MINUTES
DUKES COUNTY HEALTH COUNCIL
November 17, 2005 Meeting
West Tisbury Public Safety Building
CALL TO ORDER
Chairman Cindy Mitchell called the meeting to order at 7:37am. Chair determined that a quorum was present. Attendees included: Catherine Brennan, Terry Appenzellar, Olga Church, Jacque Cage, Linda Swanson, Paddy Moore, Rhonda Cohen, Jane Cleare, Kenneth Chisholm, Cynthia Doyle, Tom Bennett, Jo Ann Murphy, Nancy Gilfoy, Patsy McCornack, Tim Walsh, and Patrick Donegan. Member Tad Crawford arrived at 8:05 and member Chris Knowles arrived at 8:12. Also present were E. Winn Davis, member ex officio, Sarah Kuh, VHCAP and member ex officio, Mary Leddy, VHCAP, guest Dedie Wieler, and Deborah H. Potter, executive assistant to the county manager to record minutes.
NEXT MEETING:
Cindy Mitchell reminded everyone that the next meeting is set for December 15th (due to the holiday).
MINUTES:
The notes of the October 27th were acknowledged. Adoption was not required as a quorum for that meeting was not achieved. (The minutes of September 22, 2005 are still pending.)
TREASURER’S REPORT:
Terry Appenzellar advised that the budget presented is a draft. There are still 2 pending items on one warrant. On the reverse side of the budget is a report identifying the actual vs. budgeted figures to date for the various committees. Pending expenses are not reflected in this report. She also reminded all committee chairs that during the last 90 days of the budget year, the DCHC is only allowed to spend 1/12th of its annual budget in each month. If anyone had a big expense occurring during that time, they would need to get prior approval from Mr. Davis. Cindy Doyle asked when the fiscal year ended. Terry Appenzellar advised that the fiscal year was from July 1st to the following June 30th. Cindy Mitchell
asked for a motion to accept the Treasurer’s report. Rhonda Cohen made the motion, seconded by Nancy Gilfoy to accept the Treasurer’s report and the motion was SO VOTED unanimously.
INTEGRATED WORKPLAN FINAL DRAFT:
Cindy Mitchell circulated the final draft of the DCHC work plan. She advised everyone she was seeking approval of the final draft so that the DCHC can pass it on to the Dukes County Commission. The corrections suggested at the last meeting were dropped in and changes that occurred with Dr. Klein’s Public Health Care Working Group were added. Cindy Mitchell asked for a motion to accept the recommended DCHC integrated work plan. Cindy Doyle made the motion, seconded by Tom Bennett to accept recommended DCHC integrated work plan and the motion was SO VOTED unanimously.
Cindy Mitchell added that the Coordinating Committee will take responsibility for ensuring the chairs of the committees make the required reports and track the overall progress of the groups. The committees are working hard and producing some great results.
HEALTH COUNCIL COMMITTEE/PROGRAM REPORTS AND UPDATES:
Rural Health Network Oversight Committee. Dedie Wieler made the report for Dr. Klein who was unavailable to attend. Ms. Wieler reported that the first formal meeting with the selected consultants occurred. The group pounded out the guiding principals to govern the progress of the group. The consultants are going to start interviewing key consultants. Dr. Klein made a list of criteria and she is looking for individuals to participate. Dr. Klein’s suggestions for potential key informants include: key informants: a hairdresser, a schoolteacher or principal, a representative from a religious organization, a person who uses traditional and non-traditional healing modalities, someone from a 12-step program, a family with a child with
special needs, someone from law enforcement, a teen in a youth group, a representative from an Ethnic association or group, someone from the arts community or an elder association, or a veteran for example. If anyone is aware of someone who would be a good candidate, please notify Dr. Klein.
Cathy Brennan asked if Dedie could give the council a sense of the direction the group was taking. Dedie Wieler responded that the group was starting with the guiding principals. The consultants have a framework to follow and gather information. Then the group would review the data and attempt to identify services that are available and island needs. Once they have that information they can keep the momentum going and disseminating information on what was available and how to address any specific island needs. Jacque Cage suggested that the group may want to consider a “summer residents” category as they also use many of the island’s services as well. Cindy Mitchell advised anyone the suggestions to contact Dr. Klein.
Youth Task Force Community Meeting. Cindy Doyle reported the Youth Task force raised money and conducted a youth risk survey. The data is now available and the committee is working on how to present the data. The committee wants to incorporate all of the data into one single report that represents the whole view. On October 27 the group had 57 people attended a meeting facilitated by Della Hughes and Susan Curnan of Brandeis University. There was a wide variety of community wide representation and that meeting was the first step in developing a 10-year plan to address the Health needs of youths and families. One overarching idea is for the creation of a healthy environment so that kids can thrive. The group also doesn’t want
to just look at what is missing but to identify what is here and working and attempt to increase those resources.
