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HomeMy WebLinkAboutBOH minutes 092618MINUTES-Draft ORANGE COUNTY BOARD OF HEALTH September 26, 2018 S:\Managers Working Files\BOH\Agenda & Abstracts\2018 Agenda & Abstracts/ September 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 September 26, 2018 at the Orange County Health Department, 300 West Tryon Street, Hillsborough, NC. BOARD OF HEALTH MEMBERS PRESENT: Susan Elmore – Chair, Timothy Smith –Vice- Chair, Keith Bagby, Commissioner Mia Burroughs, Jennifer Deyo, Jessica Frega, Liska Lackey and Sam Lasris. BOARD OF HEALTH MEMBERS ABSENT: Bruce Baldwin, Barbara Chavious and Paul Chelminski. STAFF PRESENT: Quintana Stewart, Health Director; Rebekah Moira Beck, Environmental Health Specialist; Rebecca Crawford, Financial and Administrative Services Director; Jane Grace, Advanced Practice Practitioner; Victoria Hudson, Interim Environmental Health Director; Jennifer Jean-Baptiste, Office Assistant II-Nutrition; Renee Kemske, Nutrition Program Manager; Anitra Kincy, Patient Accounting Technician; Lisa Lowe, Public Health Nursing Supervisor II; Pam McCall, Public Health Nursing Director; Kristin Prelipp, Communications Manager; Beverly Scurry, BOH Strategic Plan Manager;and La Toya Strange, Administrative Assistant II. GUESTS PRESENT: None. I. Welcome New Employees Susan Elmore, Chair, called the meeting to order. Quintana Stewart, Health Director, welcomed new employees Jane Grace, Rebekah Moira Beck, Jennifer Jean-Baptiste and Anitra Kincy. II. Public Comment for Items NOT on Printed Agenda: None. III. Approval of the September 26, 2018 Agenda Motion was made by Mia Burroughs to approve the agenda, seconded by Sam Lasris and carried without dissent. IV. Action Items (Consent) A. Minutes of August 22, 2018 Meeting Motion was made by Jessica Frega to approve the minutes of August 2018 with edits, seconded by Sam Lasris and carried without dissent. V. Educational Sessions MINUTES-Draft ORANGE COUNTY BOARD OF HEALTH September 26, 2018 S:\Managers Working Files\BOH\Agenda & Abstracts\2018 Agenda & Abstracts/ September Page 2 A. Nutrition Update/Employee Heath and Wellness Renee Kemske, Nutrition Services Manager, provided an overview of Nutrition Services and discussed current/upcoming progress with the Community Health Grant. Overview of Services: Ms. Kemske discussed current services offered: Medical Nutrition Therapy, Diabetes Self-Management Education Services, Employee Wellness Services and CDC Minority Diabetes Prevention Program. She provided data on types of MNT clients seen and payer mix in FY18: 782 (53% OCHD referred, 47% non OCHD) and 42% Medicaid, 31% Insurance, 27% Self-Pay. History of Community Health Grant FY18: Ms. Kemske provided an overview of the Community Health Grant: Awarded funding ($122,065) for 9/17-6/30/18 to increase access to primary care and self-management support services for adult residents with chronic conditions (obesity, pre-diabetes, diabetes, abnormal lipids, and hypertension). Through the grant, OCHD piloted a voucher program covering the minimum fee for nutrition services ($20) and increased the number of primary care clients seen by threefold. The grant also purchased diabetes testing supplies, and funds for interpretation services to increase access for LEP clients. Staff held two diabetes classes in Spanish and purchased simultaneous interpretation devices to aid in interpretation. 100% of the participants had improved knowledge of diabetes self-care behaviors and were satisfied with simultaneous interpretation devices. Partners offered 5 Living Healthy Classes to 54 people and received 4.9 out of 5 for customer satisfaction ratings. OCHD hired a Community Health Worker who maintained a provider contact sheet (~500c contacts) to disseminate health/service information and conducted 58 outreach events. Grant partners convened a Community Health Collaborative to increase awareness of local chronic disease services and to establish a formalized referral system to better link residents to services. The partners held two focus groups (older adults and Spanish LEP) in May 2018 and learned that there is decreased awareness of local services, transportation, language and cost were identified barriers, and participants want more nutrition services. Overview of Community Health Grant FY18-19: OCHD was awarded $145,915 for FY19 with potential of two additional years to expand FY18 pilot work with the following additional components: Chatham County Public Health Department will replicate the voucher program for Nutrition Services, partners will pilot a transportation assistance program for patients identifying transportation as a barrier to care, OCHD will partner with the Department on Aging to provide funding and support for cholesterol screenings and wellness events, and the Community Health Worker will be trained in the Spanish Living Healthy curriculum and teach one class in Spanish. The BOH had questions that were addressed by Ms. Kemske. B. Medicaid Transformation Update Quintana Stewart, Health Director, presented an