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HomeMy WebLinkAboutBOH minutes 013019MINUTES ORANGE COUNTY BOARD OF HEALTH January 30, 2019 S:\Managers Working Files\BOH\Agenda & Abstracts\2019 Agenda & Abstracts/ January 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 January 30, 2019 at the Orange County Health Department, 300 West Tryon Street, Hillsborough, NC. BOARD OF HEALTH MEMBERS PRESENT: Jessica Frega –Vice-Chair, Keith Bagby, Bruce Baldwin, Barbara Chavious, Jennifer Deyo, Susan Elmore, Commissioner Earl McKee, Liska Lackey, and Sam Lasris. BOARD OF HEALTH MEMBERS ABSENT: Timothy Smith and Paul Chelminski. STAFF PRESENT: Quintana Stewart, Health Director; Coby Jansen Austin, Director of Programs and Policy; Susan Clifford, Immigrant and Refugee Health Program Manager; Rebecca Crawford, Financial and Administrative Services Director; Victoria Hudson, Environmental Health Director; Donna King, Health Promotion & Education Services Director; Anissa McCall, Patient Account Technician; Pam McCall, Public Health Nursing Director; Cristina Blasini Melendez (arrived after new employee introductions), Office Assistant I; Kristin Prelipp, Communications Manager; Gregory Schiltz, Registered Dietitian/Program Manager; Beverly Scurry, BOH Strategic Plan Manager; La Toya Strange, Administrative Support I and Trisha Tant, Account Technician I. GUESTS PRESENT: Amber Henry and Michael Peterson. I. Welcome New Employees Jessica Frega, Vice-Chair, called the meeting to order at 7:00pm. Quintana Stewart, Health Director, introduced the new employees in attendance: Anissa McCall, Gregory Schiltz and Trisha Tant. II. Public Comment for Items NOT on Printed Agenda: None. III. Approval of the January 30, 2019 Agenda Motion was made by Susan Elmore to approve the agenda, seconded by Keith Bagby and carried without dissent. IV. Action Items (Consent) A. Minutes of November 28, 2018 Meeting Motion was made by Susan Elmore to approve the minutes of November 2018 with an edit, seconded by Bruce Baldwin and carried without dissent. V. Educational Sessions MINUTES ORANGE COUNTY BOARD OF HEALTH January 30, 2019 S:\Managers Working Files\BOH\Agenda & Abstracts\2019 Agenda & Abstracts/ January Page 2 A. Affordable Housing Coalition Report Robert Dowling and Delores Bailey, both of the OC Affordable Housing Coalition (OCAHC), provided an update on the housing crisis in OC. Below are some highlights. • OCAHC was formed in 2013 to highlight the needs and opportunities for increasing housing affordability in OC and to foster communication and collaboration among housing providers and advocates. OCAHC members include non-profit housing developers, social service providers, advocacy groups, and local government partners. • The Affordable Housing Summit occurred in February of 2018. A summit report was created based on the presentation delivered at the summit and the brainstorming conversations that followed. The summit report was released this past October. The report contained the following sections: o An introduction to the coalition and a description of the purpose of the summit o An overview of the current state of affordable housing o A summary of the small group discussions that occurred after the summit presentation. The group’s discussion generated innovative solutions on how we can all make a difference. The solutions were organized into the following four areas:  Collaboration and Partnerships  Imagining New and Creative Ideas  Increasing Communication and Education  Better Utilization of Resources • Affordable housing is housing in which occupants pay no more than 30% of their gross monthly household income. • The Area Median Income, or AMI, is generated by the US Department of Housing and Urban Development (HUD) to determine who is eligible for certain housing. o Households making 0-30% of AMI are considered extremely low income. o Those making 30-50% of AMI are considered very low income. o Those making 50-80% of AMI are considered low income. o All households making less than 80% of AMI are eligible for income-based housing or “affordable housing”. • 1 in 3 OC households are “cost-burdened” which means they are spending more than 30% of their income on housing. • There are large income disparities by race and ethnicity as well as disparities for proportion of income spent on housing based on age. Income for African-Americans and Hispanic/Latino households are much lower than other groups. For African-Americans, there is a high percentage of households with incomes less than 30% of the AMI. One- third of African-American households are making less than 30% of AMI. • There are large income disparities by age with seniors being the most cost burdened age group; 28% of senior homeowners and 56% of senior renters are cost burdened. • Of the 56,474 housing units in Orange County, approximately 1,700 are permanently affordable (about 3%). • Types of affordable housing: o There is affordable housing that is income restricted. This is housing that is intentionally developed as affordable and is only available to households that meet specific income limits also known as subsidized housing. o Market Rate Affordable Housing, also known as Naturally Occurring Affordable Housing or NOAH, is housing that is not income restricted, but it is affordable based on the price point. This makes up the majority of affordable housing in the U.S. MINUTES ORANGE COUNTY BOARD OF HEALTH January 30, 2019 S:\Managers Working Files\BOH\Agenda & Abstracts\2019 Agenda & Abstracts/ January Page 3 • Orange County, Chapel Hill, Carrboro, and Hillsborough have really shown dedication to improving affordable housing by using mechanisms that address affordable housing such