The group wants to emphasize the positive not just the negative. For example, the Youth surveys in the past have released the “bad” information such as how many kids smoke or use marijuana or alcohol. We want to reverse the presentation of the data to show how many kids are not doing it to take a more positive approach. This has been identified as a much more effective method of distributing data.
From this meeting, the group came out with 4 areas of focus:
1. Aiming for total community responsibility for kids 0-25 years of age
2. Valuing Youth: pointing to positives and encouraging the press to emphasize good stories too.
3. Growth through opportunity: Helping youth have more off-island experiences and also to create a handbook of available resources.
4. Support Services: What support services are available if families need them
Our next step is to go to Brandeis. There will be a follow-up for those people there in December to get more input. We are looking at the Youth Task Force as a steering committee and we will probably be developing smaller committees as well. Patsy McCornack suggested that the group may want to get employers involved especially regarding young kids on their first jobs. Jane Cleare added that for inclusion the group may want to include members from the elderly on the island. She said that if it takes a village to guide children, we need to remember that children can be significantly impacted by grandparents.
Cindy Doyle responded that an additional area the group was trying to develop was a mentoring program that could tap into the retired community. Rhonda Cohen added that the clerkship even identified this during their presentation that kids want at least one person in their life that is “crazy” about them. Cindy Mitchell asked what was the attendance total, how many kids, and how many parents. Cindy Doyle replied 57 with 15 kids and 8 parents. The group tried to get a good mix of students as well not just ones who were relatively problem free. Rhonda Cohen added that this was just the beginning for the group. We really want to work on developing a plan and then putting it into effect.
The kids that attended the meeting were from the High School and Cindy Doyle advised that many of the kids were actually recommended by other students. In addition, the group got one former student who moved off-island to attend to discuss their experiences. Cindy Mitchell then asked what caused the expansion of the target group up to 25. Cindy Doyle replied that the needs of kids are not over once they graduate. They are still transitioning into a new life and they still need support. We want to keep them supported as they move into the real world and adult culture. Cathy Brennan added that the nominating committee is looking for student members so if the group had anyone to recommend to let her know.
Mental Health and Substance Abuse Committee: As part of the update on the MVCS update, Cindy Mitchell reminded everyone that the Council has voted to authorize the chair to write a letter on behalf of Community Services. She is working with Susan Wasserman on this and that letter will be completed this month.
Tom Bennett continued that the MVCS was still seeking full funding. MVCS has made a plea with the state for full funding. Community services finally received a call from Gloria Mazza, from the state DMH, and she will be scheduling a meeting at the end of the month. Cindy Mitchell asked if the 60 days notice for termination of service that had previously been discussed had been sent. Tom Bennett said that for right now it is on hold. After this meeting at the end of the month, they may be able to get some sort of workable solution, so they are waiting. Cindy Mitchell then asked if Susan Wasserman had contacted the papers and Tom Bennett said they were also waiting until after the meeting with the state was over. Sarah Kuh asked that if the best
case scenario happened, would the funds be available this July. Tom Bennett advised the MVCS would prefer to have the additional funding ASAP but anything is possible at this time. Hopefully additional funding for this year can be received but MVCS is open to discussion.
Martha's Vineyard Health Report Status: Paddy Moore reported that the group was waiting for Dr. Becker to complete her contractual obligation to revise the document. The good news is that some of the data relating to various health issues is present, has been checked by prominent experts, and will be useful to many of the other committees. The Health Committee is pushing hard to get the report and hope to publish the findings by the end of the year. Dr. Becker had suggested releasing the report is various pieces and the Health Committee has said that they want to do it instead as one complete report as they feel that would enable the best use and presentation of the data and material. Nancy Gilfoy asked if the group had included holistic
practioners in their interviews. Paddy Moore replied that it had been provided for but so few holistic practioners responded that the statistical information was not reliable because they did not have enough response for an appropriate sampling. Paddy Moore also added that if the committee were to do this again, they would make sure the definitions of some terms were more precise to avoid confusion.
Terry Appenzellar asked what were the plans for the physical distribution of the report such has how many reports will be printed and how will they be distributed? Paddy Moore responded that the idea is to put a report in at least each major distribution point, such as each of the libraries and to also have it available on the website. A certain number of printed reports will be available but the report could be emailed to anyone upon request. Tad Crawford added that any delay of this report is not the result of our committee and that they had done an admirable job.
