DAUPHIN COUNTY BOARD OF COMMISSIONERS
Legislative Meeting
October 5, 2005 (10:00AM)

MEMBERS PRESENT

Jeff Haste, Chairman
Dominic D. DiFrancesco, II, Vice Chairman
George P. Hartwick, III, Secretary

STAFF PRESENT

Marie Rebuck, Controller; Robert Dick, Treasurer; Bill Tully, Esq., Solicitor; Bruce Foreman, Esq., Assistant Solicitor; Chad Saylor, Chief Clerk/Chief of Staff; Elke Moyer, Human Services Office;; Guy Beneventano, Esq., Solicitor's Office; Randy Baratucci, Director of Purchasing; Mike Yohe, Director of Budget and Finance; Dave Schreiber, Personnel; Faye Fisher, Director of Personnel; Edgar Cohen, Director of Facilities Maintenance; Diane McNaughton, Press Secretary; Bob Hawley, Court Administer; Tom Guenther, IT Director; Carolyn Thompson, Court Administrator; Kay Sinner, Personnel; Sheila Britt, Domestic Relations; Melanie McCaffrey, Solicitor's Office; Sharon Way, Personnel; Richie Martz, Commissioners' Office; Garry Esworthy, Risk Manager; and Jena Wolgemuth, Commissioners' Office.

GUESTS PRESENT

Mike Fiaschetti, Highmark Blue Shield; Suzanne Cassel, Highmark Blue Shield; Dr. Robert Muscalis, Highmark Blue Shield; Jack Sherzer, Patriot News; Bill Smith, Esq.

MINUTES

CALL TO ORDER

Mr. Haste, Chairman of the Board, called the meeting to order at 10:00 a.m.

MOMENT OF SILENCE

Everyone observed a moment of silence.

PLEDGE OF ALLEGIANCE

Everyone stood for the Pledge of Allegiance.

APPROVAL OF MINUTES

Mr. Haste: If we could take up the September 7, 2005 Legislative Meeting minutes and the September 14, 2005 Workshop Meeting minutes. Is there a motion to approve those minutes?

It was moved by Mr. Hartwick and seconded by Mr. DiFrancesco to approve the September 7, 2005 Legislative Meeting minutes and the September 14, 2005 Workshop Meeting minutes. All were in favor. Motion carries.

EXECUTIVE SESSIONS HELD BETWEEN MEETINGS

Mr. Saylor: Commissioners I do not believe that we met in Executive Session over the past week.

PUBLIC PARTICIPATION

(There was none.)

DEPARTMENT DIRECTORS/GUESTS

1. Mike Fiaschetti - Highmark
   1. Utilization Report of County's Healthcare

Mr. Fiaschetti: Good morning Commissioners. My name is Mike Fiaschetti with Highmark Blue Shield. I have Dr. Robert Muscalis, our Chief Medical Director of Central Pennsylvania and formerly the Physician General of the State of Pennsylvania with me. We are very pleased to have Dr. Muscalis join Highmark. He is going to be working with a number of our large clients, particularly in the areas of health and wellness, which I know has been very important to you all.

I wanted to present some data to you today on your healthcare costs as they are merging in 2005. Before I start I will jump to a little bit of a conclusion. I do want to compliment the Commissioners' and other staff members of Dauphin County for doing the difficult task of walking that balance between offering good benefits, but being fiscally responsible. I think some of the difficult decisions that had to be made are paying some early dividends in 2005.

If you look at the chart that I have presented to you what I have is the claims costs broken down by the major categories of care; hospital in-patient care, hospital out-patient care, professional or physician related care, and then total. What we've done is developed these costs on a per person per month basis, or a rate basis, if you will. We compared the 2004 cost to 2003 and the 2005 costs. We only have six months so far in 2005. What you see is we'll start with the hospital in-patient component. In 2004 hospital in-patient costs went up 55% over 2003. So far for the first 6 months of 2005 those costs have gone down 14%. On out-patient, the first 6 months of 2005 they have gone down 4% and on professional services they have gone down 1%. In total they have gone down about 5% versus a 32% increase like 2004 over 2003.

