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					                        CINCINNATI BOARD OF HEALTH
                             Board of Health Meeting
                                 April 24, 2007


Dr. Linetta Collins, Chairperson, Board of Health, called the April 24, 2007 meeting of
the Cincinnati Board of Health to order at 6:02 p.m.

                                     ROLL CALL

Board Members Present: Mr. Steven Baines, Mr. Jerry Bedford, Dr. Linetta Collins,
Ms. Jacqueline Edmerson, Dr. Richard Ruddy, Dr. Wael Safi, and Dr. Stephen Wilson
Board Members Absent: Ms. Darlene Barnes and Dr. Thomas Dryer
Senior Staff Members Present: Dr. Noble Maseru, Mr. Mark Gissiner, Ms. Cynthia
Blocksom, Ms. Carol Westermeyer, Dr. Lawrence Holditch, Dr. Steven Englender, and
Dr. Lawrence Hill

                                      MINUTES
                                  (Attachment No. 1)

Dr. Collins proposed a motion to approve the March 27, 2007 Minutes.

Ms. Edmerson seconded the motion.

The March 27, 2007 Minutes were approved as submitted with one abstention.

Dr. Collins wanted it noted for the record and for the new members of the Board, that to
ensure compliance with the Bylaws, if there are any committee meetings or other smaller
meetings that need to be convened, the Chair or Vice Chair of the Board must be notified.

                                  PRESENTATION
                                  (Attachment No. 2)

Dr. Maseru introduced Mr. Hirsh Cohen, Consultant, Cincinnati Health Department. He
invited Mr. Cohen to elaborate on the Primary Care Safety Net Access Initiative, which is
a grant from the Cincinnati Health Foundation, only the second grant of this type for the
Cincinnati Health Department (CHD). Mr. Cohen has been the Project Coordinator for
the initiative. Dr. Maseru further invited Ms. Judith Warren from the Health Foundation
to address the audience. Ms. Warren is Program Officer for Community Primary Care,
one of the four focused areas of the Health Foundation

Ms. Warren began by stating that 22% of the Greater Cincinnati population is uninsured.
The purpose of this initiative is to bring about better integration, collaboration and
coordination among health care providers; i.e., the Health Department, federally qualified
health centers (FQHCs), hospitals, the Chamber of Commerce, elected officials, and
social service agencies. She said it is important to note that approximately 75% of the
uninsured are employed.

Mr. Cohen reiterated what an exciting project this is for the CHD, and emphasized the
importance of the initiative. In Cincinnati there are large numbers without health
insurance, with an under-utilization of primary care facilities, and over-utilization of
emergency departments (ED’s). There are approximately half a million people with poor
oral health, and many of these present at emergency rooms for treatment. The poverty
rate in the city is much higher than in the county, and 18% of Tri-Staters have no medical
insurance. Only 79.7% of the adult population has a “medical home.” Funding for safety
net providers has decreased, while the number eligible for services has increased. Further,
the uninsured are more likely to delay getting health care, and the poor have the greatest
risk of being uninsured.

Mr. Cohen said the Health Foundation should be commended for taking the initiative and
developing this approach. The safety net providers deliver a significant level of health
care to the uninsured and Medicaid patients. Safety net providers include public and
teaching hospitals, community health centers, and local health departments, and also
special services, such as school-based clinics.

In Cincinnati there are basically two types of providers: mandated, such as the CHD and
Community Health Centers, and mission-driven, such as the Oral Health Council or
nonprofit health centers. The CHD serves over 35,800 citizens, providing over 137,000
visits, and of these, 20,000 are uninsured. The safety net providers in Cincinnati are often
separated and uncoordinated in care management, and there is also a growing number of
uninsured due to reductions in employer based health insurance. There is a growing
number of at-risk conditions, and an increased use of hospital emergency departments.

The network approach is the only viable way to remedy the current model. CHD is
looking for ways to collaborate with all area health centers. While there are publicly
supported hospitals, there is no formal public hospital. The goal has become the
establishment of a community and public health core safety network. The Primary Care
Access Initiative is working to achieve 100% access; to increase the number of children
and adults who have a regular place to obtain medical and dental care; to increase the
appropriate use of health care resources by improving access; and to create affordable
options for working families and employees of small businesses.

