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HomeMy WebLinkAboutBOH agenda 092017ORANGE COUNTY BOARD OF HEALTH MEETING AGENDA DATE: September 20, 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 September 20, 2017 Agenda 7:10 – 7:15 IV. Actions Items (Consent) A. Minutes of August 23, 2017 Liska Lackey 7:15 – 8:00 V. Educational Sessions A. HCOC Update Ashley Mercer-Rawlinson B. Employee Wellness-Nutrition Services Renee Kemske C. STOP Act Dr. Stephanie George D. Men's Primary Care Update Rebecca Crawford 8:00 – 8:10 VII. Reports and Discussion with Possible Action A. Health Director Report Dorothy Cilenti B. Media Items Dorothy Cilenti 8:10 – 8:40 VIII. Closed Session to Discuss Health Director Recruitment 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. 8:40 – 8:40 IX. Adjourn to Open Session 8:40 – 8:45 X. Board Comments 8:45 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 August 23, 2017 S:\Managers Working Files\BOH\Agenda & Abstracts\2017 Agenda & Abstracts/ August 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 August 23, 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; Coby Jansen Austin, Programs and Policy Director; Alan Clapp, Environmental Health Director; Rebecca Crawford, Financial and Administrative Services Director; Michael DeFranco, Public Health Nurse II; Robin Gasparini, Public Health Nursing Supervisor; Donna King, Health Promotions and Education Services Director; Pam McCall, Personal Health Services Director; Dr. Erica Pettigrew, Medical Director; Kristin Prelipp, Communications Manager; Beverly Scurry, Board of Health Strategic Plan Manager; La Toya Strange, Administrative Assistant II and Allison Young, Health Informatics Manager. GUESTS PRESENT: Caitlin Fenhagen, Criminal Justice Resource Director. I. Welcome New Employees Liska Lackey, Chair, called the meeting to order. She introduced new BOH member, Dr. Bruce Baldwin. The BOH members introduced themselves. Dr. Cilenti welcomed new employees, Michael DeFranco and Kristin Prelipp, in attendance. II. Public Comment for Items NOT on Printed Agenda: None III. Approval of the August 23, 2017 Agenda Motion was made by Mia Burroughs to approve the agenda, seconded by Jessica Frega and carried without dissent. IV. Action Items (Consent) A. Minutes of June 28, 2017 Meeting Motion was made by Sam Lasris to approve the minutes of June 2017, seconded by Barbara Chavious and carried without dissent. V. Educational Sessions MINUTES-Draft ORANGE COUNTY BOARD OF HEALTH August 23, 2017 S:\Managers Working Files\BOH\Agenda & Abstracts\2017 Agenda & Abstracts/ August Page 2 A. Criminal Justice Resource Department Update Caitlin Fenhagen, Criminal Justice Resource Director, began by giving an overview of her department including staff, history, and programs. The Criminal Justice Resource Office (CJRO) opened in November 2015 as a division of the County Manager’s Office. On July 1s, 2017, it became a department in Orange County Government. The department oversees and supports jail alternatives programming in Orange County. In addition to Ms. Fenhagen, the staff consists of the Pretrial Release Case Manager, the Drug Treatment Coordinator and a Criminal Case Assessment Specialist. Misdemeanor Diversion Program Coordinator, Mental Health Liaison for Court-Involved Youth and Administrative Assistant are the positions in which they will hire for FY 17-18. These positions assist court and criminal justice stakeholders by providing recommendations for pretrial release, diversion and treatment opportunities in the community for individuals facing pretrial detention. The department also provides support and case management services to individuals participating in the Pretrial Release and Drug Court programs. In addition, the Criminal Case Assessment Specialist works directly with individuals incarcerated in the Orange County Detention Center with mental health and substance abuse issues in order to address specific therapeutic needs and to link these individuals to appropriate services and resources in the community. The department’s objective is to reduce overall rates of pretrial detention, reduce the numbers of individuals with mental illness in custody, reduce recidivism and address racial and economic disparities in pretrial detention. Some of the department’s collaborations include the Orange County Sheriff’s Office, Partnership to End Homelessness, Cardinal Innovations, Jail Mental Health Work Group, Reentry Council Planning, Justice Advisory Council and the Health Department. Ongoing Collaboration Needs are:  Continuity of behavioral health care and case management needs after incarceration in Jail and Prison.  Enhancement of health care and dental care referral process for criminal-justice involved individuals.  Discussion of community crisis resource needs that will allow for increased law enforcement diversion of minor offenses or those offenses committed by individuals experiencing homelessness, mental illness and substance use disorders.  