After a nearly three-month hiatus, the Kenai Peninsula Borough’s Healthcare Task Force launched hard into its recommendations to the borough administration at its Wednesday meeting.

The task force, convened last fall by Borough Mayor Mike Navarre to develop a strategy to reduce health care costs in the borough, has struggled with direction and scope. More than a year, dozens of presentations, multiple subcommittees and a $117,500 consultant report later, the task force’s members are moving forward with a set of finalized recommendations to the borough administration.

First, the task force recognized gaps in the health care system, including a lack of comprehensive emergency medical service coverage, 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.

Subcommittees focused on several of these topics in the spring and summer, asking for feedback from the community. Areawide emergency medical services haven’t been possible in the past — the borough does not have the authority to set them up as a second-class borough. However, that is something the borough should address in the future, said Stormy Brown, who served on the subcommittee on emergency services. She said if the task force does not solve the problem, it should be reassigned to the borough administration that will handle it.

“We hear feedback sometimes of (people saying), ‘Soldotna’s covered, Kenai’s covered, Homer’s covered, it’s not my problem,’” she said. “But yet our families drive through it … some of the folks sitting here tonight are going to drive through areas where consistent coverage is an issue. (When) our families come to visit, it’s an issue.”

Members of a subcommittee on substance abuse also made recommendations at the Wednesday meeting. Although the community has begun to talk about substance abuse issues, one of the biggest needs hasn’t been addressed yet — the need for a detox facility, said Blaine Gilman, who chaired the subcommittee.

During tours he took of existing facilities, multiple organizations expressed interest in either supporting or partnering on a detox facility, where those with addictions could come to receive treatment and education, he said. Gilman said the borough could work with multiple health agencies in the area, such as the Kenaitze Indian Tribe and Peninsula Community Health Services, and tap federal funding to establish a detox center. Some of the savings could come from coordinating services that are currently being provided by multiple separate entities and catching people earlier in their medical conditions, he said.

“Let’s cooperate,” He said. “Let’s try to figure out a way where we can build a facility where we have some medical staff where people who are going through detox can have the assistance they need and then go into the appropriate type of program … We’re not going to make money on this, but I think we can break even.”

Another piece of the puzzle is Central Peninsula Hospital’s plans for a clinically integrated network. The network would connect physicians across the peninsula to collectively bargain with an insurance company, working to improve quality of care while reducing costs. Central Peninsula Hospital CEO Rick Davis presented the plans to the task force, saying they were still early in the process and unsure of what the structure or leadership would look like.

The hospital would play a role, but the network would have to be led and operated by physicians, he said.

“In a clinically integrated network, it really means nothing whether you’re independent or employed — the relationship is the same,” he said.

The hospital also has plans to develop a coordinated care organization as a demonstration project for the state’s Medicaid program. The state is looking for innovative health care delivery models to reduce the cost of health care while improving quality and providing more access, and Central Peninsula Hospital intends to apply.

There are still some hitches to the plans for the CCO model, including gaining the confidence of the local physicians and engaging the public, Davis said.

“There’s a lot of watchful waiting on the CCO model,” he said. “Physicians locally are interested, but not all in yet. And that’s understandable. There needs to be a big cultural shift from our population. We’re pretty independent. We still as a patient population have the notion of ‘Don’t get between me and my doctor,’ and there’s going to have to be some of that to better coordinate care.”

One point task force members disagreed on was the adoption of borough-wide health powers. Adopting additional powers would precipitate the development of another borough body like the Planning Commission or the assembly. Other boroughs in the state, such as the Kodiak Island Borough and the Fairbanks North Star Borough, have instituted areawide health powers.

Several subcommittee members concluded that borough administration should consider adopting health powers, said Kelly Cooper, one of the subcommittee members. She said the hospital’s clinically integrated network plan would fit into the goal and help to comprehensively address health issues in the borough.

“Part of the issue we deal with with health care reform is the silos,” Cooper said. “… if we can get rid of that and still have people participate where they feel that they have local control, I really believe that’s the way we’re going to solve a lot of the issues we have been dealing with.”

To an extent, that conversation has been hovering in the background of the task force’s conversations since last October, when Navarre presented a tentative plan to align the borough’s three hospitals under an umbrella structure. The task force balked at the idea and the topic fell out of the conversation after the consultants’ report arrived. If the borough administration decided to propose health powers, it would have to be approved by the voters as well.

At Wednesday’s meeting, Navarre said he wished he had waited to present the idea because it should have evolved from the discussion of the task force. It could help address some of the standing issues with how service areas are funded, he said.

“I like it,” he said. “I originally wanted to go from A to B in a straight line, but you have to go through the whole alphabet to get there in terms of public education and building strong consensus and in the last campaign, one of the things I talked about was a shared community vision on a borough-wide basis. We haven’t gotten there yet.”

Other members said they would not support wide-reaching health powers until they had a more definitive structure. Task force member Julie Woodworth said she would rather see the borough try it on just emergency medical services as a pilot before moving into any other administrative powers with it. She said she would rather see the clinically integrated network take the lead.

“I feel like this will become, growing organically and methodically, a borough-wide vehicle for health care,” she said. “That, maybe coupled with an enterprise fund, may get us to where you’re talking now without creating a government health care entity. The issue with having a government controlled health care entity is that officials change, objectives change and health care is very complex.”

The borough already owns the two hospitals’ land and buildings, though, and regularly weighs in on the hospital administrations’ business decisions. The borough already executes many health power-like decisions, so formalizing the powers will be a step forward, Gilman said.

“What we should do is at least recognize reality and give the borough health care powers,” Gilman said. “… If you give us the powers, you might be able to do at least the stuff on the EMS over the road system, but we should recognize that we have governmental hospitals and we are exercising health powers in this borough.”

The Healthcare Task Force will vote on its final recommendations to the borough administration at its next meeting on Wednesday, Oct. 19.

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