aft ag 15 Years MOUNTAIN STATES HEALTH CORPORATION Ak MOUNTAIN STATES HEALTH CORPORATION BOARD OF DIRECTORS 1990 The Mountain States Health Corporation's Board of Directors collectively comprise a range of professional interests and expertise in human services. President Benson R. DaiU, M.D.: Since 1979 Dr. Daitz has served as Associate Professor, Division of Family, Community and Emergency Medicine atthe university of New Mexico, School of Medicine. Dr. Daitz is certified bythe American Board of Family Practice and has served as Acting Director for both the Division of Family Medicine and the Family Practice Residency Program at the University of New Mexico. in addition to serving on several Govemor's Task Forces involved in alcohol abuse prevention, health and physical fitness, Dr. Daitz is actively involved in the production of radio and television programs aimed at increasing consumers' awareness of health issues. In his role of writer, producer, and musical composer he has numerous health education films and videotapes - some of which aired nationally - to his credit. Vice President C.E. Smith, Ph.D.: Dr. Smith has a number of years experience in resource development and in university teaching and research. He held executive positions in a Regional Medical Program and in the Health Policy Analysis and Accountability Network, Inc. Dr. Smith serves on the Board of Directors of Health Resources Development, Inc., in New York City. At the present time, he is a real estate broker and land developer in New Mexico. Secretary/Treasurer Hartzell J. Cobbs, Rel.D.: Dr. Cobbs has had extensive experience in the ministry where he has functioned as a psychological and religious counselor as well as administrator. in the area of,hum,an services he has added the perspective of ten years experience in the field of long-term care - both as Executive Director of the Idaho Health Facilities Association and the Oregon Health Care Association@ He also serves as chairman of the Data Collection Taskforce of the American Health Care Association and was president of the National Association of State Health Care Association Directors. He is currently the president of Cobb and, Associates, a private consulting firm in Portland, Oregon. Director Louise C. Haney, R.N., N.P.: Ms. Haney is an active member of the nursing profession in Idaho where she has held numerous offices in the Idaho Nurses'Association and has been involved in the Association of Operating Room Nurses and the Idaho Mental Health Association. She was Nursing Service Assistant Director in charge of operating room and out-patient services for St. Luke's Regional Medical Center in Boise, She is currently director of operating services at the VA Medical Center in Boise. She serves as a national and international nurse consultant for several organizations - most notably the Joint Commission of Hospital Accre dita tion. Director Richard C. Mattson, Ed.D.: Dr.Mattso hasseTvedasDirectorofMSHCsinceiulyl!974,includingtwoterm or to his retirement in 1981, he served in various positions with Flathead Valley Commun include Counselor@ Dean of Students, and interim President. Dr. Mattson has been active ii rams for the rural elderly and mental health issues in Montana. MOUNTAIN STATES HEALTH CORPORATION poised for the future Fifteen years ago, mountain States Health Corporation (MSHC) began its work and its investments in improving the quality and access to health care and human services for rural citizens of the Rocky Mountain and Pacific Northwest States. In addition to later reports of current activities, it is appropriate to reflect on a decade and a half of experience and to report some major successes and failures to our public. This report therefore is addressed to our past, present and future funding agencies and foundations, and also to our vast network of volunteers, to our corporate and project advisors, and to the hundreds of colleagues and professionals who share with us our work and dreams for optimally effective health care and human services for citizens of the Western States. Loyd Kepferte, MS: Mr Kepferie has been General Director HiStory of MSHC since 1977. He also served as the Director of the n Nevada MSRMP. His experience in health and huma with resource development includes executive positions In 1974 MSHC'@ @pareht organization the inter-Tribal Council of Nevada, and with the Peace the Mountain States @ecii6nai Aedi6al Corps in Liberia and The Gambia, West Africa. He is on the (MSRMP) ha-o:j @t"@oibi)leted its Board of Directors of the WAMI Rural Health Research PrOuram u Center, the Treasure Valley AHEC, and the misiion in Idaho, Mont6 Nev6da-,@ and University/Community Health Sciences Association at, wyomina With @an @imdressive:list bf;succ@ful Boise state University. programs. MSRMP @ provided t echnic6i assistance for. y The training of pediatric and famit o The creation of Emer@@ncy@M@dical nurse practitioners to provide needed Systems in Idaho, Nevada, and health professional assistance to rural Montana; physicians. A reaional Neonatal Intensive Care In 1974, as federal funding d .Network, MSRMP was phased out, and MSH created to maintain and develop Th Mountain States programs that were critical to the TU i3oiso, id6ho,@with existence of high quality health c tui in Idah6,14@@adal and in the rural areas of the Northwest. ng;:an in 1977, the board expanded the charter agency