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MINUTES OF THE
DUKES COUNTY HEALTH COUNCIL
Regular Meeting of July 25, 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 July 25, 2002.
Meeting began at 8:10 a.m.
Members Present:
Cynthia Mitchell, Chairman *Ex Officio
Jo Ann Murphy Jacque Cage
Tad Crawford Ilene Klein
Marni Lipke Charles Silberstein
Carol Borer* Ned Robinson-Lynch
Chris Knowles Kathy Logue
Else Membreno Peter Strock
Sarah Kuh * Cathy Brennan
Patty Begley Lorna Andrade
Kathleen Fitzgibbon Dennis Hoak
Fred Rundlet
Joyce Steward
Also Present: Marsha Smolev, Nancy Kasen, Pamela Speir, Pam Putney, Carol Smith
Absent:
Marguerite Bergstrom Sarah Isenberg
Tim Walsh Michelliny Faust
Melinda Loberg Kathleen Rose
Dan Seklecki William Elbow
Jane Cleare Murray Frank Michele Lazerow Robert Sawyer
Sandra Lothrop
Cynthia Mitchell recommended that the August meeting be cancelled. Consensus was to cancel the meeting. The next meeting will be September 26, 2002. Pam Putney, new CEO of the Island Foundation for Health was introduced. Cynthia Mitchell updated the Council on Murray Frank’s illness. (Get well Murray!) A backlog of HC Minutes will be reviewed at the September meeting.
Tad Crawford reviewed the Treasurer’s year end report noting the County’s allocation of overhead for the Health Council ($6127.18) and the $3000 (Council’s half) of the Special Audit expense. There was concern about losing the $2400 left from John Snow, Inc. invoices, Phase III Part A, and members asked how these funds could be carried over. The County Manager said the funds had already been carried over once, so they could not be carried over again. She suggested speaking with Treasurer Noreen Flanders when the question was reiterated. Fred Rundlet suggested encumbering the funds. Tad Crawford commented that the Health Council was funding the County. Kathy Logue asked if there was some way to know the amount of the allocation before the end of the year. She suggested
getting a quarterly figure and projecting. Carol Borer said she would ask the Treasurer if this was possible or how else to do it. Cynthia Mitchell said the Lighthouse Alliance did it, but the County would have to have the incentive to do it and so far, communication hasn’t been great. She added that the Health Council needed the support of the County Commissioners. Kathy Logue Moved that the Treasurer’s Report be approved and communicated to Noreen Flanders so she could change her accounts to mirror the report, and also to communicate the need to prorate the allocation of overhead. Peter Strock Seconded the Motion that Passed Unanimously.
Sarah Kuh added that her time was not reflected in the allocation of overhead, nor was Tad Crawford’s time.
Cynthia Mitchell said, for the record, that the Coordinating Committee was operating on a temporary basis pending elections. Cynthia Mitchell added that she was not really on the Coordinating Committee anymore, or on the Health Council. Leadership was now really Facilitation until the Coordinating Committee could be formally reconstructed.
Ms. Mitchell spoke to the issue of the County Commissioners’ vote that called for the Board of the 501(c)(3) and Health Council to be separate and distinct. The papers had been filed and the corporation in place with 23 or 24 Health Council members. Ms. Mitchell noted that the issues of concern for the County were issues of control and conflicts of interest. She added that the 501(c)(3) had been filed with the knowledge that the Board might have to be amended. The Coordinating Committee had requested that the County Commissioners rescind their vote and reconsider, but the vote to reconsider failed. Cynthia Mitchell called the County’s legal counsel asking if a small subset of the Health Council could serve on both, but the recommendation was still not to perpetuate the problem. Ms. Mitchell
reported that it was possible to file legislation to exempt members of the Health Council from conflict of issue. She added that the Coordinating Committee felt that no matter what the Boards were called, the Health Council and Island Health Plan could move forward just the same. It would still be the same work.
