Harnett Man Named Health Director Of Year

The Daily Record
Thursday, February 16, 2012

By BRIAN HANEY, News Editor

Harnett County is known for many things - it's state-of-the-art water system, its dysfunctional board of commissioners - but now it's also know for having one of the top health directors in the state.

John Rouse, director of the Harnett County Department of Public Health, was recently named 2012 Health Director of the Year at the North Carolina State Health Director's Conference in Raleigh.  The award was given in recognition of his leadership in public health at the local and state level.

Mr. Rouse, who has been Harnett County Health director since 2003, said he was grateful to be selected as Health Director of the Year, but said the accomplishment is not his alone.

"It was an honor for me to be selected," he said, "but there are a lot of other health directors that go into making that association and what we do special.  It's my coworkers who make public health what is is through day-to-day patient care and customer service."

At present, Mr. Rouse heads a department of between 90 and 95 employees.  Since he came to Harnett County, he said the health department has been involved with the health Department Accreditation Program, taking over the department of aging which coordinates senior meal sites, and is currently working on a diabetes program.  Mr. Rouse said the department also has "a very vibrant home health program" and touted the environmental health program. 

"The most important thing that goes on here is just the day-to-day operations - the patient services we provide."  All these accomplishments, he said, have been made during a difficult economy.  "Anytime you're in tough economic times our business volume increases," he said.  He said his office has experienced 1,600 more patient visits this year than the year before.  "We're having to do that with less budget ... than we did last year; which is tough," he said.  "What I'm most proud of are the staff that come in every day and just provide those services to the citizens of Harnett County."

Mr. Rouse came to Harnett County from Sampson County where he had served as health director since 1999.  He has also served as director of the Duplin County Health Department in Kenansville.  He has a Bachelor of Arts degree in history from East Carolina University and a Master of Science degree in administration from Central Michigan University.

Mr. Rouse is past president of the North Carolina Association of Local Health Directors (NCALHD) and serves on the East Carolina University Public Health Advisory Board and Southern Regional Area Health Education Center.  He is a member of the North Carolina Department of Labor Agricultural Safety Board and serves as secretary for the Sandhills Community Care Network Board.  He is also a past president of Harnett County United Way.

The Health Director of the Year award is sanctioned by the North Carolina Association of County Commissioners and implemented through NCALHD.

Health Care Network Initiates Efforts to Curb Prescription Drug Abuse

The Pilot
Wednesday, January 18, 2012

CONTRIBUTED

The use and abuse of prescription pain medications has increased markedly in the past 10 years.

During this period, sales of pain relievers quadrupled.  Enough pain relievers were prescribed in 2010 to medicate every American adult with 5 mg of hydrocodone, taken every four hours, for an entire month, according to a news release from Community Care of the Sandhills.

Pain relievers prescribed legally for acute or chronic pain are frequently diverted for non-medical use by patients or friends or are sold on the street.  Likewise, the number of deaths from overdose of such medications has increased at a rate that is quickly approaching the number of deaths from motor vehicle accidents.

North Carolina has one of the highest rates nationally, and almost all of these deaths involved prescription pain relievers, such as methadone, oxycodone, fentanyl and morphine.  Such abuse of pain relievers costs the U.S. health care system $72.5 billion annually.

To address this crisis, Community Care of the Sandhills (CCS) is implementing the chronic pain initiative, an effort that seeks to provide clinically appropriate pain relief for patients suffering from chronic pain.  The initiative includes a broad partnership between CCS, the N.C. Hospital Association, local hospitals and emergency departments, health departments, primary care physicians, faith-based programs and local law enforcement agencies. To read more about CCS and Prescription Drug Abuse, click here.

Medical Homes, Improved Care Save N.C. Medicaid
Nearly $1 Billion

Nearly $700 Million in Savings Came in Past Two Years

RALEIGH - Care management saved N.C. Medicaid nearly $1 billion over four years, according to a new analysis by a national health care consulting firm.

The report by Milliman Inc., an actuarial firm based in San Diego, Calif., examined the impact of the state's support for primary care "medical homes" - a system to coordinate health care for Medicaid recipients.  Milliman's report, which was required by the General Assembly, found that recipients with a medical home get better care and consumed fewer Medicaid resources than those who lack a medical home.  From fiscal year 2007-2010, N.C. Medicaid avoided spending $984 million by having 1.1 million of its members enrolled into medical homes.  In just the last two fiscal years of the study - 2009 and 2010 - $677 million was saved.

"Setting government straight is one of my top priorities," Gov. Perdue said, "and that means getting more out of every dollar the state spends and fueling innovations that save money, which is exactly what this program does."

"This is further validation that we are on the right track to ensuring high-quality medical care with the most efficient use of taxpayer dollars," said DHHS Secretary Lanier Cansler.