of any government unit, and so lacks of the corporation to include other human an annual appropriation to finance essential services such as education and child welfare. core operations necessary to plan, organize MSHC began to address early childhood and seek development funding for development, sexual abuse, guardianship, continuing our mission of introducing intergenerational education programs, and a community-based innovations into the myriad of other activities related to access, delivery of health care and human services. quality, and delivery of health and human Except for a few individual programs, such as services. Child Care Connections, MSHC does not solicit contributions, The as yet unfulfilled hope of attracting a stable financial base to support those core functions has been a fundamental failure of the corporation in its fifteen year history. That need remains one of its primary challenges for the future. What then accounts for the unusual success of MSHC? Among the key factors are: (1) commitment to cooperation, community involvement, and creative solutions to service delivery problems; (2) intimate knowledge of community-based development and willingness to team further the feasibility and significance of innovations at the community level,- and (3) skill in developing fundable grants and contracts for proposals supported by a well deserved reputation among gr nting agencies and foundations for prudent management and development of important priority innovations and improvements. Corporate philosophy and operation The corporation has accumulated significant expertise and credibility in its ntain States Health UOrPu" history. Areas of expertise include non-profit corporate management and the use of volunteers in community based planning, development, initial operation and ultimately institutionalizing innovations in health care and human services systems. At any given time, the corporation may be involved in staffing and managing some dozen projects while simultaneously completing responsibilities for planning, organizing or seeking funding for another dozen. MSHC is not a foundation and therefore OW lacks an endowment to rely upon for staff and organizational stability. Neither is it an The Geriatric Nurse Practitioner Program present individuals. Virtually all staff members is one such example. MSHC has received five have been genuinely outstanding and major grants from the W.K Kellogg competent individuals - and so judged by Foundation to support this model their peers and clients. development. The wellspring of Mountain States' success, however, lies in the genuine altruism, concern and commitment of hundreds of volunteers and other professionals, luminaries in their own rights, These people joined cooperatively to develop effective solutions to community problems in health care and human services. one of the best examples of volunteer activism is the Child Care Connections program. Volunteers are critical to the continued success of this program in meeting the needs of the community. one hundred percent success in our mission is neither expected nor desirable. innovations by their nature involve calculated risk taking. The corporation has had its share of projects that did not achieve their full potential for a variety of reasons, including, failure to develop sufficient resources to continue worthwhile efforts, loss of voluntary cooperation to competition between care providers, or mistiming of the successful introduction of the innovation into the community. We constantly strive to learn from these failures. On a more specific level, however, the success of MSHC is due to committed, creative and effective people. Staff members This reservoir of good will in rural over the years have worked extra long, citizens and practicing professionals in the arduous hours collegially without the West is, unfortunately, an often overlooked or customary constraints of excess bureaucracy. ineffectively utilized resource. Not enough They also worked without the compensating can be said about the fundamental job security and organizational stability of a importance of the strength and collective bureaucracy. The cumulative sum of their wisdom and the consequent public good that individual and joint efforts, commitment and can be done in the release and fusion of the unleashed energy does credit both to the reservoir of "people power." organization and to each of these past and The fundamental corporate philosophy Total investment figures of this and modes of operation both recognize this magnitude do give pause for reflection. And, human resource and aim to mobilize its we do agree with famous mythographer strength in well designed, crucially needed Joseph Campbell's assessment that "all innovations in health care and human money is congealed energy." A careful services. review of past and current efforts supports the indisputable case that MSHC has released that energy towards the specific and identifiable improvement of the health and human services "care fabric" of our Western tapestry. We believe further that the case also is indisputable that MSHC stands uniquely poised for the future to continue its work and to grow in its mission. For this fortunate position, we extend our gratitude and appreciation to staff, advisors, volunteers, cooperating organizations, and funding foundations and agencies. Each has played a key role