Health Department role in Drug Treatment Courts. The BOH members had questions that were addressed by Ms. Fenhagen. B. 4th Quarter Financial Reports and C. 4th Quarter Billing Dashboard Reports Rebecca Crawford, Finance and Administrative Services Director, gave a report on the 2nd quarter revenue and billing accuracy. Her report is as follows: • Total Health Department Revenue: Average YTD monthly revenue in FY17 after the fourth quarter is $247k/month or $2.97 million YTD, representing 95% of our overall budgeted revenue for the year. This is an increase from an average of $225k/month in FY16. Expenses were level with revenues at 95%. MINUTES-Draft ORANGE COUNTY BOARD OF HEALTH August 23, 2017 S:\Managers Working Files\BOH\Agenda & Abstracts\2017 Agenda & Abstracts/ August Page 3 • Total Billing Accuracy: Continuing with the goal of 90% billing accuracy set in FY 14-15, the average billing accuracy rate for medical at the end of FY 16-17 is 90% as compared to 95% in FY 15-16 and the average rate for dental for FY 16-17 is 98% as compared to 97% in FY 15-16. • Dental Earned Revenue by Source: The FY 16-17 average monthly revenue ($41k/month) ended the fiscal year below our budget projection ($47.5k/month) due to decreased Medicaid and Commercial Insurance patients (Self-pay receipts exceeded budget) and level with our FY 15-16 average of $40k/month. FY 16-17 dental revenue totaled $497k at the end of the fourth quarter. • Medical Earned Revenue by Source: Medical earned revenue is currently below the budgeted projection for FY 16-17. The monthly average after the fourth quarter ($55k/month) exceeded FY16 ($50k/month) but lower than our budget projection ($59.6k/month). Medical revenue totaled $663k for FY 16-17. The BOH had questions that were addressed by Ms. Crawford. D. 2013 Medicaid Cost Settlement Program Reimbursement Rebecca Crawford, Financial and Administrative Services Director, updated the Board of the ongoing 2103 Medicaid Cost Settlement. The Health Department received official notification of a Notice of Program Reimbursement on August 3rd from the NC DHHS Department of Medical Assistance (DMA). This notice referenced the 2013 Medicaid Cost Settlement report (period ending June 30, 2013.) As you may remember, the Medicaid cost settlement process has been contested since DMA required a new cost report methodology beginning in State Fiscal Year (SFY) 2011. The main point of contention is the calculation of the Medicaid population statistic. After a long debate, the primary issue of the Medicaid population statistic has been clarified by a recent ruling in a lawsuit between DMA and Cabarrus County. DMA prevailed and will retroactively settle all Local Health Department (LHD) cost settlements beginning with SFY 2013. SFY 2013 will be the only year where an overpayment (by DMA) is applied since DMA started using the new statistic prior to payments made in SFY 2014. Orange County is in a payback situation and owes a total of $200,524 to DMA. We received funds in 2015 from the state legislature to offset the loss incurred by the SFY 2013 overpayment in the amount of $219,043.90, which when combined with the payback amount referenced above, leaves us with a net gain of $18,519.90. DMA has offered LHD’s the option to either accept the payback amount and remit payment or appeal the proposed payback by “scrubbing” our data according to the agreed upon process listed in the Cabarrus County court ruling. We’ve learned this made a significant reduction in the payback amount for Cabarrus County. Our staff have determined it is in our best interest to work with the NC Public Health Association (who historically has prepared our annual cost settlement report) to “scrub” our 2013 data. Ms. Crawford also stated that, for FY 15/16, Orange County will receive $800,000. She also mentioned that DMA now requires patient names and birth dates to be included in the coding/billing process. The BOH had questions that were addressed by Ms. Crawford and Dr. Cilenti. MINUTES-Draft ORANGE COUNTY BOARD OF HEALTH August 23, 2017 S:\Managers Working Files\BOH\Agenda & Abstracts\2017 Agenda & Abstracts/ August Page 4 E. Senate Bill 16 Alan Clapp, Environmental Health Director, discussed Senate Bill 16 Section 19 Wastewater System Permit Extension and its impact to Environmental Health. The legislature recently ratified Senate Bill 16. This Act is a regulatory reform bill that among other things extends the expiration of wastewater permits. This Act differs from previous extension legislation in that the extension affects long expired wastewater permits. The three previous extension acts only extended the life of currently valid permits. The amended new subsection in the act reads “any improvement permit or authorization for wastewater system construction issued by a local health department from January 1, 2000 to January 1, 2005, which has not been acted on and would have otherwise expired, shall remain valid until January 1, 2020, without penalty, unless there are changes in the hydraulic flows or wastewater characteristics from the original local health department evaluation....” Opponents’ Talking Points  Contradicts SL 2014-120 which says that the Health Department can advise owner of new systems and technologies available.  Rule changes and new septic system technologies that have been developed since the original permit were issued cannot be used since the original permit must be honored.  No provisions for changes in site plan or altered site conditions from manmade or natural causes.  Altered site conditions would not result in letter of revocation and appeal rights.  Greater chance that conditions on the site have changed resulting in increased potential for tort claims.  Permits issued in error would now be valid again.  The public would benefit from a new evaluation that may allow a gravity system where the old permit required a pump system.  Sites may have been permitted multiple times since 2000 due to normal course of expiration.  Well permits issued on valid permit site plans may now be invalid by resurrecting expired wastewater permits. Proponents’ Talking Points  Altered site conditions would not result in letter of revocation and appeal rights.  