annual meeting this fall. In January,
Healthy Carolinians will be hosting a Poverty Simulation where agencies/staff
have the opportunity to experience many of the everyday stressors faced by low-
income clients and customers. The Board of Health is invited to participate;
contact Ashley Rawlinson arawlinson@orangecountync.gov 919-245-2440