in the accomplishments of the past. We also solicit from them - and from you - continued involvement, cooperation and support. including, your direct and indirect help in assisting us meet our fundamental organizational challenge to continue as a financially viable organization making the kinds of contributions described in this report. - Loyd Kepferle General Director - Ben Daitz, M.D. President - Mountain States Health Corporation Concluding thoughts As a private sector organization, we have no wish to commit the all too frequent government fallacy of endless solicitation of vast sums expended for the alleged benefit of citizens. In the case of MSHC, well over $18 MOUNTAIN STATES million has been prudently and, we believe, wisely and effectively invested in improving HEALTH CORPORATION quality of life through health and human AN EQUAL OPPORTUNITY EMPLOYE services. A 11,Ll7TD D@lfl],S - 1DA -ORU LII'E@A'I.TII'EDU @A-fl@O C'@Ei@Ti-@-li@ I R - H E-C - The Idaho Rural Health Education Center The Idaho RHEC board of directors (RHEC) is an affiliated private, non-profit meets quarterly to track, evaluate, and fund corporation dedicated to advancing the specific programs and services administrated education and improving the distribution of by contracted MSHC staff. idaho's rural health care professionals. The board - currently 18 members Mountain States Health Corp. (MSHC) has strong - functions smoothly, effectively, and provided contracted staff to the Idaho RHEC creatively. A diverse but surprisingly since the Center's inception in March 1987. workable mix of contrasting geographical MSHC's administrative oversight is and professional viewpoints are represented. underwritten by a portion of the federal funds provided to the Idaho RHEC by the University Two-thirds of the board members live in of Washington School of Medicine's Area rural Gem State communities. One-third Health Education Center Program (AHEC). reside in major metropolitan centers. Twelve members of the board of directors are also The cooperative services and programs health care providers. The other six member of the Idaho RHEC facilitate and support three - three university administrators, a rancher, strategic rural health care goals: a teacher, and a student - share the perspective of informed health care service o Enhancing the quality and efficacy of "users." multi-regional health care educational programs, particularly in The board's standing committees the area of primary care, include an Executive, a Nomiriating, a Legislative, an Education, a Program, and a o Promoting and supporting rural Idaho Community Health Services Development health care institutions as utilitarian Committee. Each member of the board access centers for health care actively contributes to the work of at least education. one of these advisory committees. Improving the distribution and The Idaho RHEC is an active and utilization of primary health care effective catalyst for change. A host of providers in rural areas. innovative, on-going programs in continuing health care education, undergraduate and Center Director Loyd Kepferle dedicates graduate student training, and rural 75 percent of his MSHC time implementing community support were initiated by the Idaho RHEC strategies and goals. Field Idaho RHECStdff during the first two years of Director Linda Terrell is responsible for the Center's existence. programs and services throughout Idaho assisted by Jim Przybilla, our newest staff Encouraged by the Idaho RHEC, higher member. Secretaries Sandy Jacques and education institutions in Boise, Lewiston, and Cyndy Fuhrman coordinate the complex Pocatello are now collaborating on health communication demands of the Center. care education program planning across a broad front, On-going cooperative programs include: Nineteen continuing education The Boise Family Practice Residency programs (funded at a cost of Program, and the University of $148,585) that have served 3,110 Washington sponsored pediatric participants to date. clinical training program in Pocatello (WAMI Program Pediatric CCU) Four different family medicine received funds for critical library and programs targeted at students and/or computer resources. residents (funded at a cost of $78,564) A library of more than 100 Four undergraduate programs educational videotapes on primary targeted at nursing. health care topics has also been developed. Continuing education Four graduate programs targeted at credits are available through the pharmacists. University of Utah or the University of Washington School of Medicine. The Idaho RHEC has also initiated programs and activities designed to help rural communities and providers cope with the ever present problems of viability, OFFICE OF COMMUNITY continuity, and improved access to rural HEALTH DEVELOPMENT health care services: A model program designed to help rural a Some 400 concerned citizens hospitals develop strategic planning, participated in public "town hall" financial management, and governing skills meetings organized in 18 Idaho was initiated by Idaho RHEC's Office of communities. Community Health Development. This program was implemented to respond to the a A program to recruit rural nursing crisis in rural health care. The services students who will later return to their provided through this program include: 1) communities to work was developed Market and utilization survey; 2) Financial by the Idaho RHEC and Idaho State analysis,- 3) Management and governance University. analysis; and 4) Needs and issue assessment. Community market surveys have been 9 A library of 20 informative videotapes conducted in Arco, Gooding, Montpelier, outlining various health care careers Soda Springs, and Mountain Home. was developed. The tapes are used by high school career counselors throughout Idaho. HEALTH PROFESSIONAL o The Circuit Rider Program - a CLEARINGHOUSE statewide, state-of-the art system of medical library support - was The Health Professional Clearinghouse developed in conjunction with the (HPC) developed by the Idaho RHEC now State Library and regional medical provides recruitment services to rural Idaho centers. The program makes medical communities facing serious health care literature resource materials available manpower shortages. HPC assistance is to small rural hospitals with little or no available by contract or on a fee-for-service funds to support a stand-alone basis. Nine rural communities are currently medical library. enrolled in the Center's HPC program. Staff provides technical assistance to The Idaho RHEC's AIDS project has communities in their recruitment efforts actively joined forces with other community through a Recruitment Manual and on-site oriented AIDS-inforMdtiori groups and visits. Free advertising to all communities is agencies- the Idaho AIDS Foundation. -he provided through the quarterly newsletter, Idaho Primary Care Association, the SLa@'e of Frontier Footnotes. Recruitment strategies Idaho's AIDS Program, (Bureau of utilized include direct mail, advertising in Preventative Medicine), the Ada Coup.?,, AIDS medical journals, exhibiting at medical Task Force, the Idaho Migrant Council AIDS conferences, and residency contacts, Education Program, and the Idaho Department of Education's AIDS Program. Eighteen pivotally placed individuals MINORITY MEDICAL are disseminating AIDS information provided EDUCATION PROGRAM (MMEP) via the "Train-the-Trainers" program. Twenty- five videotapes about AIDS prevention. have A Minority Medical Education Program been distributed to minority populations. All- (MMEP) has also been funded by the iri-all, some 3,200 health care professionals, University of Washington School of 1,600 students, and 1,600 members of -he Medicine's AHEC. general public have received some level of AIDS education thanks to the work of -,he The MMEP provides an attractive, AIDS Education Training Center. interlocking mix of personal, social, and academic enrichment opportunities in order The three identified "Centers of to increase the number of minority students Competence" (geographic hubs to se,-,:e the enrolled in medical school. in the program's rural AIDS education and information needs first year, eight Idaho minority students were of tomorrow) are the Kootenai Medical placed. Future Idaho RHEC plans include the Center in idaho's panhandle, Idaho State development of a statewide MMEP program University in south-central/east Idaho, and that will actively encourage minority students the Boise AIDS office in southwest Idaho. to consider health care professions during Materials currently available include audio their high school and college years. and audiovisual tapes, publications, slide presentations, and AIDS information updates from the U.S. Centers for Disease Control and the University of Washington. AIDS EDUCATION PROJECT The Idaho RHEC initiated the AIDS Education Training Center to develop an Future efforts Idaho AIDS network, provide and distribute AIDS educational materials and resources, In order to accurately evaluate and recruit participants for the University of successfully address rural Gem State health Washington based "Train-the-Trainers" care needs now, and in the future, the Idaho program, and develop three strategically RHEC continuously strives to enhance and located service areas as Idaho "Centers of expand the range of targeted educational Competence." programs and technical assistance services already up and running. The Medical Library Circuit Rider Program, the Baccalaureate Nursing outreach Program, and the Annual Nurse RHEC BOARD MEMBERS Educator Meeting are continuing projects. The Minority Medical Education Project and Consumers: the AIDS Education and Training Project are both funded through the next program year. Susan Baker, Ashton The Idaho RHEC will also continue to provide John Black, Idaho Falls support services to rural hospitals though its Bee Biggs, Idaho City Office of Community Health Development and its Health Professional Clearinghouse. Nursing: Several new educational projects, now Ruby Crosby, Wendell in the process of implementation, have Gretchen Dimico, St. Maries already been funded- Fami@ Medicine: A Rural Nursing "Extern" Program in conjunction with Boise State Bryan Pogue, Meridian University. Mark D. Spencer, Wendell o A Continuing Education for Hospitdl Administration: Optometrists Program, and a Clinical Pharmacy Residency Program (in Rod Jacobson, Montpelier Idaho Falls), both in conjunction with Idaho State University. Education: 0 A Nursing Computer Conferencing Mary Anne Dolen, LCSC Program in conjunction with Lewis Arthur A. Nelson, ISU Clark State College. Eldon Edmundson, BSU Michael Laskowski, U of I o An Associate Degree Nursing Curriculum Evaluation Project in Optometry.