Join Us on Friday, June 24, 2022 for an Action Update from the Field – Gila County: Best Practices & Lessons Learned Responding to COVID-19, Fires, and Floods

Session Summary

Just when Gila County was hitting double digits in positive COVID cases in June of 2020 the Bush Fire hit, forcing Gila County leadership to shift resources toward the fire response. And that was just the beginning of the pandemic!

Learn how Gila County become the 1st County in the U.S. to move to vaccinating the general population while responding to the massive forest fires, evacuations, sheltering, flooding, and post-fire flooding damage.

Michael O’Driscoll, Director of the Gila County Health & Emergency Management will walk through the key policy and resource allocation decisions that led to their remarkable success, even resulting in national coverage by CNN.

Register Here

Michael O’Driscoll is the Director of Health & Emergency Management for Gila County Arizona. Michael Joined Gila County in 2011 and has more than 30 years’ experience in Emergency Management and Public Health and Emergency Preparedness. He has been integral in resolving large health disparity issues, vector-borne disease, foodborne outbreaks, ground water contamination, and hazardous materials complaints, among others—mitigating issues and ensuring public safety state-wide, across its various constituency populations.

Michael spearheaded Gila Counties community response to COVID-19 pandemic in 2020, coordinating contact tracing efforts, creating, and implementing streamlined vaccination protocols leading Gila County to become the first Local Health Department in the US to begin vaccinating general population of residents.

Where: Zoom (registrants will receive the link) 

When: Friday, June 24, 2022   9-10 am AZ Time

Cost: Free for AzPHA Members!

The Hertel Summer State of the State: Flagstaff, Friday, July 15, 2022

Discounts for AzPHA Members

The popular summer conference provides insight into health markets across Arizona including AHCCCS, Marketplace, Medicare, Medicare Advantage and local value-based trends including Arizona’s competitive community of accountable care organizations, value-based networks and direct contracting entities.

This year’s event features a panel of community stakeholders working to address health equity across the state and northern Arizona.

Attendees will also learn more about advanced alternative payment models from CMS including the new ACO REACH. The Flagstaff conference includes a full conference program, data reference pages and a directory to support post-conference networking. In-person attendees receive a boxed lunch.

2022 State of the State
Flagstaff Medical Center, McGee Auditorium

9 to 10am: Networking & Light Refreshments

10am – 12:30pm: State of the State Program

12:30-1:30pm: Boxed Lunch, stay or go!

 

Use the coupon AZPHA2022 at checkout to receive $15 off

Register Today

Arizona Burn Center – Valleywise Health Earns Re-Verification

The Arizona Burn Center – Valleywise Health announced Tuesday that they have been re-verified as an adult and pediatric burn center by the American Burn Association and the Committee on Trauma of the American College of Surgeons. Founded in 1965, the Arizona Burn Center is the only verified burn center in the state and one of the busiest in the country.

This achievement recognizes the Arizona Burn Center’s dedication and commitment to providing high quality burn care to patients across the Southwest. The Arizona Burn Center first received national verification in 2000. Read more here

48th Annual Rural Health Conference this Week in Flag

For the past 47 years, the Arizona Center for Rural Health has hosted the Annual Arizona Rural Health Conference in collaboration with the Arizona Rural Health Association, making it one of the longest continually running rural health conferences in the United States. 

View the final agenda: RHC22-Agenda

The Arizona Rural Health Conference provides an environment for networking and dissemination of pertinent information among professionals and community members from rural Arizona and the Southwest. On-line registration has ended but they traditionally allow on-site registration.

I’ll be giving the following presentations at the conference:

Infrastructure Law PPT

Harmful Preemption Laws Signed by Ducey PPT

Arizona State Hospital Governance Reform Remains in Limbo

One of our continuing priorities other than things in the budget is to get better governance in place at the Arizona State Hospital.  SB1716 Arizona State Hospital; Governing Board. The bill (by Senator Gowan) would change the governing structure for the Arizona State Hospital (ASH) from one in which the Arizona Department of Health Services both runs and ‘regulates’ ASH to a model in which ASH has independent oversight, building much better checks and balances into the system of governance. 

SB1716 sets up a new Governing Board which would oversee operations at ASH. The Superintendent would report directly to the Governing Board rather than the ADHS Director. Here’s an article by Mary Jo Pitzl at the Arizona Republic with more detail. The Arizona Department of Health Services would then be able to regulate the Arizona State Hospital free from conflicts of interest.

Why is that important? It’s simple. Right now, there’s a huge conflict of interest because the ADHS Director is responsible for both running and regulating ASH. It’s never a good governance model to have an entity regulate itself!

It’s very simple for the ADHS Director to send an implicit (or even explicit) message to her or his team to go easy on ASH to keep things quiet. Indeed, recent complaint investigations of serious allegations often find ‘no deficiencies’. That’s just hard to believe, especially when the fox is watching the henhouse. 