as creating Orange County Bonds, dedicated local budget funding, dedicated staff to advance affordable housing, inclusionary housing policy, the creation of housing advisory boards, and the Northside Neighborhood Initiative. The BOH had questions that were addressed by Mr. Dowling and Ms. Bailey. B. 2nd Quarter Financial Reports & Billing Dashboard Reports Rebecca Crawford, Financial & Administrative Services Director, gave a report on the 2nd quarter revenue and billing accuracy. The report is as follows: • Total Health Department Revenue: Average YTD monthly revenue in FY19 after the second quarter is $210k/month or $1.3m YTD, representing 36.4% of our overall budgeted revenue for the year. Multiple factors contribute to the lower than normal revenue: Electronic Medical Record (EMR) change to Epic, provider on maternity leave in Dental, and departmental closures due to hurricane Florence, snow, and overall wet weather negatively impacting onsite well and septic inspections. Allocations of Medicaid Max funds will not be transferred into our budget until the end of the fiscal year. Expenses are higher than revenues, but on trend, at 45.5% of the overall budget. • Total Billing Accuracy: Billing Accuracy is under construction due to the change in medical EMR. The Informatics team and UNC Epic reporting staff are working diligently to have this measure for both medical and dental back by the third quarter financial report. • Dental Earned Revenue by Source: The FY 18-19 average monthly revenue ($41k/month) for the second quarter is below our budget projection ($45k/month) and our FY 17-18 average of $42.6k/month due to having a dentist on maternity leave. We are now able to see our new Hygienist has quickly caught up to our existing Hygienists in terms of seeing patients and meeting monthly revenue goals and anticipate the monthly average will increase along with our total revenue to be closer to the budgeted amount. FY 18-19 dental earned revenue totaled $246k at the end of the second quarter. • Medical Earned Revenue by Source: Medical earned revenue is currently below the budgeted projection for FY 18-19 ($55.6k/month) at $29k/month (although higher than the first quarter average of $16.3k/month) due to provider turnover (2 new providers started seeing patients in late July and August) and as clinic staff continue to work through issues with the new EMR, improved customer service during the EMR transition with longer appointment times (meaning we saw fewer patients), and have dealt with clinic closures due to hurricane Florence and snow. We anticipated these issues as they arise in all new automation projects and have staff dedicated to fixes by increased training for providers, weekly workflow meetings, a Quality Improvement team called the “Epic Optimization Team”, and teams devoted to building algorithms with UNC IT to decrease errors in the billing system build (our state requirements make our billing very different from a typical UNC outpatient clinic and require much more specificity). Medical clinic revenue totals $174k for second quarter FY 18-19. MINUTES ORANGE COUNTY BOARD OF HEALTH January 30, 2019 S:\Managers Working Files\BOH\Agenda & Abstracts\2019 Agenda & Abstracts/ January Page 4 • Environmental Health Earned Revenue by Source: Environmental Health earned revenue is currently below the budgeted projection for FY 18-19 ($53k/month) at $44.1k/month although this is a seasonal trend and has been affected by office closings and wet weather, which resulted in an inability to perform as many onsite well and septic inspections. We typically see an increase in revenue during the spring with public pool and septic inspections and the division is working on a strategy to quickly decrease the number of pending weather-delayed inspections. • Grants Fund Revenue: FSA has drawn $100k of the multi-year Kenan grant. We will receive the second allocation of $100k in third quarter FY 18-19. Expenditures are steadily increasing as the new Social Work Supervisor II position has been filled and is implementing her program strategies. The BOH members had questions that were addressed by Ms. Crawford. C. Immigration Updates Susan Clifford, Immigrant and Refugee Health (IRH) Program Manager, shared updates on data, research, OCHD & community activities, and new policies and practices affecting our community and clients. Below are highlights. • The IRH Program has many tasks including language services policies & coordination, 2.5 Staff Spanish/English medical interpreters, 15 contract interpreters, ASL, telephonic & video interpreters, OC Interagency Coalitions (Latino & Refugee Health). • Non or limited-English speaking patients seen in each clinic: 31% Medical, 39% Dental with the top languages being Spanish, Karen, Burmese, Chinese, Arabic • Refugee Arrivals to OC: 102 people in FY16-17; 22 people in FY17-18; 8 people in the 1st half of FY18-19 • I-693 Process changes – o Form needs to be signed within 2 months of when Refugee Patient submits Adjustment of Status (I-485: Green Card) Application to USCIS o Form is only valid when Health Department Doctor signs form no more than 60 days before the date the Refugee Patient files the complete application package • Some activities that occurred in 2017-2018 include: o Termination of Deferred Action for Children Arrivals (DACA) and Deferred Action for Parents of Americans and Lawful Permanent Residents (DAPA) o End of Temporary Protected Status Designations o Refugee Admissions Reduction o Travel Ban & Extreme Vetting o Expansion of Enforcement Priorities o Proposed Public Charge Rule Changes (Public Comment – Dec 2018) o Citizenship question proposed for Census The BOH members had