outline of the requirements for PHPs and the impact of this for the local health departments (LHDs) in NC. She began with the background on the Medicaid Transformation. Below are highlights: MINUTES-Draft ORANGE COUNTY BOARD OF HEALTH September 26, 2018 S:\Managers Working Files\BOH\Agenda & Abstracts\2018 Agenda & Abstracts/ September Page 3 • Medicaid will transition from a predominantly fee-for-service structure to managed care where DHHS will remain responsible for all aspects of the Medicaid and NC Health Choice programs. • Regarding Prepaid Health Plans (PHPs), there will be 4 statewide MCOs and up to 12 Provider-Led Entities (PLEs) in 6 regions. • Regional Rollout  Phase 1 involves the rollout of 2 regions in November 2019; while in phase 2, the remaining 4 regions will do so in February 2020. • Standard health plans will rollout first. They will cover physical health and mild to moderate behavior health. • Tailored health plans will rollout in 2020. They will cover physical health, complex behavior health needs, serious mental illness, substance abuse, etc. • NC goals for Medicaid managed care are to 1)measurably improve health, 2)maximize value to ensure program sustainability and 3)increase access to care. • For the most part, OCHD services will remain the same. As a primary care provider, the OCHD will concurrently launch the Advanced Medical Home (AMH) model with the Managed Care Model. There will be one standardized contract across the state in which DHHS will be responsible for developing and requiring PHPs to use. The PHPs will be responsible for frontline oversight and have the right to terminate with the LHDs. • There are 4 tiers in the AMH model. OCHD is currently a level 2 Carolina Access program meaning we will be grandfathered into tier 2 but are able to attest to tier 3. Before doing so, the OCHD must make sure that it’s a good fit for us. The biggest difference between the two tiers is the reimbursement rates. • DHHS will require PHPs to monitor the performance of AMHs in all tiers and calculate performance-based measures based on a set of quality measures. • AMH implications for LHDs include the LHDs having options to choose which tier they want to participate in depending on eligibility and readiness. • The safety net and current access to care for Medicaid patients should not decrease, but be enhanced. • There will be no changes to our Managed Care payments for the first 2 years. Cost Settlement will continue for Medicaid services provided that are not in the Medicaid Transformation plan. OCHD will bill and receive payment from the PHPs for services provided to their patients. • Some of the participating PHPs include Aetna, United Healthcare and UNC. The BOH had questions that were addressed by Ms. Stewart. VI. Action Items (Non-Consent) A. BOH Policy Quintana Stewart, Health Director, led the Board in a discussion of the proposed revisions to the Standard Operating Procedures. The proposed revisions went sent to the Board for their review prior to the BOH meeting. Proposed revisions included: III. Composition A. The composition of the Board of Health is governed by NCGS 130A-35(b)-(d) which states the composition of the board shall reasonably reflect the population and makeup of the county. MINUTES-Draft ORANGE COUNTY BOARD OF HEALTH September 26, 2018 S:\Managers Working Files\BOH\Agenda & Abstracts\2018 Agenda & Abstracts/ September Page 4 B. For purposes of Board composition, diversity includes, but is not limited to, professional experience, cultural and educational background, geography, age, gender, race and ethnicity. When assessing Board composition or identifying suitable candidates for appointment/re- appointment, the Board will consider candidates on merit and statutory requirement with consideration to the benefits of diversity. C. The Orange County Board of Health is committed to ensuring diversity among members and values the benefits that diversity brings. Diversity promotes the inclusion of different perspectives and ideas, mitigates against group think and ensures that the Board has the opportunity to benefit from a variety of skills, backgrounds and experiences. D. The Board’s commitment to diversity shows internal and external stakeholders that the organization emphasizes diverse constituencies and does not discriminate against minorities, thereby enhancing the Board’s reputation with county government and residents. C. Committees 3. Physical Activity & Nutrition to replace Access to Care 5. Social Determinants of Health to replace Childhood and Family Obesity Prevention The BOH members had questions that were addressed by Ms. Stewart. Motion to forward to the County Attorney with the added change of “citizens” to “residents” and approve contingent upon the County Attorney’s approval was made by Jessica Frega, seconded by Jennifer Deyo and carried without dissent. Rebecca Crawford, Financial and Administrative Services Director, began by informing the BOH members that the BOH is required to review its policy manual annually. Updates to two sections of the Fee and