Now a couple words of caution with this information. First of all, in 2004 the County had some very severely ill people, we call those shock cases. These are cases where people accumulate over $125,000 in claims expense in one year. There were several people who had in excess of a half of a million dollars in claims expense. The shock cases represented over 11% of claims expenses in 2004. A normal large employer would incur about 4% in shock cases so you were very high there. Those shock cases have gone away for the most part in 2005 so you are seeing some benefit of that.

Secondly, what we are seeing is some decrease in the professional or physician utilization. We believe it is due to the implementation of the co-payment program that you put into place. That has both a cost and utilization impact. In other words it lowers the use of services.

Finally, you did implement a wellness program. While those are a more long-term initiative initially when people fill out a health risk appraisal and they realize issues with their health status they take it more seriously and we tend to see some impact of that. We think the combination of lower shock claims, the fact that you implemented some benefit sharing of the co-payments and that you are creating the culture of health and wellness has all paid dividends.

Now again, this is only 6 months of data for 2005 and we all know that can change. The initial signs are that your trends are looking much better in 2005 over 2004 than they did in 2004 over 2003.

We will take any questions that you may have at this time.

Mr. Haste: I have just one so I understand this. If we were using 2003 as the baseline even this year we are still above 2003.

Mr. Fiaschetti: That is correct.

Mr. Haste: Okay, but we are headed in the right direction?

Mr. Fiaschetti: Correct.

Mr. Haste: Okay.

Mr. Hartwick: Just two questions. The first one is how are these trends moving in the right direction going to be affecting future increases in premiums?

Mr. Fiaschetti: What we see is a reduction in the increase in the premiums. For the next renewal period we are seeing a drop from the last renewal period of almost 10 points in terms of increase. I believe you had an increase in the 25 plus percent range last year. That is looking like it is going to be more around 15. Given this information the next year should be even better if this continues, if we don't get hit with any more of these adverse shock cases. What we are seeing is a reduction in the increase of costs. We believe not only the shocks but the change in benefits is having an impact on that.

Mr. Hartwick: I know one of the questions that you were asked to talk about a little bit before you got here today, and I just want to raise as well, was just taking a look at how many individuals participate in the benefits program at Spring Creek. Could you sort of give us an update on how many individuals participate for health insurance and what the numbers are at Spring Creek? If in fact the Board were to move in the direction of trying to downsize or replace that facility out there, what that would mean in total healthcare savings costs.

Mr. Fiaschetti: To our count we have 352 employees covered under our health benefits plan at the Spring Creek Facility. We show 296 of them being union and 56 non-union. Those benefit plans are a slightly different cost. When we multiply those by the premiums that you are paying for those individuals we come up with an elimination of $3,064,000. That is just north of $3 million of eliminations of cost if you were not to pay benefits on those individuals.

Mr. Hartwick: Those are some costs obviously in addition to the actual running of the facility and all of the things that we are taking into consideration that are also a major expense for the county.

Mr. Fiaschetti: That is a big number. You can see how much those premiums.

Mr. Hartwick: The utilization trends out there are pretty high as well?

Mr. Fiaschetti: That is correct.

Mr. Hartwick: Last question, I know Nick has done a bang up job with wellness. One of the things that Dr. Muscalis is here to discuss as well, with wellness I know we started out with a big boom. I was saying this morning that I couldn't even go to the bathroom without seeing a splashing dolphin. I know that in order to make a wellness program work it needs to start from the top down in trying to invest financial resources, as well as incentives in trying to continue to control the cost that we can control within the organization and obviously putting together a budget. What have you felt with other organizations? I know we have gotten a good start but what would be some of your suggestions on where we go from here to continue to help control some of those costs?

Mr. Fiaschetti: Sure Commissioner. As you have said, you have gotten off to a good start in establishing a Wellness Committee, the 10,000 Step Program and now you will be beginning another program this fall related to nutrition. Those are all positive things. I think it is important again to emphasize that this is an initiative that is supported at all levels within the organization. It becomes a culture within that organization. I also think it is important to point out that this is something that is directed at the health of the individual and we are representing a health insurance company that can impact trends with regard to health insurance, but it also can impact other things including; productivity of individual employees, short-term disability costs and worker's compensations costs. There are a lot of costs that go beyond just pure medical costs. I think it is important for an organization to provide an incentive for their employees, whether they are financial incentives or time off incentives. We discussed an initiative whereby employees can participate in a program over a period of 6 weeks, take for an example, where they can earn points doing certain types of procedures or educational activities. Not necessarily physical activities but over a period of time they can earn points and then be rewarded for that. The idea being that after 6 weeks people can begin to see the benefit of that and they can become long-term changes in their daily behaviors.

