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Section III. Community Process
- Description of Community Integration Efforts Prior to DRIS
- Development of the Community Health Council
- Work Plan for Phase 1
- Accomplishments of DRIS Learning Objectives
By the end of 1994, managed care penetration for commercial insurance in the Lompoc market was greater than 50%. However, the local providers were still organized primarily to respond to a fee for service environment. As a result of these market changes and the realization by the Lompoc District Hospital and local physicians that significant change was needed to continue assuring access to quality affordable services in the Lompoc Valley; in January 1995, the Lompoc Valley Health Care Council was established. In the Mission Statement, the Council proposed to, Aassess and prioritize community health needs and resources@, and Aseek community input and representation with regards to health decisions affecting Lompoc, recognizing these decisions are best made at a local level@. The initial goals of the council were to improve community and individual health; maintain quality healthcare services in our community; keep health care costs competitive; and encourage the utilization of local health care services.
The Council was divided into two committees: the Community Health Plan Committee and the Community Health Assessment Committee. These committees met independently for 20 months. The goals for the Community Health Plan Committee were to form a purchasing coalition to buy healthcare coverage and to consider feasibility of developing a community based health plan. The Committee surveyed local employers and determined that a self-funded plan by employers in the community was not feasible at the present time. The Committee reviewed information for Tulare and Mt. Shasta and decided to send requests for proposals to different health plans and insurance companies with a list of partnership criteria. The expectation was to find a health plan partner that would be willing to work with all the providers in the Lompoc Valley and with employers. The result of that RFP was the selection of CIGNA as a partner with the Council. The Lompoc Valley CIGNA Health Plan was offered to employers in the area. On February 1, 1996, the Lompoc Hospital began using the plan for its employees. World Minerals/Celite, Lompoc=s largest private employer began using the plan on January 1, 1997. (See Appendix for organization chart and partner criteria.)
The Community Health Assessment Committee developed a community survey. Between March and August of 1995 the Committee developed, distributed and compiled the survey. Seven areas of the community were identified for distribution and local high school students were recruited to distribute and collect the surveys. 419 households completed the survey. The survey respondents represented a true cross section of the ethnic mix in the Lompoc Valley: 58% Caucasian, 19% Hispanic, 8.5% Asian/Pacific Islanders, 5.5% African Americans, .7% Native American and the remainder were bi-racial or non identified. The survey focused on access to care and Service Needs. Cancer care locally in the community was at the top of the list of community concerns. As a result of this data in July 1996, additional medical oncologists through the Santa Barbara Cancer Foundation began providing outpatient chemotherapy services in Lompoc on a weekly basis. The second most prevalent concern was adequate drug and alcohol prevention and treatment services for the community. This issue is now being continued forward in the DRIS effort through the development of community pathways for substance abuse treatment.
Due to the activities of the Council during 1995 and 1996, the Community Council helped facilitate the creation of a new insurance product in the community and additional oncology services for the community. The one limiting factor for the Council was its narrow representation. The Health Plan committee was made up almost exclusively of providers: four doctors, two hospital board members, a hospital director, a hospital attorney and one business representative. The entire group was male. Many purchasers of health insurance viewed the effort as a means to potentially limit choice of insurance plan. The Community Assessment Committee, though chaired by a local businessman, had an all female membership comprised of providers of social services and health. After the surveying and the work to get oncology services provided locally, the Committee was in the process of developing further work plans when the DRIS project began.
This title would best be stated Expansion of the Community Healthcare Council. The Community Systems Consultant began involvement in the community by meeting with the two committees, a broad spectrum of providers and community citizens (See Appendix A). At the conclusion of these meetings it was the recommendation of the consultant that the committees ought to be merged and to begin meeting as one group and that the Lompoc Valley Health Care Council should significantly expand community representation. The report of these Key Informant Interviews was presented to the expanded Community Health Council in July. The council now has 57 members representing almost all sectors of the community (See Appendix A). Though it may sound like a cliche, there is a true sense of community here. This sense shows in all the activities of the Council and the community leaders participating. The commitment by the community to find community solutions is quite high. As work of the Council has progressed, volunteering for committee work started out high and one year later continues to be high.