Ms. Mitchell said the hope was to constitute the Health Plan Board to mirror a community health center board and that requires that 50% of the board be users of the service. She asked that the County Commissioners defer their need for an answer while these issues are worked on. Mrs. Borer asked when they needed the structured Board, next month? Ms. Mitchell asked whether they could wait until the end of September and bring a proposal to that meeting. The 23 people now on the 501(c)(3) Board (Health Council members) could then vote to amend the Corporation. Mrs. Borer asked if that meant 23 members would be participating in both Boards for the purpose of amending that.
Charles Silberstein asked about the Health Council’s relationship with the County. Mrs. Borer said there were people on the Health Council who hadn’t been appointed by the County. Once the decision was made at the end of September, the county would appoint new members of the Health Council. She stressed that the County supports the Health Council, that it appointed it. Kathy Logue asked the County Manager to show her where the County supported the Health Council. She added that the County didn’t support the Board or fund it. In fact, she said, it wasn’t supporting the Council at all. She said she saw no reason to continue to ‘play the game.’
Mrs. Borer said she wouldn’t continue to sit there and hash it out. She suggested that the members bring their issues to the County Commissioners or resign from the Health Council if they were dissatisfied. She got up to leave at 8:47 AM. Peter Strock objected to Carol Borer’s leaving, saying it ended the conversation. The County Manager said the “County bashing’ was just taking away from the agenda. Dr. Strock added that if Mrs. Borer left, it wasn’t a dialogue. Mrs. Borer explained that she takes the policy that the County Commissioners set. She can’t change the Commissioners’ votes, she just carries them forward. She suggested that the Health Council come to the County Commissioners’ meetings. She said she would tell the
Commissioners that the Health Council wasn’t happy with their decision to not reconsider their vote and that the Council feels a lack of support, but it wasn’t the case. Mrs. Borer said this was an opportunity. If some Council members went to the 501(c)(3) then other members could work on other tasks. Dr. Strock added that had Mrs. Borer left, there wouldn’t have been even this much dialogue. Mrs. Borer said she would stay if there wasn’t an attack.
Ned Robinson-Lynch said that despite the problems, Kathy Logue was out of line to raise her voice. He said it was inappropriate and unhelpful to blame. Ms. Logue apologized for her tone.
Fred Rundlet said they would all need more information to make their individual choices. He thought it important to look at the future of both Boards, the Health Plan and the Health Council. He added that the Plan wouldn’t exist without the Health Council and there was a reason to work together. He suggested a retreat to define where they’re going. He said he had no idea anymore what other groups were doing, such as Hospice and Community Services. It was time to tune in. He said if they couldn’t do that, then he ‘was out.’
Patty Begley said if the County Commissioners feel they have other people interested in working on the Health Council, then she’d like to hear where the Commissioners want to go. She asked why hadn’t they heard from them?
The County Manager said by the end of September there would be an amendment to the non-profit. Maybe there should be amendments to the Health Council’s goals too. She suggested spending August and September examining goals, presenting them to the County Commissioners, asking who wants to help out. She reiterated that it was an opportunity to examine where the Council’s been going for the past few years and that the County Commissioners would expect that.
Cynthia Mitchell urged that the Council members not ‘think either/or.’ She still thought they might come up with a proposal involving both. She said the present goal of the Health Council hasn’t changed. There may be other things that the County Commissioners wanted them to do, but the Health Council had a record. It was a high priority not to get in the way of that record. Ms. Mitchell said it was possible that the Health Council could serve in an advisory capacity to the Health Plan. Ms. Mitchell disagreed with Ned Robinson-Lynch and added that she thought it was okay to speak passionately. She thought it would be unfortunate if they couldn’t speak out without people walking out.
Tad Crawford asked to defer the issue while they try to find a way for people to preserve the work they do on the Health Council and work to launch the Health Plan. He said every time they grasp at a solution, it evaporates. Having three members serve on both Boards was a suggestion. The Community Center type entity was another. Mr. Crawford said he tried to speak one on one with a Commissioner and understood his concerns, but it forces the members to decide and ‘split the baby.’ He stressed they needed time.
Kathy Logue said she was distressed by the idea of bifurcating or separating the entities because there was always a ‘very healthy tension’ between the insurance road and the Whole Health Alliance/Healthy Communities road. If they have to split, the Insurance Plan would become just another insurance plan and the Health Council would be just an ideas forum. She said she was as frustrated as Carol Borer by the time spent on all this.
