Conference 2000: Humboldt/Del Norte
by Don Avant

Our previous speaker, Alan Glaseroff, has briefly presented an illuminating history of the DRIS project in Humboldt County. Although the history of the project is admittedly problematic, it parallels the ups and downs that occur when attempting to enlarge community capacity. Old relationships and power structures are often challenged. The desired realignment by those advocating for change is often mischaracterized by some as “utopian crack pot ideas.” Speaking personally, there have been times over the last three years when I thought that our critics have been right. You get discouraged. But when you step back and look at our strategic goals, what we are trying to do through DRIS is worthy of any rural community.

These values add quality to our community or any community. So, if the life of the community is important to you, you become re-energized and consider new implementation strategies not as an act of capitalization but as an effort to be more inclusive, which is what community is all about.

The most contentious topic to emerge from our three-year journey was governance. It was a deal breaker for the large self-insured employers who thought that their interests would be materially compromised by the DRIS proposed governance structure. Others who generally supported DRIS believed that the proposed governance structure was to heavily weighted towards personal health care interests.

As stated early, the focus of our initial effort, the large self-insured employers, didn’t buy the governance scheme. And there were others who believed that the structure was too heavily focused on personal health services.

Last month, the DRIS Regional Council voted to modify the proposed structure. The members believe that more priority should be given to community functions. The council has asked the DRIS Business Strategy Committee to iron out the details.

Under the revised governance proposal, the Regional Council wants consideration given to broader community representation (labor and ethnic), clarification of the role of Community Health Councils and county health department district advisory committees and clarification of the integration of a business product(s) into the revised governance structure. Size of the board is an issue with the council.

Three strategic financial factors that will heavily influence the long-term success of the organization include:

1. Defining and implementing a business relationship with the local foundation that provides medical claims services and other ASO type services for the Humboldt/Del Norte IPA.
2. Acceptance by the business community of the integration of DRIS business ventures into its governance structure.
3. Attracting grant funds

Humboldt/Del Norte Strategic Goals

1. Establish a DRIS governance that is inclusive
2. Be sensitive to community values and culture
3. Support health improvement and prevention programs
4. Develop effective medical management systems
5. Maintain local control over health resources decision
6. Improve access to a full range of health care resources
7. Disseminate health care information to the community

Humboldt/Del Norte DRIS Organization, Activities, and Goals

1. Community Health Committees
   Seven committees-six operating.
   1. Membership
      1. Membership size (12-15)
      2. Membership composition (business, lawyer, health care providers, seniors, school officials, government reps; public health staff, other health planning groups)
   2. Purposes
      1. Provide community input to Regional Health Council
      2. Identify local health needs through use of surveys and health care data
      3. Prioritize need for services
      4. Inform and educate local community populations
      5. Participate on Regional Health Council
   3. Current Activities
      1. Recruit and maintain committee membership
      2. Identify local health issues through use of DRIS health care data and membership’s experience, independent health surveys, and a meta analysis sponsored by SJH
      3. Prioritizing health services
      4. Participating on Regional Health Council
   4. Strategic Goal
      Promote improved local health care quality, access to health services, and community input on a wide range of health care topics
2. Humboldt/Del Norte Regional Health Council
   1. Membership
      1. Membership size-15
      2. Membership composition
         1. One-three representative from each CHC
         2. Five members at large
   2. Purposes
      1. Determine regional service priorities based on CHC recommendations and other data
      2. Determine the feasibility of establishing a community based health plan.
         1. Conduct preliminary and necessary follow up economic feasibility studies
         2. Shape health plan in accordance with service priorities recommended by CHC
         3. Determine strategies for implementation that reflect CIRHM characteristics for an integrated delivery system and community controlled health plan
      3. Assist CHC maintain their vitality
      4. Inform and educate community regarding health services and delivery methods
   3. Current and future activities
      1. Feasibility study
      2. Environmental Assessment
         1. Urgency for action
            1. The advanced state of planning by the North Coast Community Health System
            2. Consolidation of north coast market by out side vendors
         2. Collaborating with North Coast Community Health System
            1. Compatibility of visions ( see CIRHM memos regarding “Issues to Consider Surrounding the Development of a Rural Community-Controlled Health Plan” November 17, 1997 and “Developing a Rural Integrated System” no date)
            2. Detailing health plan product
            3. Required capital for further developmental studies and start up costs
            4. Timetable and implementation strategies
         3. Alternatives

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