Island Health Plan Update: Cindy Mitchell distributed a handout reprinted from the Boston Globe delineating the various health care plans currently being considered for implementation. There are many similarities between our plan and the State’s plans. A clear component of the plans is the insurance funding and the subsidy prices which will reduce the premiums of the plans to affordable levels.
Cindy Mitchell continued by stating the Island Health Plan has overcome many obstacles but the last hurdle comes at a time when there are now going to be other similar programs competing for the same funds as our group. Our program is getting marginalized. Although we don’t necessarily rely on State funding, we are dependant on Federal Funds. So we are concerned about competing interests for the Medicare/Medicaid funds and cuts in these programs. Unfortunately, on the surface, it appears that our plan is expanding services that may create another hurdle. We are still waiting on JSI for further information on this. We will continue to move forward and if we were to get permission, we could have the plan up and running by April 1st. We do have the support and assistance of Senator Kennedy on this. We have had some political success in the past so this still could happen.
If not, the group is looking at:
1. Redesigning the health plan to be smaller. Cindy Mitchell said she was opposed to this because this was not the original goal of the group which was to provide health care to individuals 300% and below over the poverty group.
2. Or refashioning the plan so that at least some of the elements that can be made available and useful are implemented.
After a short discussion on the various reconfiguration options, Paddy Moore asked what the connection to the OMB (Office of Management & Budget) was. Cindy Mitchell explained that the Island Health Plan was looking for a 1115 waiver. This covers the agreement between the State and Federal government on how to administer Medicare/Medicaid. OMB is stalling our request at this moment. However, the State waiver has already been approved. Paddy Moore then asked if there were pieces of the State plans that we could support. Cindy Mitchell said that once the plans starts there are elements of these other plans that can support our needs as well.
Tad Crawford asked if the group could start at the 200% and below figure to just get the program going. Cindy Mitchell replied that was not how the plan was advertised and there is already opportunities for enroll for this group already. It is the 200-300% group that needs assistance. Tad Crawford then asked if these other plans become a reality would they override the Island Health Plan. Cindy Mitchell replied that certain opportunities would change but that Island Health Plan can find a way to fit in. Jane Clare added that the group 300 – 400% over the poverty level are the working poor or are missing insurance because of the expense and this is the group we are trying to target. Mary Leddy added that some of the state programs seem to be the
same as what Island Health is doing. They could also support many of the IHP goals as well. Cindy Mitchell agreed and introduced Mary Leddy to the group.
Other Updates: Cindy Mitchell noted that the Health Forum committee will report in December.
Sarah Kuh advised that there was a new regional group looking into diabetes on the Cape and Islands especially for people of color and low-income individuals to determine if a disparity in care exists. It is funded by a private foundation. The first year is for planning with the next 2 years for implementation of any efforts. The study is trying to determine if the disparities exist and how to remove the disparities in health care. Dr. Klein is looking for participants and there is a strong interest in consumers. Anyone with recommendations can contact Sarah.
Cathy Brennan advised the group that the nominating committee has openings in both the consumer and practioners areas and anyone with recommendations can contact her. She also advised that she would be e-mailing a new membership roster with a few corrections on it to all the members. Paddy Moore suggested that this might be a good time for the nominating committee to consider increasing the number of student members as it seems they are more willing to participate in these kinds of activities when they are in groups.
SPECIAL REPORT-MVH DETERMINATION OF NEED: Chris Knowles, the Special Projects Manager for the MVH, reported to the DCHC that the MV Hospital is in the process of raising funds for building and making additions to the Hospital in the range of $40-42 million dollars. As they are doing this they are required to make an investment in community health in the amount of $2 million dollars distributed out over 5 years. These funds are funds that the hospital will have to finance or fund-raise.
What we have come up with is a plan to distribute the funds once the ground breaking starts, which in all probability will be the last quarter of FY2006, over a subsequent five year period. There are three areas of interest that we will be emphasizing.
- Behavioral Health: The hospital, in collaboration with the Associate Commissioner for Health Care Access, the DCHC, and other agencies, is proposing to allocate $400,000 dollars over the five years to grants that would assist behavioral health providers in meeting the needs of the Martha’s Vineyard. The hospital would provide support to the grant recipients but would not be part of the decision making process. The proposals would be graded by a refined matrix in consultation with the Associate Commissioner for Health Care Access, the County Commissioners, and the Office of Healthy Communities at DPH to make sure that these grants are deemed to be responsive to the needs of the residents of Dukes County.
