​NACo 2014 Healthy Counties Initiative Forum

Improving Health in a Climate of Change

The 2014 Health Counties Initiative Forum: Improving Health in a Climate of Change was held January 30-31, 2014 in San Diego County, CA.


Emmanuelle St. Jean
Program Manager

Program Description

​The Affordable Care Act (ACA) creates new opportunities for counties to improve both community and employee health. Some counties are using the ACA to create and maintain Accountable Care Communities (ACCs). This model of care permits counties to align and prioritize the needs of their residents and employees to prevent disease and reduce health care costs. Counties can begin to create ACCs  by addressing employee health and integrating primary care and behavioral health services to serve individuals living with mental illness and substance use disorders. 

During this one and a half day forum on catalyzing, advancing, and sustaining health changes in your county in the new health care world, participants explored various models and practices for improving community health. They also learned:​

  • The role(s) counties can play in developing ACCs.
  • Viable and efficient strategies for addressing the challenges counties face in serving individuals living with mental illness and substance abuse.
  • How employee wellness programs can be used to drive and sustain a healthier community. 

This forum was offered as part of NACo's Healthy Counties Initiative, which supports innovative public-private partnerships within the many areas of health that counties are involved with and highlights county health best practices enhanced through collaboration with the private sector.


Thursday Sessions

Accountable Care Communities 101

Various care models have been proposed to address the lack of care coordination and the disparities in the quality of care and costs. However, few models of care incorporate all facets of the community and leverage all of the community’s resources. A new initiative, Accountable Care Communities (ACCs), creates a broad-based coalition to improve the health of the community, achieve cost savings, and improve the community’s economic vitality. During this session, participants will learn (1) what novel ways are being used to improve the health and wellness of counties and (2) how they can leverage their counties’ existing resources.

  • Moderator: Mr. Nick Macchione​, Director, Health and Human Services Agency, San Diego County, Calif.; NACo Healthy Counties Initiative Advisory Board Vice Chair
  • Ms. Donna Skoda, Assistant Health Commissioner, Summit County, Ohio
  • Ms. Jennifer Flynn, Senior Director, State Affairs, Premier, Inc.

Engaging Federal and State Partners

Creating and sustaining healthier communities requires synergy of the economic, social, and physical environments. Counties have long been at the forefront of leveraging their resources beyond traditional health entities and partners to improve health. In recent years, the state and federal governments have worked to enhance the work of counties to ensure there is a lasting impact at the local level. Participants will learn how state and federal governments are working with counties to advance policies and programs to support healthy counties.

  • ​Moderator: Mr. Nick Macchione, Director, Health and Human Services Agency, San Diego County, Calif.; NACo Healthy Counties Initiative Advisory Board Vice Chair
  • Ms. Nadine Simons, Regional Health Administrator, Region IX, United States Department of Health and Human Services
  • Ms. Melissa Hansen, Program Principal, National Conference of State Legislators

What about the Data?

When reforming and/or creating a delivery system of care, it will be critical for counties to utilize data across systems from various sectors. This session will discuss how to engage insurers and consider challenges and opportunities of the data needs counties require from partners to effectively develop and/or participate in an ACC. How can systems communicate and what data are needed?
  • Moderator: Mr. Nick Macchione, Director, Health and Human Services Agency, San Diego County, Calif.; NACo Healthy Counties Initiative Advisory Board Vice Chair
  • Mr. Clarence Williams, Vice President, Accountable Care Solutions Regional Head of Sales, Aetna – Accountable Care Solutions

Keynote Luncheon: Using Information for Better Outcomes​

What do you do once you have all of the data and information? What does it all mean? Esri, a Healthy Counties corporate sponsor, will present how geography can help bring your data to life. By understanding the demographic composition and lifestyles of neighborhood residents, you can better understand the needs of your county, make better informed decisions, and work towards improving the overall health of your community.
  • Ms. Angelica Baltazar, Health and Human Services Specialist, Esri

Wellness: Engaging Employees to Drive Behavioral Change​​

A critical component of Accountable Care Communities is enabling health improvements among residents and employees. As employers, counties can influence their workforce to drive change in their communities through wellness programs. This can lead to a reduction in health care costs and increase productivity. In this session, participants will learn (1) what type of wellness programs urban and rural counties are offering their employees and (2) how they encourage and sustain employee participation in wellness programs.
  • Moderator: Ms. Jan Mazone, Deputy Director, Human Resources, San Diego County, Calif.
  • Ms. Cindy Jones, Treasurer, Hopkins County, Ky​
  • Mr. Dave Douglas, National Vice President of Sales, Healthstat, Inc.

