HomeMy WebLinkAboutBOH Minutes of 012920 MINUTES - Draft
ORANGE COUNTY BOARD OF HEALTH
January 29, 2020
ORANGE COUNTY HEALTH DEPARTMENT MISSION STATEMENT: To enhance the quality
Hof 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 29, 2020 at the Orange
County Health Department, 300 West Tryon Street, Hillsborough, NC.
BOARD OF HEALTH MEMBERS PRESENT: Jessica Frega, Chair, Jennifer Deyo, Vice-Chair,
Keith Bagby, Liska Lackey, Sam Lasris, Commissioner Earl McKee, Aparna Jonnal, Lee Pickett,
and Alison Stuebe.
BOARD OF HEALTH MEMBERS ABSENT: Bruce Baldwin and Timothy Smith
STAFF PRESENT: Quintana Stewart, Health Director; Rebecca Crawford, Financial and
Administrative Services Director; Victoria Hudson, Environmental Health Director; Donna King,
Health Promotion & Education Services Director; Meredith McMonigle, Public Health Education
Program Manager; Kristin Prelipp, Communications Manager; and Ana Salas, Dental Assistant.
GUESTS PRESENT: Diane Uzarski.
I. Welcome New Employees
Jessica Frega, Chair, called the meeting to order at 7:02pm. Quintana Stewart introduced the
new employees in attendance: Natalie Bontrager, Kendall Conder, and Sarah Manfred.
II. Public Comment for Items NOT on Printed Agenda: None.
III. Approval of the January 29, 2020 Agenda
Motion was made by Earl McKee to approve the agenda, seconded by Alison Stuebe and
carried without dissent.
IV. Action Items (Consent)
A. Minutes of November 20, 2019 Meeting
Motion was made by Jennifer Deyo to approve the minutes of November 2019, seconded
by Alison Stuebe and carried without dissent.
V. Educational Sessions
A. Immigrant and Refugee Updates
Susan Clifford, Immigrant and Refugee Health (IRH) Program Manager, shared updates on
county and OCHD data, issues affecting our community and clients, and OCHD's resources and
efforts to address identified needs. Below are highlights.
2019 Demographic Data
S:\Managers Working Files\BOH\Agenda &Abstracts\2020 Agenda &Abstracts/
January Page 1
MINUTES - Draft
ORANGE COUNTY BOARD OF HEALTH
January 29, 2020
➢ Orange County
Hispanic population = 8.5%
Asian population =8.2%
Foreign-born = 12.7%
Language other than English spoken at home = 16.7%
Speaks English "less than very well" [Limited English Proficiency (LEP)] = 6.4%*
➢ OC Health Department
Hispanic population = 30%
Asian population = 8%
LEP = 36% Medical Encounters and 42% Dental Encounters
Refugee arrivals — FY 18-19 = 34 and FY 19-20 YTD = 6
Top languages = 1)Spanish, 2)Karen, 3)Burmese, 4)Chinese, 5)Arabic
• The OCHD has many language resources including language services policies &
coordination, 2.5 Staff Spanish medical interpreters/translators, 17+ contractors, ASL,
and telephonic & video interpreters.
• Some current immigration climate concerns include:
➢ Deferred Action for Childhood Arrivals (DACA) and Temporary Protected Status
(TPS) at risk
➢ Refugee admissions reduction
➢ Family separation
➢ Unsafe and unsanitary conditions in detention centers and
➢ Raids and threats of raids.
As a result of the above-mentioned concerns, trauma may occur which could present
barriers to essential needs and services as well as threats to health, safety, and well-
being.
• The OCHD has an Immigration Task Force & IRH Team, IRH Coalition, and Equity Work
to assist with immigrant and refugee concerns.
• Ms. Clifford invited the Board to two upcoming events and stated that she will be sending
out the registration links shortly:
➢ Serving Muslims with Cultural Sensitivity on Friday, March 6`" from 1:30-3:30pm in
Chapel Hill
➢ Let's Talk on March 261" from 8:00-11:30am
'McKee requested data supporting the percentage of L.E.P. in Orange County as the information presented had the
statistic at 16.7% which was an error.
The BOH members had questions that were addressed by Ms. Clifford.
B. Racial Equity Strategic Plan Feedback
Kristin Prelipp, Communications Manager, and Ana Salas, Dental Assistant, presented the
Racial Equity Commission's (REC) Strategic Plan to the Board. Highlights are below.