I think the county can provide incentives and should consider what would be the best ways to develop those incentives to encourage people to participate in these programs along with the health risk assessments and also engaging in other opportunities that exist through Highmark with our Blues on Call Health Coaches. Those are just a few examples.

Mr. Hartwick: I think a part of our discussions in the budget for next year needs to be trying to put some numbers behind what it is going to take for us to really continue to control these costs from an incentive stand point what type of investment is it going to take from days off to other bonuses and incentives. From what I am hearing the program got off to a great start but has slowed down. We are trying to continue to keep peoples interests. How does it affect them, why are they going to want to participate and we need to provide some incentives in order for them to continue to participate?

Mr. Fiaschetti: Absolutely. To change behavior requires great motivation and incentives. It is important for those incentives to exist to encourage those changes.

Mr. Hartwick: Thank you.

Mr. Haste: I had a question. Those shock cases that you were referring to, that 11%. How many of those cases, I don't know if you are familiar enough with them, are disease related? How many of those, if there was a wellness program 10 years ago, might we have been able to really minimize or change some of those around? Were they preventable by a wellness type of program or were they more genetic disease.

Mr. Fiaschetti: I don't know if that's the case. As I sit here I don't believe I can give you the details of those cases. We can furnish you with that with the right confidentiality. I can furnish the Commissioners with more details on the cases. I don't want to sit here and ..I have the cases but I don't know the background of those. I don't believe Dr. Muscalis you had a chance to review those as well. Unfortunately I can't answer your question Commissioner Haste. We can find out if they were disease related cases or if they were more trauma type things that occurred, but they were very high dollar. We do know that.

Mr. Haste: That again, I would just try to speak to the wellness in trying to prevent another occurrence like that in the future.

Dr. Muscalis: Commissioner, if I may, often what we see in the shock claims are cases that are not preventable. The events or occurrences around many of those cases are things that were never foreseen and could not have been prevented. However, when you look at claims data and look at areas that can't have an impact through a wellness initiative you would find they represent significant costs. I am thinking of things such as hypercholesterolemia, coronary artery disease, obesity, and diabetes. Those are areas where a wellness initiative can have a significant impact. We know that if we can impact individuals either before they develop those conditions, or in the early stages of those conditions, we can have an impact on the severity and the complication that would translate into significant costs later on. I am not minimizing the importance of the shock claims, but my point is that while they represent a significant amount of dollars it is very important to focus on the chronic conditions that we can predict, to an extent, and have a significant impact on.

Mr. Fiaschetti: We can find out if any of those were a result of a chronic condition and whether they could have been prevented or not through wellness in the past. I think that is your question. We will go back and get the details of those and then go through that with you. We can schedule another time to do that.

Mr. Haste: Okay, very good. Any other questions? (There were none.) Thank you.

SALARY BOARD

A complete set of Salary Board Meeting minutes is on file in the Chief Clerk's Office.

PERSONNEL

Ms. Sinner: Moving on to the Personnel Packet I have an addendum, which includes the request to fill the Painter vacancy, and the Boiler Operator or Boiler Maintenance person. There are also some new hires in DJ Zozo's office and in Night Court. I had no changes to the remainder of the packet.

Mr. Haste: Any questions of Kay?

Mr. Hartwick: I see you are starting to do all sorts of addendums and attachments and trying to follow this I need a manual again. If we could try to.

Ms. Sinner: Try to keep it down? Yes, I know.

Mr. Hartwick: If you could put them together it would be great. Are these because they have been late submittals?

Ms. Sinner: Well, the court positions they have been trying to get these positions filled prior to this and we're not able to. They just couldn't wait any longer though. They just didn't have other hires in time for the packet last week. It would have at least condensed it into one addendum rather than splitting it into two. Because they had some of them in time for an addendum last week, but we waited and put them all through this week.

Mr. Hartwick: Just a reminder to try and have all directors submit these things in a timely manner.