Some measurable outcomes will be a reduction in the number of ER visits and costs
related thereto; and to establish primary care medical and dental homes, to provide
continuity of care. There should be access to a full range of preventive services, and
improved overall health status. These would include transportation, pharmaceuticals, and
mental health services.

Mr. Cohen listed all of the partners: CHD, University Hospital, Cincinnati Children’s
Hospital Medical Center, Good Samaritan Hospital, Community Health Centers
including Crossroads Health Center, the Cincinnati Health Network, Neighborhood



                                             2
Health Care, Inc. (Mt. Auburn, Walnut Hills/Evanston, and East End), West End Health
Center, Winton Hills Medical Center, the Greater Cincinnati Oral Health Council, Ohio
Shared Information Services, and the Health Bridge.

Mr. Cohen introduced Ms. Puspa Das, Executive Director of the West End Health Center,
who explained that FQHC’s are commonly referred to as community health centers. She
said they must respond to the cultural diversity of the community they serve. They serve
all of the population, regardless of ability to pay. They offer affordable access to quality
care based on a sliding fee scale. They are covered by the Federal Tort Claims Act.

She said there are many models of FQHC’s, most of which are community based. There
are also special programs, such as Care for the Homeless, and links with the
schools/neighborhoods, such as Winton Hills Medical & Health Center. Ms. Das went on
to list some of the services of the FQHC’s, and said they provide care from infancy
through geriatrics. The services include dental care, psychiatric, ob/gyn, ophthalmology,
pharmacy and social services.

Goals of the FQHC’s include being identified as Medical Homes for the community, and
100% access, with 0% disparities. She said that community health centers have been
involved for many years, but they are fragmented, independent and isolated. There are
not adequate resources, as the recent budget cuts have “shaken their ground.” There is a
need for collaboration, and to create a city-wide continuum of health care. She said it
does “take a village” to establish medical homes, and to achieve the 100% access.

Mr. Cohen then introduced Ms. Lori Uphaus, Director of Graduate Education, Research
and Behavioral Health, Good Samaritan Hospital (GSH). Ms. Uphaus said there had
been 49,000 annual visits to GSH Emergency Department, with over 14,000 of those, or
approximately 30%, for non-urgent problems. That calculates to 40 unnecessary ED
visits daily.

They identified frequent users of the ED and established a point of entry coordinator who
determines the management plan. They coordinate with the primary care physician
(PCP), if the patient has been established with one, or refer through the call list and
establish a PCP. By utilizing these procedures, the goal is to reduce unnecessary (and
expensive) ED visits, and to improve patient satisfaction.

The program is in its initial stage, only six months in practice. They will analyze the
impact, and determine the number of and satisfaction of patients placed with a primary
care provider.

Mr. Cohen said that the enthusiasm for this initiative is very strong, and they are still
discussing and sharing ideas on how to implement all that needs to be done. He said the
data to date is very encouraging.

Dr. Safi agreed that the initiative is a challenge, but that this is a beautiful model. He did
question why Closing the Health Gap was not on the list of partners. Mr. Cohen said it is



                                              3
possible they will be brought in as the initiative broadens into a more community-wide
approach, but the key here was to initially bring in the front-line providers. Ms.
Edmerson echoed that it is a wonderful program, but asked about prevention, rather than
just focusing on the sick. She asked about tracking the population; what type of
information system is being used? Mr. Cohen said there are three separate information
systems, and one of the goals is to link together a common patient identifier, and track
where patients are coming from.

He said research shows that 20% of the users consume 80% of the resources. There is a
population that needs chronic care management. Ultimately they hope for a data system
to improve care management.

Dr. Wilson said there is a high rate of over-utilization of ED’s, and asked if the plan was
to incorporate open access to PCP’s. Mr. Cohen said they are looking at various models,
including nine-to-five care or after-hours access, and the goal is to “define, describe and
test.” The incremental costs are significant, so the means of funding also is very
important. Dr. Hill pointed out that various plans have been tried in the past, and it is
very important that the Health Foundation is trying to develop the approach of looking at
and coordinating what has been successful in the past, and coordinating and
implementing those plans. They seek to bring together primary, secondary and tertiary
providers, and collaborating as to what the best technique might be. He commented that
the effort is commendable. Ms. Edmerson agreed, and stressed that the teaching aspect is
also a consideration; educating this population in the proper use of ED’s, and when and
where to seek care. Dr. Ruddy said that as an ED provider, this has been a very positive
initiative.

Dr. Maseru said that in light of the recent budget cuts, the CHD is keenly aware of the
health improvement opportunities, but also the fiscal consequences of not utilizing the
network. He applauds the Health Foundation for providing this opportunity.

                                         ******
At this point Dr. Collins invited Ms. Jill Guthrie to come forward. Ms. Guthrie presented
as a concerned citizen, an uninsured, with questions regarding eligibility. Ms. Guthrie
inquired who sets the standards for health insurance; she feels the standards are
unrealistic. Ms. Guthrie is a working citizen, but has no health insurance. Mr. Cohen
tried to explain the state and federal guidelines, and how eligibility for Medicaid is
determined. He said that, unfortunately, there is really no safety net at present, although
initiatives of the type presented are being explored. Dr. Collins volunteered to put Ms.
Guthrie in touch with the CHD Medical Director.

                                       ******
Mr. Curtis Wells, a community advocate who has addressed the Board before, came
forward to address the mental health levy/health issues. He expressed his concerns with
Mr. Dwight Tillery having previously addressed the Board. He further elaborated on the
presentation regarding the Primary Care Access Initiative, citing benchmarks that were
not included, and said that basically everyone has access to health care. He is also



                                            4
concerned that many physicians have left the city because they were not on the provider
list, and he is concerned about the ratio of physicians to the population.

Dr. Collins stated that due to time constraints, after the Financial Report the agenda will
skip to Contracts, and then return to Personnel Actions.

                                FINANCIAL REPORT
                                  (Attachment No. 3)

Mr. Gissiner said that so far we are living within the budget, but in years past we have
been under budget, and that is not the case at present. The situation is due to the $2
million in budget cuts. Nursing has been working very hard to serve their clients, and
that is commendable. The 395 Revenue fund is also in line, and again, that is due to the
hard work of all the departments. We are pretty close to maximizing funds. Mr. Gissiner
thanked Mr. Schlanz, Dr. Holditch, Dr. Hill, and all the staff who have been working so
diligently to keep revenues under control.

                               CONTRACTS/GRANTS

A.     US Script,, Inc. – Accounts Receivable
       January 1, 2007 – December 31, 2007 (Attachment No. 5)

       Dr. Collins proposed the motion,

       At the request of the Health Commissioner,

       “That the Board of Health approve the contract which allows the Cincinnati
       Health Department to provide prescription benefits to patients enrolled in
       Buckeye Community Health Plan, Inc. and to receive reimbursement for these
       services.”

       Second:        Mr. Bedford
       Discussion:    Dr. Larry Hill said this is simply a contract which allows the CHD
                      to be reimbursed. US Script is a third-party administrator used by
                      Buckeye Community Health Plan to reimburse pharmacy
                      providers. Buckeye is a Medicaid managed care company, and will
                      be working with the Medicaid Aged, Blind and Disabled members.

       Vote/Action: Passed unanimously and approved

B.     Buckeye Community Health Plan – Accounts Receivable
       January 1, 2007 – December 31, 2007 (Attachment No. 6)

       Dr. Collins proposed the motion,

       At the request of the Health Commissioner,



                                            5
     “That the Board of Health approve the contract which allows the Cincinnati
     Health Department to provide medical and home health services to patients
     enrolled in Buckeye Community Health Plan, Inc. and to receive reimbursement
     for these services.”

     Second:       Ms. Edmerson
     Discussion:   Dr. Hill said this is the parent contract to US Script. The
                   reimbursement is at 105% of Medicaid rates. It covers the same
                   population provided for in the US Script contract. Dr. Wilson
                   asked if this covers disease management, such as heart disease or
                   diabetes. Dr. Hill said that had been under discussion, and they are
                   now considering prevention, with rewards and incentives.

     Vote/Action: Passed unanimously and approved

C.   Health Management Associates of Illinois
     $53,000-Not to Exceed $64,000
     May 1, 2007 – August 31, 2007 (Attachment No. 7)

     Dr. Collins proposed the motion,

     At the request of the Health Commissioner,

     “That the Board of Health approve the contract in the amount of $53,000-Not to
     Exceed $64,000 to assist CHD in preparing a Federally Qualified Health Center
     (FQHC) Look-Alike Application.”