Greater chance that conditions on the site have changed resulting in increased potential for tort claims.  Permits issued in error would now be valid again.  The public would benefit from a new evaluation that may allow a gravity system where the old permit required a pump system.  Sites may have been permitted multiple times since 2000 due to normal course of expiration.  Well permits issued on valid permit site plans may now be invalid by resurrecting expired wastewater permits. Mr. Clapp also mentioned some local effects of the bill which include:  Altered site conditions would not result in letter of revocation and appeal rights.  Greater chance that conditions on the site have changed resulting in increased potential for tort claims. MINUTES-Draft ORANGE COUNTY BOARD OF HEALTH August 23, 2017 S:\Managers Working Files\BOH\Agenda & Abstracts\2017 Agenda & Abstracts/ August Page 5  Permits issued in error would now be valid again.  The public would benefit from a new evaluation that may allow a gravity system where the old permit required a pump system.  Sites may have been permitted multiple times since 2000 due to normal course of expiration.  Well permits issued on valid permit site plans may now be invalid by resurrecting expired wastewater permits. The bill status is as follows:  Ratified by the Legislature 8/3/17  Vetoed by the Governor 8/14/17  Legislature back in Session in September  Override of veto is quite possible  All House and Senate Republicans voted in favor of the Bill  Some Democrat House members voted in favor of the Bill Mr. Clapp suggested:  Contacting your representatives in House and Senate  Encouraging supporting the Governor’s veto  Or removing Section 19 from the Bill The BOH had questions that were addressed by Mr. Clapp. F. NALBOH Update BOH Strategic Plan Manager, Beverly Scurry and Susan Elmore, BOH Co-chair, attended this year’s NALBOH 2017 Annual Conference that was held in Cleveland, OH on August 2-4, 2017. Ms. Scurry began by thanking the Board for the opportunity to attend. Ms. Elmore had emailed a link to the BOH members with session links. Some of the concepts covered at the conference were innovation, partnership building, community engagement and involvement. Ms. Scurry recalled a session that dealt with the opioid crisis in Wake County. She also mentioned that Orange County has been more proactive through our usage of needle boxes and naloxone. There was another session whose focus was on the tobacco age limit raise. Unfortunately, Orange County BOH cannot raise the legal buying age to 21; however, the BOH has passed a resolution in support of the age limit increase. Ms. Elmore also praised a pre-conference workshop titled “How Can I be a Public Health Leader?”. Lastly, Ms. Scurry stated that next year’s NALBOH conference will be held in Raleigh and that abstracts will be requested soon. VI. Action Items (Non Consent) A. FY 16/17 Delinquent Accounts Per the department’s Delinquent and Uncollectable Accounts policy (15.0), uncollectible accounts are to be administratively written off the books. The purpose of this accounting function is to precisely account for and pursue funds which are truly unrecoverable. The last administrative write-offs were performed by the Board of Health in August 2016 (Personal Health, Dental Health, and Environmental Health) for FY 2015. MINUTES-Draft ORANGE COUNTY BOARD OF HEALTH August 23, 2017 S:\Managers Working Files\BOH\Agenda & Abstracts\2017 Agenda & Abstracts/ August Page 6 Personal Health, Dental Health, and Environmental Health continue to participate in the NC Debt Set-Off Program, which allows the county to collect debts on delinquent accounts with a balance between $50 and $4,000 through the customer’s tax refund. The Health Department anticipate Per the department’s Delinquent and Uncollectable Accounts policy (15.0), uncollectible accounts are to be administratively written off the books. The purpose of this accounting function is to precisely account for and pursue funds which are truly unrecoverable. The last administrative write-offs were performed by the Board of Health in August 2016 (Personal Health, Dental Health, and Environmental Health) for FY 2015-2016. Personal Health, Dental Health, and Environmental Health continue to participate in the NC Debt Set-Off Program, which allows the county to collect debts on delinquent accounts with a balance between $50 and $4,000 through the customer’s tax refund. The Health Department anticipates collecting payments on delinquent accounts being pursued through the NC Debt Set-Off program; therefore, those accounts are not included in this write-off request. Based on the definitions of uncollectible accounts in the department’s policy, Rebecca Crawford, Director of Financial and Administrative Services, informed the BOH of the uncollectible debt from clients for FY 2016-17 which is displayed in the table below. Division Number of Uncollectable Accounts Write-Off Amount Personal Health 80 $1,401.15 Dental Health 89 $2,348.10 Environmental Health 6 $780.00 Total 175 $4,529.25 We request to administratively move a total of $4,529.25 in uncollectible debt from ‘active’ to ‘inactive’ status for the reasons indicted in the table above. The customer will never be informed that a debt has been written off. If a customer whose account had been determined uncollectible returns to clinic within three years, the delinquent write-off amount will be reactivated and the billing process resumed. Likewise, if a customer requests a non-required service from Environmental Health, the delinquent write-off amount will