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Health Care: Health Action narrows focus to healthy living

LONG-TERM PREVENTION SEEN AS FAR SUPERIOR TO PATCHING SYSTEM

When Sonoma County leaders assembled Health Action seven months ago, it was unclear where or how the 32 community leaders would be able to have an impact on the increasingly strained local health care system.

Some hoped they might help the county’s struggling community hospitals find their fiscal footing, or perhaps they would fill the holes in the fragmented mental health system. Others saw the county picking up where state leaders fumbled by finding health insurance for all residents.

Then last month, the group decided to take a different approach. With health care providers reeling from the disturbing trend of increasing chronic disease, it became clear the group would not have an impact by just fixing gaps in the system. It had to go to the source of the problem such as lifestyle and access to primary care.

“When I was in medical school, the model was more one of cause and effect. You got pneumonia, strep throat, you went to the doctor and they fixed it. It’s really been fairly recently that the model has started to shift with the prevalence of diabetes and heart disease. Health care is about prevention, and this is the approach we took to deciding on our focus area,” said Bo Greaves, president for Primary Care Associates and co-chair of the health care delivery task force.

At the end of April, the group hit a transition point in its plans to better the health of Sonoma County residents. Collectively, they narrowed down three focus areas to one starting point, choosing the broadest of the three: healthy living, including healthy eating and exercise.

The other two possible issue areas that could be looked at again in Health Action’s two-year time frame include healthy aging and mental health.

“I was really supportive of the choice to focus on healthy eating and lifestyle because it has the greatest potential for long-term change. Mental health is definitely important and there is a crisis right now that really needs to be addressed. But this will allow us to attack the root of health problems where the mental health problems are more institutional right now,” said Mary Szecsey, executive director for West County Health Centers and member of the health care delivery task force.

Health Action has now split into two task forces, one to address healthy living through a community health lens and the other to look at the topic with health care delivery in mind, such as preventative care. The two groups recruited 25 additional community members who made their first list of possible projects April 25.

All asked: What do we want health in Sonoma County to look like in 2020?

In the health care delivery task force, Dr. Greaves said the group had a long list of possible projects, but a few stood out.

“One idea that got a lot of interest was finding a medical home for all patients in the county. We looked at the increasing price of primary care in the community and the difficulties we are having as the population ages,” he said.

“I think everyone agreed that you can’t separate the current problems facing the health care system without asking how accessible is the delivery network?”

The group discussed launching anywhere from three to 20 pilot projects for medical homes focusing on patient-centered care, which can include nutrition consultations, exercise specialists and others.

Others suggested creating robust employer wellness programs similar to those at Medtronic CardioVascular or Agilent Technologies, with a special focus on small employers. The project could work through financial incentives from insurers or from other sources.

The group also talked about creating a county-wide collaborative electronic medical records system and organizing a provider training program that focuses on integrating healthy living choices into treatment.

In the community health task force, the group also brainstormed a list of possible projects.

“Some people had really big visions of what they wanted to see and others had specific ideas, but it was clear people have really been thinking about this,” said Santa Rosa City Councilwoman Jane Bender, who serves as co-chair for the community health task force.

“Toward the end we started to say, ‘If you could do one thing what would be?’ And it’s interesting because there are so many issues we have to tackle. The goal is to reach the greatest number of people to create the largest measurable effect.”

Some ideas that came out of the session included focusing on city infrastructure, like biking and pedestrian paths along with a public education campaign that addresses the importance of healthy eating and physical activity.

“I truly believe in the concept of exercise as medicine,” said Dr. Kirk Pappas, newly elected president of the Sonoma County Medical Association, a specialty physician at Kaiser Permanente Santa Rosa and recently added member to the community health task force.

He and other members in the group had the idea to make a proclamation that every resident commit at least 150 minutes a week to exercise as well as establish policy incentives to promote access to local healthy foods.

“I think this planning is long overdue and I am excited to be a part of it,” said Ginny Doyle, program planner for the Area Agency on Aging and a recently added community member. “I think the biggest thing is finding a way to make more people exercise and I think something really innovative will come out of this.”

During the course of the summer, the two groups will continue to meet independently to continue brainstorming, as well as seek input from the community. And this fall they are expected to make their first recommendation to the board of supervisors.

“Once we get through the skeletons of what we want to do, we are going to take the ideas out and see if there is any resonance in the community. A huge part of making this work is having the community buy into it. I don’t at all see this as us coming up with something and forcing it on everybody,” said Judy House, chief executive officer for PsychStrategies and co-chair for the health care delivery task force.

For more details on task force planning and Health Action visit www

.sonomahealthaction.org.

•••

Submit items for this column to D. Ashley Verrill at 707-579-2900 ext. 215, averrill@busjrnl.com or fax 707-579-8475.

Initiatives identified in community health task force:

1)    Increase the number of children walking or bike riding to school

2)    All residents of Sonoma County exercising daily

3)    Increase the number of employee wellness programs

4)    Residents eat more local foods and increase the number of school and community gardens

5)    Create a public education campaign with a recognizable slogan or logo and a return on investment analysis

Ideas identified in health care delivery task force:

1)    Medical home pilot project in a variety of provider settings funded by a collaboration of local and state funders

2)    Increase the number of work-site wellness programs and build a business case for their value and impact

3)    Create a conversation about the importance of technology connectivity

4)    Expand local provider training

5)    Expand the number of school health centers

6)    Expand availability of community-based, easily accessible health education resources for behavior change

7)    Enhance community engagement in health and health care

8)    Initiate policy changes on a local level to support health care delivery

9)    Expand local health insurance products for uninsured residents

10)    Expand the number of trained caregivers for seniors to allow them to remain independent as long as possible