MINUTES OF THE
DUKES COUNTY HEALTH COUNCIL
Regular Meeting of June 27, 2002
I certify that to the best of my ability to record and recall, these are the Minutes of the Regular Meeting of the Dukes County Health Council held on June 27, 2002.
Meeting began at 8:10 a.m. without a quorum.
Members Present: Cynthia Mitchell, Chairman *Ex
Officio
Jo Ann Murphy Michele Lazerow (8:20)
Tad Crawford Murray Frank
Robert Sawyer Charles Silberstein
Carol Borer*
Chris Knowles Kathy Logue
Else Membreno Peter Strock
Sarah Kuh *
Patty Begley Lorna Andrade
Kathleen Fitzgibbon Dennis Hoak
Fred Rundlet
Joyce Steward
Also Present: Marsha Smolev, Nancy Kasen (8:26), Art Bingham, Dan Greenberg, Pamela Speir, Carole Cohen, Patty Blakesley (8:42), Susan Desmarais (8:42), Judy Olsen (8:42) Kira Law, Jennifer Austin, Susan Van Steiger (9:07.)
Absent:
Marni Lipke Marguerite Bergstrom Sarah Isenberg
Tim Walsh Michelliny Faust Sandra Lothrop
Ned Robinson-Lynch Melinda Loberg Kathleen Rose
Cathy Brennan Dan Seklecki William Elbow
Jane Cleare Jacque Cage Ilene Klein
The next meeting will be held July 25th. This meeting began with the Treasurer’s Report.
Tad Crawford reviewed balances remaining at the end of the fiscal year. He said the County needed to change the way it kept some records so money was allocated to the proper accounts. For example, some funds were put in the VHCAP account, but need to be transferred out. Some funds from the third year of the Lighthouse Grant would be used to complete the Island Health Plan Phase III Part C. There was still a need to raise funds for the Access Program. Only $30,000 would be rolled over into the next fiscal year.
There was a discussion about the Allocation of Overhead funds that would be due the County. Chairman Mitchell asked the County Manager how much this figure would be. Mrs. Borer suggested that the County Treasurer, Noreen Flanders, might have the figure by now. Cynthia Mitchell referred to the $2500 left in the budget and wondered how to avoid losing these funds if any money was left over after Allocation of Overhead. The County Manager suggested writing a letter to Noreen Flanders requesting the funds be used for Allocation of Overhead, with any remaining funds carried over to the next fiscal year.
Kathy Logue Moved that the Treasurer’s Report be Accepted. Charles Silberstein Seconded the Motion that Passed Unanimously.
Joyce Steward asked that the word “mandate” in the May 23, 2002 Minutes be changed to “prefer.” Kathy Logue Moved that the Minutes of May 23, 2002 be Accepted as Amended. Charles Silberstein Seconded the Motion that Passed Unanimously.
Chairman Mitchell reviewed that the Health Council had asked for the County Commissioners’ blessing in regard to filing for a 501(c)(3). She noted that the County Manager had sent an email reporting on the Commissioners vote to support the 501(c)(3) but requiring that the Health Council and Island Health Plan Boards remain separate and distinct. Ms. Mitchell asked Commissioner Robert Sawyer to report on the vote taken by the County Commissioners requiring Health Council members to choose membership on one board or the other, but not both.
Commissioner Sawyer said it was his conviction that the County Commissioners support the Health Council and that the vote was a result of communication that had broken down. He said the next meeting of the County Commissioners would be on July 10, 2002. He added that he was optimistic that the vote would be rescinded and a vote would be taken to do as the Health Council requested. He stressed that the vote was a misunderstanding. Cynthia Mitchell asked Health Council members to hold off on responding to the County Manager’s email asking that they decide on which board they wished to serve. She said there may not be a need to choose.
Peter Strock said he was reluctant to “go quietly.” He asked that the County realize that the Health Council was an asset. His sense, ‘watching the missiles go by,’ was that the Health Council was not valued. He said the Commissioners shouldn’t just try to make them feel good by what they say, but what do they get from the County? He said talk was cheap and asked that the Commissioners deal with funding issues or the process could continue to go downhill.
