1. Exploring Community Health Service Opportunities for West County: A Report for the Palm Drive District Board Prepared by: Elli Hall Health Policy and Management Consulting 503-292-3240 ~ ElliHall@comcast.net ~ October 16, 2014ElliHall@comcast.net

2. District Boundaries 2

3. The Palm Drive Health Care District is a community asset What is the best and highest use of this asset? Exploring Health Care Opportunities for West County 3 The District Board is exploring the options and receiving input and advice from many sources.

4. 4 Palm Drive District Board RFP Responses & Review Committee Input Community Listening Sessions State Regulators Consultant Report on Community Service Options Bankruptcy Attorney & Financial Consultants Individual Interviews with Health Leaders

5. Community Listening Sessions Over 100 people participated in four meetings o June 23, 2014 in Bodega Bay o June 30, 2014 in Sebastopol o July 10, 2014 in Guerneville o July 12, 2014 in Sebastopol Small groups brainstormed and reported out, comment cards were collected A full report is on the District web site 5

6. Top 4 Services Mentioned Most Frequently by Small Works Groups 6 *Percentages based on the number of groups that mentioned the service divided by the total number of groups at all four listening sessions.

7. This presentation focuses on Community-Based Health Care Services 7 Exploring Health Care Opportunities for West County

8. Individual Interviews with Health Care Leaders Twenty-four health care leaders were interviewed by phone this summer. Their perspectives and recommendations on community-based services inform this report. 8

9. Individuals Interviewed Lynn Campanario, Sub Abuse Prevention, Sonoma County Health Susan Castillo, Behavioral Health, Sonoma County Health Services Bryan Cleaver, Director, Coastal Valley EMS Agency Liz Claret, Seniors Programs, Sonoma County Human Services Dept. Daymon Doss, Interim Exec. Director, Palm Drive Health District Barbara Graves, Health Educator, Community member, Sebastopol Terry Kelly, Director, Sebastopol Senior Center Richard Loos, Hospital services consultant Kara Hawkins. Community Services, Petaluma Health Care District Mary Maddux-Gonzales M.D, Med Director, Redwood Com. Health Lydia Missaelides, Exec. Dir. CA Assoc. for Adult Day Services Lee Nicholson, CEO, Sequoia Health Care District 9

10. Individuals Interviewed... continued Tom Petersen, Director, Association of CA Health Care Districts Richard Powers, MD, Family Medicine practice, Sebastopol Mike Purvis, CEO, Sutter Hospital Kara Ralston, COO, Camarillo Health District, Ventura County Celine Regalia, Manager, Adult Day Health Center, Napa Rita Scardaci, Director, Sonoma County Health Services Dept. Lynn Scuri, Marshall Kubota MD, Partnership Health Plan Mary Szecsey, (and staff) Exec. Director, West County Health Centers Todd Salnas, CEO, Memorial Hospital Gail Thomas, President, Palm Drive Foundation Jeff Weaver, Police Chief, Sebastopol Misty Zelk MD, Med. Director, West County Health, Sebastopol 10

11. CA Health Care Districts and Community-Based Services Exploring Health Care Opportunities for West County 11

12. CA Hospital Districts The CA Hospital District law passed in 1946 o Build and operate hospitals o Recruit and support physicians In 1994, the Legislature renamed its statue the “Health Care District Law” in recognition of districts’ broadening responsibilities Approximately 78 districts exist today 12

13. CA Health Care Districts: Evolving Rapidly Districts are authorized by the State to do anything “necessary for the maintenance of good physical and mental health ” About 1/3 of Districts no longer operate a hospital o Sold or leased to another entity o Used for other health-related purposes o Closed 13

14. Some Districts that Don’t Operate Hospitals Beach Cities (LA) Bloss Memorial Camarillo (Ventura) Cambria (San Luis Obispo) Corning Del Puerto (Stanislaus) Desert East Kern Eden Township Fallbrook 14 Grossmont Lindsay Los Medanos Mark Twain Mt Diablo Redbud Peninsula Petaluma Selma Sequoia