DHHS' partner in providing medical homes is the Community Care of North Carolina (CCNC), a nonprofit group of local health care provider networks that provide and coordinate care for Medicaid recipients.  The 14 regional CCNC networks since 1998 have pooled resources for technological and administrative purposes, which not only saves operational costs but also provides opportunities for cooperation and collaboration throughout the networks.

The key to the success of medical homes approach is a stron emphasis on preventative care, and aggressive care management.  Although the cost of frequent office visists and treatment of newly diagnosed conditions adds to program costs initially, the reduction of emergency room visits and hospital admissions, as well as capturing of efficiences and improving quality of care, results in significant savings and better health for the recipient.

As N.C. Medicaid enrolled higher numbers of its members into a CCNC medical home, Milliman found annual savings increased-$103 million in fiscal 2007 (July 1, 2006-June 30, 2007); $204 million in FY 2008; $295 million in FY2009; and $382 million in FY 2010.

Milliman also reported that N.C. Medicaid is on a successful path to decrease cost by enrolling aged, blind or disabled (ABD) members into a medical home.  Those Medicaid populations are generally the least healthy overall and costliest to treat.  Enrollment into medical homes initially would add to the cost of caring for them but pays off in the long term.  Indeed, Milliman found that in FY 2006, medical home enrollment of ABD populations cost the state an additional $82 million.  But by FY 2010, enrollment of ABE Medicaid recipients into medical homes had paid off with the state avoiding $53 million in costs.

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Cause for Hope in North Carolina
Pregnancy Medical Home Capturing National Interest

Infant mortality rates are widely used in this country and internationally as a barometer of the quality of a community's, or a nation's, health care system - and with good reason.  Despite our sophisticated and expensive health resources, the infant mortality rate in the United States is significantly higher than that of many other countries.  In 2005, for example, our infant mortality rate of 6.9 per thousand births put us above that of most European countries, Canada, Australia, New Zealand, Hong Kong, Singapore, Japan and Israel.

Our maternal mortality rate - the measure of women dying in childbirth - is also shockingly high compared to that of European countries.  What's worse, it is rising.  In 1990 in the United States, 343 women died in childbirth; by 2007 that number had increased to 548.  A report released July 6 by the National Institute of Child Health and Human Development documents some progress on reducing the incidence of preterm births, down from 12.8 percent in 2006 to 12.2 percent in 2009.  But that rate is still woefully behind the U.S. Healthy People 2010 target of 7.6 percent of all live births.

Taken together, these statistics should be a cause of major concern and inspire action to reverse that trend.

One state, North Carolina, has set out to address these programs.  In March, North Carolina opened a Pregnancy Medical Home program for women eligible for Medicaid.  Working with their medical community, local health departments, and a network of community support organizations called Community Care of North Carolina (CCNC), state health leaders combined payment incentives and specific care requirements into a package they believe will improve pregnancy outcomes throughout the state.  

To read more about this article, please click on the following link: CauseforHopeinNC

"However, there is one state that has done a wonderful job and an incredible job and that is the state of North Carolina."

For transcript and audio of story, please visit: NPR.org

Integration In Action: Four International Case Studies 

Community Care of North Carolina was one of four organizations recently analyzed by Nuffield Trust, an independent source of evidence-based research and policy analysis for improving health care.  The four organizations analyzed were:

• Community Care North Carolina, US: a government-funded network that aims to improve access and quality levels for Medicaid beneficiaries;
• Greater Rochester Independent Practice Association, US: an independent practice association in upstate New York;
• Regionale HuisartsenZorg Huevelland, the Netherlands: an organisation providing support to GPs to deliver integrated diabetes care;
• North Lanarkshire Health and Care Partnership, Scotland: an NHS and social care partnership.

The experience of the four organizations suggest strongly the influence of six groups of operational activities ("integrative processes") that served to embed coordinated care into daily practice: clinical, organizational, informational, financial, administrative and normative (see Figure 1 below).  In addition, national policy, regulation and payment systems were found to be important enablers - or inhibitors - of integrated care.

The six groups of integrative processes identified were:

1. Clinical - delivering consistent and standardized clinical care to patients along the whole continuum of care.
2. Informational - developing clinical and managerial information systems to support aligned practice across different care settings, communication between clinical teams, outcome measurement and performance management.
3. Organizational - such as developing governance arrangements within and between institutions, and designing organizational structure to aid integration. 
4. Financial - such as joint budgetary arrangements and payment systems across organizations.
5. Administrative - administrative support (for example, shared human resource management and seconded staff) to support small practices and build links with the parent case study organization.
6. Normative - such as identifying, communicating and operationalizing the shared vision, goals and values across individuals and organizations.

The full report and summary are available for download at: Nuffield Trust

County Health Rankings

The County Health Rankings show us that where we live matters to our health. The health of a community depends on many different factors - ranging from health behaviors, education and jobs, to quality of health care, to the environment.  For an interactive map to see a snapshot of your county and other healthcare measures, click here.  

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EHRs.pdf

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