Section III. Community Process

Siskiyou County is located in far northern California, about 225 miles north of Sacramento. It is bordered by the state of Oregon to the north, Humboldt and Del Norte Counties to the west, Modoc County to the east, and Shasta County to the south. Siskiyou covers over 6,200 square miles, making it one of the largest counties in the United States. It is larger than the state of Connecticut and almost six times the size of Rhode Island. The county’s topography is varied, ranging from forested mountains, dominated by 14,162 foot Mt. Shasta in the southern half of the county, to high desert terrain in the north.

Siskiyou’s population of 45,000 is located in scattered small communities throughout the county. Most health care services are located along Interstate 5, which runs north-south through the middle of the county, but a significant proportion of the population lives in outlying areas. Yreka, in the northern part of the county, is Siskiyou’s largest town, containing just over 7,000 residents.

Timber is one of the major industries in Siskiyou, but has been in decline for the last ten years. Partly as a result of this decline, the county unemployment rate is about 15 percent, more than double the State and national averages. Tourism is an increasingly important economic sector, particularly in southern Siskiyou, and government, ranching, retail, and health care are also large employers.

In light of the decline in the timber industry and resulting economic impact, a need to assess the county’s health needs, status, and resources was identified. In 1991, with leadership from Mercy Medical Center in Mt. Shasta and support from the Sierra Foundation, the county residents engaged in a community health system planning process. Through that process, a 36 member Health Services Council was formed and collected information on community needs and other issues, focusing on the southern part of the county, where Mercy Medical Center is located. This process identified a number of issues, including the need for additional primary care providers and mental health/substance abuse programs, improved transportation, information on the availability and capability of health care resources, better communication among providers and between physicians and patients, and additional community health education. This identification of needs has informed discussion and community action since the planning process took place. However, most of the concerns raised in 1991 continue to be issues for Siskiyou County.

As an outgrowth of the planning process, the Health Services Council recommended the development of a locally managed health plan. In 1994, health care providers and members of the business community created the Community Health Plan of the Siskiyous (CHPS), a not-for-profit mutual benefit corporation designed to reduce the rate of increase in health insurance costs for local self-insured employers and also play a role in improving the quality and efficiency of the local health care system, enhancing community health status, and contributing to local economic development. Over the long-term, CHPS envisions partnering with a licensed health plan to offer coverage to the Medicare, Medi-Cal, and commercial populations and to use profits from these groups to subsidize care to the uninsured.

CHPS has developed a provider panel in Siskiyou and holds a contract with the County government to serve as a preferred provider panel option in the county employee health benefit plan. No other employers are currently under contract with CHPS. CHPS does not directly employ staff and subcontracts all administrative functions. The CHPS Executive Director, is a contracted consultant. In addition, health care providers in the county (particularly the two hospitals) provide in-kind administrative services to CHPS.

Outside of efforts by CHPS, providers and services in the county are not integrated. Mercy Medical Center in Mt. Shasta is part of the Catholic Health West (CHW) system and maintains formal linkages with other CHW providers, all located outside Siskiyou County. Most of the local physicians are solo practitioners or members of small groups practices.

The enormous size of the county and its dispersed population limit community efforts, including integration of health services. A "north-south" county mentality is reflected in all aspects of life, from where residents go for health services to where they buy goods to culture and beliefs. Residents of the southern part of the county frequently travel south to Redding for goods and services. "South County" is also a center of tourism and is home to many adherents of new age and other non-mainstream beliefs. Residents of the northern part of the county often travel north to Medford and other cities in Oregon for goods and services. "North County" retains an "old west" atmosphere and ranching is a major industry. County residents often mention this north-south dichotomy in discussing aspects of life in Siskiyou and have noted that it represents an issue to be overcome in order to create a county-wide system of care.

The existence of CHPS was a primary reason that Siskiyou County was selected as a DRIS project site. Because of this decision to "piggyback" on CHPS and support its ongoing efforts, the CHPS Board of Directors decided early in Phase I that it would also serve as the separate DRIS Community Health Council (CHC).

At the start of the DRIS project, the CHPS Board consisted of seven members, one from each of the local hospitals, a primary care physician, a specialist physician, two local businessmen, and the Executive Director:

The CHPS Board met approximately once per quarter. Most activities were handled by the Executive Director in consultation with the Board Chairman. As part of the DRIS project, the Board/CHC decided to meet once per month to discuss the project and begin to carry out the project objectives.

After the DRIS Initiative commenced in Siskiyou, the Board of CHPS decided to expand its membership to include representation from additional groups, such as Public Health, and small businesses. As the CHPS bylaws at that time required a 14-member Board, this expansion was also consistent with CHPS own requirements.

In November of 1997, CHPS expanded its Board/CHC to 12 members:

CHPS Board/CHC -- April 1998

The expansion of the Board brought women, minorities and representation of the Public Health Department onto the CHC. The current makeup of the Board/CHC continues to be reflective of the primary CHPS mission of holding down health insurance costs of local self-insured businesses.

The first year of the DRIS process in Siskiyou focused on setting up the DRIS Council and defining the appropriate relationship between CHPS and DRIS. After all the new members were brought onto the Board/CHC, an all-day educational session was held in January 1998. This session covered the DRIS learning objectives dealing with basic education on health system and managed care issues and operations, including integration and collaboration. It was attended by most Board/CHC members and the new Local Coordinator.

The CHC definition of the service area, Siskiyou County, coincides with the DRIS site selection and the CHPS’ defined service area. Limiting the service area to the I-5 corridor was discussed, however, it was agreed that narrowing the service area in such a way, would leave out the county’s most vulnerable isolated rural residents, including the poor, the uninsured, and ethnic minorities (primarily Native Americans) living in outlying areas.

CHPS was easily identified as the Collaborative Vehicle for the Siskiyou site. Due to the evolution of DRIS as a supportive partner to existing community integration efforts, the obvious and only real choice of a Collaborative Vehicle was CHPS, 

The following outline details the issues addressed through March 1998: