Archive for the ‘General’ category

Az Health Improvement Plan Paying Dividends

February 27th, 2015
web az-state-health-assessment-coverAz Health Improvement Plan Paying Dividends
We made progress this week on one of our key Arizona Health Improvement Plan (AzHIP) objectives: To improve access to well care in underserved areas of Arizona.  This week the Governor signed Senate Bill 1194 which enhances our State Loan Repayment Program by expanding the types of providers who can receive loan repayment assistance, increasing the award amounts for the initial and succeeding commitment years, and removing the 4-year service cap.  
When the law becomes effective this summer, mental health providers, pharmacists and geriatrics will be added to the list of eligible providers joining the currently eligible primary care physicians, dentists, and advanced practice providers like nurse practitioners, physician assistants, and nurse midwives.  The new law makes up to $65,000 available (for a 2-year commitment) for physicians and dentists (a $40,000 increase).  Advanced practice providers can qualify for up to $50,000 (up from $15,000).  The incentives even get better as providers stay longer in the program.  For each year of continued service in the underserved area after the first two years, physicians and dentists can receive up to $35,000 from $25,000.
We expect the improved funding and eligibility structure to increase access to primary care in underserved communities by bringing in more providers and retaining those that are already serving while helping put a significant dent on their student loan debt.  More information about the State Loan Repayment Program is available on our website or by contacting Ana Roscetti.

EMTALA & Ebola

February 24th, 2015

clinicianThe Emergency Medical Treatment and Active Labor Act (EMTALA) is a federal law that requires hospitals that accept Medicare payments to provide emergency healthcare to anybody regardless of citizenship or immigration status or their ability to pay.  Under the law, hospitals that accept Medicare payments can’t transfer or discharge patients that need emergency treatment unless there’s informed consent on the part of the patient or after the patient is stabilized.  An exception is when the patient’s condition requires the patient’s transfer to a hospital that’s better equipped to administer treatment.

Because patient care for Ebola patients is so unique, we (and most other states) have been struggling to interpret EMTALA requirements when building our protocol for assessment and treatment of Ebola (or potential Ebola) patients.  Last Fall the Centers for Medicare and Medicaid Services sent out a survey and certification letter to provide guidance to hospitals regarding meeting EMTALA requirements if a patient presents who was potentially exposed to Ebola.

Last week they followed up their earlier memo with a Q & A for clarification.  The short story is that all Medicare-certified hospitals with an emergency department are expected (at a minimum) to screen, isolate and begin stabilizing treatment for any patient with possible Ebola symptoms.  Medicare-participating hospitals with specialized capabilities (our designated hospitals) are required (within the limits of their capability and capacity) to accept appropriate transfers of individuals protected under EMTALA from other hospitals, without regard to insurance or ability to pay.  CMS hasn’t published the Q & A publically yet – but we’ll make sure it gets into our Ebola website when it’s ready for broad distribution.

We’ll be taking a close look at the new clarification as we continue to build our protocols for treating Ebola and other emerging infectious diseases.


ADHS Community Profiles Dashboard Gets International Recognition

February 23rd, 2015

StatisticsOur Community Profiles Dashboard is featured this month in the ESRI News, for State & Local Government newsletter as an example of the benefits from making health date more accessible.  I’ve blogged about our Dashboard, which is a leap forward for public health professionals, city planners, non-profit organizations, medical providers and anyone who needs public health data to improve their performance.

What makes the Dashboard revolutionary is the way you can access, sort, and analyze the information.  The Dashboard provides several options for looking at the state, county, or small community level data among the more than 100 Primary Care Areas in Arizona.

In addition to the news feature in ESRI, our Dashboard has received worldwide recognition this year.  The Geowise Company, which built our Dashboard using Instant Atlas (IA) Software analyzed dashboards from around the world to determine what works and what doesn’t in IA dashboard creation.  Based on this analysis, our Community Profiles Dashboard was voted number three in the world.  This will be featured in the next Instant Atlas Newsletter.

