Public Health rises to demand

Kittitas County Public Health is an agency that responds when a need arises.

It faces a future where the need may rise and remain.

Traditionally the need involves an emerging public health concern (infectious diseases, food-borne illness, etc.), but in the coming months and years it may be responding to more consistent needs in the community.

Robin Read, the county’s public health administrator, and Dr. Mark Larson, county public health officer, said changes driving a potential increase in need for public health services are coming at the federal, state and local level.

“We are seeing direct and indirect impact on the services we provide here,” Read said.

Read said the changes on the federal level stem from the Affordable Care Act and it is too early to determine which direction that will go.

Under the Affordable Care Act, Read said more people will have health insurance.

“As more people get health insurance, we’re not sure what will happen. Will it overwhelm the health care system?” Read said.

If there are more patients than providers, people may turn to public health for services such as vaccinations. But if the private/public sector meets the needs, public health may not see an increase.

“There are a lot of unanswered questions at this moment,” Read said.

One potentially significant development at the health department is how it bills patients’ insurance companies for service provided. Read said the health department is going through the learning curve with billing insurance companies.

“Insurance billings are very complicated,” Read said. “There are a lot of tricks to learn.”

Ups and downs over the years

The department is a health services provider — immunizations, travel and tuberculosis management. Larson said that role has waxed and waned over time, and in recent years some of those duties have been cut back as the private sector took up the responsibilities.

“Doctors in the community have been absorbing patients who need those services,” Larson said.

That trend may now be shifting as the provider situation changes locally.

“We at the health department may need to ramp up services, mostly related to immunizations,” Larson said.

Where public and private meet

Larson is in the unique position of being a KVH-employed physician, who in some situations (in his role as county health officer) can tell the hospital what to do.

“For example, I’m the person who tells the hospital when to pull the trigger on masking their employees who do not get the flu vaccine,” Larson said.

In terms of practical application there is a good working relationship between the health department and KVH, he said.

Part of that is because several health department employees now work at KVH.

“We (health department) are well aware of what’s happening at the hospital partly because much of the leadership there used to work at public health,” Larson said.

In good shape

Larson said the Affordable Care Act is an endorsement of the public health model.

“The fee-for-service model to keeping people healthy is really a public health model,” Larson said.

While the act may tip its cap to public health, it doesn’t tip its coffers — no additional money is allocated to public health.

“They’re always cutting funding to public health,” Larson said.

Read said if the Affordable Care Act achieves its goal of improving health, then there will be health care savings for insurance companies.

“If that happens we will need to make sure that is reinvested in community health systems,” Read said.

The way public health may access additional funds, Larson said, is through partnerships with the hospital and with school districts.

But, he emphasized, public health in Kittitas County is in good shape.

“It’s strong, stable and supported by the county commissioners,” Larson said. “Public health is not going away because it’s work that no one else is going to do.”

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