15. Health Care: THE BIG SHIFT Fewer inpatient days due to fewer admissions and shorter stays 15 Increased competition to provide hospital care to insured patients; Kaiser is key in California Financing for hospitals has changed From ‘any willing provider’ to narrow networks From fee-for-service to managed care From paying for procedures to paying for outcomes

16. The BIG SHIFT 16 Our “health system” is evolving to support: Greater integration of providers Primary care and outpatient services Cost containment Wellness and prevention

17. Hospitals Are Evolving Too Many hospitals, both district and private provide community-based services: 17 To fulfill their mission of fostering health and reducing suffering To achieve better outcomes for patients after hospitalization To build community support To meet payer mandates

18. Districts Providing Community Services District:Services/Programs: Beach Cities Health District Blue Zones Project, Medical Reserve Corp, AdventurePlex, Center for Health & Fitness, Community Care Services: MoveWell/Peer counseling/Care Management/Conversation Companions/Errand Volunteers/Support Groups/Memory Club, LiveWell program for tots/kids/adults, Center for Health Connection: medical, dental, & counseling services for the underinsured and uninsured. Camarillo Healthcare District Adult Day Program, Senior Support Line, Lifeline of Ventura County, Senior Lunch Program, Care-A-Van Transportation Services, Wellness & Caregiver Center, Chronic Disease Mgmnt, Caregiver training/education/support Corning Healthcare District Meuser Memorial Health Center leases space for health related services provided to the public including: Tehama County Social Services, Tehama County Health Agency, Quest Diagnostics, Podiatry services, Children First, Corning X-ray, Corning Medical Associates. Also provides grants to support Northern Valley Catholic Social Services for senior health. 18

19. Districts Providing Community Services Desert Healthcare District Wellness Park, Grant Funding Certified Health Navigators for ACA education and enrollment, Funding for healthy school initiatives and Healthcorps coordinators (a national health education/peer mentor program). East Kern Health Care District Leases offices to the following health professionals: A.V. Chiropractic, West Point Physical Therapy, Cal City Clinic, Tehachapi Family Health Center, and T. SRI, MD, FACP Eden Township Healthcare District Grants for the following programs: Eden I&R, Service Opportunities for Seniors Meals on Wheels, Mercy Retirement & Care Center, La Clinica de La Raza, Inc., San Leandro Boys & Girls Club, East Bay Agency for Children, Davis Street Community Center, Tiburcio Vasquez Health Center, Spectrum Community Services, and Building Futures with Women and Children Fallbrook Healthcare District Publish an annual Community Resources Directory, sponsor health fairs, PSA Screenings, and a grant program Grossmont Healthcare District Half of revenue goes to hospital, the other half goes into grants to local non-profit health-related organizations 19

20. Districts Providing Community Services Lindsay Local Hospital District Helps pay for Lindsay Wellness Center, provides a licensed vocational nurse for the school district, owns and rents several medical offices for physicians and clinics. Los Medanos Community Healthcare District A More Excellent Way' Program, 'CPR FAST' Program, 'City of Pittsburg-Swim Academy' Program, 'Eyeglass' Program, 'St. Vincent de Paul- RotaCare' Program, Community Garden Program, and yearly grant programs Mark Twain Health Care District Free Nurse Call Center, Health Fairs, Breast Cancer Awareness Events, Family Medical Center Funding, Chronic disease management awareness events. 20

21. Districts Providing Community Services Mt. Diablo Health Care District Subsidiary district of the City of Concord, uses tax revenue to fund grants for local health programs Peninsula Health Care District The Trousdale assisted living and memory care facility, Healthy Schools initiative grants in the Peninsula school district, Apple Tree dental clinic program grant, community health grants, grant supporting County Health System’s ACE Program, grant to fund a full-time psychiatric resident physician in the county's Behavioral Health Program, partners with the Red Cross, partners with Lions Club & police for emergency preparedness, supports Lesley Senior Community. Petaluma Health Care District Healthquest community CPR classes, provide defibrillators and training to the community, Lifeline services, health education & wellness classes 21