I encourage public health professionals, city planners, and medical providers to use the Community Profiles Dashboard to look at health indicators in their communities.  This information is vital in developing healthy communities and targeting resources where they’re needed most.  To help you learn how to use the Dashboard, we’ve created a four part online video tutorial.

AzPHA Spring Conference

February 20th, 2015

AZPHA_Logo_Clr-1pngRegistration is now open for the Arizona Public Health Association (AzPHA) 2015 Spring Conference.  The conference titled: “It Starts Upstream:  A Public Health Approach to Building a Healthy Future” will be held on Thursday, April 9, at the Phoenix Zoo.

This year’s conference will feature panel discussions on the Social Determinants of Health and Nutrition through a Cultural Lens, a presentation on preconception health and a keynote presentation on epigenetics.  The afternoon will feature a World Café, which will include four 20 minutes presentations at several tables.  There will be a wide variety of public health topics, including healthy aging, developing sustainable public health policies, comprehensive medical and dental program for children in foster care, and many more topics.  The conference is a great opportunity to learn about emerging public health issues and network with your fellow public health professionals.

AzPHA is a key stakeholder in Arizona’s public health network of community partners that includes government agencies, medical professionals, community groups, advocates, private industry, and individual citizens – all working together to make our communities healthier.  They’re a non-profit organization that’s been around since 1928.

AzPHA provides a way for members to network with other public health and medical professionals from around the state, enhance their skills by attending professional development trainings, and advocate for a better public health system in Arizona.  Take a look at their website to learn about all the benefits of joining and the discounted memberships.

Southern AZ RBHA Procurement Protest

February 19th, 2015

arnold-sarn1In mid-December (2014) we awarded contracts for the Northern and Southern regions of the state to Health Choice Integrated Care (Northern AZ) and Cenpatico Integrated Care (in Southern AZ).  On January 2nd United Healthcare filed a Protest with the ADHS for the award in Southern AZ, requesting an Emergency Stay and Administrative Hearing.  Last month (January 21) we denied the Protest.

United HealthCare has until tomorrow (February 20th) to file a Notice of Appeal to the ADOA Director.  If United Healthcare appeals our Decision, then we would have 21 days from the date of the appeal to file an Agency Report to the ADOA Director and interested parties.  After review of our Agency Report, the ADOA Director can issue a Stay, dismiss the appeal in whole or part, terminate the award, or schedule an Administrative Hearing.

The contracts for the Northern and Southern regions are scheduled to begin on October 1, 2015 and are three-year contracts with the option for two additional two-year extensions.

Coping with Stress

February 18th, 2015

WStress can have a profound impact on health and affects your body, thoughts, feelings, and behavior.  Symptoms like chronic headaches, insomnia, and lower productivity can be a direct result of stress.  Being able to recognize common stress symptoms can give you a jump on managing them.  Stress management is important, because, left unchecked, it can cause high blood pressure, heart disease, obesity, and diabetes.  It can also lead to behavioral health conditions like anxiety or depression.

Each year since 2007, the American Psychological Association publishes a study called the Stress in AmericaPaying With Our Health.  This year’s report came out last week.  It’s only 23 pages long- so it’s digestible.  The survey measures stress among Americans including the leading sources of stress, things people do to manage stress, and the impact that stress has on our lives.

The Association’s annual awareness campaign educates folks about the connection between stress and physical health and how you can change your lifestyle and behaviors to better manage stress.  They also have a Psychology Help Center, which is an online consumer resource featuring articles and information like Stress management: How to strengthen your social support network; Face the numbers: Moving beyond financial denial; Money and family: Creating good financial habits; and Happy couples: How to avoid money arguments.

Helping our team manage stress is one key to helping employees achieve wellness.  Benefits Options are available for employees, retirees, and their spouses and dependents.  In addition to an Employee Assistance Program, Benefit Options offers resources like Fact Sheet: Mental Well-Being and Learn How to Stop the Cycle of Stress.