- conjunction with Lewis Clark State College, Boise State University, and Terry Sanderson, Soda Springs Idaho State University. Primary Care: o A Rural Summer Opportunities for Medical Students project in Dean Hungerford, Boise conjunction with the University of Idaho WAMI Regional Medical student Program. Kathy Nelson, Rexburg Additional funds have also been earmarked as seed money for the Minority Health: development of a family practice residency program in southeastern Idaho. Connie Evans, Lewiston Camilo M. Lopez, Caldwell Ex-officio: Blaine Durrant, VA AHEC, Boise FOSTER GRANDPARENT PROGRAPvl The Foster Grandparent Program (FGP) is of their assigned children. Participating a unique coupling of generations that helps seniors that build loving and stable role- low-income senior volunteers build model relationships with these special-needs meaningful, interactive relationships with drid disavantaged children, in turn, can feet special-needs and disadvantaged children. useful, healthy, active, and independent. The Treasure Valley FGP is funded by ACTION (the Federal Domestic Volunteer Agency), and administered by Mountain States Health Corp. Participating seniors must meet federally designated low-income guidelines and serve 20 volunteer hours a week in regular and special education public school classrooms, Head Start programs, State of Idaho child development centers, the Idaho State School and Hospital, or non-profit child care facilities. Debra Roetto is the Treasure Valley FGP project director. More than 60 Southwest Idaho FGP volunteers, ranging in age from 60 to 86, are currently helping children at targeted sites throughout Ada County, Canyon County, Gem County, and Payette County. These low- income seniors receive a non-taxable stipend, an annual physical examination, and tranportation to and from their volunteer site (or a commuting mileage allowance) for particiiDatinq in the program. Monthly senior- volunteer training sessions and social events are also provided. FGP volunteers work under the supervision of teachers and therapists to actively improve and support the self-esteem, social skills, and learning potential CIIILD CARE CONNECTIONS Child Care Connections (CCC) is an Sharon Bixby is the Director of CCC. affiliated private, non-profit child care Holly Bostick was the Training and Resources resource and referral project that actively Coordinator from January 1985 to August promotes the availability of affordable, 1989, Mary Lou Kinney is the new raining quality child care for the families of Ada and Resources Coordinator. County, Idaho. Myrna Ferguson is the Referral Grdnts from the Northwest Area Coordinator and the CCC Administrative Foundation supported CCC activities from Assistant. Sue Moore is the Early Childhood January 1985 to December 1987. Since then, Consultant. the CCC community project has been funded through United Way of Ada County, by Margaret Arnold (d VISTA volunteer) is service contracts (with 31 businesses seeking the Child Development Associate Trainer for enhanced child care referrals for their Family Day Care. Marion Lansford (also a employees), other fees for services, VISTA volunteer) is the Program Coordinator foundation grants, a Federal grant, corporate for the Boise City Child Care Assistance donations, and honorariums received for Program. Boise State University social work community organization presentations. intern Molly Nicely, community volunteer Referral Counselor Pat Frankle, and Child care is an important "quality of community volunteer Barbara Shinn, also life" issue both nationally and locally. The contribute to CCC's productivity. needs of children, parents, and providers must all be met for a community to enjoy the The CCC Administrative Council has 28 best, most affordable child care possible. members. The council's Resource Development Committee is responsible for More than 19,000 Ada County children stategic planning. This committee also up to nine years old need child care, addresses the funding needs of CCC through according to the latest Idaho Department of private and public grants, annual community- Commerce figures. Some 8,647 of these support appeals, United Way contributions, children are four years old or less. Another business and public-service contracts, and 10,718 are school-age children five to nine increased volunteer development. years old. The council's Public Relations Committee "Child Care Connections provides an is responsible for increasing the community- ambassadorship between the parents and wide understanding of early childhood care providers of Ada County and promotes and education, enhancing the public quality child care for all children," according perception of the child care profession, and to former CCC Administrative Council pinpointing and addressing specific Chairperson Patricia Kempthorne community needs with the aid of the CCC (1986-1989). child care data bank. The councit's Parent/Provider Services Additional 1989 CCC activities included, Committee, in coordination with the CCC staff, informs all child care providers about o Consultations with three local provider training opportunities offered in the hospitals interested in starting their community. This committee also works with own child care centers. staff to develop training programs for child care providers and parents. o Providing employer-benefit information on how to develop a The child care referral service for company program to numerous local parents is a primary CCC service, In Fiscal businesses. 