The Kenai Peninsula Borough’s task force on health care reached a set of final recommendations to the borough Wednesday night.

The Healthcare Task Force, which has been meeting for more than a year, unanimously approved an 11-page report to the borough administration and assembly with recommendations for how to move forward into health care reform and make care more affordable for peninsula residents.

After debating direction and hearing from providers, hospital executives and a pair of health care consultants, the task force drafted a report outlining problems the members identified in the current health care system and suggestions for what the borough can do to help bridge the gaps.

The task force identified six major gaps since it began meeting: the need for areawide emergency medical service response, a lack of chronic disease education and prevention, widespread substance abuse, a lack of home health, hospice and end-of-life care, a lack of mental health resources and a lack of non-emergency affordable transportation. Additionally, the task force wrangled with the question of how to reconcile the current hospital service areas with declining revenues and the impending transition to population-based payment for health care many other systems in the country have taken on.

However, the task force only made ultimate recommendations that address the service area structure issues, the emergency medical service response issue and the need for a community substance abuse and mental health facility in the central peninsula.

A note in the final report acknowledges that there are identified problems it did not address.

“The task force recognizing that although many other recommendations could have been made to address the other issues identified in this report, the above recommendations are deemed to be the most significant and highest priorities,” the report states.

The task force formally lent its support to the ongoing effort to establish a clinically integrated network on the peninsula, currently being spearheaded by Central Peninsula Hospital. The network would connect physicians all over the peninsula to collectively bargain with insurance companies as well as make sure doctors are communicating to better coordinate patient care. There are currently legal barriers to creating such a network, and the task force recommended the assembly work to “actively remove barriers” blocking the development of the network. The borough’s lease and operating agreements with Central Peninsula Hospital and South Peninsula Hospital should also include language to enable the network to work, according to the report.

The task force also recommended the borough pursue a restructuring of the current EMS system. Many areas of the peninsula, such as Cooper Landing and Ninilchik, have only volunteer EMS departments with patchy coverage. Though Central Emergency Services has mutual aid agreements to respond when volunteer departments like the one in Cooper Landing call for additional, there are areas where there are no services at all.

“The (Kenai Peninsula Borough) assembly and administration should prioritize working toward a solution on this issue,” the report states. “Structural changes that allow a consistent baseline availability of resources across the borough should be an immediate priority.”

The borough doesn’t have the authority to set up a peninsula-wide emergency service area unless the voters approve it. Legally, the borough cannot provide services outside its defined service areas using borough assets, according to a Sept. 16 memo to the Healthcare Task Force from borough attorney Colette Thompson.

The same problem applies to the hospitals working together across the service area boundaries.

“At a simplistic level, if such coordination does not include providing hospital services outside of each service area there is no legal impediment to coordinating the provision of health care services,” Thompson wrote in the memo. “However, this appears to be a grey area as running a hospital includes coordinating the provision of medical services. A determination of this issue will depend upon the facts.”

Hence, the task force considered recommending the borough adopt areawide health powers. Several members raised concerns about the recommendation at the Wednesday meeting. Member Julie Woodworth of Homer said the term “health powers” seemed too vague and suggested instead changing the recommendation to ask the assembly to explore alternative structural and authority options that would address gaps.

“Borough-wide health care powers sends my mind to one structure of power, and we could be talking about a different tax structure, an enterprise fund — there’s a lot of alternatives we could talk about,” she said.

Borough Mayor Mike Navarre said he didn’t want the recommendation for health powers to be seen as a threat to the current hospital operating boards or their independence.

“The reality is that we’ll be forced into some changes over time,” he said.

Recommending a broader review of “structural changes” is acceptable as long as it doesn’t preclude the option of adopting health care powers if the borough assembly chose to do so, said task force member Pat Linton.

“I do think that health powers could be a very legitimate, very nonthreatening approach to helping to resolve some of the gaps that we’ve identified through the work and subgroups,” he said. “I look at health powers as a reasonable tool and means to an end that may or may not have anything to do with the hospitals.”

Task force chair Rick Ross said the task force’s recommendations should allow the borough the flexibility to change the current hospital structure if need be in the future.

“We’re preparing something for a future that we can’t even envision what’s going to be happening,” he said. “… We’re not making a recommendation for some immediate change.”

The task force did not set another meeting but can be called back at the discretion of the chair. The recommendations will be submitted to the borough administration and assembly for review.

Reach Elizabeth Earl at elizabeth.earl@peninsulaclarion.com.