be reactivated and the billing process resumed. Motion to administratively move a total of $4,529.25 in uncollectable debt from “active” to “inactive” status was made by Susan Elmore, seconded by Jessica Frega and carried without dissent. B. Mid-Year Fee Request Rebecca Crawford, Director of Financial and Administrative Services, presented a proposed fee change to the Board. The Health Department reviews fee schedules on an annual basis through the budget approval process; however, the Nutrition Program was awarded funding from a regional Minority Disease Prevention Program (led by Alamance County) through NCDHHS for FY 17-18 after the FY 17-18 budget was approved. The Agreement Addendum associated with this funding requires that all funding recipients charge program participants a one-time fee of $25 unless a scholarship (i.e. fee waiver) is provided (see Section III.7 of the attached MINUTES-Draft ORANGE COUNTY BOARD OF HEALTH August 23, 2017 S:\Managers Working Files\BOH\Agenda & Abstracts\2017 Agenda & Abstracts/ August Page 7 Addendum). As this is a newly identified fee, it is necessary to add it to our fee schedule in an effort to remain in compliance with our Agreement Addendum. The proposed change is detailed below: Name of Fee 2017-18 Current Fee 2017-18 Proposed Fee 2017-18 Budget Impact MDPP Flat Fee $0 $25 $1,875 Motion to approve the proposed fee changes for 2017-2018 as presented and forward to the Board of County Commissioners for action was made by Barbara Chavious, seconded by Jennifer Deyo and carried without dissent. C. FIT Program Pam McCall, Personal Health Services Director, gave an overview of the Formerly Incarcerated Transitions (FIT) Program which is a project funded by the Duke Endowment to provide people released from NC prisons assistance in accessing medical services and other community reentry services. She began with some statistics and reasons detailing the need for the FIT Program. They include:  There are over 36,000 incarcerated in NC State Prisons.  Chronic disease are burden high (80%). Those include chronic medical problems, mental illness, and substance use disorders.  There is no system in place to transition into health care.  Only 15%-25% see a medical provider in first year post-release.  Death rate is 12 times normal in the first 2 weeks post-release. The NC Department of Public Safety (DPS) is in the process of improving the reentry process. Transition sites, which are existing prisons that will create protocols to facilitate coordination of services with local reentry service providers, are being created. Prisoners will be relocated to a transition site near their county of residence up to a year prior to release, enhancing opportunities to establish a reentry plan prior to discharge. To organize these efforts, DPS has encouraged regional reentry councils, where local organizations and agencies collaborate in supporting successful reentry. The missing component in the reentry process has been coordination of medical care. Presently, there is no system in place to link released prisoners with comprehensive health care services. The FIT Program will utilize a Community Health Worker who will engage people with chronic disease prior to release at a Transition Site, and along with the local reentry council, develop a comprehensive reentry plan. OCHD is partnering with UNC Family Medicine to implement the program by hiring and supervising a Community Health Worker to provide case manag ement services to people being released from prison in Orange County. For year one, the funding amount will be $35,594. The goals of the FIT program are:  Increase utilization of Primary Care and Behavioral Health Services.  Decrease rates of ED visits and hospitalization.  Increase adherence with use of medications and treatment plans.  Decrease recidivism. MINUTES-Draft ORANGE COUNTY BOARD OF HEALTH August 23, 2017 S:\Managers Working Files\BOH\Agenda & Abstracts\2017 Agenda & Abstracts/ August Page 8  Improve health outcomes and satisfaction with health care services. The BOH had questions that were addressed by Ms. McCall. Motion to approve acceptanvce of Duke Endowment grant funds to employ community health worker and forward to the BOCC for their approval was made by Susan Elmore, seconded by Sam Lasris and carried without dissent. D. Youth Tobacco Prevention Funding Donna King, Health Promotion and Education Services Director, presented the Board with a background on the acquisition of the funds. The North Carolina General Assembly appropriated $500,000 per year in non-recurring funds in FY17-18 and FY18-19 for youth tobacco use prevention. The budget provides funding to develop strategies to prevent the use of all tobacco products, with a focus on new and emerging tobacco products, including electronic cigarettes by youth and people of childbearing age. Orange County Health Department was recognized as a leader in youth tobacco use prevention by the Region 5 Health Directors and will receive $45,500 to support and enhance current youth tobacco use prevention programming. April Richard, Tobacco Prevention and Control, is currently collaborating with all five local high schools; engaging youth in peer prevention work through TRU Clubs. Most of these high school clubs are running on very low funds. The BOH members had questions that were addressed by Ms. King and Dr. Cilenti. Motion to approve OCHD receiving funds to support and enhance current youth tobacco use prevention programming and forward to the BOCC for their approval was made by Jessica Frega, seconded by and Sam Lasris and carried without