1989, some 1,612 families (who needed care for 2,421 chilldren) received referral 9 Monthly work-and-family issues counseling, up-to-date information on 229 Working Parents' Luncheon Seminars child care providers, and consumer held in downtown Boise. education information on how to select a quality provider. 9 Child care issue workshops at Statewide Private industry Council Over the same period, the CCC staff and Workforce 2000 conferences. communicated with child care providers more than 11,000 times in a variety of ways- o Providing CCC data bank information telephone and face-to-face conversations, to community organizations, agencies, group training sessions, CCC Toy and task forces, and the media. Resource Library checkouts, informal visits to child care providers, and mailings. 0 Providing training and technical assistance to child care resource and In conjunction with Boise City, CCC also referral agencies thoughout Idaho. administers a child care assistance program (This statewide program is funded funded as part of the city's Community through the dependent care grants Development Block Grant Program. These program of the Idaho Department of funds promote economic self sufficiency for Health and Welfare.) one and two parent low-income families by paying up to 50 percent of the cost of child "Both the private and public sector are care in a licensed center, family day care looking for solutions and assitance in meeting home, or group home. (Participating child our child care needs," observes Gary Felt, the care providers are directly reimbursed on a 1989-1990 CCC Administrative Council monthly basis.) Some 74 children from 52 Chairperson. "Much remains to be done. With low-income families received child care continued and growing community support, scholarships" in 1989. the staff and volunteer Administrative Council of Child Care Connections will be here to address those needs. Their expertise and continuous commitment have contributed greatly to the strong foundation of community service on which our bright new future will be built." COIVIIVIUNIT'Y DECISION MAKING IN RURAL HOSPITAL COI@UNITIES The Community Decision making in A locally employed Community Rural Hospital Communities project (CDM-in- Encourager facilitates CDM-in-RHC activates RHC, for short) encourages the citizens of in each pilot project community. These CDM- rural communities to become active in-RHC trained Community Encouragers participants in the ongoing search for understand economic development strategies solutions to the perplexing problems that face and rural health care issues. They are assisted their local health-service delivery systems. in their activities by locally formed, representatively structured Community Informed and educated citizens who Councils. Paul McGinnis, the CDM-in-RHC understand and appreciate the role a Project Director, and other health care hospital can play in local economics, future professionals provide technical assistance. expansion and growth, and the overall health status of the community can play a very Loyd Kepferie, General Director of important role. Their decision-making input Mountain States Health Corp., is the CDM-in- accelerates and simplifies the locally RHC Project Administrator. generated formulation and development of viable solutions to the rural health care crisis. Douglas Atkinson, Brim & Associates,- Marcia Shoup, Oregon Health Sciences Citizens who take an active and decisive University-, Tony Wellever, Montana Hospital role in analyzing and meeting existing and Association; Dorthy Eck, Montana State future health care needs by participating in Senator,, John Black, Idaho Rural Health CDM-in-RHC programs and projects will also Education Center,- and Mahlon Heistand M.D., contribute to the progressive, long-ten a rural Idaho Family Practioner are members support and expansion of the community- of the CDM-in-RHC Advisory Board. tailored options that are ultimately selected and implemented. The five Community Encouragers have received all sorts of involvement, generating The CDM-in-RHC regional demonstration "public interest" attention from local grant project is funded by the Northwest Area television stations, radio stations, and Foundation (NWAF) of St. Paul Minnesota. newpapers since the five community pilot NWAF funds are supplemented by local projects were initiated in November 1988. contributions from selected project communities. Highlights of the first year's accomplishments include: CDM-in-RHC is actively working in five pitot-project communities: Bums, Oregon-, Burns, Oregon, received a $10,000 Enterprise, Oregon-, orofino, Idaho; Pomeroy, MD-recruitment grant from the Oregon Washington; and Dillon, Montana. Department of Economic Development, Two doctors were recruited. The 6th annual Oregon Rural Health LIFE SERVICES PROGRAM Conference was held in Burns. ,3 A resolution supporting rural hospitals Life Services Program (LSP), a home- passed the Grange Association based services program affiliated with Convention in Enterprise, OR. Mountain States Health Corp., was formed in January 1989. The Dillon, Montana, Community Encourager generated community Qualified citizens pay a one-time $50 support for a new primary Care LSP membership fee. These members can program and participated in meetings then obtain important