About Health Action

Background

It is widely acknowledged that the local health care delivery system is in crisis. The number of uninsured in Sonoma County is estimated at over 42,000 and growing. Physicians continue to leave the community and specialists are in short supply. District hospitals are struggling financially as the competitive pressures of a rapidly changing health care marketplace continue to threaten and destabilize an already broken health care system.

Sonoma County is not alone in experiencing the impacts of the health care situation. Communities throughout the state have come together seeking solutions at the local level. Dealing with the state's estimated six million uninsured has become the highest priority for the Governor and many in the California legislature. Calls for health care reform from across the nation are likely to make health care a central issue of the 2008 presidential campaign.

The level of community concern about Sonoma County's health care system increased significantly with the January 2007 announcement of the proposed closure of Sutter Medical Center of Santa Rosa. Many local community and health care organizations called on the Board of Supervisors to create a forum to analyze local health care problems and offer solutions. On August 14, 2007, the Sonoma County Board of Supervisors authorized the Department of Health Services to convene a health action council to work on improving health and health care for all Sonoma County residents.

Mission and Focus

To achieve its mission of community health improvement, Health Action will focus on community health issues that significantly impact the health system in Sonoma County. It will develop complementary recommendations for addressing these issues through the dual focus of community health and health care delivery system improvement. In developing its recommendations, Health Action will explore barriers to health in Sonoma County and will identify strategic opportunities to create systemic improvements in community health.

Health Action's focus on community health improvement reflects the recognition that, while access to health care is an important contributor to community health, other determinants include individual behaviors and choices and the impacts of our workplaces, schools and neighborhoods on those choices and behaviors.

For these reasons, the goals of Health Action will be to:

• Engage a broad spectrum of stakeholders in a community dialogue on health improvement;
• Enrich the collective understanding of local health and health care issues and solutions;
• Create a shared vision for community health improvement that is based on the multiple determinants of health, such as individual behaviors, cultural beliefs and practices, environmental and socio-economic factors;
• Develop and implement collaborative recommendations to promote and protect community health and improve the local health care delivery system.

Planning Process Overview

Building on the successful Healthy Kids and Medi-Cal Managed Care Planning projects and the interest and commitment of community stakeholders, the Department of Health Services will recruit and convene a diverse, multidisciplinary group of recognized community leaders and health care experts to work through a collaborative process to develop focused, specific recommendations on local approaches to promote the health of our community and improve the health care delivery system. The planning process will be facilitated and highly focused in order to maintain the engagement of Health Action members, address those issues that will have significant impact on the health system, and deliver products of value to the community.

By Fall 2008, Health Action will return to the Board of Supervisors with an initial set of priority recommendations for review and, where appropriate, Board action. While many, if not most, of the recommendations may fall outside the County's scope action, the Supervisors' engagement will be critical in encouraging and supporting local initiatives at all levels. Once its recommendations have been prioritized, Health Action will move into implementation planning, developing concrete action plans. Health Action members and others engaged through the planning process will work together to create the partnerships and secure the resources necessary to implement specific projects beginning in the Spring of 2009.

Key Milestones

• October 2007: Convene Health Action and establish task force structures.
• October 2007 - June 2008: Collaborative learning and dialogue to build consensus on priority issues and begin development of recommendations.
• July 2008: Public forums to present Health Action findings and preliminary recommendations and gather public feedback.
• Fall 2008: Present recommendations to the Board and begin implementation planning.
• Spring 2009: Complete implementation planning, present action plans to the Board, and assemble task groups to implement and monitor progress on action plans.
• Fall 2009: Report progress to the Board; evaluate the effectiveness and accomplishments of Health Action and determine its continued role.

Membership and Structure

Health Action is co-chaired by Sonoma County Supervisor Tim Smith and the County Health Services Director, Rita Scardaci. Health Action members were appointed by the Health Services director, and include representatives from the physician community, hospital and health maintenance organizations, community clinics, the county health officer, local employers, local governments, labor organizations and consumer advocates. Approximately 30-35 members, selected for their demonstrated leadership and expertise, have agreed to participate for an initial two-year term. Membership is configured to balance the interests of the community's diverse stakeholder groups and to reflect the county's geographic and ethnic diversity.

To accomplish its objectives, two (2) advisory task forces will be created to develop recommendations for Health Action consideration:

• The Community Health Task Force will look at community conditions that contribute to the selected priority health issue(s) and will develop recommendations for improvement.
• The Health Care Delivery System Task Force will look at potential improvements to the health care delivery system for selected priority issue(s).

The task forces will extend the reach of Health Action by engaging expertise beyond council membership and linking to key health care work groups and consumer advocacy organizations. Health Action members will chair the task forces. In addition to Health Action members, task force co-chairs may appoint community members who can offer a critical perspective on selected priority issues and who can provide expertise and/or resources (e.g. data, information on best practices) needed to develop recommendations. Information on the selection of priority issues will be posted on the Health Action website. Individuals with background or expertise in selected issue areas, who wish to serve on a task force, may contact Ellen Bauer at ebauer@sonoma-county.org or 707-565-6684.

All Health Action and task force meetings are open to the public. Information on meeting times and locations are posted on the Health Action website.

Relationship to Proposed Hospital Closure

Recent activities related to the proposed hospital closure highlight both the challenges and opportunities to address ongoing problems in the Sonoma County health care delivery system. While the County of Sonoma will continue its process to assure that the provisions of the Healthcare Access Agreement are met by Sutter Medical Center, Health Action provides an additional forum for health care organizations and other stakeholders to explore health access issues raised by the proposed hospital closure and, as feasible, continue their work on the development of collaborative solutions to these and other challenges. In this way, Health Action is a community platform from which initiatives and partnerships, large and small, can be developed, launched, supported and evaluated.