Carol Borer said to look beyond the Health Council and consider other members who weren’t on either Board and who then had no conflict.
Cathy Brennan voiced concern, as she did last May, about shared Boards. She said the responsibility of the 501(c)(3) Board was different than that of the Health Council. She said there were different needs, business needs, needs for fundraisers. She asked who the 23 members were and said some overlap would help communication, but having both Boards be the same concerned her.
Cynthia Mitchell explained how people were asked whether or not they wanted to sit on both Boards and 23 responded favorably. She said there was a reason to retain the tension and accountability that Kathy Logue mentioned. What they did was, she believed, the simplest way to get public accountability.
Sarah Kuh asked how they would move forward. Cynthia Mitchell didn’t have an outline for a plan. Fred Rundlet suggested people send issues to Cynthia Mitchell. The Coordinating Committee could then sort out the issues. He mentioned the Health Insurance Affordability Act and liability issues and asked what they were subjecting themselves to, how this all affected them as individuals.
Marsha Smolev mentioned that it appeared the two Boards would exist until at least the end of September and suggested that there could be liability or conflicts of interest during that period. Cynthia Mitchell said members could resign from the Health Plan if they were concerned. Kathy Logue asked if they had Directors’ Insurance. Cynthia Mitchell replied that they did not. She added if people wanted to remain on the Health Council, they would need meetings to decide the Health Council’s future.
Dennis Hoak asked if JSI had set up the Insurance Plan? Cynthia Mitchell said the Island Health Plan was not an Insurance Plan. It was a partnership with and Insurance Plan and it would contract with the Neighborhood Health Plan. Dr. Hoak said he didn’t think that was the view that the public had. He believed it was presented as an Insurance Plan.
Marni Lipke asked that the Coordinating Committee contact each member to discuss the decision that needed to be made.
Peter Strock Moved that the members of the Council be encouraged to send to the Coordinating Committee, issues they have with regard to the Island Health Plan, future directions and programs and the Coordinating Committee use those to create an agenda for a retreat. At the retreat the Coordinating Committee can present the benefits and disadvantages of being a member of the Island Health Plan and/or Health Council.
Cynthia Mitchell asked if the retreat could be in early September and Peter Strock agreed to add that to his Motion. Kathy Logue Seconded the Motion.
Chris Knowles asked that the Council remember that it grew out of the Vineyard Health Study and MV Healthcare Consortium. The County Commissioners created the Health Council in April or 1995. He said if there was to be bifurcation, then it was important to revisit these reports and see what the County Commissioners approved. He added that the reasons the Health Council was created hadn’t gone away. Cynthia Mitchell thought revisiting the reports was a good idea.
Peter Strock amended the Motion to make the agenda available in advance so people could know the issues.
Pam Putney suggested getting a facilitator for the retreat since, in her opinion, a series of retreats should be planned. Cynthia Mitchell explained that there was a time constraint, but if they were not prepared by the end of September, they wouldn’t act. They’d attempt to move ahead. Charlie Silberstein asked to move the question. Peter Strock Seconded that. The vote to call the question was unanimous.
The Motion for the retreat, etc. Passed, with Ned Robinson-Lynch abstaining.
Carol Borer noted that Murray Frank had mentioned the possibility of amending the 501(c)(3) so perhaps that could be a component of the September meeting. Peter Strock said the County Commissioners should be encouraged to send issues to the Coordinating Council too.
Ned Robinson-Lynch said he had a real concern, that there was a void in the Chair’s role. He said Cynthia Mitchell was playing both roles, Chair and Staff and he was uncomfortable with the dual role. He asked are you Chair or Staff? Cynthia Mitchell said she was not Staff to the Health Council, but to the Insurance Plan, the Lighthouse. Ned Robinson-Lynch said someone else should Chair since her role at the Council was around that issue. He said playing both roles led to a lack of clarity for Cynthia and for the Council. Cynthia Mitchell reminded him that it was temporary. Marni Lipke suggested also addressing this at the retreat, along with reorganization of the Coordinating Committee.