services at a of the local hospital's strategic guaranteed price through the LSP pipeline- planning and building committees. quality home repairs and maintenance, home companionship, persondl-care The Community Encourager in coordination, daily money management Orofino, Idaho, was deeply involved services, limited investment services, and in the development of a new rural guardianship and conservatorship services. retirement housing project. LSP coordinates money-management The Orofino CDM-in-RHC Community and persopal-care services for Ada County Council helped gather previously senior citizens and disabled adults who are unavailable patient-origin information. unable to receive the kinds of support a family normally provides. LSP is a fee-for- The Pomeroy, Washington, Community services agency that is financially assisted Encourager organized an "in-service" by grants from the Boise Laura Moore training seminar. A team of Spokane Cunningham Charitable Trust and the Ada County mental health professionals County United Way. met with members of the local hospitals Stdff to discuss the Doug Yunker is the LSP project assessment of psychiatric disorders. director. "The 1990s should see an extensive LSP provides consumer protection, replication of the basic community decision freedom of choice, and increase making model throughout the western states, independence to older and disabled according to CDM-in-RHC Project Director members of the community. Paul McGinnis. "This model could encourage active citizen participartion in other areas of Over 40 members were using LSP public concern, including public schools, services on a regular basis as of January 'Main-Street' development, economic 1990@ development, and recreational opportunities. Establishing a Community Encourager Training institute would allow many more communities to participate in CDM-in-RHC projects and programs." FISCAL REPORT The financial component of Mountain States As funding sources have shifted from federal Health Corporation encompasses the fiscal to a broader, mlilti-source base, there has been a maintenance and reporting for the programs, necessity for a more sophisticated and flexible personnel administration and the management of dccountirig structure. fee based ancillary programs, in the last several years, computerization of Jaime MOSS, Fiscal Officer and Annd Fritz, accounting processes and the streamlining of Fiscal Assistant provide the oversite to MSHC procedures have allowed for d healthy, creative financial operations, mix of good management of available resources, and evaluation of the consequences of current The ancillary programs which generate issues on funding sources. funds for the administrative budget include the payroll and benefits administration for the Idaho This growth in fiscal sophistication bodes Health Facilities Authority and the Idaho Primary well for the corporations's ability to diversify its Care Association. The fees from these services are program funding base and continue to serve the intended to supplement the indirect rates Northwest with innovative health and human charged to the projects and provide additional services. funding for administrative staff, overhead costs and project over-runs which are not reimbursed The following illustrates the diverse funding by the funding agency. sources the corporation has had over the past ten years. The majority of our funds have come from The Veteran's Fiduciary Guardian Program is foundation support. The W.K. Kellogg Foundation, d[SO managed by MSHC as an ancillary program. the North West Area Foundation, the Charles MSHC manages the finances of incapacitated or Stuart Mott Foundation, the Laura Moore incompetent veterans by providing bill payment, Cunningham Foundation, the Gannett Foundation, budget preparation, investment management, and the Whedon Cancer Foundation have all and annual reconciliation. in addition, fiscal contributed to the development of many of our management and accounting services are programs. provided to the Idaho Primary Care Association using the in-house computer system to generate a full accounting system, prepare their federal and state quarterly reports and submit billing reports to the State of Idaho and the U, S. Public Health Service, Department of Health and Human Services, Distribution of Funds by Source 1 9 8 0 - 1 9 9 0 C)'Lher Foundations Government (Fe,--erc;I/City) 34.6% @lort@i West Arec-, FoLndation 1 1.2 Privote (Ccrporate/Donations) 1.3% Multi-sourcp- Funds 17.1% W.K. Kellogg Fcij,)dation 34.6% Total Funds - t7,859,965 MSHC has been d catalyst in the The distribution of funds by Program and by development of numerous programs over the past type over the past ten years is displayed below. fifteen years. Several projects not previously The next page is a sumniary of the combined mentioned include Head Start, several volunteer balance sheet and statement of revenues, projects through the Office of Volunteer Citizen expenditures and changes in fund balances. Participation, and several projects dedicated to improving health and human services to the elderly, such dS Patient Activated Care. I Distribution of Funds by Program 1 9 8 0 I 9 9 0 G,--riotric t'@Lir@-e Prcctitic)ri,--r 32.5% Rural H-@alt@@ 12.2/-. Child Care Connections 5.5% Other 1.8% Foster Crindparents 3.6% Head Start 7.8% EidF--r Care Programs 7.97. Community Decision @Aaking 3.