Wrong Pocket

One more lesson learned from several current teams (a couple in Nebraska and one in North Carolina): it is hard to create a sustainable wellness program.

I think a key reason is the "wrong pocket" issue: the dollar saved by preventing disease does not necessarily return to the pocket of the person who spent the dollar on wellness. This makes it a challenge to sell wellness programs to customers.

Three teams are working hard to figure out how to make it work-- what are the wellness services that can be offered, to whom, such that the health department does not go broke, customers are pleased, and the community as a whole winds up healthier in five years?

Would love to hear your comments and suggestions...

--Stephen Orton

Back in Nebraska

Reflections on my latest trip to Nebraska, where five new teams started writing business plans last week.

•  Nebraska public health folks are really well networked in their communities. These five teams include representatives from the YMCA, school systems, a non-profit doing youth development, multiple hospitals, extension service, a board of health, and a rep from the Chamber of Commerce. 
•  Nebraska communities do a good job on their CHA process as a result of their strong networks, and people involved in Community Health Assessment work (especially partners) are ready to get down to action. For the more action-oriented, it is a huge relief to get down to the specifics of *what we're going to do* in response to the data and the priorities. 
• If you have a good CHA, you are ready to write a business plan. These Nebraska teams clearly have the data they need (or they know where to find it). And they have committed partners - even more committed now than they were before!
• If you spend time driving in Nebraska, you may come to believe that your GPS is broken, because it displays a single straight line in the middle of the screen for long stretches of time. It isn't a malfunction, it's just I-80. 
• Nebraska demographical fact: five cows for every person. North Carolina fact: three turkeys for every person.

Next session: next week in Asheville! I'll be watching for turkeys.

-- Stephen Orton

Model Practices

I've written before about a team from the Cumberland Plateau district in Virginia -- they wrote a business plan for mass flu vaccination in schools in Tazewell and Russell Counties. Took a few years, but they finally got the pilot completed, and the pilot worked, and they expanded.

Yadda yadda yadda, things progressed, Flu's Clues is now Flu-a-gator, and the team won a "Model Practice" award from NACCHO for the projectd. I hope you will read about the award and the team's implementation here: http://bit.ly/IRZ3Tm

Congratulations (belatedly) to the whole team, especially Kathy Hypes, who always stays in touch on their doings. You've been a model for many other health departments who are trying to build on your success!

--Stephen Orton

Graduates in the news...

Congrats Pat Townley on your retirement-- so proud to number you among the graduates of the Management Academy!

Pat got a lovely write-up in her local paper in Rome, Georgia:

http://romenews-tribune.com/view/full_story/16938884/article-Townley%E2%80%99s-legacy-as-public-health-advocate--nurse-manager-honored?instance=home_news

Mental Health and Substance Abuse

I'm seeing a trend of interest in integrating mental health and substance abuse services-- and I'm seeing some implications in the way agencies are approaching the idea.

By "a trend" I mean that it has come up three times in the last couple of weeks.

Talking with a potential customer a few weeks ago I asked about their project ideas. I look for ideas that galvanize key partners, meet a key need, and involve revenue generation. One of their key priorities was to figure out a way to integrate mental health and substance abuse services in a way that makes more sense for clients, makes more sense in terms of efficiency, and looks forward to a time beyond block grants, to a reimbursement model.

To me, this sounds like a great fit for a business plan: priority need, committed partners, revenue generation required.

One week later, I got an email from a Management Academy grad from several years back. They had just received HRSA funding for their business plan, doing similar work in rural Nebraska.

Last week, a group from Maryland presented their final business plan on the same topic. The team really impressed us with their commitment to see the change through, because they really believe that they can provide measurably better care and deliver better outcomes, and also create measurable administrative efficiencies, by doing the hard work of integrating. They are committed to this path even though the reimbursement picture is foggy at best. No one is sure how this work will get compensated. The only certainty seems to be that the funding model will be changing often, and perhaps dramatically, at least for the next couple of years.

You can't plan for everything. It certainly puts you way ahead of the curve to have planned for what you can plan for, though. These teams are being proactive. They are moving with purpose toward a better future state. And they are preparing themselves, as part of their plan, for uncertainty on the revenue side of the equation.

--Stephen Orton

On The Road in North Platte

A week or two after launching four new groups in North Platte I'm still thinking about the amazing public health system in Nebraska.

The four teams we are working with from north central Nebraska are all rural. Very rural. In fact they would tell you that they don't have enough population to count as rural: most of their counties are "frontier," a few with densities of less than one person per square mile. The health districts themselves have only been around for ten years. The state used tobacco settlement money to establish public health infrastructure.

The teams are working on great public health prevention issues: restaurant inspections (a role not in the public health portfolio in some areas), dental sealants for kids, healthy workplace products, sustainable plans for distributing vaccinations (flu and whatever comes next).

In all four cases they are working hard to find the sustainable revenue stream to support their work over the long haul.

One more thing they all share: great partnerships. Before there were health districts, many of these rural areas had health coalitions of health-conscious partners. As a result, the health leaders in these areas all think very deeply about how to engage and empower their partners. And the partners respond.

To me, the trip it felt like a glimpse at the origins of public health agencies: energy and green shoots and wide-open spaces for the community service mission to express itself.

--Stephen Orton

Wanted to share this email with you from Nancy Cripps, long-time staffer to the Management Academy.

It is with both joy and sadness I send this email. I am retiring on Friday, September 9.

Forty years ago, I embarked on a vocational path looking for a meaningful career. From a telephone operator, to sales representative to administrative assistant. However, I would not know what meaningful was until I joined the public health profession. These last 10 years have been the best time of my life because I was working with the most dedicated of all professions. Certainly, public health workers are dedicated to leaving the world a better place.

I also was able to learn from the best of the best. I will be forever grateful for having the best teachers in the country Janet Porter, Steve Orton and Karl Umble. From them, I learned many skills among them are communication, management and relationship building. Best of all, by observing them in action, I learned leadership skills. With those leadership skills, I was able to do community work and will continue that community work in my retirement.

My greatest joy was helping all you, my students, write your own business plans while fulfilling all your other responsibilities. Whether it was a friendly reminder or a word of encouragement, I felt I was helping your communities through you.

I am excited about this new adventure in my life. I promise you I will take all I learned from you to make my own community happier, safer and most of all healthier.

It was an honor and pleasure working with you.

--Nancy Cripps