dissent. E. BOH Policy Updates Beverly Scurry, Board of Health Strategic Plan Manager, began by informing the BOH members that the BOH is required to review their Policies and Procedures each year to meet accreditation standards. Updates to the Fee and Eligibility Policy recommendations are below: I.E. Fee and Eligibility Policy • Addition of Family Home Visiting under income eligibility. • Change from 10 days to 30 days or less in which patients must provide verification of income and/or residency • Residency requirements specify residents or non-resident ‘may’ be eligible instead of ‘is’ eligible. Also excludes Family Home Visiting programs. • Fee for service statement added - Fees for 340b drugs dispensed to Medicaid patients will be reviewed and set annually based on the average, annual cost to the County to purchase the drugs. Section I.E. Attachment B • Reflects the change from 10 business days to 30 business days or less MINUTES-Draft ORANGE COUNTY BOARD OF HEALTH August 23, 2017 S:\Managers Working Files\BOH\Agenda & Abstracts\2017 Agenda & Abstracts/ August Page 9 Motion to update the BOH Fee and Eligibility Policy and Complaint Policy as staff recommends was made by Mia Burroughs, seconded by Timothy Smith and carried without dissent. VII. Reports and Discussion with Possible Action A. Health Director Report In addition to her report, Dr. Cilenti thanked Commissioner Burroughs for forwarding the Family Success Alliance’s (FSA) Impact Report to the BOCC. The Impact Report highlights what the FSA’s accomplishments over the last couple of years. It included various data and outcomes including feedback received from families receiving services. The FSA will continue to measure their activities. Dr. Cilenti also praised Nancy Largent, Communications Specialist, as she was the graphic designer that made the document visually appealing. B. Update on Health Director Search Liska Lackey, Chair, informed the Board that although, Miguel Ozuna has left Springsted Waters; the recruitment process hasn’t been affected. The health director position was posted on various sites including state and national associations. Springsted Waters has reached out to selected candidates to solicit their interest or to ask if they are aware of qualified candidates. Active outreach will continue until the first review date of August 28th. They’ll give the list of qualified applicants to the Board for review. C. Media Items Media items were in the packet which focused on Orange County’s events and our involvement in various efforts. X. Board Comments. New BOH member, Dr. Bruce Baldwin reintroduced himself and informed the BOH of his personal and professional background. XI. Adjournment Jessica Frega moved to adjourn the meeting at 8:45pm and Mia Burroughs seconded. The next Board of Health Meeting will be held September 20, 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 S:\MANAGERS WORKING FILES\BOH\AGENDAS & ABSTRACTS \2017 Agenda & Abstracts\September 2017\V.A. BOH 2017 HCOC Update Abstract.doc Agenda Item Number: ____ ORANGE COUNTY BOARD OF HEALTH AGENDA ITEM SUMMARY Meeting Date: September 20, 2017 Agenda Item Subject: 2017 Healthy Carolinians Update Attachment(s): Healthy Carolinians of Orange County 2017 Update Staff or Board Member Reporting: Ashley Mercer, Healthy Carolinians Coordinator Purpose/Recommended Action: ___ Approve ___ Approve & forward to Board of Commissioners ___ Information with possible action _X_ Accept as information ___ Revise & schedule for future action Summary Information: Since the last HCOC presentation, in March 2017, HCOC committees have been working hard planning and preparing to implement the goals that were identified in the 2016-2019 Community Action Plans. This presentation will share what has been implemented thus far and share the plans of what is in store for the rest of 2017. Financial Considerations: None Recommended Motion (if any): Ashley Rawlinson, MPH Healthy Carolinians Coordinator Access By March 2019, the Access committee will produce a transportation access improvement activity guide and recruit 5 partner agencies to adopt one or more activities listed within the guide. Transportation Survey Survey Respondents: Health Dept. Piedmont Health Services Community Health Centers  UNC Healthcare UNC Family Medicine Physician’s Network Board of Health Transportation Barriers 0 1 2 3 4 5 Don't know how to use the transit system Routes don't go where I need them to go Buses are not operating at the times I need Language Barrier Too many transfers required Bus stop not within walking distance Cost 0 20 40 60 80 100 Staff in-service on local transit options Information on local bus service providers Local Map Routes Fee schedule Guide on how to access bus services Guidance on ADA Transit Info Center Try Transit Event Try Transit Week Try Transit Week October 23 – 28 Try Transit Academy October 10th @ UNC Hospital, Hillsborough Campus October 13th @ Seymour Center Mental Health & Substance Abuse By March 2019, we will create a suicide prevention campaign to encourage residents to access 911, the Suicide Prevention Lifeline, and Cardinal Access line as sources of intervention, treatment and referral Suicide in Orange County Suicide Rate – 8.8 per 100,000 persons. Suicide is the 2nd leading cause of preventable death for individuals between the ages of 20 and 39. Suicide is the 4th leading cause of preventable death for individuals between the ages of 40 and 64. Suicide is most prevalent among white males. The Campaign #BeThe1To: Highlights the fact that everyone has a role to play in suicide prevention The 5 components