1. Family Nurse Partnership – Mrs. Gailor explained that this program was under investigation before CTC. Mrs. Feuerherm explained that this is a nursing home visitation program that has been successful throughout the country. It was piloted in Elmira. It has been successful in improving health outcomes for single mothers and their children under two years of age. The site must apply to Colorado to become a part of this program. There is intensive training – one week in Colorado – and then further on-site training. The training must be administered as taught, so the training is critical to the program. This is an outcome-based program. There are definitive factors that gauge the success of the program with the mothers and children. There has been long-term success with the program and Pennsylvania has adopted the program throughout the state. New York State has four locations that are utilizing the program at this time. Dr. DiGiovanni recalled that a year ago there was an issue with nurse staffing in order to implement; what is the staffing level now. Mrs. Feuerherm indicated that this will require four nurses. Staffing is good right now. These are new positions that would be advertised. This would require nurses with a specific interest to accept a position like this. We would either have to create positions and fund them or find funding. Mrs. Gailor indicated that what is being requested today is permission to seek outside funding, as we would not want to implement the program without outside funding. Karen Mastronardi is looking at grant funding that would support the program for two years, at which time, the revenues should start to pay for the program. Mrs. Tytler is pleased that we are looking at something that will be outcome based; how will we gather our baseline data? Mrs. Feuerherm indicated that we would use the data we currently have available, as we have good data in place on many of these issues. The data on repeat pregnancies is not as thorough, probably, as we need, so we would work with area providers to gather the data we need. Mrs. Tytler asked if when proposals are submitted, there is a plan for staff time to gather the data? Mrs. Feuerherm said there is a plan. Mr. Willcox asked if Mrs. Feuerherm anticipated this taxpayer contribution next year as well. She explained that she would expect some contribution next year, but we are looking at a long-term benefit from the program. Mrs. Tytler asked if this is targeted to single moms? Mrs. Feuerherm indicated that it is targeted to first-time mothers. Mrs. Gailor would like a sense of the committee as to whether to pursue outside funding for the start up. Mr. Willcox asked what happens if funding in not available in future years; will they come back to the committee asking for County dollars? Mrs. Feuerherm indicated they are looking for long-term funding; however, if the program is successful and outside funding is not available, they would come to the committee to ask for funding. Mrs. Gailor indicated that if we cannot prove that it is beneficial long-term or if the funding is not granted, we will still benefit from the training that the staff receives. Dr. DiGiovanni recalled that last year we were going for funding that would be part of the study itself. Mrs. Gailor indicated once we start participating, we are part of the study. Mrs. Feuerherm indicated that the funding was for the training portion only. There is a possibility that that funding stream might still be available. We are looking to the Ford Foundation for funding for the training and the start up of the program. Mrs. Tytler indicated that she believes it is imperative that they look at multi-year funding, preferably a three-year funding stream. Mrs. Tytler moved that the Health Department pursue foundation funding, in particular with a multi-year funding stream; seconded by Mr. VanDee. Mrs. Gailor indicated that we are not looking to start this program without outside funding. All members voting in favor; none opposed; motion adopted.