- ministration 5.3% Ancillary Programs' 10.8% Volunteerism 8.3% Total F-unds - $7,859,9'05 Distribution of Funds by Type I 9 8 0 - 1 9 9 0 Rural Health 16.9% Volunteerism 8.3% @linorlt\/ Support Children & Y(D@"h '13.4% tvllscelloneous .,% Administratiori .3% Elderl cillary Progrcm@, 10.8% Total Funds - $7,859,965 MOUN-FAIN STATES 11,EAL-ffl CORPORATIO@,L COMBINED BALANCE SHEET ALL FUND TYPES AND ACCOUNT GROUPS SEPTEMBER 30, 1989 FUND TYPES AC(T GROUPS TOTALS GOVERNMENTAL FIDUCIARY GENERAL MEMORANDUM GENERAL SPECIAL TRUST FIXED ASSETS ONLY ASSETS CASH ........................ S 15,834 S (6,904) S 7,461 s - S 16.391 ACCTS RECEIVABLE ............... 1,598 393,986 - - 395,584 INVESTMENTS ................... 8,471 13,894 73,059 - 95.424 PREPAID EXPENSES ............... 4,655 - - - 4,655 GEN FIXED ASSETS ............... - - 62,998 62,998 TOTAL ASSETS .................. S 30,558 S400,976 S 80,520 S 62,998 S575,052 LIABILITIES AND FUND EQUITY LIABILITIES ACCTS PAYABLE ................. S 28,019 S 75,533 s - s - S103.552 ACCRUED EXPENSES .............. 1.860 18,304 - - 20.164 DEFERRED REVENUE .............. - 247,146 24 7,146 DUE VETERANS ................. - - 80,520 - 80,520 TOTAL LIABILITIES ................ S 29.879 S340,983 S 80,520 s - S451.382 FUND EQUITY INVESTMENT IN GEN FIXED ASSETS ............... s - - S 62,998 S 62,998 FUND BALANCE RESERVED ....... ............. - 59,993 - - 59.993 UNRESERVED ................... 679 - - 679 TOTAL EQUITY .................. S 679 S 59,993 s - S 62,998 $123,670 TOTAL LIABILITIES & FUND EQUITY ................ S 30,558 S400,976 S 80,520 $ 62,998 S575,052 COMBINED STATEMENT OF REVENUES, EXPENDITURES AND CHANGES IN FUND BALANCES - ALL GOVERNMENTAL TYPES FOR THE YEAR ENDED SEPTEMBER 30, 1989 SPECIAL TOTALS GENERAL REVENUE MEMORANDUM ONLY REVENUES: ACCOUNTING .......................... S 9,026 $ 5,380 S 14,406 GRANTS .............................. 0 911,726 911,726 REIMBURSEMENTS ....................... 0 176,328 176,328 INDIRECT RATE ......................... 56,132 0 56,132 OTHER ............................... 10,649 71,112 81,761 INTEREST ............................. 5,996 685 6,681 IN-KIND ........ I..................... 0 23,142 23,142 TOTAL ............................... 81,803 1,188,373 1,270,176 EXPENSES: SALARIES ............................. S 30,435 $ 465,187 $ 495,622 BENEFITS ............................. 7,044 98,887 105,931 CONSULTING ........................... 912 21,422 22,334 CONTRACTS ........................... 0 189,184 189,184 STIPENDS ............................. 0 141,570 141,570 TRAVEL .............................. 6,182 93,255 99,437 PRINTING ............................. 0 11,345 Ili345 COMMUNICATION ....................... 271 6,119 6,390 OFFICE SUPPLIES ........................ 957 4,754 5,711 OFFICE RENTAL ......................... 1,473 19,427 20,900 EQUIP. RENTAL &MAINT . ................. 2,044 617 2,661 EQUIP. PURCHASE ....................... 0 3,729 3,729 OTHER ............................... 17,721 57,192 74,913 INDIRECT ............................. 0 56,133 56,133 IN-KIND ........ ..................... 0 23,142 23,142 TOTAL EXPENDITURES .................... 67,039 1,191,963 1.259,002 EXCESS (DEFICIENCY) OF REVENUE OVER EXPENDITURES .............. 14,764 (3,590) 11,174 FIJND BALANCE BEGINNING OF YEAR ......... (14,085) 63,583 49.498 n itin R Al ANIRF AT F7mn nF YFAR - - - . . s 679 $ 59,993 $ 60,672 MOUNTAIN STATES HEALTH CORPORATION Program Staff 1990 Child Care Connections(CCC) Idaho Rural Health Education Center Sharon Bixby Loyd Kepferle Director/Referral Coordinator RHEC Center Director Mary Lou Kinney Linda Terrell Trainer/Resource Coordinator Field Director Myrnd Ferguson Doug Yunker Administrative Secretary AIDS Project Director Marion Lansford Jim Przybilla VISTA Volunteer Health Development Specialist Sandy Jacques Receptionist/Secretary Cyndy Fuhrman Office Assistant Community Decision Making in Rural Hospital Communities I - R - H - E - C Paul McGinnis Project Director Fiscal Office Foster Grandparents Program Jaime Moss Deborah Roetto Fiscal Director Project Director Anna Fritz Fiscal Assistant Life Services Program A k Doug Yunker Project Director MOUNTAIN STATES HEALTH CORPORATION AN EOUAL OPPORTUNITY EMPLOYER This Report Is Dedicated To The Following individuals Alfred M. Popma, MD - first MSRMP director John W. Gerdes, PhD - first MSHC director Arthur Abbey - MSRMP board chairman Richard Mattson, EdD - MSRMP & MSHC board chairman Louise Haney, RN, NP - MSHC board chairman Fred Gibson, Jr. - MSHC board chairman Lorin R Gaarder, PhD - past associate director, MSHC State Directors of MSRMP David M. Barton, MD - Idaho Fred Graeber, MD - Idaho Ralph Christenson, MD - Idaho Loren Phillips, MD - Nevada Joseph Deisher, MD - Nevada Loyd Kepferle, MS - Nevada Sydney Pratt, MD - Montana Claude Grizzle, MD - Wyoming Don Ericson, MPH - Wyoming Outstanding Staff Contribution Saul Cohen, MPH - former staff Sharon Bixby - current staff Paul McGinnis - current staff Myma Ferguson - current staff -Linda Terrell - current staff Others who have provided support, advice and ideas DeWitt "Bud" Baldwin, MD - University of Nevada Medical School and the American Medical Association E. E. "Gil" Gilbertson - project director of the first grant provided throug MSRMP Mary Anne Saunders - director Region IV, Dept. of Health and Welfare previous director Idaho Health Systems Agency