- Preventive Care: The second piece is Health promotion and disease prevention. Many providers of these services have gone out of business, as the models used to operate them were not viable. This means that these providers of these services either need to operate more efficiently, try to get more funding from the towns, or a combination of both. Another new twist is what happens if VNS is no longer part of MVCS. MVCS will not be obligated to continue these services. These events will provide an opportunity to work towards the development of an ongoing, viable service. The current contract only covers about 30 to 50 cents of each dollar it costs to provide this service.
- Primary Care: We are designated 2 primary care physicians short on Martha's Vineyard; however, with Drs. Klein and Tsikitas closing their practices we will be 4 short. What we have to do is develop a number of ways to get people to come here and stay.
As a result of a telephone with DPH, a fourth area has just been added. An emerging needs and public health initiatives category will be established to provide money for areas such as bio-terrorism, avian flu, and other areas that may require rapid funding outside of the normal pipeline. Any changes to this plan would require DPH approval and the hospital is not working in a vacuum as it has discussed many of these areas with many various participants. As a result of these conversations, the document has grown from a three page document to a six page document that details some of the specifics or process governing the distribution of these funds.
The MV Hospital will be spending 2 million dollars over a five year period in these four areas. The current breakdown is:
Primary Care $925,000.00
Behavioral Health $400,000.00
Disease Prevention $575,000.00
Emerging Needs $100,000.00
The total figure for this area and all other figures at this point are estimates at this point. The total amount will be spent, however, if one area does not spend all its funds they will be spent in another category.
Cindy Mitchell asked at what point does this become final and was there a deadline for the DCHC’s input. Chris Knowles replied that once the final plan is submitted there is a lengthy review process and that although there was not deadline per se, the hospital wanted to get this completed as soon as possible. Tom Bennett commented that he thought the proposal was good and he really pleased with the proposal becoming formal. Tad Crawford asked what comments the DCHC groups working in these had and would a letter of support from the DCHC help. Mr. Knowles advised that members of the health council had reviewed the plan and a letter would be helpful. Cindy Mitchell then deferred the topic to the December meeting so the DCHC members could review the
material.
SPECIAL REPORT-VHCAP CURRENT SERVICES SCOPE AND LEVELS: Sarah Kuh updated the council on the state of services within her department. The department is staffed by 5 part-time personnel that is the rough equivalent of 3 full-time people. The current annual budget is $200,000.00 and in 2006 we will lose about $60,000 in funding. The department is working hard towards developing a sustainability plan to enable the department to continue to provide services at current levels. The primary goals set 6 years ago when the department was created included enrolling people in Mass Health services and coordinating primary care services.
The VHCAP 4 month data survey shows how we are achieving those goals. The department helped, over the 4 month period, 697 people apply for Mass Health services, 12 people apply for MassHealth Disability, received 824 approvals from Mass Health for enrollments, trouble shooted 352 problems for clients, received approvals for Mass Health to MVH of 231 (over 5 months) and received approvals for Mass Health to IHC of 212 (over 5 months).
The department receives over 100 letters a week regarding problems with applications and we work towards sharing information and providing on-going support to make sure that all requirements are being met. In addition, we also try to direct users to other services that might be met by other agencies as there is often more than just one problem needing attention.
E. Winn Davis asked if their department was troubleshooting 50% of their applications. Sarah Kuh responded roughly as some of the applications have more than one problem that occurs. Jacque Cage mentioned to Sarah that it would be helpful if she could add to her last two items the agencies that referred these people to VHCAP.
Sarah Kuh continued by presenting the 4 month information for services provided that were Non-MassHealth related. The highest areas of use included scheduling appointments, coordinating payments for services, and prescription assistance. Mary Ledder then continued by explaining that the numbers themselves don’t always accurately reflect the involvement or level of effort and labor required to provide the service. Frequently, someone will come in for service in one area and during the course of the conversation we will discover they have other areas of need as well. One of the most important factors affecting the people we see is the island economy. Many are self-employed or seasonally employed. They are constantly changing jobs or have income
changes. More people are coming in who have insurance but are looking for other options because they can’t afford to pay for it anymore.
Some examples include how we are seeing more individuals from the real-estate industry who haven’t sold a house in a few months or restaurant employees. Some restaurant employees qualify for unemployment while others don’t. Some restaurants are now closing even earlier so their employees who previously qualified for unemployment now don’t because they didn’t work long enough. We are seeing a lot of people who have good jobs that they have been at for a while but the business doesn’t offer health care. Other problem areas include self-employed people who are injured or individuals with progressive diseases.
These are just a snapshot of some of the human perspectives of the numbers that you see described here.
Adjournment
A motion to adjourn was made by Cindy Doyle, seconded by Rhonda Cohen. The meeting adjourned unanimously at 9:40 a.m.
Respectfully submitted,
Deborah Holtzer Potter
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