22. Districts Providing Community Services Redbud Healthcare District Senior Center Grants, Fire District Ambulance Grants, Adult Day Care Service Grants, School District Grants, Youth program grants, literacy program grants, St. Helena Hospital Grants Selma Healthcare District Donates to Selma Ambulance, Selma High School Health Education donation, 2013-2014 Diabetic Nurse at Abraham Lincoln Middle School donation, Pregnancy Prevention Program at Abraham Lincoln Middle School donation, donates to the Doctors Academy at Selma High School Sequoia Healthcare District District Programs: Healthy Schools Initiative, HeartSafe, Living Healthy Workshops, Caring Community Awards. District Funded Programs: Samaritan House Redwood City Clinic, Children’s Health Initiative, Ravenswood Family Health Clinic, SFSU Nursing program, SMMC Clinic in North Fair Oaks. Gives community grants for food, seniors, drugs/alcohol, Youth, domestic violence, planned parenthood, and developmental disability programs. 22

23. Three Districts Dedicated to Community Services Sequoia District, San Mateo County o HeartSafe and School Health Initiative Camarillo District, Ventura County o Education/Support Groups and Senior Services Petaluma District, Sonoma County o CHIPRA work on community planning and programs; community grants 23

24. Sequoia Healthcare District First CA Hospital District, founded in 1946; Dignity Health owns/operates Sequoia Hospital 220,000 residents in Central and South San Mateo County. Tax revenues are $9.4m/year ($100 average assessment) The District’s community services reach 50,000 residents each year 24

25. Sequoia Healthcare District HeartSafe Program: Improving the “chain of cardiac survival” in order to reduce sudden cardiac arrest deaths 25 350 automated electronic defibrillators have been placed around the community wherever people gather (and exercise) CPR and defibrillator training provided at no charge to first responders, residents, school children

26. Sequoia Healthcare District Healthy Schools Initiative Funding school nurses, counselors, wellness coordinators, physical education coaches and outreach specialists Modeled on the CDC’s Coordinated School Health approach www.cdc.gov/healthyyouth/cshpwww.cdc.gov/healthyyouth/cshp Working with all 8 districts reaching 27,000 students, plus their parents and school personnel 26

27. Camarillo Health Care District Serves Pleasant Valley in Ventura Founded in 1969; Hospital is now owned and operated by Dignity Health District tax revenues are $2.1m but annual budget is $3.7m. Very entrepreneurial! 27

28. Camarillo Health Care District Classes and Support Groups: Chronic health conditions: stroke, brain injury, Parkinson’s, dementia, Scleroderma, arthritis Chronic Pain Management training Memory Boost training, UCLA program AA meetings of all types Moms supporting Moms Caregiver support Weight loss Friendship groups (for seniors) 28

29. Camarillo Health Care District Services for Seniors and Adults with Disabilities “Wellness and Caregiver Center of Ventura County ” Adult Day Program Senior Meals Program: home delivered and congregate Senior Support Line Transportation Services Chronic Disease Management Healthy IDEAS (mental health) Durable Medical Equipment Fall Prevention, home safety Immunizations 29

30. Petaluma Health Care District Formed in 1947; hospital was leased to Santa Rosa Memorial Hospital in 1997 CHIPA, Community Health Initiative For the Petaluma Area, has a 63 member advisory board that serves as the local Health Action Chapter CHIPA meets quarterly; its 3 work groups meet monthly to coordinate community actions and programs that achieve CHIPA’s health goals 30

31. Petaluma Health Care District CHIPA’s Three Priority Areas: 31 Cradle to Career: “our children enter kindergarten ready to succeed and are supported in and out of school” Mental & Behavioral Health: improve access to mental health and substance abuse services especially culturally responsive and language-appropriate services Wellness & Prevention: “our residents eat healthy food and are physically active”