     Second:       Mr. Bedford
     Discussion:   Dr. Maseru explained that the amount of money CHD is allowed
                   by law to charge has changed, and the reimbursement for Medicaid
                   patients has been substantially reduced. CHD is losing
                   approximately 40% of the actual charge. FQHC’s are exempt from
                   that limitation. This contract allows the CHD clinics to qualify as
                   look-alike clinics, or FQHC’s, and therefore receive 100%
                   reimbursement. The application will be complete no later than
                   August 2007, and the likelihood for approval is at least 95%.

                   Basically, this contract is for Health Management Associates of
                   Illinois to fill out the application. They have the experience and
                   technical expertise, and it is highly advantageous to have them.
                   They had previously completed the feasibility study that was
                   consigned by the Health Alliance.

                   Ms. Allison Davidson, Assistant City Solicitor, interjected at this
                   point that this topic had been discussed and explored in depth, and



                                         6
                      it is a quite complicated endeavor. This would be money well
                      spent.

       Vote/Action: Passed unanimously and approved

D.     Cincinnati Health Network – Lease
       $10.00 – May 1, 2007 – April 30, 2017 (Attachment No. 8)

       Dr. Collins proposed the motion,

       At the request of the Health Commissioner,

       “That the Board of Health approve the lease in the amount of $10.00 for 10 years
       for the van to provide health services for homeless persons. The CHD will lease
       the van from the Cincinnati Health Network which is funded by a federal grant.”

       Second:        Mr. Baines
       Discussion:    Dr. Hill said this has been a successful program in the past. The
                      Cincinnati Health Network (CHN) owns the vehicle, which was
                      purchased through funds raised by the CHN from a number of
                      foundations. CHD will lease the vehicle for a dollar a year for ten
                      years, and CHD is responsible for repairs and maintenance. CHD
                      is prominently visible on the exterior of the van, and it will be
                      operational by the end of May. It travels to all of the homeless
                      shelters. After it is operational, a determination will be made on
                      the use of the present van.

       Vote/Action: Dr. Wilson    Yes
                    Dr. Collins   Yes
                    Mr. Baines    Yes
                    Mr. Bedford Abstain
                    Ms. Edmerson Yes
                    Dr. Ruddy     Yes
                    Dr. Safi      Yes
                    Passed by majority and approved.

                              PERSONNEL ACTIONS
                                (Attachment No. 4)

Dr. Collins proposed the motion,

       At the request of the Health Commissioner,

       “That the Board of Health approve the personnel actions on the list
       identified as Attachment No. 4 dated April 24, 2007.”




                                           7
       Second:        Ms. Edmerson
       Discussion:    Mr. Gissiner said that Mr. Dale Cornes is being recommended for
                      promotion to a Utility Laborer for the Maintenance Section.

       Vote/Action: Passed unanimously and approved


                               EXECUTIVE SESSION

Dr. Collins proposed the motion:

       At the request of the Health Commissioner,

       “That the Board of Health go into Executive Session pursuant to Ohio Revised
       Code Section 121.22(G)(1) for the purpose of discussing a personnel issue.”

       Second:      Mr. Baines
       Vote/Action: Passed unanimously and approved.

Upon return from Executive Session, Dr. Collins proposed the following motion:

       “That the Board of Health approve the Disciplinary Action of a charge of
       Excessive Absenteeism and an eight-hour suspension without pay for Employee
       No. 10753.”

       Second:      Mr. Bedford
       Vote/Action: Passed unanimously and approved.

                     HEALTH COMMISSIONER’S COMMENTS/
                              OTHER BUSINESS

Mr. Dale Grigsby, Supervisor, Environmental Services, elaborated on the Non-Smoking
law which had been passed last November for the State of Ohio. The Ohio Department
of Health worked on the rules, and recently came up with the final draft of how the law
will be enforced. He said there currently is approximately 90% compliance with the rule.
The expectation is for very few citations, and most of the issues will be with private
clubs.
                                        ******
Mr. Bernard Young, Health Program Manager, CHD, appeared before the Board to
elaborate on HIV/STD issues, which had been addressed at the March 27th Board
meeting. Mr. Young thanked the Board for their support.

