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HomeMy WebLinkAbout2010-03-03 Work Session Minutes Deschutes County Board of Commissioners 1300 NW Wall St., Suite 200, Bend, OR 97701-1960 (541) 388-6570 - Fax (541) 385-3202 - www.deschutes.org MINUTES OF WORK SESSION DESCHUTES COUNTY BOARD OF COMMISSIONERS WEDNESDAY, MARCH 3, 2010 ___________________________ Present were Commissioners Dennis R Luke, Alan Unger and Tammy Baney; Dave Kanner, County Administrator; Erik Kropp, Deputy County Administrator; and, for a portion of the meeting, Ronda Connor, Personnel; Laurie Craghead, Scott Johnson, Health and Human Services; Jay Henry, CEO of St. Charles Medical Center, Bend; and, by conference call, Mark Nelson and Erica Hagedorn of the Public Affairs Counsel. No representatives of the media or other citizens were present. Chair Luke opened the meeting at 1:30 p.m. 1. Conference Call with Public Affairs Counsel regarding February Session Wrap-up. Erica Hagedorn said that the major pieces of legislation dealt with greenhouse gas emission goals. HB 3604 and SB 1050, which dealt with public contracting requirements – “buy USA” – did not pass. SB 1031 regarding Destination Resorts passed. SB 1039 regarding nonprofit clubs’ liquor licensing died. Mark Nelson stated that the question of having annual sessions is going to the ballot in November. He suspects there will be dollars raised to support it. He does not know whom, if anyone, will oppose it at this time. Commissioner Luke said in regard to 2011, he would like to see an interim work group address events proposed for EFU ground. He thinks that AOC may help staff the study group to look into this issue. Mr. Nelson asked how Deschutes County will develop its 2011 legislative agenda. Dave Kanner replied that the summer prior to the session they will solicit input from department heads and bring PAC into the discussion in late August or early September. Minutes of Board of Commissioners’ Work Session Wednesday, March 3, 2010 Page 1 of 6 Pages Minutes of Board of Commissioners’ Work Session Wednesday, March 3, 2010 Page 2 of 6 Pages Commissioner Unger added that they need to look at working with partners to see what they need. He would also like to build stronger relationships with local representative offices. Commissioner Baney expressed interest in farmers’ markets types of events and licensing. Scott Johnson said he would like to see public safety more in balance with the needs of communities. 2. Discussion of Health Care Service Delivery in Central Oregon. Jay Henry, CEO of St. Charles Medical Center, Bend, gave a little information about his background. He then talked about collaboration that reduces the overall cost of medical care for everyone. Discussion occurred about how bringing in an extra hospital requires a lot more equipment, staffing and trailing. Collaborating reduces the overall costs, and requires a smaller number of protocols that allow for world-class care. He explained that getting physicians on board is a major challenge. Services have become segmented and there is much more dependence on physician assistants and nurses. There are not enough doctors. A health care delivery system that uses all aspects and talent is needed. Commissioner Baney observed that there is a big difference between health care and medical care. Mr. Henry said that it will take hospitals working with each other and other entities taking a community approach to be successful. Physicians need to be aligned and health models examined. Central Oregon is in a unique situation due to the isolation from the mountains and desert, making it a bit easier to analyze and find ways to collaborate. He feels that the County and hospital are good partners and wants to keep the dialogue going. Ronda Connor said that the physician/hospital alignment has been discussed, but what is missing is the payor, who needs to be involved as much as possible, instead of forcing change. Mr. Henry noted that there is a similar issue with insurance companies. Most are open to working on the issues together. Minutes of Board of Commissioners’ Work Session Wednesday, March 3, 2010 Page 3 of 6 Pages Ms. Connor stated that there are surgery centers in town, but Medicaid patients seem to be going to the hospital. Mr. Henry said that OR’s have not been run as effectively as they could be. The centers were formed to be profitable but also because hospitals were not run as efficiently as they should be. He wants to be able to bring back the surgeons. Commissioner Luke pointed out that the County is self-insured, and St. Charles receives a lot of payments made. Discounts are made to larger carriers, and this results in local groups like Deschutes County having to subsidize. He asked if there are discounts in place for the County. Mr. Henry replied that he is not sure and is not familiar with the historical aspects. They try to keep things relatively parallel. He is open to talking further about changes in the benefit plan. They are working on health reform in general, and hope to lower the cost of access to doctors. Commissioner Luke said that the County is looking at forming an employee clinic. He asked if Mr. Henry is familiar with those. Mr. Henry said that he has not seen any since the late 1980’s, and those were mostly within huge corporations. They can make a big difference and are not necessarily competition to the hospitals, but might be to family