32. Petaluma Health Care District Healthy Community Consortium Hospice of Petaluma Latino Health Forum Northern California Center for Well-Being Petaluma Valley Hospital Foundation Rotary North Bay Children's Center 32 Next Gen PEP Housing Petaluma Arts Council Petaluma East Side Farmers' Market Petaluma Education Foundation Petaluma People Services Center Coalition on the Shelterless COTS Friends of the Petaluma River Mentor Me Petaluma Sponsors Community Activities and Groups Contributing to Health

33. Which Paths for the Palm Drive District? Exploring Health Care Opportunities for West County 33

34. The Palm Drive District is a Community Asset A centrally-located, well-designed facility that is handicapped accessible, seismically safe, with adequate parking 34 Annual tax revenues are $4m Some medical and facility equipment remain Infrastructure to support a sophisticated telemedicine program Ability to educate and mobilize your community in support of health programs and policies

35. Criteria for Community Services o Responsive to community health needs o Within the District’s powers o Regulatory requirements can be reasonably met o Financially viable 35

36. Criteria for Community Services o Good value: benefit is proportionate to cost o Synergy: Align other health programs and organizations to increase impact o Proven models: evaluated for effectiveness, succeeding in other communities 36

37. Highly Recommended Community-Based Services Emergency services including “Save Lives Sonoma” and/or HeartSafe Urgent Care Center(s) Outpatient Services Health Programs for Seniors Healthy Schools Initiatives Prevention and Wellness Mental Health Services 37

38. Emergency and Ambulance Services Work with Coastal Valley EMS to document any EMS transport issues and define solutions Support the HeartSafe and/or “Save Lives Sonoma” http://savelivessonoma.com http://savelivessonoma.com 38

39. “Save Lives Sonoma” Mission: Train 100% of Sonoma County residents in “hands-only CPR” which is easy and quick to learn Bystander CPR triples the survival rate for cardiac arrest but sadly 89% don’t receive it The entire district could benefit; especially rural areas 39

40. “Save Lives Sonoma” Partners 40

41. Urgent Care Center Urgent Care could be provided in Sebastopol and/or in Guerneville 41

42. What does Urgent Care Offer? MDs diagnose, treat, and triage patients; Appointments not needed, extended hours 42 Can do sutures, can cast some fractures May have access to specialty consults/referrals District $ support could help assure access for all May have sophisticated imaging and lab

43. Support Outpatient Services West County Health Centers: a great potential partner 43 Federal funds helps pay WCHCs for care provided to the uninsured; Medi-Cal pays higher, cost-based rate WCHC could expand Dental Services beyond their Guerneville Dental Clinic Could expand clinic to Bodega Bay, other locations Could expand outpatient Mental Health services Could provide mobile services, home visits, and/or school-based health clinics

44. Other Possible Outpatient Supports Improve coordination between Santa Rosa hospitals and local primary care providers 44 Support physician retention and recruitment Create local access to imaging and more immediate lab reports

45. Health Programs for Seniors and People with Disabilities Health issues were by far the biggest concern of Sonoma County seniors who participated in the AAA needs assessment survey and focus groups 45

46. The Silver Surge: Seniors 46 Population

47. Seniors: A Priority Population At least 1,000 District Residents are over 85 Approximately 50% of the District Hospital’s services were for Medicare patients Annual health care costs for seniors are 3 to 5 times the cost for a younger person 47

48. There are Options! Chronic conditions can be prevented; decline and disability can be delayed or prevented A continuum of health-related services can support healthy aging and minimize use of acute medical care services The challenge is to apply what we know and build services for our communities 48

49. Healthy Aging Programs Need Support Case management and referral Transportation to medical care Adult Day Health Center Mental health services (depression) Palliative Care, Home Care Residential Hospice Services Nutrition support Alzheimer's services for patients and caregivers Caregiver education and respite Chronic disease education, monitoring, treatment Telephone check-in calls, friendly visitors 49

50. Adult Day Health Centers Provide a diverse program of health, social and rehabilitation services that: Maximize independence for participants Improve management of chronic conditions Prevent hospitalization and premature nursing home placement Offer support and respite to caregivers 50