As discussed in Section II, the goal of Phase One of the DRIS project was to educate the community about managed care and the need for community responses to assure that accessible, affordable and accountable health services could continue to be provided at the local community level. The key elements in the process were to analyze the community data (which is the bulk of this document), and use this data to select integrative functions which would facilitate assuring access to quality, cost effective care. The following outline details the work plan for the Lompoc Valley Community Health Council.
Work Plan |
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| JUNE | Introductions, Goals, Role of CAC |
| JULY | Results of 50 Key Informant Interviews:
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| AUGUST | What does the data say? Part 1
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| SEPTEMBER | What does the data say? Part 2 |
| OCTOBER | Special Educational workshop for Council Members |
| NOVEMBER | Community Health Council Dialogue |
| DEC-JAN | Work Groups meet |
| FEB-MAR | Community Health Council selects functions |
One of the realities learned over this past year is that the DRIS learning objectives are substantial and that they are part of a process which will continue over the entire three years of the Initiative. Members of the Community Healthcare Council began the process with a wide variety of experience and understanding in healthcare. This disparity made the educational process more challenging and gave the Community Systems Consultant a better understanding of the challenges facing many educators in our public school systems.
The DRIS Initiative and its focus on assuring that decisions be based on good data was readily understandable by the Council members. The issues of the need for integration of services, differences between financing of health care and the delivery of health care and special problems of the medically indigent are more complicated issues which have been evolving over the course of the year and will continue to be a part of ongoing education for the community and the Council. There was some confusion at the beginning of the process concerning the need to perform another assessment, since the earlier effort by the Community Assessment Committee had gathered significant information on perceptions in the community. As the presentation of the data unfolded over the course of the project it became evident that the additional data provided by DRIS was nicely complementary to the information obtained through the survey. Coupling quantitative data with the community survey data yielded a comprehensive picture of both community perception and the quantitative realities of the delivery system. A more problematic issue early on was the need by many community members to do something, not just learn. The whole Council expressed this opinion almost from the outset of the process and the group showed both good manners and excellent patience in being students.
One of the key elements of the DRIS process is to define the service area which will be examined and for which decisions about integration will be based. Given the geographical location and the isolation of the zip codes which comprise the Lompoc Valley, this issue was quickly and easily resolved. The four zip codes of the Lompoc Valley and the 62,000 people who live there comprise the service area. Regardless of the ability to always reach consensus on other issues, the agreement on this issue is firm.
A second key element of the DRIS process is to reach consensus on what are the essential services which need to be provided in the service area. The concept of essential services is easy to understand and yet difficult. Essential services depend on characteristics of the community, special needs, geographic location, changing patterns of treatment and other issues related to quality and financial feasibility. Essential services is a continuously moving target that requires regular dialogue in the community and ongoing surveillance of need. Many community members view the concept as any service which at least one person in the community needs. This definition led to the early community survey asking what services would you like to have in our community. In a managed care environment, rural communities have to differentiate what they would like to have from what is financially practical, what has the utilization to maintain the necessary providers and can be provided in a manner which assures quality. Neurosurgery is most often used as an example of a service which does not make sense to provide in every rural community. The data in Lompoc suggest that in terms of hospital and medical services the attempt is to provide those services which make sense for the community. There is a serious shortage of primary care providers and in the area of mental health and substance abuse there is also agreement that diagnostic and outpatient treatment services should be available locally but currently there are significant shortages of personnel to make that a reality.
The issues of managed care and the most appropriate rural response which includes examining integration and collaboration between providers and the community are complex, and issues which many folks who have been in the health care field for a long time have not yet fully understood. Currently, the level of understanding about these issues runs the entire spectrum from little understanding to comprehensive. These particular issues will best be understood as the planning to implement the selected functions continues over the next year.
© CIRHM