Ms. Sinner: In this case, the part-time Night Court people, they actually were still interviewing last week and had not made a final decision. We were hoping we could get it through and not have to go through the next set of meetings because they have been paying overtime to staff the Night Court.

Mr. Hartwick: You know how I feel about it.

Ms. Sinner: Yes, I do.

Mr. DiFrancesco: Can we keep track of when our people go on the Disaster Relief Leave?

Ms. Sinner: Okay, there are two at the Prison.

Mr. DiFrancesco: Their comings and goings basically, when they go and when they come home.

Ms. Sinner: Okay.

Mr. DiFrancesco: I'd like to make sure we know.

Ms. Sinner: In fact Mark is still holding the originals of those Personnel Action Forms. He is going to send them to me when he actually has a date.

Mr. DiFrancesco: I know I'd like to know how many people we have out and so forth.

Mr. Haste: It sounds like only one has completed the training out there and the other is waiting to take the training.

Ms. Sinner: Right. I think the other one goes on the 7th or 9th.

Mr. Haste: Okay. Any further questions of Kay? (There were none.) Is there a motion to approve the Personnel Packet?

It was moved by Mr. DiFrancesco and seconded by Mr. Hartwick to approve the Personnel Packet. All were in favor. Motion carries.

PURCHASE ORDERS

Mr. Baratucci: Commissioners there were no over budgets to correct from last week. The only change is that on page 2 of the packet I added two requisitions that cover our 2006 dated materials, appointment books, calendars, all of those items. We had some quotes out for that and just finally got them finished. We have people clamoring for their 2006 items so I wanted to have those added, if that's alright, so we can get the purchase orders out and placed and get the items in. That was the addition on page 2 otherwise it is the same packet with no over budgets. Do you have any questions? (There were none.)

It was moved by Mr. Hartwick and seconded by Mr. DiFrancesco to approve the Purchase Order Packet as presented. All were in favor. Motion carries.

REPORT FROM BUDGET & FINANCE - MIKE YOHE, BUDGET DIRECTOR

Report from the Office of Budget & Finance
October 5, 2005

• September 23, 2005 transferred $1,536,676.07 to the Payables account from the County's Concentration account for checks issued that week. (Real Estate Transfer Taxes - $1.1 million)
• September 30, 2005 transferred $3,326,783.31 to the Payables account and $1,864,571.20 to the Payroll account from the County's Concentration account for checks issued that week.
• Total Term Investments - N/A
• Balance today in INVEST account $125,021.79 rate 3.580%
• Balance today in Community Banks investment account $27,000,749.16 rate 3.970% (This rate equals today's Fed Funds Rate of 3.750% plus 22 basis points)
• Balance today in Commerce Bank investment account $13,500,724.59 rate 3.875% (This rate equals today's 91-day T-Bill rate of 3.525% plus 35 basis points)
• Balance today in Sovereign Bank investment account $13,400,094.24 rate 3.640% (This rate is fixed through 10/31/05)

$10M TRAN Line-of-Credit Status at PNC: No activity to date.

Mr. Yohe: That is my report.

Mr. Haste: Did they say why, weren't they the ones who started the Libor plus bidding and now they are with a fixed rate?'

Mr. Yohe: Well, they gave us that option. Remember they gave us the option of which one we wanted to go with. After the first two months that is the one we went with, but they have the option to switch it too if they wanted.

Mr. Haste: Okay, any questions of Mike? (There were none.)

REPORT FROM CHIEF CLERK/CHIEF OF STAFF - CHAD SAYLOR

Mr. Saylor: I actually have two things. Last week on the training packet attention was drawn to Item #13 and I have investigated that issue. What had happened was this particular individual had gone to training, was approved in a timely fashion for that training for $250 and expenses. Apparently the costs came back at $500 and she explored the possibility of getting the other $250 reimbursed. This was approved by the oversight and that is why it is in the packet, it is not for post approval.

Mr. Haste: Do we need to put #13 back on the training packet?

Mr. Saylor: It is on there. I just wanted to follow-up with that and make sure you understood.