Editorial Note: I submitted a complaint to ADHS Licensing more than a month ago, after there were more than 7 Code Grays in a single day at the State Hospital (Code Gray’s mean that there was an assault bad enough to require a significant intervention). I received an automated response suggesting that they would follow up. To date I have heard nothing about what the status of that complaint is.

That bill continues to languish, needing a hearing in the House Rules Committee and then a floor vote in the House before going to the Governor for a signature (the bill had consensus support in the Senate). We’re continuing to make sure legislators know how important this bill is!

See: How is the Arizona State Hospital Regulated & Why is Governance Reform Needed?

Ducey Administration Failure to Implement Unemployment Insurance Identity Verification Resulted in $4.4 Billion Dollars in Fraudulent Payouts

More than 31% of ADES Unemployment Insurance Claims Paid Out During the Christ/Betlach Leadership Era were Fraudulent- to the Tune of Billions of Dollars

The Arizona Auditor General’s Office plays a key role in keeping state government accountable in several ways. They help State agencies, universities, community college districts, counties, school districts, and other governmental entities work better by analyzing their operations and recommending improvements, so they spend and account for public monies appropriately, efficiently, and effectively. In fiscal year 2021, the Auditor General issued 171 audits, reviews, investigations, and follow-ups with 624 recommendations.

Their audits and reviews assess how various State governmental entities, such as State agencies and school districts are performing—that is, how well they are fulfilling their statutory mandates and serving Arizona’s citizens. Sunset reviews help the Legislature decide whether to continue or terminate (“sunset”) an agency. There were two key reports recently published that highlight this important work.

Unemployment Insurance Fraud

In a new report this week, the auditors found disturbing financial irregularities in which ADES (during the Christ Betlach leadership era) misspent and fraudulently distributed literally billions of dollars in federal funds. That report, published on May 25 for the Joint Legislative Audit Committee meeting found that:

During the time when Acting Director’s Christ and Betlach were in charge of the Arizona Department of Economic Security, the agency failed to put identity verification or other anti-fraud measures in place and ended up over $1.6B in fraudulent unemployment insurance claims out of the $5.1Billion dollars in total claims paid as of June 30, 2020. In other words, more than 31% of the unemployment insurance claims paid out through June 30, 2020 were fraudulent!

ADES paid an additional $2.8 billion in fraudulent claims between June 30, 2020 through September 4, 2021, for a total of $4.4 billion of fraudulent claims paidSee Page 4 of the Joint Legislative Audit Committee report.

It’s unclear whether any kind of punishment is in the offing from the federal government for this astonishing lack of attention to detail.

COVID Vaccine for Kids Under 5 Years Old Finally On the Way: Here’s How the Rollout Will Work

Parents with kids under 5 years old have been anxiously awaiting an opportunity to get their kids vaccinated for COVID-19. In fact, it’s been more than 18 months since vaccine was authorized for adults. Many things slowed down the process, but primarily because the clinical trials for kids under 5 were the last to be conducted and the dosing and spacing of the vaccine to determine safety and efficacy was trickier.

The day parents of toddlers have been waiting for is finally almost here. The FDA’s advisory committee (Vaccines and Related Biological Products Advisory Committee) is meeting on June 14th and 15th and is expected to recommend that the FDA Director issue an emergency use authorization of the Pfizer and Moderna vaccine for kids 6 months old to 5 years old shortly after the meeting. CDC is expected to quickly follow suit and recommend the vaccine.

The Pfizer vaccine will be a 3-dose series with the second shot 3 weeks after the 1st and the final dose 2 months after that. The Moderna series will be 2 doses 4 weeks apart. Clinical trials found that the Pfizer 3-dose series was 80% effective at preventing infection while Moderna’s 2 shot series came in at about 40%. Perhaps that 3rd dose is making the difference. Also, keep in mind that the clinical trials were conducted pre-Omicron, so the actual efficacy for both may be a smidge lower.

In anticipation of FDA authorization & CDC recommendation, states are now able to start ordering vaccine for 6 months to 5-year-olds. Arizona’s initial allocation is about 200,000 doses. There are roughly 400,000 kids under 5 years old in Arizona, so the initial tranche should cover roughly ½ of Arizona kids for their first dose.

Any pediatric, family practice provider or pharmacy that’s enrolled in ADHS’ Arizona State Immunization Information System (ASIIS) and has gone through the ADHS’ COVID vaccine ‘on-boarding process’ can order vaccine starting today (pharmacists can only vaccinate kids 24 months old and up… so some pharmacies may elect to not order the under 5 vaccines).

Ordering is through ASIIS, with a 200-dose maximum order limit for all providers that aren’t county health departments or tribal entities. Expected delivery for the first shipment of pediatric (under 5) doses is June 20th with a subsequent delivery expected on the 21st (contingent on those FDA & CDC decisions).

The supply of the new pediatric vaccine is expected to increase rapidly by the end of the month, and the 200-dose maximum order is expected to be dropped by the end of June.

Special Note: The ADHS, county health departments, and tribal partners collaborated to come up with the distribution plan (far different from the Director Christ era when partners found out major policy decisions in an ADHS media release or on the news).