Mr. Young stated approximately $670,000 in federal dollars are received through the
Ohio Department of Health for HIV prevention services. $519,000 of these monies are




                                           8
contracted to programs outside of the CHD. There are representatives from several of
these programs present to explain the programs, and to answer any questions.

Ms. Mamie Harris represented 4/CHARIS (Compassionate Hearts Assisting, Rebuilding,
Instructing, Serving), which is a faith-based HIV testing site within the City of
Cincinnati. It is the first minority agency to gain access to funding that comes in through
CHD. CHARIS reaches most of their clients through residential substance abuse,
residential criminal justice and homes for adjustment programs. Dr. Collins asked if
CHARIS offers any type of training for other faith-based groups, and Ms. Harris
responded they do not, but they are willing to assist any group in education and training.
She has done some training for the Centers for Closing the Health Gap.

Mr. Charles Wallner introduced himself as the Coordinator for the Greater Cincinnati
AIDS Consortium (GCAC). They provide assistance to the programs that do
intervention, prevention and treatment. They help support POCWA (People of Color
Wellness Alliance) and CRAG (Cincinnati Regional Advisory Group). They created,
maintain and update the HIV/AIDS resources website. They are also the Ryan White
Fund coordinating body.

Dr. Michael Lyons, University Emergency Department, said that University Emergency
Physicians, Inc. has established an Early Intervention Program (EIP). He said that as of
2006 there has been an emphasis on Emergency Departments (ED’s) specifically, the
reason being that the at-risk population comes to the ED. The mission of the ED has not
been prevention. But with the partnering with CHD and access to the Infectious Disease
Center, the EIP will identify patients in need of intervention that previously may have
been missed in the ED. Their model has been nationally recognized, and recently was
developed into a 24/7 service. For Preventions for Positive, in their pilot year 106
patients were identified in need of intervention. In terms of total cost, the testing
program is several hundred dollars less than other community programs. Another benefit
is matching funds, through the National Institutes of Health (NIH), the Ryan White Fund,
and other research support. With additional resources, the organization could
dramatically increase testing.

Dr. Ruddy asked if Dr. Lyons had a sense of the benefit to be realized from joining with
other ED’s, and Dr. Lyons said this is under study at the present time. It would of course
depend on which ED, but University Hospital undoubtedly has the lion’s share. Dr.
Lyons further stated that through a close collaboration with the Justice Center, theirs is a
very high risk population, with a high turnover rate and a high overlap with the
Emergency Department.

Ms. Melissa Meyer, Training Manager for Planned Parenthood in Cincinnati, said they
offer a 10-session HIV Prevention Education curricula to the youth of Greater Cincinnati,
including Butler, Hamilton and Clermont Counties. It is a rigorously evaluated program
which has reached over 4,000 youth in the area in the last 7 years. Dr. Collins asked how
they enroll youth, and Ms. Meyer said the greatest source has been the Cincinnati Public
Health nurses. The nurses are “in the trenches” and see the need. They see youth from



                                             9
the ages of 13 to 24, the vast majority between 13-16, and 60% are already sexually
active. Ms. Meyer provided the phone number of 513-721-7635, Ex. 257.

Mr. Baines inquired if there is a certain criteria for students, and Ms. Meyer responded
that it is more generating enough to form a group, such as getting a commitment of 10-12
students. They have been partnering with AVOC, which is a nice collaboration. They
see male and female, approximately 4,000 clients, and she does not have a breakdown of
how many are in Cincinnati, although a large number are Cincinnati Public School
students.

Ms. Victoria Brook, CEO of AIDS Volunteers of Cincinnati (AVOC), provided the
AVOC handout which contained information on their criteria, program models,
prevention and history. She also said that AVOC has a 25-year track record of providing
outstanding HIV prevention and education services to the Greater Cincinnati community.
In 2006 AVOC had the highest rate of positive tests of any testing location in the city,
testing the second highest number of individuals (2,193). They also test for Hepatitis C.
Their programs include outreach testing, group preventions and one-on-one interventions.
They achieved or exceeded their goals for 2006. All of their programs are designed to
reach the African American population. They also work with Cincinnati Public Schools;
they had a pilot project at Wyoming, and tested at Millvale and Dater.