The other item, some time ago you had asked about when we were going to approve the increase in mileage reimbursement. I think it was Commissioner Hartwick, but all three of you indicated interest in flushing out the costs for mileage versus increasing the fleet. We are exploring that. Greg Schneider is pulling together some numbers. He is trying to figure what is the best way to present this information to you. He is working with Edgar and I hope soon to have some numbers for you to look at to make a decision in going forward.

Unless there are any questions, those are the two items I wanted to mention.

Mr. Haste: Actually that would be commissions we will need to know for the budget so we can decide which direction we are going. Thank you. Any questions of Chad? (There were none.)

SOLICITOR'S REPORT-BILL TULLY, ESQ., SOLICITOR

Mr. Tully: Nothing to add to last weeks report but I would be happy to answer any questions that you might have. (There were none.)

Mr. Haste: Thank you.

MATTERS REQUIRING BOARD ACTION

Mr. Haste: We have Matters Requiring Board Action items A through W. Do any items need to be pulled out separately?

Mr. Hartwick: No.

Mr. Haste: Any further discussion on any of the items? (There was none.) Is there a motion to approve items A through W?

It was moved by Mr. DiFrancesco and seconded by Mr. Hartwick to approve Items A through W in the Matters Requiring Board Action. All were in favor. Motion carries.

1. Training Packet
2. Approval of FY04/05 Per Diem Rates between Children & Youth Agency and Silver Springs-Martin Luther School (Residential Treatment Facility JCAHO - $264.75 and Personal expenses & allowances - $3.00).
3. Approval of Adoption Assistance Agreement #2005-28.
4. Purchase of Service Agreements for FY2005/06 between the Children and Youth Agency and:
   1. Mission Home Ministries, Inc.
   2. Saint Joseph's Center
   3. Philhaven, Inc.
   4. Visiting Nurse Association of Central Pennsylvania, Inc.
   5. Valley Youth House, Inc.
   6. Perseus House, Inc.
   7. Best Nest, Inc.
   8. Silver Springs - Martin Luther School (2004/05)
5. Purchase of Service Agreement for FY2004/05 between MH/MR and Focus Fitness.
6. Emergency Shelter Grant Agreements for FY2005/06 between MH/MR and:
   1. Catholic Charities
   2. YWCA of Greater Harrisburg
7. Purchase of Service Agreement Addendums for FY2004/05 between MH/MR and:
   1. Country Meadows of Hershey (Amendment #1)
   2. Contact Helpline, Inc. (Amendment #1)
   3. Diakon Lutheran Social Ministries (Amendment #1)
   4. 2 Communik 8 (Amendment #1)
   5. Geisinger Community Health Services, Living Unlimited Program (Amendment #1)
   6. Grayson View, Inc. (Amendment #1)
8. Addendum #1 to Purchase of Service Agreement between Area Agency on Aging and Cumberland County for "PERS" units.
9. Approval for the submission of a CJAB Sub-Grant #2003-DS-04-14667 with the PA Commission on Crime and Delinquency. This is for the continuation of a grant approved last year for a four-year term.
10. Satisfaction Piece(s) with:
    1. Michelle D. Lane, 104 S. 17th St., Harrisburg
    2. Kimberly Ferguson, 3538 N. 6th St., Harrisburg
    3. Deborah Carpenter, 746 Huntingdon St., Harrisburg
11. Subordination Agreements with:
    1. Adriene Brown, 3212 Kensington St., Harrisburg
    2. Paul L. McDaniels, 222 Crescent St., Harrisburg
    3. Renae D. Seegars, 1137 S. 18th St., Harrisburg
12. Resolution #30-2005 designating representatives of the County to meet with the Susquehanna Township Commercial and Industrial Development Authority regarding the creation of a Tax Increment District within the Township for the proposed improvements to a portion of Kohn Road.
13. Resolution #31-2005 approving the County of Dauphin's participation regarding the creation of a Tax Increment District within Susquehanna Township for the proposed improvements to a portion of Kohn Road.
14. Resolution #32-2005 establishing a Parks and Recreation Advisory Board.
15. Partial refund of 2003, 2004 and 2005 Real Estate Taxes - John & Kathy Bull (Parcel #62-008-052) - $958.70.
16. Intergovernmental Cooperation and Technology License Agreement between the County of Dauphin and the City of Harrisburg regarding GIS services.
17. Lease Agreement with HP Financial Services for 34 personal computers to be installed in various County offices.
18. State and Local Government Single Schedule Lease Purchase Agreement with HP Financial Services for computer networking equipment.
19. State and Local Government Single Schedule Lease Purchase Agreement with HP Financial Services for server/san equipment to be installed at the Dauphin County Prison.
20. Software License Agreement with Aptitude Solutions, Inc. (Recorder of Deeds).
21. Approval to pay Morgan, Lewis & Bockius, LLP $7,821.25 for employee policy development.
22. Space Agreement with Hershey Entertainment d/b/a Hotel Hershey to temporarily relocate radio equipment from the Milton Hershey School property.
23. Agreement with Crabtree, Rohrbaugh & Associates for the complete demolition and disposal of the modular housing units at the Dauphin County Prison.

