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HomeMy WebLinkAboutBOH Minutes of 082620 MINUTES - Draft ORANGE COUNTY BOARD OF HEALTH August 26,2020 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 August 26, 2020 virtually via Go To Meeting. BOARD OF HEALTH MEMBERS PRESENT: Jessica Frega — Chair, Sam Lasris —Vice-Chair, Keith Bagby, Aparna Jonnal, Lee Pickett, Shielda Rodgers, Timothy Smith and Alison Stuebe. BOARD OF HEALTH MEMBERS ABSENT: Bruce Baldwin and Commissioner Earl McKee. STAFF PRESENT: Quintana Stewart, Health Director; Rebecca Crawford, Financial and Administrative Services Director; Victoria Hudson, Environmental Health Director; Renee Kemske, Nutrition Program Manager; Asuka Nakamura, Community Outreach Specialist; Erica Pettigrew, Medical Director; Kristin Prelipp, Communications Manager; Beverly Scurry, BOH Strategic Plan Manager; and La Toya Strange, Administrative Support I. GUESTS PRESENT: Cheryl Wray. Jessica Frega, Chair, called the meeting to order. There were no new employees in attendance. I. Public Comment for Items NOT on Printed Agenda: None. II. Approval of the August 26, 2020 Agenda Motion was made by Alison Stuebe to approve the agenda, seconded by Lee Pickett and carried without dissent. III. Action Items (Consent) A. Minutes of June 24, 2020 Meeting Motion was made by Sam Lasris to approve the minutes of June 2020 with the edit of changing Ms. Bagby to Mr. Bagby on the last page of the minutes, seconded by Alison Stuebe and carried without dissent. IV. Educational Sessions A. Nutritional Update/Employee Health and Wellness Renee Kemske, Nutrition Program Manager, gave an update on the OCHD's Nutrition Services section. Below are some highlights of her presentation. • Nutrition Services ➢ Nutrition counseling also known as Medical Nutrition Therapy (MNT), is a service provided by a registered dietitian nutritionist (RDN) who works with a referring S:\Managers Working Files\BOH\Agenda &Abstracts\2020 Agenda &Abstracts/ August Page 1 MINUTES - Draft ORANGE COUNTY BOARD OF HEALTH August 26,2020 medical provider to improve a variety of conditions such as diabetes, heart disease, and obesity. Referrals are received from medical providers within and outside of the OCHD. The RDN conducts a review of the medical history, medications, diet, and lifestyle patterns and together with the referred client or a family member, if it's a young child. A personalized plan is developed to help them meet their nutrition goals. There were 852 encounters in FY 2019-20. The payment type for these visits is almost even: insurance at 34%, Medicaid at 33% and self-pay at 32%. • Diabetes Self-Management Education Services (DSME) ➢ This is an American Diabetes Association recognized program in which a client will receive 10 hours of education on the basics of diabetes prevention and management. There's an initial health assessment. They also sign up for 2 of the group education classes on the basics of diabetes care. Then the client will come back in 3 months for a follow-up appointment where knowledge is measured as well as any change in blood sugar management. Nutrition Services have partnered with local experts in the different areas of diabetes management including partnering with Walgreens to provide the medications and utilizing an exercise physiologist who's been working with Nutrition Services since 2005. ➢ The OCHD DSME program was awarded the 2019 John Bowdish Community Award from the North Carolina Diabetes Advisory Council at the Division of Public Health for providing outstanding service to community members with an emphasis of increasing access to care. ➢ OCHD DSME was selected by the North Carolina Diabetes Recognition Program, NC Diabetes Smart, to be featured in a statewide marketing initiative. Some of the OCHD staff were involved as mock participants in the video. ➢ Due to COVID-19, DSME classes went to a telehealth format on May 14th using Doxy.me and Zoom. In June, simultaneous Spanish interpretation via Zoom began. • Community Health Grant (CHG) ➢ In 2017, the CHG was awarded by the Office of Rural Health. A 2nd award was provided for an additional 3 year period. The purpose of this award is to increase access to primary care and self-management support services for residents with chronic disease. Groups specifically targeted include adults who are uninsured, on Medicaid or Medicare. The focus is on the chronic conditions of obesity, pre- diabetes and diabetes abnormal lipids, which is cholesterol and hypertension. ➢ A voucher program has been developed for some of the clients in which the $20 fee is a barrier. Diabetes tests and supplies are offered at no cost to help clients manage their diabetes. ➢ Some of the specific objectives and outcomes