questions that were addressed by Ms. Clifford. D. 474 CLAS Standards Advancing Health Equity AA Beverly Scurry, BOH Strategic Manager, and Donna King, Health Promotion & Education Services Director, provided an update on the funding received from the NC Office of Minority Health and Health Disparities (OMHHD) to address the health status gap between racial/ethnic MINUTES ORANGE COUNTY BOARD OF HEALTH January 30, 2019 S:\Managers Working Files\BOH\Agenda & Abstracts\2019 Agenda & Abstracts/ January Page 5 minorities and the general population. The goal is to provide training for agencies and communities to increase cultural and linguistic competence through adoption of the National Standards for Culturally and Linguistically Appropriate Services (CLAS) in Health and Health Care. Below are highlights of the presentation. • Service period - December 1, 2018 – May 31, 2019 • Award amount is $18,000 • Nine deliverables – o Identify Health Department Staff that will implement the CLAS program. o Convene Health Equity Council (HEC) that must meet minimum requirements of having representation from the health department to include the health director or designee, a health educator, social worker, nurse, an administrative staff and translation/interpreter staff. Representation must also be from at least 7 community agencies such as hospital, mental health services, local health agencies, etc. o 30% of OCHD staff and HEC members will go through trainings provided by the NC Office of Minority Health and Health Disparities. o 30% of OCHD staff, HEC, and new OCHD employees will go through trainings related to health equity, racial equity, social justice, or cultural competency. o Collect patient/client demographic data and conduct CLAS-related assessments. o Conduct a community forum around health equity and CLAS-related data. o Share progress to the community through social media, print materials, newsletter, emails, presentations, website postings, etc. o REC will serve as the materials review team to analyze materials created and/or distributed by OCHD for high quality, understandability and multiple languages. • Will be working with consultant, Deitre Epps, to facilitate the community forum that will occur in May. • Program plan and budget have been submitted. • First HEC meeting will be on February 13th. VI. Reports and Discussion with Possible Action A. BOCC Work Plan Review As the BOCC will review the Annual Work Plan reports from advisory boards and commissions at their April 4th work session, the BOH will need to select a topic from their 2018 Annual Report/Work Plan to present to the BOCC. After some discussion, the BOH chose the topic of Adverse Childhood Experiences (ACEs). Reminders will be sent and an invitation was extended to the BOH members to attend the BOCC work session presentation. Motion to approve Annual Report/Work Plan for presentation to BOCC and highlight the topic of Adverse Childhood Experiences and forward to the Clerk to the Board was made by Liska Lackey and seconded by Jennifer Deyo. B. Health Director Report In addition to her report, some of the highlights Ms. Stewart gave are below: • Ms. Stewart congratulated Victoria Hudson on her appointment as Environmental Health MINUTES ORANGE COUNTY BOARD OF HEALTH January 30, 2019 S:\Managers Working Files\BOH\Agenda & Abstracts\2019 Agenda & Abstracts/ January Page 6 Director as of January 5th. Since her leadership as Interim Environmental Health Director, complaints have been down and customer service has improved. • The Chapel Hill Campus & Community Coalition Town Hall meeting was rescheduled to March 20th as they wanted to get feedback from the community before the meeting. The March 20th meeting will be held at the Chapel Hill Library. Elinor Landess will present the last 5 years of data at our Board meeting next month. • On the 2019 legislative front, Ms. Stewart briefly mentioned the Medicaid Expansion, Communicable Disease funding, Enact Tobacco 21 and the Women’s & Children’s Health Block Grant. • Ms. Stewart agreed to serve as a member and co-chair the Education and Awards Committee for the Health Directors Association. Major tasks include planning the annual awards luncheon and the new health directors orientation. • Rebecca Crawford and Ms. Stewart attended the Annual Public Health Leaders Conference in Raleigh. Health equity was the main topic of discussion with a focus on social determinants of health. There was much conversation about Healthy People 2030. The disparity gap is getting wider even though health is getting better. • Ms. Stewart will be orienting Commissioner Sally Green on January 28th. VII. Board Comments. Jessica Frega reminded all that next month’s meeting will take place at the SHSC. Keith Bagby disclosed that he was approached by former client, NC Medical Society, when with BCBS, to fill in as an underwriter. Commissioner McKee suggested that Mr. Bagby consult our county attorney to make sure there wasn’t a conflict of interest. Ms. Frega also mentioned that the OC Board of Education has recognized that they haven’t done a great job at racial equity. She suggested a possible letter of support of their efforts to improve racial equity and stated that this matter may be more suitable for one of the Board’s subcommittees. Bruce Baldwin commended Ms. Frega on her first time presiding as Chair. VIII. Adjournment Bruce Baldwin moved to adjourn the meeting at 8:47pm and Barbara Chavious seconded. The next Board of Health Meeting will be held February 27, 2019 at the Southern Human Services Center, 2501 Homestead Road, Chapel Hill, NC at 7:00 p.m. Respectfully submitted, Quintana Stewart, MPA Orange County Health Director Secretary to the Board