FORMER BUSINESS

(There was none.)

NEW BUSINESS

(There was none.)

COMMISSIONERS' DISCUSSION & ACTIONS

Mr. Haste: Any discussions by the Board? (There was none.)

CORRESPONDENCE

Mr. Haste: See the correspondence that has been received by the Board in the past week, which will be handled by the staff appropriately.

1. Receipt of a copy of a letter from Herbert, Rowland & Grubic to Barry Hoffman of the PA Department of Transportation enclosing bridge inspection reports for the following bridges: BR-11, BR-28, BR-54N, BR-122, McClay St., Paxton St., HBG-9, HBG-10, HBG-12, HBG-13, HBG-19, HBG-16, and HBG-24.
2. Notification from Millersburg Area Authority indicating that they plan to submit an application for an NPDES Permit for the Millersburg Area Authority Wastewater Treatment Plant, which would renew or replace the existing permit allowing the Authority to discharge treated municipal wastewater into the Susquehanna River.
3. Notification from Mellott Engineering, Inc. indicating that Harry H. Fox, Jr. will be filing an application with DEP for an NPDES Permit for the "Abbey Meadows" residential subdivision located in Washington Township.
4. Notification from Mary J. Esquivel that she is applying to DEP for a BWM-GP-11 Permit for the removal of an existing mobile home and replacing with newer model of mobile home, using same footprint in Middle Paxton Township.
5. Notification from Camp Hebron indicating that they plan on submitting an application to DEP to renew an existing NDPES Permit to discharge up to 19,400 gallons per day of treated effluent into Powell's Creek.
6. Notification from United Water indicating that they are in the process of applying to DEP for a permit to slip-line an existing 16" water main under the Susquehanna River. This project includes creating a temporary entrance to the work site and digging an access pit near the river.
7. Notification from Harsco indicating that MultiServ has submitted a renewal application for a State Only Permit plan approval to DEP. The air pollution source requiring a permit renewal is located on the grounds of Mittal Steel in Steelton.
8. Notification from Fischbach Morgan & Associates, LLC indicating that Lesher Realty Partnership is applying to DEP for a GP-4 Permit Application for the removal of an existing stormwater management facility, new discharge pipe and outfall in Middletown.
9. Notification from Librandi's advising that their Operating Permit Renewal application will soon be completed and submitted to DEP.
10. Receipt of a letter from the PA Department of Community Economic Development enclosing a copy of the notice advising the public of the availability of the Draft Action Plan for 2006, which is the second supplement to the Consolidated Plan for 2004-2008.
11. Notification from ARM Group, Inc. indicating that the Country Club of Harrisburg has filed a Groundwater Withdrawal Application and Consumptive Water Use Application with the Susquehanna River Basin Commission for the withdrawal of groundwater from two recently-installed irrigation supply wells, and for the consumptive use of water associated with golf course irrigation.
12. Notification from CET Engineering indicating that the Lower Paxton Township Authority is submitting notification to use General Permit 3 for the stabilization of the channel of an intermittent tributary to an unnamed tributary to Paxton Creek located in Brightbill Park.
13. Notification from the East Hanover Township Public Safety Advisory Council indicating that they intend to register the use of two General Permit 4 at sites within East Hanover Township for the installation of two dry hydrants at approved locations.

PUBLIC PARTICIPATION

(There was none.)

ADJOURNMENT

It was moved by Mr. DiFrancesco and seconded by Mr. Hartwick that the meeting adjourn. All were in favor.