of the campaign are to: Ask Keep them safe Be There Help them connect Follow up Kickoff Event 11 13 11 13 10 11 6 3 3 1 4 2 4 1 Overall organization Guest Appearances "Be the 1 To" Presentation Personal Testimony Length of the Meeting Facility Setting Food Poor Fair Good Excellent Partnering with K97.5 Partnering with CH Transit Upcoming Events Physical Activity & Nutrition By March 2019, the PAN committee will increase knowledge and influence behavior change related to eating smart and moving more by encouraging 10 agency partners to promote a county-wide consistent messaging campaign that will distribute messages through a variety of established channels and media, over 6-months. Overweight & Obesity in OC 51% of adults are not a healthy weight 14% of low income preschool children are obese 48% of adults are not getting the recommended exercise 81% of HS students are not getting 60 min exercise/day (CHCCS) 75% of adults are not getting 5+ servings of fruits or veggies/day Consistent Messaging Campaign Participants OCHD OC Dept on Aging OCS CHCCS Carrboro Rec & Parks Bridging the Gap CDC OCPYC Kidzu UNC Wellness Centers UNC Healthcare No Kid Hungry OC Head Start/Early Head Start CMC Messages & Pledges The 6 messages, to be shared over a 6 month period: October - Move More November – Fruits & Veggies December – Prepare More Meals at Home January – Screen Time February – Re-Think your Drink March – Right Size your Portions Questions? Agenda Item Number: ORANGE COUNTY BOARD OF HEALTH AGENDA ITEM SUMMARY Meeting Date: September 20, 2017 Agenda Item Subject: Employee Wellness- Nutrition Services Attachment(s): Staff or Board Member Reporting: Renée Kemske, Nutrition Program Manager Purpose: ____ Action _X _ Information only ____ Information with possible action Summary Information: In November 2016, the County Manager approved the proposal to allocate wellness funds ($10,000) to support one of the Health Department’s registered dietitians’ salaries to provide Nutrition Counseling and Diabetes Self- Management Education services that are not covered by the County Health Plan. The County Health Plan only covers nutrition services for people with diabetes, obesity, hypertension and/or abnormal lipids. The purpose of these funds is to increase access to these preventive services to keep employees well and to reduce health care costs due to uncontrolled illness. Current Progress: Nutrition Services staff initiated wellness nutrition counseling appointments on 11/29/16 and provided 29 individual appointments, 4 group classes to 45 people, and 2 DSME appointments (FY16-17; short staffed 1FTE RD position February-June 2017). Most of the individual appointments were for weight management and/or general healthy eating to prevent chronic conditions. The most effective marketing methods have shown to be promotional emails and/or promotion at County-wide employee wellness events. The next steps are to provide coordinated outreach efforts with the human resources department when promoting other wellness events and continue providing at least one group class per quarter. 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): Employee Wellness Nutrition Update ORANGE COUNTY HEALTH DEPARTMENT NUTRITION SERVICES Renée Kemske, MPH, RD, LDN, Nutrition Program Manager OBJECTIVES Provide an overview of Nutrition Services Discuss progress of new employee wellness nutrition initiatives Present upcoming plans for FY17-18 NUTRITION COUNSELING NUTRITION COUNSELING Medical Nutrition Therapy (MNT) Provided by an RD who works with the referring medical provider to improve conditions such as diabetes, heart disease, and obesity Conducts thorough review of medical history, medications, labs, diet, and lifestyle patterns Develops a personalized nutrition treatment plan/goals to improve health outcomes MEDICAL NUTRITION THERAPY (MNT) MNT Data Total Encounters for FY 2016-2017: 741 Health Department 395 53% Non-Health Department 346 47% Types of clients Count % Maternal Health 132 18% Child Health 213 29% PC 31 4% FP 19 2% Adult Non Health-Dept Referrals 236 32% Child Non Health- Dept Referrals 110 15% MEDICAL NUTRITION THERAPY (MNT) Clients by Payment Type (741 Total) Payer Count % Medicaid 339 46% Insurance 274 37% Self-Pay 128 17% DIABETES SELF-MANAGEMENT EDUCATION PROGRAM (DSME) DIABETES SELF-MANAGEMENT EDUCATION PROGRAM (DSME) Participants will receive 10-hours of education: Initial health assessment Two 4-hours group education classes on the basics of diabetes care Follow-up appointment 3-months after the group class (1-hour group) WELLNESS NUTRITION SERVICES Background •County Health Plan covers nutrition counseling for obesity, diabetes, high cholesterol and high blood pressure •IF employees do not have these conditions, they would have to pay for the service –MNT Cost: $136/hour –DSME Cost: $410 for 10-hours WELLNESS NUTRITION SERVICES Background Fall 2016- presented proposal to Human Resources to fund a percentage of one of the Health Department’s registered dietitian’s salaries to provide additional nutrition services not already covered by the County Health Plan First Wellness Client 11/29/16 WELLNESS NUTRITION SERVICES FY16-17 Service Data 29 Individual MNT Appointments 45 Group MNT Classes 2 DSME Appointments FY17-18 Service Data 22 Individual MNT Appointments 8 Group MNT Class 2 DSME Appointment WELLNESS NUTRITION SERVICES WELLNESS NUTRITION SERVICES WELLNESS NUTRITION SERVICES WELLNESS NUTRITION SERVICES Outreach and Marketing Employee Appreciation Lunch-October 2016 EAR Meetings Holiday Challenge/Email Promotion New Employee Orientation National Nutrition