51. Adult Day Health Centers Participants attend 1 - 5 days/week Medical services include nursing, PT, OT, speech, wound care, meds management, transportation, meals, nutrition counseling Social activities make attendance a highlight in participants’ lives 51

52. Linkages, Care Management, Home Visiting “Linkages:” short-term information, referral, problem-solving Care Management: On-going, home visiting and care management by professionals MSSP: Intensive home visiting for frail elderly; Nurses and social workers use flexible funds to buy services, help clients remain at home. MSSP has 122 slots but “always a waiting list” 52

53. Healthy Schools Initiative: The Facts Add Up Establishing healthy behaviors during childhood is more effective than trying to change unhealthy behaviors in adulthood Health related factors such as physical and emotional abuse, hunger, and chronic illness can lead to poor school performance 53

54. Healthy Schools Initiative: Eight Possible Elements 1.Health Education 2.Physical Education 3.Health Services 4.Nutrition 5.Counseling and Mental Health 6.Healthy and safe school environment 7.Health promotion opportunities for school staff 8.Family and community involvement 54

55. Healthy Schools: Focusing on Teens Schools, parents, teens, communities address risk and support health for adolescents: Alcohol and other drugs Accidents, injuries Criminal behavior, gangs, violence Teen pregnancy, STDs, HIV School failure, unemployment Bullying, isolation Depression, mental illness, suicide 55

56. Youth Involvement is Key Forestville Teen Clinic, supported by WCHC Run by teens for teens; services include mental health, peer education, family planning and after school snacks! Analy High School 1:4:1 Club A youth led organization whose motto is “Living Better. Their 4 focus areas are bullying, diet and obesity, stress, and gratitude 56

57. Prevention and Wellness Keeping people healthy is a strategic means to reduce cost and improve the quality of care Communities need entities to coordinate and manage prevention and wellness programs The District could fill this need in West County and focus on prevention and wellness 57

58. Why Prevention Matters We are shifting from acute to chronic conditions 80% of today’s healthcare costs are for treating chronic yet preventable diseases. Diabetes medical treatment now costs $176 billion 40% of US deaths have preventable causes: poor diet, tobacco use, substance abuse, physical inactivity, violence, unintentional injury 58

59. Prevention Programs Across the Lifespan Sonoma County is rich in prevention programs; help them expand into and serve West County Home visiting for high-risk pregnant women and/or those with newborns e.g. The Nurse Family Partnership Screen for Adverse Childhood Experiences (ACEs)and refer for early intervention and treatment Prevent falls in the elderly: 17% of county residents over 65, fell to the ground more than once last year; falls can be fatal 59

60. Community Mental Health Services The ACA requires health insurance coverage for mental health & substance abuse services Options to expand Mental Health in West County: o Reduce stigma to encourage use of services o Expand access to outpatient counseling o Support professionally-facilitated groups o Screen for depression among at-risk populations o Use telemedicine to enable remote visits o Support day treatment services 60

61. Mental Health for Youth and Seniors Healthy “IDEAS” (Identifying Depression, Empowering Activities for Seniors). Proven program for depression screening, suicide prevention, counseling and case management Support School-based Mental Health Services for kids and parents o CAPE, Success Plus+ now in high schools o Additional school-based MH counselors, groups o Parenting groups 61

62. Next Steps Exploring Health Care Opportunities for West County 62

63. Invest Wisely Decide if the District will financially support or directly provide a community service Consider providing start-up support for a service that can become self sustaining Be entrepreneurial: generate grants, fees, donations, contracts, volunteers Plan for accountability: track activities, measure outcomes, determine client satisfaction 63

64. Moving Forward with Community Services Prioritize populations, regions and/or services 64 Learn more by sponsoring presentations Create a business plan for selected new services Appoint subcommittees or work with existing groups to prioritize and define in more detail Issue an RFP or negotiate a contract

65. 65 Community-Based services can contribute to a bright future for Palm Drive Health Care District