Bob Sawyer said the Health Council was ‘one of the greatest stars in the arena of County activities’ and he supported it always. He added that it was his conviction that a good majority of the Commissioners shared that support, but there was a communication problem. He added that the County would support the Health Council. As to finances, he said the County had financial constraints and needed a new source of funding. He suggested that something was in the works and if it went through there would be money earmarked for Health and Human Services including housing.
Fred Rundlet said he hoped the lawyer for the County Commissioners and the lawyer for the Health Council could meet and sort out the issues. Bob Sawyer said it wasn’t necessary. He talked with the attorney first hand and he was not sure the issue was as it was defined and previously thought.
Kathy Logue agreed with Peter Strock, that there were words and there were actions. She asked Bob Sawyer and Carol Borer to tell her how she could help with the communication problem.
The County Manager explained that the email was sent as a result of the County Commissioners’ vote and legal information that said the 501(c)(3) needed to be separate and distinct. She said she didn’t create the vote. She conveyed policy. She said the issue would be reviewed and she would get back to the Health Council.
Cynthia Mitchell said the Coordinating Committee created language to present to the County Commissioners requesting that they rescind their vote and appoint a subcommittee to examine the issues and work out the details. She added, “you’re all still on the Health Council.” On Monday the Director of the Island Health Plan (Cindy Mitchell) would have one of two offices in the Islander building. (The other office would be funded by the Insurance Partnership funds, $100,000.)
Fred Rundlet agreed with Peter Strock that there needed to be a meaningful collaborative effort on health care issues. He questioned the County’s “last minute” budget numbers and said he was already working on the FY 04 Budget at his work. He said the need to keep funding current was crucial.
Cynthia Mitchell asked that the Coordinating Committee elections be deferred again, since the issue of who would be on what Board was still up in the air. It was mentioned that Ilene Klein, Jacque Cage, were interested in serving on the Coordinating Committee and that Tim Walsh might be interested. Ms. Mitchell asked any other interested parties to contact her.
Peter Strock asked about the Intermunicipal Agreement. Patty Begley gave a history of the Agreement and brought the Health Council up to date on the present status. Discussion followed about the present movement to ask the Selectmen to appoint a representative to sit on an Ad Hoc Committee to continue looking at these issues.
Sarah Kuh said part of the Hospital’s Contract was to provide some outreach and enrollment for under and uninsured, but the Hospital never demonstrated that it met that part of the Contract. In fact, Sarah Kuh’s Access Program provided many of these services for the Hospital. Patty Begley said despite that fact, the Emergency Medical Services Procurement Committee (EMSPC) vote to give the Hospital the remaining funds. Bob Sawyer, Chair of the EMSPC, reviewed the history and noted that the Intermunicipal Agreement would expire on June 30, 2002. Fred Rundlet referred to a recent report about the Emergency Room that stated that 67% of the people seen there were not presenting with emergencies. He said it was ludicrous to pump more money into the Emergency Room without looking at this
study. He asked that the Health Council address what is needed, how to provide it, and how much it would cost.
Peter Strock Moved that a small committee be created to develop a strategy for the Health Council to move forward with its concept. Bob Sawyer seconded the Motion. Peter Strock, Bob Sawyer, Fred Rundlet and Carol Cohen said they would be willing to serve on the subcommittee. The Vote to create the subcommittee Passed Unanimously.
Murray Frank Moved that the Health Council ‘memorialize’ the Hospital adding that the Health Council was aware that the Hospital hadn’t completely implemented part of its Contract, and urging $22,400 be given to the VHCAP since Sarah Kuh and VHCAP staff performed services for the Hospital. A subcontract of $22,400 would buy $30,000 worth of service. Kathy Logue Seconded the Motion. Dennis Hoak noted that there was nobody present from the Hospital and thought the Hospital’s point of view should be heard before charging ahead. Bob Sawyer agreed that Sarah Kuh’s Access Program took up the slack for the Hospital and should be given the $22, 400. He added that some Health Council members and he had met with Tim Walsh, but he would not even acknowledge the issue. Bob Sawyer
said that social consciousness dictated that the Health Council do something and suggested presenting the issue to the Hospital Board of Directors. The Vote Passed with Dennis Hoak Abstaining.