of the CHG include: o Working on increasing accessibility of interpretation services for the L.E.P. clients of the MNT and DSME programs. o Offering behavior change incentives by providing water bottles, calories tracking books, scales, exercise DVD's and step trackers. o Piloting a transportation assistance program for adults and pregnant women in which 45 rides were provided pre-COVID-19. Those funds have since been reallocated for telehealth services. • Primary care bag initiative ➢ The goal is to help people that have high blood pressure or diabetes self-monitor at home. Funds are used to purchase blood pressure cuffs and diabetes testing S:\Managers Working Files\BOH\Agenda &Abstracts\2020 Agenda &Abstracts/ August Page 2 MINUTES - Draft ORANGE COUNTY BOARD OF HEALTH August 26,2020 supplies, etc. to help them keep well at home. Participants are scheduled for a lab only appointment and then are scheduled for a MNT telehealth appointment. • Community partnerships include establishing relationships with people individually to better help them linked to services and working with the OC Department of Aging as they wanted more health promotion and nutrition services. Nutrition Services is also partnering with UNC to enhance the community health worker role. • Diabetes Prevention Program (DPP) ➢ DPP is a 16-week class for people with prediabetes or who are at risk for Type 2 diabetes make realistic and achievable lifestyle changes that can cut their risk of developing Type 2 diabetes by 50%. The goal is to help them lose at least 5% of their body weight and/or to achieve 150 minutes or more physical activity per week. Grant funding is used to provide prizes to aid in behavior change. • Employee Wellness ➢ Background — Human Resources agreed to give a portion of their wellness funds to pay for one of the OCHD's registered dietitian's salary. A small portion of that allows the nutrition services to be able to provide services to employees that are not covered under the employee county health plan. ➢ 100 appointments (61 individual and 39 group) have occurred. A variety of topics including meal planning and New Year's weight management have been offered as well as department-specific presentations conducted. The BOH members had questions and comments that were addressed by Ms. Kemske. B. Child Fatality Task Force Report Quintana Stewart, OC Health Director, provided a summary of the 2019 Child Fatality Prevention Team (CFPT) Annual Report. Before she began, Ms. Stewart, filling in for Pam McCall as she recently retired, stated that the CFPT meets on a quarterly basis, now virtually due to COVID-19, and briefly explained its purpose which included reviewing medical records, discussing outcomes, identifying deficiencies and carrying out recommendations to prevent further child deaths. The CFPT members' composition is defined by statute and includes members of law enforcement, school, mental health, EMS and providers. In 2019, the CFPT reviewed 7 child deaths. There was 1 system issue identified — unsafe sleep environment. The team's recommendation was to strengthen the message of safe sleep habits to parents. A plan was developed to produce a video on Safe Sleep to run in waiting rooms and other places where caregivers will be able to view. There was discussion amongst BOH members related to suggestions of running the video at the REC centers and partners' websites and including messaging in the video that mentions the correct and not so safe sleeping habits for caregivers to view. The BOH members had questions and comments that were addressed by Ms. Stewart. C. 4th Quarter Financial and Billing Dashboards Rebecca Crawford, Financial &Administrative Services Director, gave a report on the 4t" quarter revenue and billing accuracy. Her report is as follows: S:\Managers Working Files\BOH\Agenda &Abstracts\2020 Agenda &Abstracts/ August Page 3 MINUTES - Draft ORANGE COUNTY BOARD OF HEALTH August 26,2020 • Total Health Department Budget vs. Actuals: Average YTD monthly revenue in FY19-20 after the fourth quarter is $271 k/month or $3.3M YTD, representing 91.8% of our overall budgeted revenue for the year compared to last year, which was 91.6%. Expenses are above revenues, at 92% of the overall budget. This shows how well staff did in reducing expenditures in order to match decreased revenues during office closures. Additional state and federal funding to offset revenue shortages and support the pandemic response contributed to an almost equal percent of overall revenue received of what was budgeted to the prior fiscal year. • 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 ($39k/month)for the fourth quarter is below our budget projection ($45k/month) and our FY 18-19 average of$46.6k/month. As