Month® Events Employee Wellness Fair-June 2017 Most Effective Methods –Email Promotion and Promotion at County Events WELLNESS NUTRITION SERVICES Next Steps Coordinate Outreach Efforts with HR Wellness Initiatives Offer quarterly group MNT appointments Continue individual appointments Disseminate promotional emails Continue New Employee Orientation Show Need for Continued Use of Funds FOR MORE SUPPORT IN MAKING HEALTHY CHOICES…. Agenda Item Number: ORANGE COUNTY BOARD OF HEALTH AGENDA ITEM SUMMARY Meeting Date: September 20, 2017 Agenda Item Subject: S.T.O.P. Act Update for Dental Clinic Attachment(s): PowerPoint Summary Staff or Board Member Reporting: Stephanie George, DMD Purpose: ___ Action _X_Information only ___ Information with possible action Summary Information: The S.T.O.P Act (House Bill 243/Senate Bill 175) was signed by Roy Cooper on June 29th. The purpose of the Act is to decrease the circulation and misuse of opioids in NC, and thus reduce the overall mortality and morbidity from these drugs in our state. This presentation will summarize the implications of the S.T.O.P. Act on the OCHD Dental Clinic as well as outline steps we are taking to help reduce opioid dependence and its implications for our patients. Recommended Action: ___Approve ___Approve & forward to Board of Commissioners for action ___Approve & forward to ___________________________ ___Accept as information ___Revise & schedule for future action ___Other (detail): S.T.O.P Act Update Stephanie George, DMD Orange County Board of Health Meeting September 20, 2017 S.T.O.P. Act Overview Strengthen Opioid Misuse Prevention Act, signed by Roy Cooper on June 29, 2017. Part of larger action plan for the state. Goals: combat the opioid epidemic by reducing misuse and overuse. Targeting Schedule II and Schedule III Opioids 3 people die per day in NC from opioid overdose1 Over 1200 unintentional opioid deaths in 20161 1.Source: Average daily deaths using N.C. State Center for Health Statistics, Vital Statistics-Deaths, 2015-2016. NC Opioid Overview NC Opioid Overview OCHD Dental Clinic Implications New Provisions for Pharmacists EFFECTIVE SEPTEMBER 1, 2017 Pharmacists must input controlled substance prescriptions into the North Carolina Controlled Substances Reporting System (NCCSRS) by the close of business day. (Previously three days) Pharmacist can also call provider if they feel a prescription may be fraudulent or if a patient is misusing opioid. North Carolina Controlled Substances Reporting System (NC CSRS) North Carolina Controlled Substances Reporting System (NC CSRS) New Provisions for Providers EFFECTIVE JANUARY 1, 2018 Limits first -time prescriptions for acute pain to no more than 5 days Surgical procedures are limited to 7 days Subsequent consultations for same pain, can renew, refill, or issue new prescription of controlled substance New Provisions for Providers EFFECTIVE: January 1, 2020 Electronic prescribing of targeted controlled substances Will be integrated with the CSRS database New Provisions for Providers EFFECTIVE: TBD Must check CSRS for the past twelve months Must document check in treatment notes OCHD Dental Clinic Procedures ●Checking CSRS before any opioid prescription ●Baseline Rx is Ibuprofen 800 mg ●Opioid prescription only if: ○Cannot take ibuprofen for medical reasons ○Multiple teeth extracted ○Surgical extraction of teeth w/ bone removal, requiring extensive healing. ●No more than 15 tabs per procedure ●No refills within 30 days ●No schedule II drugs for any patient under 21 or pregnant ●Letting patients know that opioids are strong medications and can lead to addiction ●Flagging/monitoring patients who may be drug seekers Questions? Agenda Item Number: ORANGE COUNTY BOARD OF HEALTH AGENDA ITEM SUMMARY Meeting Date: September 20, 2017 Agenda Item Subject: Men’s Primary Care Pilot Update Attachment(s): Powerpoint Presentation Staff or Board Member Reporting: Pam McCall and Rebecca Crawford Purpose: __ Action _X_Information only ___ Information with possible action Summary Information: The Health Department began a pilot program in February 2016 to refer male, Orange County residents to Family Centered Healthcare, a local medical practice in Hillsborough. This program was designed to provide low-income males, specifically those from northern Orange County, with access to low-cost primary care. OCHD reimburses Family Centered Healthcare for all uninsured, referred patients according to the published Medicaid fee schedule. Uninsured clients are responsible for a portion of the total charges based on income unless they are determined to be homeless. We are now a year and a half into the project and based on the low cost and high impact to residents, staff recommend making this an ongoing program within the Health department. 