Eligibility section of the policy are recommended below: I.E. Fee and Eligibility Policy Staff recommends making the following revisions to the Fee and Eligibility Policy for the purposes of clarification, to be in compliance with state requirements, and to update according to system changes: - Service Limitation/Denial (Section V.C.): Expanded the section stating that Family Planning patients will never be refused service due to an outstanding balance or inability to provide proof of income to include Maternal Health and Child Health patients at the recommendation of the DHHS Administrative Consultant. - Fees Collection (Section VII.E.): Clarified that clients are given a statement showing the cost of services after charges are processed upon request rather than at the time services are received since the Epic Electronic Medical Record (EMR) system is unable to produce a statement until after charges are processed, which may not occur until after the patient has left the clinic. - Fees Collection (Section VII.I.): Updated the Billing Cycle section to specify the billing statement process for the Epic Electronic Medical Record (EMR) system since MINUTES-Draft ORANGE COUNTY BOARD OF HEALTH September 26, 2018 S:\Managers Working Files\BOH\Agenda & Abstracts\2018 Agenda & Abstracts/ September Page 5 it differs from both the Patagonia EMR and Eaglesoft EMR that was detailed in the previous version. The BOH will vote on the Fee and Eligibility Policy updates at the next meeting. The BOH members had questions that were addressed by Ms. Crawford. VII. Reports and Discussion with Possible Action A. Health Director Annual Evaluation Susan Elmore, Chair, reviewed this year’s process for the annual review. She will meet with the County Manager. A survey will be sent to Ms. Stewart’s direct reports and a random sampling of approximately 10 staff at the OCHD. The annual review will occur during a closed session at the November 2018 meeting where the results will be discussed as well as her performance. B. Committee for 2019 Vice-Chair Selection As it is customary for the current Vice-Chair to occupy the Chair position because of the experience gained as Vice-Chair, there will be a committee formed for Vice-Chair selection. Susan Elmore, Chair, stated that Timothy Smith and Liska Lackey (Vice-Chair and past Chair, respectively) will be on that committee and suggested that any BOH members interested in serving on the committee contact Mr. Smith and/or Ms. Lackey. She also gave a brief overview of the Vice-Chair duties. The BOH members had questions that were addressed by Ms. Elmore. C. Health Director Report Highlights of Ms. Stewart’s report are below: • She thanked all of the BOH members that met with her for their time to have the 1-on-1 meetings and mentioned that she’ll meet with Sam Lasris once his meeting time has been rescheduled. • As of September 11th, the County had gone into full blown Hurricane Florence mode. She gave a big Kudos and thanks to OCHD staff as they all stepped up during this time assisting with shelters, Environmental Health going above and beyond with their inspections of the shelters, Kristin for all of her assistance, etc. The OCHD received compliments from various agencies for their help. • On yesterday, the first Strategic Planning training occurred with Deitre Epps which was centered around Results Based Accountability. There are various Strategic Plans (Ashley Rawlinson – Healthy Carolinians; Beverly Scurry – Racial Equity Commission; Coby Jansen Austin – FSA) within the OCHD and the goal is to have them fall under one big comprehensive plan. • Ed Kerwin will send the BOH letter to his board at OWASA. He stated that they were appreciative that we’re assisting them with the fluoridation issue. MINUTES-Draft ORANGE COUNTY BOARD OF HEALTH September 26, 2018 S:\Managers Working Files\BOH\Agenda & Abstracts\2018 Agenda & Abstracts/ September Page 6 • Beverly Scurry attended a conference on fluoridation and public health in Concord. There were a lot of opponents of fluoridation that were also in attendance. Some of them caused disruptions to some of the speakers. • Last Friday, the Suicide Prevention Walk took place. Ms. Stewart thanked Timothy Smith for attending. D. Media Items Kristin Prelipp, Communications Manager, briefly mentioned the article in which LaTosha Scott was featured which was included in the Media Items packet. Media items were in the packet which focused on Orange County’s events and our involvement in various efforts. VIII. Board Comments Keith Bagby attended Orange County Schools Health, Safety and Wellness Resource Fair that was held this past Saturday at the Hillsborough Walmart. He stated that it was a great event with a good turnout. IX. Adjournment Liska Lackey moved to adjourn the meeting at 8:26pm and Keith Bagby seconded. The next Board of Health Meeting will be held October 24, 2018 at the Orange County Health Department, 300 West Tryon Street, Hillsborough, NC at 7:00 p.m. Respectfully submitted, Quintana Stewart, MPA Orange County Health Director Secretary to the Board