anticipated, the dental clinic saw a more immediate, negative impact on revenues than the medical clinics as a result of the severely decreased operations and very limited appointments. We began seeing more patients in June when PPE was more readily available, which led to slightly higher than anticipated revenue totals for that time period. FY 19-20 dental earned revenue totaled $468k at the end of the fourth quarter compared to $559k at the end of the FY 18-19 fourth quarter. • Medical Earned Revenue by Source: Medical earned revenue is below the budgeted projection for FY 19-20 ($57k/month) at $40.1 k/month. Our billing team worked hard over the last quarter to correct and submit outstanding claims in the medical clinic in order to bring in as much revenue as possible, which helped insulate the medical clinic from the large revenue decrease experienced by the dental clinic. The medical clinic continued to have many telehealth visits and some in-person visits, which contributed to revenue receipts. Medical clinic revenue totals $482k after the fourth quarter FY 19-20 compared to $487k after fourth quarter FY 18- 19. • Environmental Health Earned Revenue by Source: Environmental Health earned revenue is below the budgeted projection for FY 19-20 ($54k/month) at $46k/month. Permanent staff in EH added WTMP inspections to their current workloads in order to complete them as required by the end of the fiscal year. EH staff did an amazing job and continued to inspect where able during the Stay at Home Order, which resulted in only a slight decrease in projected revenue for the remainder of the FY. FY 19-20 YTD revenue totals $552k compared to FY 18-19 YTD revenue of $594k. • Grants Fund Revenue: FSA has drawn $200k of the multi-year Kenan grant. Expenditures are tracking as anticipated and will continue to increase since 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 and comments that were addressed by Ms. Crawford. S:\Managers Working Files\BOH\Agenda &Abstracts\2020 Agenda &Abstracts/ August Page 4 MINUTES - Draft ORANGE COUNTY BOARD OF HEALTH August 26,2020 V. Action Items (Non-Consent) A. Policy Review Beverly Scurry, BOH Strategic Plan Manager, briefly discussed the minor changes that were previously made. There were some suggested changes including better placement for the statement regarding family planning on page 7 of 8 in the Fee and Eligibility Policy in the Billing Cycle for the Health Department Section I, Number 2 Dental Health Divisions. The Board will review the proposed changes and will vote at next month's Board meeting in September. VI. Reports and Discussion with Possible Action Action Items A. Health Director Report In addition to the Ms. Stewart's report, highlights of the non-COVID related items are below. • Ms. Stewart virtually participated on the State Health Coordinating Council public health hearings on July 81h and 10th • NC Association of Local Health Directors are still meeting virtually. Ms. Stewart serves as the chair of the education subcommittee and partakes in new health director orientation. The orientation will have a virtual platform and will occur on the 2nd Friday of each month over 8 months with the 1st session taking place last Friday. • Ms. Stewart started attending the CFTF meetings in July. • The dental director position recruitment process has been completed. Sam Lasris was thanked for sitting on the panel as the dental representative on the BOH. An offer was made to the candidate last week and accepted; although, the candidate has to give a 90 day notice to get out of her contract with her current employer. She'll start on December 7th • The Dental Mobile Van has arrived and is parked at the Fleet department. Currently, construction is underway at the SHSC. The van will be stationed at the SHSC once construction is done. Ms. Stewart stated that pictures of it can be sent to the Board and hopefully, once in-person Board meetings are able to occur again, the van can be brought over for them to see. Staff are still working on the logistics. B. COVID-19 Update Quintana Stewart, Health Director, gave an update on the COVID-19 status in Orange County as well as took questions from the Board. Some highlights are below. • As of today, o There are 158,985 confirmed cases in the state and 2,009 cases specifically in Orange County. o There are 2,606 deaths in the state and 50 deaths in Orange County. o We are actively monitoring 128 cases in Orange County. o There have been 6 outbreaks with 3 occurring in nursing homes, 2 in residential facilities and 1 in a correctional facility, the county jail. In order for them to come off of outbreak status, they must go 28 straight days with no new cases. S:\Managers Working Files\BOH\Agenda &Abstracts\2020 Agenda &Abstracts/ August Page 5 MINUTES - Draft ORANGE COUNTY BOARD OF HEALTH August 26,2020 • As of last Wednesday, approximately 33,126 people have been tested in Orange County which equates to roughly 22% of our population. • A testing event was held on July 22nd in Carrboro which tested over 200 community members using an outside vendor named StarMed from the Charlotte area. We have another testing event on Friday to be held on Martin Luther King, Jr. Blvd in Chapel Hill across from Root Cellar in the big parking lot that belongs to the campus. The goal behind the test is to attempt to capture UNC students that reside in some of the apartment complexes and off campus housing. • The OCHD has been all hands on deck with getting the word out on some of these testing events due to the short turnaround time. We've, literallly, walked down Franklin Street promoting the testing events. Other advertising, posting the info on social media outlets as well as worked with UNC to ensure that they've included these events on their listservs to promote these testing events. • DHHS announced they awarded contracts to vendors in this state to assist some counties with some additional testing resources. Orange County is one of those counties. • Despite new CDC testing guidance regarding asymptomatic close contacts to a positive case, our state guidance hasn't changed and we'll continue to test close contacts. • DHHS is in the process of creating Regional Prevention Support Teams for long term care facilities within the counties across the state. This is similar to what we've already done in Orange County with our Strike Team that includes a CD nurse, EMS staff and a community paramedic. Each region will receive funding to create teams with the focus on prevention, not outbreak management with the goal of spreading a lot of education regarding infection control. We're in region 5 which will receive $198k for 6 months to get these teams up and going. Ms. Stewart will be the fiscal agent for this region with the help of other members of the OCHD staff that will lead to coordinate this for our region. • Age demographic of 18-24 year olds have seen an increase in positive cases. • UNC has under 1000 students living on campus. There is a hardship application process required in order to remain in the residential dorms. There was a dashboard titled "Board of Health Dashboard — OCHD COVID-19 Response" displayed. This dashboard was created by Rebecca Crawford to show how the OCHD clinics responses have been affected by COVID-19. Below are some highlights. • Patients are still being seen at both the SHSC Clinic, deemed the "well clinic" where primary care visits occur, and the Whitted Clinic, deemed the "sick clinic" for those symptomatic patients. Telehealth appointments continue to increase monthly. • The Dental Clinic continues to see emergency appointment only. • In regards to data on communications, o Communication is pretty steady with COVID nurse calls. COVID info line is Monday through Friday from 8-5pm. There hasn't been enough demand for a 24 hour or weekend shift. o COVID testing numbers include those patients that had a telehealth appointment and were instructed by the provider to come into the office for testing based off of their symptoms and those tests performed by the Strike Team. We continue to send referrals to the UNC RDC. o With the COVID funds we've received, we plan to increase testing. o We still have a strong social media presence thanks to Kristin Prelipp and the Joint Information Center (JIC). They're still doing a great job. S:\Managers Working Files\BOH\Agenda &Abstracts\2020 Agenda &Abstracts/ August Page 6 MINUTES - Draft ORANGE COUNTY BOARD OF HEALTH August 26,2020 C. Media Items Kristin Prelipp, Communications Manager, mentioned that all of the COVID-19 articles were related to the University of North Carolina. Ms. Prelipp stated that she did not compile all of the articles as there were too many to gather. Media items were in the packet which focused on Orange County's events and our involvement in various efforts. VI. Board Comments. Ms. Frega mentioned that, on September 10t", the BOCC is planning to vote on the BOH's pharmacist seat recommendation. In hopes of the BOCC approving the recommendation, she also stated to Ms. Scurry that they'll need to think about subcommittees for them to join. VII. Adjournment Sam Lasris moved to adjourn the meeting at 8:47pm and Alison Stuebe seconded. The next Board of Health Meeting will be held September 23, 2020 at 7:00pm via Go To Meeting. Respectfully submitted, Quintana Stewart, MPA Orange County Health Director Secretary to the Board S:\Managers Working Files\BOH\Agenda &Abstracts\2020 Agenda &Abstracts/ August Page 7