• REC was formed in July 2017, guarded by a charter and a strategic plan, and is
comprised of 10 members including 5 division representatives, 1 Leadership Team
representative, and 4 open seats. The co-chairs are Meredith McMonigle and Beverly
Scurry.
• Health disparities vs health inequities
➢ Health disparities (or inequalities) are differences in the presence of disease, health
outcomes or access to health care between population groups. Health inequities are
S:\Managers Working Files\BOH\Agenda &Abstracts\2020 Agenda &Abstracts/
January Page 2
MINUTES - Draft
ORANGE COUNTY BOARD OF HEALTH
January 29, 2020
differences in health that are not only unnecessary and avoidable but are considered
unfair and unjust. Health inequities are rooted in social injustices that make some
population groups more vulnerable to poor health than other groups.
• Equity is defined as the absence of avoidable or remediable differences, allowing for the
attainment of optimal health for all people. Health equity is achieved when everyone has
the opportunity to attain their full health potential and no one is disadvantaged because
of socially determined circumstances.
• Achieving it requires focused and ongoing societal efforts to address avoidable
inequalities, historical and contemporary injustices, and the elimination of health and
health care disparities.
• Orange County has the largest income inequality for a county with more than 100,000
residents in the state. The number of children in poverty in Orange County varies widely
by race, with 4 percent of white children living in poverty, 32 percent of Hispanic children
and 25 percent of black children.
• It's estimated that 69 percent of children born into poverty will remain in poverty unless
there is an intervention and/or a significant change in the system.
• Racism is different from racial prejudice, hatred, or discrimination. Racism involves one
group having the power to carry out systematic discrimination through the major
institutions of society. Racism is a system. A system of advantage based on a socially
constructed concept of race. Created to justify social, political, and economic hierarchy.
Racism operates on four levels— internalized, interpersonal, institutional and structural.
• Some learning communities available to help staff get acquainted to racial equity work
include book club, caucus, library, Meet Up to Eat Up, and the departmental newsletter.
The BOH members had questions that were addressed by Ms. Prelipp and Ms. Salas.
C. 2--d Quarter Financial Reports & Billing Dashboard Reports
Rebecca Crawford, Financial &Administrative Services Director, gave a report on the 2nd
quarter revenue and billing accuracy. Her report is as follows:
• Total Health Department Budget vs. Actuals:
Average YTD monthly revenue in FY19-20 after the second quarter is $209k/month or
$1.3M YTD, representing 35.5% of our overall budgeted revenue for the year. As usual
though, the total second quarter revenue is 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 will not be transferred into our budget until the end of the fiscal year. Expenses are
slightly above revenues, at 42.6% of the overall budget but on trend with prior fiscal
years.
• Total Billing Accuracy:
The medical and dental billing accuracy measure continues to be a challenge as we
work with UNC and the Dental EHR, Eaglesoft, to improve the accuracy of the reporting
system for Health Department revenue and is not included in this quarter's dashboard.
• Dental Earned Revenue by Source:
The FY 19-20 average monthly revenue ($50.7k/month) for the second quarter is above
our budget projection ($45k/month) and our FY 18-19 average of$46.6k/month. We are
seeing the direct impact of adding the additional Dental Hygienist in FY 18-19 and will
potentially exceed our projected annual revenue related to this position ($72,157) since
S:\Managers Working Files\BOH\Agenda &Abstracts\2020 Agenda &Abstracts/
January Page 3
MINUTES - Draft
ORANGE COUNTY BOARD OF HEALTH
January 29, 2020
the dental clinic is fully staffed. FY 19-20 dental earned revenue totaled $304k at the
end of the second quarter compared $246k at the end of the FY 18-19 second quarter.
• Medical Earned Revenue by Source:
Medical earned revenue is currently below the budgeted projection for FY 19-20
($57k/month) at $41.6k/month due to provider turnover and as clinic staff continue to
work through issues with the billing in the Epic EMR. Most appointments will return to 30
minute lengths in January as the medical clinic is almost fully staffed (visit lengths were
extended to 1 hour while we oriented 3 new nurses and experienced provider turnover).