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): Primary Care for Uninsured Men Pilot Project Update September 20, 2017 REFERRAL QUICK FACTS •53 men referred between July 1, 2016 and June 30, 2017 •In FY 16-17, 55% of those referred kept appointments (29 unique patients) •In FY 15-17, 50% of those referred kept appointments (20 unique patients) •42 unique patient visits in FY 16-17 • 30% of the unique patient visits were referred in FY 15-16 0 5 10 15 20 25 30 CALLED FAMILY MEMBER CALLED WALK-IN SAW A FLYER AT DSS OCHD PATIENT OUTSIDE REFERRAL Nu m b e r o f P a t i e n t s Methods of Contact How Did You Hear About Us? PAYMENT QUICK FACTS •Total Amount Expended by OCHD: $13,347 •Average Amount Expended by OCHD per patient: $318 ($253 in FY 15-16) •Average Amount Expended by patient: $28 ($47 in FY 15-16) 0 5 10 15 20 25 30 35 40 0%20%40%60%80%100% Nu m b e r o f P a t i e n t s R e f e r r e d Sliding Fee Scale Percentages Patients Referred by Percent Owed for Services TREND QUICK FACTS •Months with largest number of visits to Family Centered Healthcare: •July, September, October, March •Most frequent diagnoses: •Essential (Primary) hypertension, Major Depressive Disorder, Obesity, Type 2 Diabetes without complications 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 July August September October November December January February March April May June Nu m b e r o f P a t i e n t s Months FY 16-17 Number of Male Patients Seen Per Month Health Director’s Report September 20, 2017 • Suicide Prevention Activities September is Suicide Prevention Month. Healthy Carolinians has organized a series of community events to promote the “Be the 1 to….” message, including a Suicide Prevention Awareness Walk which will begin and end at “The Pit” on UNC campus on September 22 at 6 pm. Gently used, good condition shoes will be collected in advance of the vigil in memory of those “lost” to suicide. Collected shoes will be donated after the walk to Club NOVA Thrift Shop. To donate shoes, contact Kiana Redd at kredd@orangecountync.gov or call (919) 24-2379.5 • Family Success Alliance On September 5, Coby Austin presented an update on the Family Success Alliance to the Board of County Commissioners, including highlights from the recently released Impact Report, current activities, and a preview of the strategic planning process that is planned for this spring. The only feedback was approval of FSA's intention to pilot expansion into early childhood this fiscal year and a question about possible expansion to other geographic areas of the county. Coby will begin her maternity leave by the end of October, at the latest, at which time Meredith McMonigle will become Interim Director for FSA. • Ann Wolfe Mini-Grant The Health Department has been awarded an Ann Wolfe Mini-Grant for $8000 which will be presented at the NCPHA Awards Dinner on Sept. 28 in Asheville. With the funding, we will provide baby boxes that provide a safe sleep space for infants in addition to education on positive parenting behaviors and information to connect parents with community resources for newborns and young children. This is a pilot initiative to provide baby boxes to all health department prenatal clients to reduce the need for co-sleeping which has been shown to increase risk of SIDS. Distribution will be integrated into our OB Care Management services (for mothers who are not using the health department for prenatal services) and the Family Success Alliance initiative. Baby box implementation is based on a successful model from Finland. • EH Staffing Alan Clapp, Environmental Health (EH) Director, announced his retirement effective September 30, 2017. John Kase, EH Program Supervisor, will assume the Interim EH Director position effective October 2, 2017. We are grateful to Alan for his long-term service to Orange County Health Department and appreciate John’s willingness to assume this leadership role on an interim basis. The EH Director position will be posted following the appointment of a permanent Local Health Director. • Norovirus Outbreak On August 31, 2017 the health department received information about multiple cases of gastrointestinal symptoms among sorority members on the UNC campus. Thirty-five students were known ill on 8/31/2017 and 41 were sick by Friday, Sept. 1. Three samples were sent to labs and all came back positive for Norovirus Type 2. The health department in collaboration with Campus Health sent a letter to all students, parents, faculty and staff with information about Norovirus, ways to prevent further spread of the disease, and proper ways to disinfect areas where infected students were housed. Due to the high number of sick students (all associated with the sorority), the health department recommended that the sorority rush that was scheduled for Thursday and Friday nights be canceled given that 800 students were expected to rotate through the 12 sorority houses. The sorority rush was postponed until Sept. 7th. In addition, sick students were confined to an area hotel in Chapel Hill and healthy students were housed in a second hotel while the house was cleaned. While the exact source of the infection was not determined, it appeared that infected students ate at a food bar offered at the sorority house on Tuesday, August 29th. The sous-chef also became ill on August 30th. By the end of the investigation, communicable disease staff were able to interview 20 students, however phone interviews were not effective with this population and the response rate was low. In the future, information may be better obtained from students via electronic surveys. • Walking Challenge Orange County Health Department Staff are attempting to walk the distance of the Appalachian Trail, which is 320 miles, in six weeks. Staff members are putting their feet where their mouth is as they compete in a challenge with the Alamance and Durham County Health Departments. As a way to improve employee health and spread the message about the importance of physical activity staff members have begun tracking their steps every day using a variety of health monitors from Fitbits to pedometers. Their goal is to reach 320 miles in six weeks. The health department with the most miles by the end of the challenge wins a handsome trophy and bragging rights. Alamance, Orange and Durham health departments will gather on Wednesday, October 25th at 3 p.m. at the Whitted Building to announce the winner.