By Mary Alice Murphy

The Grant County Community Health Council is undergoing a transition, as Gila Regional Medical Center will no longer be the fiscal agent for the council.

At the special meeting of the Grant Council Community Health Council held Monday, June 22, 2015 at the Grant County Administration Center Commission Chambers, Council Co-Chairwoman Priscilla Lucero said the Steering Committee has been working quite a bit on transition plans.

"We are scheduled to present to the County Commission tomorrow for Grant County to become our fiscal agent," Lucero said. "We looked at various entities, but the Health Council and its activities belong to all of the county, so we felt the county was the best fit.

"We are working on the job description, as well as the budget," she continued. "Once the fiscal agency is approved by Grant County, then we will have a clearer picture of where we are headed. The transition should be done by July 1, and the hospital will continue to be a support as we go forward."

Health Council Member Mary Stoecker asked if the coordinator position would be a county employee or a contractor.

"We are looking at all the pieces," Lucero replied. "There are a lot of things to weigh, as well as looking at deliverable. We are still looking to finalize that decision."

Co-Chairwoman Terry Anderson asked Stoecker if she saw anything missing in the job description.

Stoecker said the job of coordinator and the responsibilities would be covered somewhat in the slideshow she would present at the meeting.

"It's important for us to know what the Department of Health deliverables are," Lucero said. "Insight on that would be helpful, because we have to prioritize for the coordinator."

Stoecker, in looking at the job description that was handed out by Health Council staff said some of the language seemed to be the same as what several members had determined was vague in the prior draft. She said with the general language, other health councils in the state had found the counties telling the councils what to do instead of the councils serving the counties as advisory boards.

Council Member Marilyn Alcorn said she did not see the language that had been recommended at a prior meeting.

It was determined that the wrong draft had been distributed, but Anderson had a copy of the recommended language, which Alcorn and Stoecker reviewed and added to the draft.

"It has been a difficult process," Lucero said. "We are doing the best we can. We all have busy jobs, but the Steering Committee has been wonderful."

Council Member Tony Trujillo thanked Lucero "for your leadership to get us where we are. I, for one, appreciate what you've done."

"By Thursday, when the County Commission will vote on being our fiscal agent, we'll know more about what to do next," Lucero said.

Stoecker, who works for the Department of Health at the Silver City Public Health Office, gave the first of her two presentations-A Mini-Version: The Best of Health Councils.

"This is just to remind council members of what health councils are all about, and what expectations we have for the coordinator and the fiscal agent," Stoecker said.

She introduced Amy Bennett and Jasmine Saenz as DOH health promotion team members.

"Three aspects of health councils overlap," Stocker said. "We are always working on the data from the community assessment and prioritizing the community needs; community action is required to address the priorities; and community and capacity building strengthen the community."

Efforts to affect population health address the population, not an individual. "It's not going to happen today," Stoecker said, "but they must have a targeted approach, with a broad reach."

A slide described population health as an approach to health that aims to improve the health of the entire population and to reduce health inequities among population groups. The approach must focus on the root causes of a problem, with evidence to support the strategy to address the problem. "These are called change concepts and are what has been proven to work."

One of the eight key elements, she emphasized is to increase upstream investments to keep something from happening. For instance, she asked, if an area has a large asthma problem, could it be housing that is causing the asthma?

Health Councils support public health essential services, 3, 4, and 5, according to the Office of Public Health, U.S. Department of Health and Human Services. Councils inform, educate and empower people about health issues; mobilize community partnerships to identify and solve health problems; and develop policies and plan that support individual and community health efforts.

Health Council Coordinator and staff roles and responsibilities include assuring periodic community health assessments are developed and implemented; assuring analysis of the community health assessment; and developing community health and wellness priorities and a plan of action. Others include supporting the ongoing implementation of the plan; maintaining open communication with the fiscal agent, the County Commission and community members and partners; acting as staff to Health Council and assuring council capacity and active involvement; managing day-to-day activities; assuring maintenance of appropriate records to support compliance with contract and/or purchase order requirements; and assuring financial accounts are monitored to include income, expenditures, invoices, etc.