Leaked Draft State Budget Has Some Encouraging Health & Human Services Line Items

I managed to get my hands on a leaked draft state budget this morning. Word on the street (from reliable sources) is that this version has the support of legislative leadership & the governor’s office but not necessarily support from enough rank-and-file legislators.

I went through the changes from last year’s Joint Legislative Budget Committee in the health and human service areas & found some encouraging increases in several areas. I don’t know if the dollar figures noted in this draft are sufficient, but it was encouraging to see that there is some support in the governor’s office and among leadership for some important changes. Note: I didn’t go through the list of needs for public education- I just stuck to my wheelhouse in the health and human services sector.

Here’s a link to the leaked spreadsheet. Below are some bullets summarizing the increases over last year’s baseline (I highlighted the health and human service line items in green):

 

AHCCCS

Postpartum Care ($2.7M)

Pregnancy Care Rate Increase ($10M)

ALTCS Elderly Rate Increase ($24M)

Allowing Kids Care to Stay Eligible for 1yr ($600K)

Secure Behavior Health Facility Rate Increase ($10M)

Behavioral Health Worker Training ($5M – Federal)

Clinical Rotations ($27M – Federal)

Secure Behavioral Health Facilities ($25M)

 

Department of Economic Security

More Adult Protective Services Staff ($11.2M)

Early Intervention Rate Increases (Federal)

Developmental Disability Provider Rate Increase ($56.7M or 9.7%)

Other DD Rate Increase (efficiency) ($7.2M)

 

ADHS

Behavioral Health Practitioner Student Loans ($2M)

AZ State Hospital Hiring Bonus ($700K)

AZ State Hospital Increased Staffing ($6.9M)

 

Department of Child Safety

Healthy Families Expansion ($10M)

Foster Care Stipend Increase ($4.8M)

Kinship Stipend Increase ($19.8M)

 

Note: We’re not endorsing this as a final budget but at least there are some encouraging new increases in the health and human services sectors. Of course, more analysis needs to be done…  but I wanted to get this out in the public domain for all to see for analysis and advocacy purposes

UA Center for Rural Health Helping Rural Providers w/ Medication Assisted Treatment for Opioid Use Disorders: Slots Still Available

Medication assisted treatment (MAT) is an evidence-based practice to help patients with substance use disorder including opioid use disorder. Yet, access is limited particularly in rural counties. In 2020, federal requirements changed to expand providers’ ability to offer MAT in office-based settings. 

Providers who are new to offering MAT often need some additional technical support to get started providing this important evidence-based service. That’s where the Arizona Center for Rural Health’s AzMAT Mentors Program comes in. Their team support new & less experienced MAT providers to get them off the ground or to help them implement more effectively & serve more folks.

Space is still available for less experienced MAT providers interested in collaborating with an experienced MAT provider. Participation is free and is an effective way to build capacity to offer treatment. Visit https://crh.arizona.edu/mentor

What’s Up with All that Opioid Settlement Money & How Come There’s No State Plan for It Yet?

I’m sure you’ve heard about the settlement agreement that was finally reached in a multi-state lawsuit (including Arizona) against Cardinal, McKesson, AmerisourceBergen, and Johnson & Johnson – punishing the firms for their unethical behavior as they marketed their opioid products.

Arizona is set to receive $542 million over the next 18 years to combat an ongoing epidemic after the defendants and state plaintiffs $26 billion settlement for their roles in the opioid crisis. Settlement funds will be disbursed to the state and its subdivisions.

90 cities and towns and all 15 counties are signed on to a framework called the One Arizona Memorandum of Understanding (One Arizona Plan) to expeditiously distribute funds. The One Arizona Plan provides funding for programs to address and ameliorate opioid abuse, and includes reporting requirements for greater transparency of how money is used:

  • 56% of the total settlement will go to local governments for opioid mitigation programs.
  • 44% of the total settlement goes to a State for yet to be determined interventions.
  • Funds must be spent in accordance with approved, nationally recognized strategies to pay for future costs incurred by the State and local governments to address the opioid epidemic.

The funds are in some ways restricted in that they are supposed to go directly to relief and resources related to opioids, including to diversion programs to prevent people from going to prison for an addiction or substance-use disorder.

Because these are long-term funds that recently became available, there’s still not a lot of granularity about how the state and local jurisdictions intend to invest the funds… but county staff is certainly undergoing planning to make sure that they wisely use the funds. A priority for Pima County is to make sure they get input from the community before making decisions- always a good idea.

There’s no information on the ADHS website about the opioid settlement funds. If you do a google search, you’ll see that other states have info about the settlement on their website, but not in Arizona. Perhaps the executive branch is yet to decide whether ADHS or AHCCCS will be the primary recipient of the funds. Who knows?

In any event- we will have a new governor in just 208 days, so perhaps the new governor and their leadership team will finally put together a comprehensive plan for the state funds that will work hand in hand with the counties and cities. Frankly, I think the best steward for the state funds would be AHCCCS rather than ADHS (given current leadership).

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