Prepared by: Elli Hall Health Policy and Management Consulting

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, 2014

2. District Boundaries

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 The District Board is exploring the options and receiving input and advice from many sources.

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

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

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

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

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.

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

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

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

12. CA Hospital Districts • The CA Hospital District law passed in 1946 • Build and operate hospitals • 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

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 • Sold or leased to another entity • Used for other health-related purposes • Closed

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 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 • 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 Increased competition to provide hospital care to insured patients; Kaiser is key in California

16. The BIG SHIFT 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: • 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

19. Districts Providing Community Services

20. Districts Providing Community Services

21. Districts Providing Community Services

22. Districts Providing Community Services

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

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

25. Sequoia Healthcare District HeartSafe Program: Improving the “chain of cardiac survival” in order to reduce sudden cardiac arrest deaths • 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/cshp • Working with all 8 districts reaching 27,000 students, plus their parents and school personnel

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 $2.1mbut annual budget is $3.7m. Very entrepreneurial!

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)

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

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

31. Petaluma Health Care District CHIPA’s Three Priority Areas: 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 Sponsors Community Activities and Groups Contributing to Health • 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 • 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

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

34. The Palm Drive District is a Community Asset • A centrally-located, well-designed facility that is handicapped accessible, seismically safe, with adequate parking • 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 • Responsive to community health needs • Within the District’s powers • Regulatory requirements can be reasonably met • Financially viable

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

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

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

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

40. “Save Lives Sonoma” Partners

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

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

43. Support Outpatient Services West County Health Centers: a great potential partner • 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 outpatient Mental Health services • Could expand clinic to Bodega Bay, other locations • 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 • 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

46. The Silver Surge: Seniors 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

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

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

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