AMR Certificate of Necessity

February 17th, 2015

rural-metro webYou might recall that a few weeks ago I approved American Medical Response’s (AMR Maricopa) application to operate ambulances in Maricopa County (called a Certificate of Necessity or CON). I approved the Certificate of Necessity after reviewing a host of evidence presented to an Administrative Law Judge and her Order recommending approval.  Approval of the application doesn’t mean that AMR Maricopa actually possesses the CON.

According to the administrative and due process statutes involved, we wait 30 days before physically issuing the Certificate of Necessity.  A.R.S. § 12-901(2) says that decisions in administrative adjudications are not “final” until after a request for rehearing or review is denied, or the decision on a request for rehearing or review is rendered.

Rural Metro (pursuant to A.R.S. § 41-1092.09) has filed a request for rehearing or review of my prior decision.  We received AMR Maricopa’s response to Rural Metro’s request.  I now have until February 26 to make a final decision on this matter.

To Everything, There is a Season

February 16th, 2015
When I started working at our agency in 1992 (doing risk assessments for state superfund sites) I never dreamed that one day I’d have the honor of serving as the agency director.  Quite honestly, I never had a goal of being the director- but somehow it just happened.  This has been an awesome job. 
We’ve made tremendous progress in so many areas.  Accomplishments that change and save lives every day in Arizona.  From making it more convenient and quick to get a birth certificate, to saving hundreds of lives a year with our cardiac arrest initiatives, to overhauling our healthcare institution and childcare licensing programs, to building a behavioral health system focused on measurable outcomes, and literally hundreds of other system improvements- we have a lot to be proud of.  And we had fun along the way.
Improving public health outcomes really does take a village.  The village includes our agency team (of course), but our community partners and Stakeholders who work with us and truly care about improving outcomes and the quality of life of Arizonans. Those partnerships are the absolute key improving public health outcomes.
As I reflect back on the last 6 years, it’s our people and relationships that will mean the most to me. Not just the friends I’ve made here at the agency, but the friendships and partnerships that we’ve made, maintained and improved.  I will always be grateful for those relationships.
Careers have a lifecycle.  Figuring out when it’s time to turn the page and to move on to something else is a hard thing to do.  That time has come for me.  After a lot of thinking I’ve decided that it’s time for me to move on to something else… and Friday I let the Governor know that I’ll be signing off my post on March 3.  I’ll keep you updated over the next couple of weeks regarding who will be named Interim or Permanent Director of our agency.     
I don’t have any exact professional plans yet.  I think I’ll just catch my breath for a while and see what turns up- but I’m sure it’ll be in public health in one way, shape, or form.  
Thank you for your friendship, trust, dedication, and teamwork.

Thanks a Million

February 15th, 2015

Award CertificateOne of the services we sometimes take for granted is mail service.  At ADHS we have a small mailroom, staffed by Susan Barnes and Meredith Chernov, who processes mail sent through the US Postal Department and the inter-office mail between state offices.

In 2014 our mailroom processed over 1,000,000 pieces of outgoing US mail for the first time ever.  It was surprising to me that we were sending that much mail, let alone that it could be processed by only 2 people.  Congratulations to the hard working staff of our ADHS Mailroom.

The Forgotten Plague: Tuberculosis in America

February 10th, 2015

nationalhealthreportTonight at 8 pm PBS American Experience will feature an episode called “The Forgotten Plague: Tuberculosis in America.”   Tuberculosis was the deadliest killer in human history prior to 1900.  In fact, TB (then sometimes called Consumption) killed about 14% of all the people who ever lived prior to 1900.  TB rifled through the US at the turn of the century, sometimes taking out entire communities, especially in cities with crowded tenement housing.

The battle against TB in the 20th century required a multi-sectoral approach – including interventions in social habits, economic development, housing, science and medicine, and especially public health.  Taken as a whole, the list of interventions that ended up quelling TB applied the principles of population health.

The public health battle against TB had a profound and long-lasting impact on the country.  This episode promises to be a good one.  Try to watch.