Less is more

At their May 3 meeting, the Buncombe County commissioners heard a glowing report from Social Services Director Mandy Stone concerning the county’s contract with Western North Carolina Community Health Services to provide primary care. In January of 2010, the county Health Department transferred many of its services and staff to the nonprofit, which qualifies for a higher federal reimbursement rate and thus can treat more patients at lower cost.

Before the change, "The Health Department was turning away about 400 people a month … that we could not accommodate," Stone reminded the board. The county was spending about $4.5 million a year on primary-care services, and it would have cost another $1.5 million to serve those additional clients, she explained.

The transfer enabled the county to save money while increasing patient capacity, particularly among uninsured adults, reported Stone. In 2008, the Health Department provided services to about 9,000 adult patients; last year, the county paid the nonprofit $2.3 million to provide services to 10,000 adult patients, she said.

But WNCCHS dramatically exceeded that goal, providing care to 13,248 patients. "You got more than what you asked for," declared Curtis Venable, chair of the nonprofit’s board.

Meanwhile, Dr. Polly Ross, the clinic’s medical director, emphasized, "It's not just about getting people in the door — it's about delivering a good product." She cited statistics showing that the clinic is exceeding federal treatment standards for hypertension and diabetes. And Venable asserted that the care provided "was at least as good as the county's primary care and was better than the national average."

Stone also outlined how the move had helped the Health Department provide other legally mandated services. In 2009, 34 percent of the department's budget went for clinical services, she said. For the new fiscal year (which begins July 1), that number has been slashed to just 16 percent. This allows for a "10 percent increase in community protection and preparedness, a 6 percent increase in school nurses, and a 4 percent increase in community health promotion," she explained.

Commissioner Holly Jones called the funding reshuffle "awesome," adding that she thinks it will "pay off tenfold down the line." But she was less enthusiastic about the county's plans to transfer prenatal services to the nonprofit in July.

"I'm concerned for women and children, and also juxtaposed with how well that program's gone under the auspices of Buncombe County," Jones explained, "because those are very vulnerable people. … I really want to make sure that, in this little world, they're being done right by."

Both Venable and Ross assured her that the clinic would provide quality prenatal care and would update the commissioners regularly.

"They had a great program at the Health Department, and it's a great honor to take that responsibility and hopefully expand it and build that same level of trust with the community," noted Ross, adding that the nonprofit is excited to have Dr. Cynthia Yancey, the Health Department's current medical director, joining the clinic’s prenatal team. Yancey, a staff physician at the Health Department for 23 years, helped organize the county's prenatal services.

Stone also stressed that the nonprofit had offered positions to "almost all county staff" who’d been working in primary care at the Health Department.

"We tried to be sensitive to the fact that our staff had delivered high-quality services for many years, and we wanted to make sure the transition was supportive to our staff as well as responsible to the taxpayers [while providing] the best level of care we could to the consumers," she explained.

Several commissioners expressed strong support for the changes. “I'm thrilled," declared board Chair David Gantt. "We'll keep looking at it, but everyone on this board wants low-income people to get health service. … Let's keep up the good work."

Commissioner Carol Peterson added: "We broke some molds. … I could not be prouder of what's been said tonight."

Adult-care population changing

On a related but less-optimistic front, the commissioners heard a report from the Adult Care Home Community Advisory Committee. Buncombe County leads the state with 82 such facilities, serving 1,240 older and/or otherwise challenged residents. But committee members, the report said, are “alarmed” that these homes are being increasingly populated by younger, mentally ill residents.

“The supervisors and staff of adult-care and family-care homes do not have appropriate training to handle residents with severe, persistent mental illness, thus endangering everyone in the home, including staff,” the report noted. “Training of any kind for supervisors and staff is minimal, and staff turnover can be high due to the demands of caring for the needs of the residents and the facility.”

Commissioners oppose state-mandated district elections

In other business, the commissioners:
• Unanimously agreed to send a letter to the state Senate outlining the board’s opposition to pending legislation that would retool the Buncombe County Board of Commissioners. The bill, which would affect only Buncombe County, would expand the board from five to seven members and switch from the current at-large elections to district representation. The House version, sponsored by Buncombe Republican Tim Moffitt, was approved May 2 mostly along party lines, with three Democrats joining 66 Republican legislators in supporting it and 48 Democrats opposed. The commissioners (all Democrats) say Moffitt didn’t consult with them before filing his bill. If the Senate approves its version, the bill will likely take effect ahead of the 2012 elections.
• Unanimously approved two rezoning requests concerning parcels in Black Mountain that had been incorrectly mapped.
• Heard another appeal by producers and board members of the WNC Community Media Center for money they say the county has improperly withheld from the nonprofit, which operates public-access station URTV. The Media Center is in danger of shutting down due to financial problems; its board is considering legal action against the county.

— Jake Frankel can be reached at 251-1333, ext. 115, or at jfrankel@mountainx.com.