Pam Putney reminded everyone that the Symposium was scheduled for August 4th. Charlie Silberstein said it would be a public forum and everyone was invited to attend.
Else Membreno reported on the Women in Power Office in the Islander Building. Sarah Kuh asked if the organization was anti-choice. Else Membreno said there were some people there who had worked at Birth Right, but the Office aimed to educate women about available choices. Fred Rundlet asked that each Council member receive a packet of information about the Office. He said it was a great resource for women.
Sarah Kuh mentioned that there was an article in the MV Times about the Access Program.
Cynthia Mitchell reported that Wendy Warring, Commissioner of Medicaid had visited and updated the Council about budget constraints. She added that the Commissioner’s message was to make sure that people understand that the Division of Medical Assistance supports the Island Health Plan, but is not interested in rewarding inefficiencies in the system. They would not encourage specializing costs at the MV Hospital or inefficiencies. Cynthia Mitchell said there will be changes here.
Nancy Kasen reported on the Health Plan. There have been meetings with providers, primary care and mental health. She said she heard that providers have the will to sign on, but are disappointed with the reimbursement. The Neighborhood Health Plan will be contacting local practices to see if they could find other ways to impact the practices. Beacon Health strategists met with Mental Health Providers to explain the partnership. Nancy Kasen said the focus was still to have the network by the end of August and launch date January 1. Dennis Hoak said the consensus of the staff was that the fee schedule was unacceptable. He said, tie it to Medicare and there would be no problem. Fred Rundlet talked about the reimbursements for physicians and services that go into the ‘cup.’
He said they had a public responsibility to get the best deal. He asked to what degree the Health Plan will be able to contract services to lower costs. That would leave more money in the cup for providers. He spoke in defense of physicians, saying it was a shame to cut their reimbursements. He also said they hadn’t addressed the Mental Health Providers’ issues. Nancy Kasen said they were working on that and they had arrived at a Medicaid blended rate for services.
Ned Robinson-Lynch said he wanted the Plan to work out, but he had concerns about the Mental Health piece. He said the Mass Behavioral Partnership was a plan that covered any number of visits. He said the population that providers saw at MVCS was chronic. He researched Beacon Health and discovered that providers were dissatisfied with it because it only funded 12 visits and after that, providers couldn’t get paid. If the population migrated, there would be fragmentation. There’d be no charts, no prior authorization, for example, if a patient of a private practitioner went into crises after the 12 visits. He said this would equal poor continuation of care.
Dennis Hoak noted that Medicare pays the same rate for tests like MRI’s regardless of where the patient undergoes them. Nancy Kasen added that Mass Health is not negotiable. It’s set. Fred Rundlet said a Health Plan could negotiate, either contract or not.
Ilene Klein voiced concern about the time frame. She asked how married the group was to the launch date, considering there were unresolved issues and the Board was in transition.
Cynthia Mitchell said it was important to keep the pressure on. Dr. Klein said pressure’s okay if it moves towards a decision, but she sensed a ‘disconnect’ between what the Council was saying and what was really happening. She was not sure the Plan could be marketed with such concerns looming. Dr. Hoak reported that he’d heard that a doctor thought it ‘wouldn’t fly,’ and he knows where he stands.
Fred Rundlet said he echoed Ilene Klein. The issues were very serious and worthy of a lot of thought. He said liability with respect to insurance is an important issue. Don’t take it lightly.
Charlie Silberstein said he wanted to see the Plan move forward. He was frustrated about the meeting though, that the entire meeting gets taken up by it. He said the Prevention and Wellness Committee wanted to collaborate with the Council, and that hadn’t happened for months now. Another meeting went by. Cynthia Mitchell responded by asking heads of committees to prepare reports for the next meeting, but Charlie Silberstein said while he’d be happy to do that, he was looking for discussion. Cynthia Mitchell added, then as a preparation to discussion. She asked that reports be submitted by August 20. Ned Robinson-Lynch said there were immediate concerns that had to be addressed and asked that the Council meet soon. Kathy Logue asked that the August meeting date be left on the
calendar and held open.
Kathy Logue Moved to adjourn. Ilene Klein Seconded the motion.
The meeting adjourned at 10:14 AM.
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