(Kathy Logue, Carol Borer, Bob Sawyer, Kira Law left at 9:07AM.)
Susan Desmarais presented the report of the Geriatric Mental Health and Substance Abuse Committee. Ms. Desmarais stressed the need for home counseling for elders, and stated that very few hours of counseling for elders are devoted to actual direct services. She said there needed to be a central screening place accessible to elders, and greater awareness and collaboration between providers. Too often, elders are treated in isolation. There needed to be greater interaction between mental and physical health providers. Discussion followed with Health Council members stating their appreciation of the compelling presentation. Charles Silberstein said psychiatrists were well funded for elderly seen in their offices, but coverage for home visits was not funded. Services for the elderly by
psychologists and social workers were poorly funded. Fred Rundlet suggested that the opportunity for the Island to work on a demonstration grant for these services for the elderly should be researched. Joyce Steward asked that sexual activity among elders be included, as HIV numbers continue to climb.
Susan Desmarais asked that the Task Force continue, perhaps to work on implementing the screening piece for depression and anxiety.
Charlie Silberstein left at 9:30. Others were beginning to leave also.
June 28 – Community Grand Rounds – Oral Health Needs of Vineyard Children
July 1 – A Conversation with Wendy Warring (Commissioner of MassHealth)
The Open Houses to discuss Health Issues were discussed.
Nancy Kasen updated the HC on the Island Health Plan. Cynthia Mitchell said even though formal agreements hadn’t yet been signed, the Neighborhood Health Plan was the Island Health Plan’s partner. It was announced that the Lighthouse Grant will receive third year funding. The Division of Medical Assistance gave $100,000 to market the subsidy piece of the IHP. DMA was applying to the Robert Wood Johnson Foundation for State coverage. The three year grant would be $1.3 million to expand the insurance partnership from 200% to 400%. Cynthia Mitchell said it was a demonstration grant, that if it works on the Vineyard it would show how to save money on healthcare insurance.
Nancy Kasen reported on a meeting with providers that included representatives from NHP, Tim Walsh, Dennis Hoak, Stuart Kendall, Michael Goldfein, Murray Frank and Cynthia Mitchell. NHP would not reimburse more that 75% of Medicare, though the HC was looking for 100% reimbursement. Cynthia Mitchell said they were in conversation with NHP about how to reimburse the 100%, and stressed that there did not appear to be any issue with providers that couldn’t be worked out. Art Bingham asked how they intended to make the 75% be 100%. Cynthia Mitchell said it won’t come from NHP, but there was movement to find it.
Fred Rundlet stressed the need to build a new philosophy. He said doctors who sign on, who do well with a patient, (thus provide good healthcare and keep the person healthier…which costs less) should be reimbursed higher as a reward. Also, he added, the premium could then go down.
Michele Lazerow said she would like to see meetings with alternative/complementary providers and Nancy Kasen or Cynthia and NHP. She said the HC had been talking about creating a Vineyard model of primary prevention for years and she’d believed that was the Health Council’s intention. When it appeared that nothing had been done about including an innovative primary prevention/wellness model, Michele Lazerow questioned signing onto the plan.
Target dates for IHP:
Network in place by mid August
Market and MassHealth conversion in fall
Open for coverage – January, 2003.
Sarah Kuh mentioned that if a person was insured for 61 days prior to the new plan, they may encounter a 6 month exclusion of services other than Emergency Room services when switching. Nancy Kasen said she would research that.
Dennis Hoak cautioned that once fees were set, they would be hard to change, and they would influence other fees. He stressed the need to properly set fees at the outset.
Michele Lazerow asked that the Health and Wellness Committee be part of the discussion.
Joyce Steward asked that the second survey on behavior in youth be included on a coming agenda.
Fred Rundlet asked the Cynthia Mitchell to write a letter on behalf of the Health Council to the Mass Highway and towns, to clean the sides of the roads. He said sand, glass, etc. make biking dangerous.
The meeting adjourned at 10:09 AM.
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