Health Council members also have roles and responsibilities. They should be knowledgeable about the council mission, vision, plan and community wellness in general; attend at least 50 percent of meetings in any given year, with proxy votes being occasionally used; actively, consistently and effectively participating in council initiatives and assisting in mobilization of community resources; approving community assessments, plan and evaluation processes; participating in the update of community assessments by contributing data, knowledge and/or physical assistance; reporting organizational sector or individual activities and needs to staff and membership; serving on at least one health council committee or community action team; working with staff to facilitate partnership efforts; and treating staff and council members with professionalism, courtesy and respect.

The fiscal agent should have a relationship with the council that is collaborative and ensures independent and open dialogue to support the work of the council. Award of fiscal agent status is subject to New Mexico Department of Health approval and existing county health council membership approval. The fiscal agent shall provide administrative support, if needed, to provide a venue for health council meetings; support networking among health and wellness-related agencies in the county; provide limited administrative support; have a representative from the fiscal agency attend meetings; ensure a representative from the council attends quarterly regional meetings; ensure the scope of work for the department purchase order is completed; and submit invoices, each with required deliverables to the NMDOH.

Anderson asked that the job description reflect the duties as listed in the document.

Gila Regional Medical Center Chief Executive Officer Brian Cunningham, a health council member, suggested narrowing the focus of the health council.

"We have four priorities right now," Stoecker said. "They are based on the assessment last done in 2012." She also noted that the next presentation she would give on the Health System Innovation Design might affect what happens in health councils.

Between slideshows, Anderson presented a certificate of appreciation to former health council member, Juan Castañon, for his 12 years on the council. He has retired. "We grew and learned together," he said.

"We could always count on your participation," Trujillo noted.

Stoecker next gave a presentation on the New Mexico Health System Innovation design phase to improving health outcomes and population health "For a Healthier New Mexico." The project is funded by the Centers of Medicare and Medicaid Services, CMS Innovation Center.

The initiative is created by the Affordable Care Act to test innovative health delivery and payment models through the "Triple Aim" to reduce spending, enhance the quality of care and improve population health. The project has two phases, the design and the testing of the design.

The experience of care should include integration of primary care, behavioral health services and social services. Reduction of costs will be achieved through reimbursement of services that are value or outcome-based versus fee for service. Improving health and health outcomes should include community health workers and paramedics who participate in the delivery of primary care and the interoperability of health information systems.

Among the objectives of New Mexico's design are to increase the number of New Mexicans who have health insurance, build the healthcare workforce and supporting infrastructure and expanding the use of health information technology.

"The design phase requires a huge number of sectors to participate," Stoecker said.

The structure for the process includes seven stakeholder committees and ongoing community engagement. Stoecker said present Health Council Coordinator Chris DeBolt has been nominated to one of the statewide stakeholder groups. Debolt said she was nominated for the 60 years old to end-of-life group.

The recommendations will flow from Health Council focus groups to statewide stakeholder committees and work groups to the Health System Innovation Committee to the DOH and Human Services Department to develop deliverables to the key partners and back to the health councils for implementation.

DeBolt noted that health councils across the state are at different capacities. Stoecker said each council would receive a template for the focus groups and for the council to gather data.

The timeline is from August to October 5 for the focus groups, with the draft recommendations to be made by Oct. 15.

Cunningham said health care is "bankrupting the nation. Health care costs a lot less in other countries. We could take more responsibility for our own health outcomes. It's the right thing to do."

Debolt said the changes are required, and six states, which have already developed the model have produced impressive cost savings. "We have to make it better for future generations."

Stoecker said: "It's scary to make changes, but we have to preserve health rather than just taking care of the sick, although that, too, will be necessary."