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
District Boundaries
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Exploring Health Care Opportunities for West County
The Palm Drive Health Care District
is a community asset
What is the best and highest use of this asset?
The District Board is exploring the options and
receiving input and advice from many sources.
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State Regulators
Palm Drive
District
Board
Individual Interviews
with Health Leaders
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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
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Top 4 Services Mentioned Most Frequently
by Small Works Groups
Emergency 84%*
Prevention 63%
Hospital 58%
Mental Health 53%
*Percentages based on the number of groups that mentioned the service
divided by the total number of groups at all four listening sessions.
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Exploring Health Care Opportunities for West County
This presentation focuses on
Community-Based Health Care Services
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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.
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Individuals Interviewed
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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
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Individuals Interviewed ... continued
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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
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Exploring Health Care Opportunities for West County
CA Health Care Districts
and
Community-Based Services
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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
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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
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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
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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
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The BIG SHIFT
Our “health system” is evolving to support:
• Greater integration of providers
• Primary care and outpatient services
• Cost containment
• Wellness and prevention
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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
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Districts Providing Community Services
District:
Services/Programs:
Blue Zones Project, Medical Reserve Corp, AdventurePlex,
Center for Health & Fitness, Community Care Services:
MoveWell/Peer counseling/Care Management/Conversation
Beach Cities
Companions/Errand Volunteers/Support Groups/Memory
Health District
Club, LiveWell program for tots/kids/adults, Center for Health
Connection: medical, dental, & counseling services for the
underinsured and uninsured.
Adult Day Program, Senior Support Line, Lifeline of Ventura
Camarillo
County, Senior Lunch Program, Care-A-Van Transportation
Healthcare
Services, Wellness & Caregiver Center, Chronic Disease
District
Mgmnt, Caregiver training/education/support
Meuser Memorial Health Center leases space for health
related services provided to the public including: Tehama
Corning
County Social Services, Tehama County Health Agency, Quest
Healthcare
Diagnostics, Podiatry services, Children First, Corning X-ray,
District
Corning Medical Associates. Also provides grants to support
Northern Valley Catholic Social Services for senior health.
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Districts Providing Community Services
Wellness Park, Grant Funding Certified Health Navigators
Desert Healthcare District for ACA education and enrollment, Funding for healthy
school initiatives and Healthcorps coordinators (a
national health education/peer mentor program).
Leases offices to the following health professionals: A.V.
East Kern Health Care
Chiropractic, West Point Physical Therapy, Cal City Clinic,
District
Tehachapi Family Health Center, and T. SRI, MD, FACP
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
Eden Township Healthcare
Leandro Boys & Girls Club, East Bay Agency for Children,
District
Davis Street Community Center, Tiburcio Vasquez Health
Center, Spectrum Community Services, and Building
Futures with Women and Children
Publish an annual Community Resources Directory,
Fallbrook Healthcare
sponsor health fairs, PSA Screenings, and a grant
District
program
Half of revenue goes to hospital, the other half goes into
Grossmont Healthcare
grants to local non-profit health-related organizations
District
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Districts Providing Community Services
Helps pay for Lindsay Wellness Center, provides a
Lindsay Local Hospital licensed vocational nurse for the school district,
owns and rents several medical offices for
District
physicians and clinics.
A More Excellent Way' Program, 'CPR FAST'
Program, 'City of Pittsburg-Swim Academy'
Los Medanos
Community Healthcare Program, 'Eyeglass' Program, 'St. Vincent de PaulRotaCare' Program, Community Garden Program,
District
and yearly grant programs
Free Nurse Call Center, Health Fairs, Breast Cancer
Mark Twain Health Care
Awareness Events, Family Medical Center Funding,
District
Chronic disease management awareness events.
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Districts Providing Community Services
Mt. Diablo Health
Care District
Peninsula Health
Care District
Petaluma Health
Care District
Subsidiary district of the City of Concord, uses tax
revenue to fund grants for local health programs
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.
Healthquest community CPR classes, provide
defibrillators and training to the community, Lifeline
services, health education & wellness classes
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Districts Providing Community Services
Redbud
Healthcare
District
Selma
Healthcare
District
Sequoia
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
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
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.
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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
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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
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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
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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
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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!
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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)
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Camarillo Health Care District
Services for Seniors and Adults with Disabilities
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“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
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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
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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”
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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
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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
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Exploring Health Care Opportunities for West County
Which Paths for the Palm Drive District?
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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
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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
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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
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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
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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
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“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
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“Save Lives Sonoma” Partners
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Urgent Care Center
Urgent Care could be provided in Sebastopol
and/or in Guerneville
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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
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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
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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
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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
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The Silver Surge: Seniors
Population
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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
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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
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Healthy Aging Programs Need Support
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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
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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
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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
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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”
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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
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Healthy Schools Initiative:
Eight Possible Elements
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Health Education
Physical Education
Health Services
Nutrition
Counseling and Mental Health
Healthy and safe school environment
Health promotion opportunities for school staff
Family and community involvement
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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
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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
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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
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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
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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
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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
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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
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Exploring Health Care Opportunities for West County
Next Steps
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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
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Moving Forward with Community Services
• Prioritize populations, regions and/or services
• Learn more by sponsoring presentations
• Appoint subcommittees or work with existing
groups to prioritize and define in more detail
• Create a business plan for selected new services
• Issue an RFP or negotiate a contract
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Community-Based services can
contribute to a bright future for
Palm Drive Health Care District
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