2. Facilitated Enrollment – Mrs. Tytler thanked Mrs. Feuerherm for the spreadsheet identifying the number of facilitated enrollments for 2004. Mrs. Tytler would like to know more about the effectiveness of the program, based on the numbers of enrollments we are experiencing at the various sites. Mrs. Tytler asked how the number in the last column on the right was arrived at, as she could not get them to add when adding across. The explanation is that it is the total of the first, third, and fourth columns. Mrs. Tytler asked why applications that were screened ineligible were included in the total. Mrs. Feuerherm explained because we still have to process the applications, and upon review, the applicant is deemed ineligible. It is not included in the number of applications submitted. Mrs. Tytler asked why we are giving $21,000 to CMH, which is doing twice as much work as FHN, which is receiving the same amount of money. Mrs. Feuerherm explained that this is due to the FTE differential in the agencies; CMH is contributing a portion of the expense for a position to conduct the Facilitated Enrollment. Mrs. Tytler is seeking clarification on why we are providing the same amount of funding to two different agencies, when one agency is doing twice as much work. If we are paying for a full-time FTE at one agency that appears to be providing less services, would we be better served providing more money to CMH or retaining it in our own Health Department, as opposed to providing the funding to FHN. Mrs. Tytler would like to see the chart carried one step further to assess the performance of the agencies. Mrs. Feuerherm indicated that she can provide a statewide comparison, but she cannot provide performance indicators for the local agencies. She feels both sites are good sites. Mrs. Tytler indicated that she is not questioning the sites; she is just questioning whether we are getting the most for our money at FHN. Dr. DiGiovanni indicated he doesn’t know if there is much flexibility in the funding of this program to keep more money in the Health Department for this program to free up other money for a different program being administered by the Health Department. Mrs. Tytler is not convinced that we are getting the most services for our money. Mr. McKee asked what will bring in more applications each year than reflected on the report. Mrs. Feuerherm indicated that every shift in our economy will bring in a new wave of applicants. Mrs. Tytler indicated that this is a good program and it is good that we participate, but we are not funding it in the best way. Are we going to change the way we fund it? Dr. DiGiovanni indicated that he agrees and hopes we will allocate it in the most effective manner as allowed by the funding stream. Mrs. Gailor indicated that the YW and Catholic Charities are no longer funded. This is due to the low number of applicants processed by these agencies. Mrs. Gailor indicated that we are not paying for one FTE, but we are receiving one FTE. That is what Mrs. Tytler wants to know. What are we getting for the money we pay out? Is it fair that FHN is getting the same as CMH and enrolling half the people. Chairman Steve asked how the funding is determined? Mrs. Feuerherm indicated that it was determined at the beginning of the grant when agencies applied to become administrators. It was based on .7 FTE from FHN and one FTE from CMH. There were projections on the applications that would be processed and the agencies basically met those projections. The longer the program, the fewer the applications. We have not reduced the funding as the applications have decreased. We believe we are reaching the eligible population. Chairman Steve asked what the incentive for FHN to reach any more individuals than they are currently reaching if the funding is not reduced. Mrs. Feuerherm indicated that the incentive is their patient population. They have a vested interest in ensuring that their patients are insured. Mrs. Tytler asked if we are locked in to the $21,000 per each agency. The response is that we are not locked in to that number. Mrs. Tytler believes that the 40% of the funding we are providing outside the County should be based on the volume of enrollment – 1/3 to FHN and 2/3 to CMH. Dr. DiGiovanni is asking if FHN and CMH are doing the same amount of work per application. Mrs. Feuerherm indicated that the same amount of work is involved in completing the application; FHN travels to its rural sites; CMH remains at the hospital only; both organizations take in walk-in clients. Chairman Steve asked if the State said we can’t fund the YWCA and Catholic Charities? Mrs. Feuerherm indicated that the State asked if we wanted to continue funding to the agencies with such low enrollment numbers. Chairman Steve indicated that it is to the benefit of CMH to enroll these individuals, as with FHN. YWCA and Catholic Charities do not have a way to recoup money, as they do not have a way to charge. Those two agencies are actually being punished under this allocation, as they are actually administering the programs in the way we would like to see it administered. Dr. DiGiovanni indicated that the people interacting at the YWCA or Catholic Charities could go to CMH or FHN. Mrs. Feuerherm indicated we were investing a lot of time at those two agencies re-training people because the applications were few and far between and it was difficult for staff to stay current. Mrs. Tytler moved that we combine the applications submitted column with the recertifications with the applications submitted ineligible to have a total for the two organizations –CMH and FHN – and the $42,000 be divided proportionally; seconded by Mr. Willcox. All members voting in favor; none opposed; motion adopted.