Summer 1998 ~ Vol 1, #4

Dear Friend,

Tim Dabney (center), Chair of the Lompoc Valley Community Council, and Pat Brady (right), Local Coordinator, receive $20,000 milestone check from CIRHM Executive Director Luisa Buada (left).

As the five DRIS sites move forward to Phase II of the DRIS Initiative, this issue of our newsletter highlights their accomplishments. In addition to zooming in to take a close look at the development of a Community Health Organization (CHO) in Lompoc, we also examine some of the legal issues faced by networking, as well as provide an update on the initiative evaluation.

We have specially featured the CIRHM Board of Directors, the DRIS Inititative Phase I Data Consultants and Mike Fadden, the Feasibility Consultant, and have continued to provide glossary definitions to assist our readers with the endless proliferation of alphabet soup that the health care industry invents for us. We hope, as always, that these articles illuminate issues of critical importance to assist you in your rural health system integration efforts.

CIRHM heartily congratulates all of the five DRIS sites for moving to Phase II of the Initiative Process. All sites have selected the integrated rural health care system functions they wish to explore through feasibility analysis and business planning. In March, the Lompoc Council selected the following three functions: to develop a CHO as its cooperative vehicle, to perform managed care administrative functions (quality assurance, utilization management, group purchasing, etc.); to develop a community pathway for substance abuse; and to link provider information systems. In April, the Imperial Council agreed to explore the functions of an Administrative Services Organization (ASO) as an alternative for dealing with managed care plans on behalf of local providers. An ASO performs managed care administrative functions to give rural communities greater control over how care will be managed and keep dollars for these services local.

Yvonne Smith (left) and Robin Raeker (right) of the Imperial County Health Department and the Imperial Valley Health Advisory Council accepted the Council’s $10,000 milestone check to help perform a Community Health Assessment Survey.

Over the month of May, both Siskiyou and Humboldt-Del Norte chose their DRIS functions for Phase II. Siskiyou, through Community Health Plan of the Siskiyous (CHPS) as its cooperative vehicle, will look at the opportunities for implementing claims administration, payor negotiations, network development and management, and medical management information systems. Humboldt-Del Norte Regional Health Council and six Community Health Committees are supporting the development of an ASO as an interim step towards their long desired goal of creating a locally owned, community health plan. The functions of the ASO will be determined through the work of a business strategy committee and refined through the financial feasibility analysis process.

In June, the Indian Wells Valley Community Health Council in Ridgecrest selected as its functions to support Sierra CommCare, the local integrated provider network, in its efforts to expand its interface capacity with managed care as it looks for a licensed health plan partner to serve the needs of small employers, and to additionally explore the implementation of mental health/substance abuse and respiratory clinical pathways.

Jim Cross (right), Chair of the Community Health Plan of the Siskiyous (CHPS), accepts a $20,000 milestone check from Marty Campbell (left) Program Director for the James Irvine Foundation.

Over the summer, the DRIS sites, through their committee structures, are working on the design of their integrated health system functions. They are also exploring governance including membership, bylaws and articles, and the relationship between the DRIS Councils and the chosen cooperative vehicle. The cooperative vehicle will be the single accountable corporate entity responsible for implementing the proposed functions in each community.

Concurrent to the governance efforts of the local councils, feasibility studies are underway in Lompoc and Imperial. Siskiyou and Humboldt/Del-Norte will undergo feasibility studies in the fall. The feasibility studies in these four communities will be undertaken by Mike Fadden of Rural Health Consultants.

We commend the countless hours of effort of the Community Health Council volunteers who are investing in their communities as they wrestle with:

1. the challenges of local control of health care decisions,
2. governance and leadership issues,
3. community wide participation and cooperation, and
4. community pathways for preventative health.

Sincerely,

Luisa Buada
CIRHM Executive Director

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