They do ensure the privacy of the individual. They recently received funding for a van
for testing, to go into the various neighborhoods. They go anywhere people are at risk,
including gay bars, the Drop-Inn Shelter, and any other popular location.

Mr. Young concluded by saying that people who do test positive are reported to the
CHD. All the information ultimately goes to the State, and the duplicates are weeded out.
They report back to the Health Department the Zip Code where the patient resides, as
opposed to where the testing was done. The lag time is approximately two years,
between the time of the actual testing and the final reporting. This lag time only applies
to physician reporting, and not to the labs. It has only been in the last two years that the
State of Ohio has required physicians to report their testing results.

Mr. Young further pointed out that there is a lot of good collaboration among the various
organizations. Dr. Maseru asked what the Health Department can do to try to eradicate
the disease; are there any suggestions – other than money, of course. It was suggested
that to bring the entire issue out of the closet would be very helpful. It is an uphill battle,
because people don’t want to recognize it. If the Health Department could assume more
of a leadership role, to reduce the stigma, it would influence other local leaders, and
involve more corporate sponsors. People look to CHD to show leadership, and by setting
an example, they could encourage collaborations.

The opportunities are out there, and especially in light of the budget cuts, the closer
everyone bands together, the stronger the organization will be. HIV, tuberculosis and
Hepatitis C need to be considered the same type of issue. They are all tied together with
HIV, substance abuse and mental health. They are considered distinct issues, but they all



                                              10
affect the same types of people. Ms. Harris said she thought it would be advantageous
for the Health Department to make known the importance of the community outreach that
the CHD is promoting.

Dr. Lyons said that anything that can be done for support from the public health sector,
for physicians and health care centers to partner in this effort, is in agreement with the
Centers for Disease Control (CDC). Exposure is critical, and the websites need to be
coordinated. The website is www.cincinnatiaids.org.

Dr. Hill thanked the Board for devoting this amount of time to this topic. AIDS is a
devastating disease, and the number of undetected cases is still very high. Dr. Hill said
that CDC is now asking for dental patients to have rapid HIV tests.

Dr. Collins thanked Mr. Young and all the others for their participation, and for the
valuable information which was presented.

                                        ******
Dr. Collins pointed out the Information Items which had been previously distributed, with
particular attention to the Community Forum to be held on Friday, April 27, 2007. Board
members Ms. Barnes and Ms. Edmerson have been working collaboratively with Ms.
Gloria Walker, who has previously appeared before the Board and is very active in
mental health issues. Ms. Walker had extended the invitation to the Community Forum
on behalf of the National Alliance on Mental Illness (NAMI).

Dr. Collins also pointed out a number of smaller contracts, involving volunteer services,
home health services and field experience for nursing students.

Dr. Englender addressed the contract with the National Association of County and City
Health Officials (NACCHO) which provides $10,000 to recruit and train volunteers, and
support exercises and equipment. The money is good until it is spent, i.e., it does not
have to be used by the end of July, which is the date specified in the contract.

Dr. Maseru said that in the absence of Ms. Watson, Public Information Officer, he was
very pleased to announce the CHD Community Health Forum, June 16, 2007, at the
Cintas Center at Xavier University. Some of the invitees are the neighborhood health
associations, the presidents of those associations, and other selected guests. The theme is
“Growing a Healthy Cincinnati through Neighborhood Solutions.” Dr. Alvin Jackson,
the new Director of the Ohio Department of Health, has agreed to give the Keynote
Address. Ms. Watson has also confirmed the attendance of Ohio Governor Ted
Strickland.

                                   NEXT MEETING

The next Board of Health meeting will be held on Tuesday, May 22, 2007 at 6:00 p.m. in
the Delores L. Bowen Auditorium, 3101 Burnet Avenue.




                                            11
                                  ADJOURNMENT

As there was no further business, the meeting was adjourned at 9:12 p.m.



Minutes Prepared by:                                      Minutes Approved by:



___________________________                              _______________________
Donna Christos, Clerk                                    Linetta D. C. Collins, Ed.D.
Cincinnati Board of Health                                Chairperson, Board of Health




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