practitioners or immediate care clinics. The size of the population makes a difference. Commissioner Luke pointed out that some people go to the emergency room for minor things because they don’t have a regular physician. Mr. Henry stated that starting on April 1, they will have an immediate care clinic. It will be cheaper than the emergency room, but won’t be open 24 hours a day. It will be located on the hospital campus. Commissioner Unger explained that the Commission on Children & Families has a list of assets of what is needed to be productive in life. This includes what is needed for children so they form well. He thought that perhaps some kind of partnership between the CCF and the hospital could help with this. Mr. Henry noted that there are lots of opportunities to start children off right. They can make gains in people over age 20, but biggest impact is in those who are younger. When asked what his employees pay for health coverage, he replied that it is tiered by family status, but is free to the employee. Ms. Connor said that all County employees pay, as their program is not tiered. Mr. Henry and Ms. Connor left at this time. Minutes of Board of Commissioners’ Work Session Wednesday, March 3, 2010 Page 4 of 6 Pages 3. Other Items. The minutes of the department head meeting were removed from the consent agenda earlier in the day, as they have not yet been reviewed. BANEY: Move approval of the minutes from the morning business meeting agenda, with the except of the department heads meeting. UNGER: Second. VOTE: BANEY: Yes. UNGER: Yes. LUKE: Chair votes yes. __________________________________ Discussion occurred about an e-mail that is circulating regarding a wellness program that costs $35 per month. Mr. Kanner said another way to spin this is to go up to $65, or increase it to $60, encourage a wellness program and then drop it back down again. It would reduce costs tremendously. He said that he explained to the Bulletin e-board that the co-pay could be used as an incentive to enter a wellness program. This taxes behavior you want to discourage. Commissioner Baney said that discussion has occurred regarding adding health benefits costs to the departments as indirects. Mr. Kanner stated that this was discussed at a January budget meeting. The general fund revenue forecast is not yet available, and it needs to be balanced against budget requests. They are still using a zero increase in health insurance and PERS charges. This will cost about $2 million next year, but they are drawing down from the health benefits trust fund. The health clinic may help reduce this number. Next year will not be that bad even if there are no wage concessions. __________________________________ The growth in property tax revenue will be zero or maybe negative. They need to determine how large to make the general fund contingency, and how to pay for one-time expenditures. They can lower PERS expenses if needed. They are still in relatively good shape. Management and supervisory employees are not going to get the whole increase. Going forward, after next fiscal year, a way has to be found on how to make that up to them in a way that does not impact payroll. There are ways to do this. Minutes of Board of Commissioners’ Work Session Wednesday, March 3, 2010 Page 5 of 6 Pages __________________________________ At this time, discussion occurred regarding debt service on the various buildings and how to fund these expenses. Commissioner Luke asked about the Deschutes Recovery Center and how long-term repairs would be handled. He asked about the 911/OSP building as well. The Fair/Expo facility was set up for its own repairs and maintenance. Commissioner Baney said they have asked for general funds in the past, however. __________________________________ Commissioner Unger stated that groups need help getting up to speed on how to handle the RFP process and the history behind the idea. The RPF process should be addressed in a public venue. If you are adding a benefit to the health plan, you ask EBAC to make recommendation. If the Board bypasses the process, EBAC will feel they are not needed. It was determined that a meeting should take place to see what the Commissioners want in the RFP process, and then see what EBAC comes up with. Mr. Kanner said that he would like to see an RFP out in June. Commissioner Baney stated that it may help to have an outside group look at it. Commissioner Luke said that adding bariatric surgery is small compared with opening a County clinic. It may work, but he has a problem with the process. It is a major change and a huge investment. Mr. Kanner noted that it went to EBAC and then to a subcommittee. Commissioner Baney feels it is on track, but to keep the Board in the loop. Commissioner Luke stated that he is not happy with process. It would be good to bring in someone who does this kind of thing all the time. No one on staff has ever built one of these. Mr. Kanner noted that Ms. Connor has put one together. Commissioner Luke would like a field trip to visit some, along with additional research. Mr. Kanner said he would arrange for site visits. Commissioner Unger noted that every site is different. __________________________________ Commissioner Unger said he met with representatives of the Bureau of Reclamation. They are learning about activities in this area; he told them about the Deschutes Water Alliance model. __________________________________