Our EMR Quality Improvement team called the "Epic Optimization Team" along with
clinic staff have made a large amount of progress in improving revenue from medical
clinic services from the Epic system and the monthly average revenue of$41.6k/month
is already higher than it was in FY 18-19 at $29k/month. We anticipate this trend toward
increased revenue will continue. Medical clinic revenue totals $250k after the second
quarter FY 19-20 compared to $174k after second quarter FY 18-19.
• Environmental Health Earned Revenue by Source:
Environmental Health earned revenue is currently below the budgeted projection for FY
19-20 ($54k/month) at $40.6k/month. It is a seasonal trend to see lower revenue in the
first half of the year than in later quarters due to spring pool inspections; however, the
decreased revenue is directly related to the limited number of temporary staff available
to complete WTMP inspections. EH had 7 temporary Environmental Health Specialists
(EHS) working regularly to complete the inspections at this time last year and now have
only 3 temporary EHS working irregularly. We found it difficult to recruit and retain the
temporary EHS this summer given the heat. As a result, permanent staff in EH are
adding WTMP inspections to their current workloads in order to complete them as
required by the end of the fiscal year. FY 19-20 YTD revenue totals $243k compared to
FY 18-19 YTD revenue of$264k.
• Grants Fund Revenue:
FSA has drawn $200k of the multi-year Kenan grant. Expenditures are tracking as
anticipated and will continue to increase as we filled the vacant Navigator position in
November. This position was dependent upon additional United Way funds in order to
hire at the full time equivalent level, which were approved by the BOCC in September.
The BOH members had questions that were addressed by Ms. Crawford.
D. Updated BOH Policy Manual
The Board was presented with the updated BOH policy. The Board members updated their
binders with the updated BOH policy.
The BOH members had questions that were addressed by Ms. Stewart.
VI. Reports and Discussion with Possible Action
A. Health Director Report
In addition to mentioning upcoming events, Ms. Stewart also reiterated the items below from her
report.
S:\Managers Working Files\BOH\Agenda &Abstracts\2020 Agenda &Abstracts/
January Page 4
MINUTES - Draft
ORANGE COUNTY BOARD OF HEALTH
January 29, 2020
• Ms. Stewart continues to serve as Chair of the 2020 Hard to Reach Subcommittee for
the upcoming Census. Kristin Prelipp, OCHD Communications Manager, created an
educational video about the Census and why it is so important for everyone to
participate. The video will be available in English, Spanish, Burmese, Karen,
Kinyarwanda (or Swahili), Mandarin and Arabic. We are planning to participate in various
community events to provide education and answer questions about the Census.
• The Board was invited to attend the Opioid Task Force meetings. The next one will take
place in February 17, 2020.
• An update on the Tom Tom Foundation's 2020 Tom Tom Summit. Jessica Frega, BOH
Chair, and Ms. Stewart scheduled a call with Program Coordinator, Ben Wilkes, to hear
more about the Chapel Hill City Team they were trying to pull together. The Summit
started in 2012 as a result of the Charlottesville, VA community wanting to break down
barriers between the arts, government and business to create a brighter future. The goal
was to have big conversations about small city life living. The event has grown to a
larger national event held each April in Charlottesville, VA. A focus area for this year's
Summit includes Health Equity. After asking about others that have signed up for the
Chapel Hill Team, we didn't receive any confirmations on participation. Since the work of
the Foundation appears to overlap with some of the other efforts currently underway in
the department, we respectfully declined this year's invitation.
• Alison Stuebe, Board member, wanted to know the number of methadone clinics in
Orange County. Ms. Stewart will research and inform her of the correct number of
clinics.
• Krishnaveni Balakrishnan, OCHD Healthy Homes Coordinator will be speaking at UNC's
41 st Minority Health conference on February 28tn.
B. Media Items
There were no media items.
VII. Board Comments.
Jessica Frega mentioned that the 2"d Amendment Sanctuary may be coming to Orange County
in the future.
Vill. Adjournment
Aparna Jonnal moved to adjourn the meeting at 8:37pm and Alison Stuebe seconded.
The next Board of Health Meeting will be held February 26, 2020 at the Whitted Human
Services Center, 300 West Tryon Street, Hillsborough, NC at 7:00 p.m.
Respectfully submitted,
Quintana Stewart, MPA
Orange County Health Director
Secretary to the Board
S:\Managers Working Files\BOH\Agenda &Abstracts\2020 Agenda &Abstracts/
January Page 5