Exploring Cost Drivers

This response session will explore 10 questions county elected officials should be asking to better understand cost drivers among county employees’ health care coverage. The discussion will also explore how they can use the answers to those questions to ensure appropriate coverage and prevention activities that result in better outcomes and controlled costs over a long term period.
  • Moderator: Ms. Jan Mazone, Deputy Director, Human Resources, San Diego County, Calif.
  • Ms. Cindy Jones, Treasurer, Hopkins County, Ky.
  • Mr. Dave Douglas, National Vice President of Sales, Healthstat, Inc.

Creating Healthier Counties with the Criminal Justice System as Your Partner 

There are unconventional partners in a coordinated and integrated care system. Jails, which are often overlooked, interact with many vulnerable individuals. These individuals can be engaged to obtain care and treatment, which can ultimately impact recidivism. The criteria and process for enrolling individuals for health insurance will be discussed during this session in addition to using technology as part of the continuum of care. 
  • Moderator: Hon. Jim McDonough, Commissioner, Ramsey County, Minn.; NACo Healthy Counties Initiative Advisory Board Chair
  • Ms. Farrah McDaid Ting, Associate Legislative Representative, Health and Human Services, California State Association of Counties
  • Ms. Barbara Lee, Medical Services Administrator, San Diego County Sheriff’s Department, San Diego County, Calif.
  • Ms. Kristen Guillaume, Vice President and General Manager, Public Sector, Netsmart Technologies Inc. 
  • Ms. Teri Vetter​, Practice Director, Public Sector, Netsmart Technologies Inc.

Friday Sessions

Counties continuously grapple with how to deliver quality and effective mental health services to their residents. Integrating primary care and behavioral health can be a key component of creating an Accountable Care Community. During the first hour of this session, leaders from community health organizations and the private sector will discuss various models and strategies for integrating behavioral health efficiently. In the second hour, county officials will share their perspectives on the challenges they face in serving those living with mental illness and substance use disorders and how they are addressing them.
  • Mr. Charles (Chuck) Ingoglia, Senior Vice President, Public Policy and Practice Improvement, National Council for Behavioral Health
  • Ms. Marianne Burdison, Senior Director, Strategic Alliances and Development, Cenpatico
  • Mr. Pat Fleming, Director, Behavioral Health Services, Salt Lake County, Utah
  • Mr. Mark Refowitz, Director, Health Care Agency, Orange County, Calif.
  • Hon. Felicia Brabec, Commissioner, Washtenaw County, Mich.
  • Ms. Trish Cortes, Executive Director, Washtenaw Community Health Organization, Washtenaw County, Mich.

Transforming Rural Counties into ACCs

Like urban counties, rural counties are exploring new ways to improve care and reduce costs. Despite challenges such as geographic location, small and older populations, the scarcity of financial resources, the need to acquire new technologies, limited workforce, and access to care rural counties have implemented solutions such as Accountable Care Organizations and collaborative community health initiatives to address the needs of their communities. This session will explore some of the ways counties with modest resources are leveraging their existing resources to improve the health of their communities.
  • Moderator: Ms. Terry Speiker, Chief Assistant County Administrator, Contra Costa County, Calif.; NACo Healthy Counties Advisory Board Vice Chair
  • Ms. Mimi Khin Hall, Director, Plumas County Public Health Agency, Plumas County, Calif.
  • Dr. Clint MacKinney, M.D., M.S., Deputy Director and Assistant Clinical Professor, Rural Policy Research Institute Center for Rural Health Policy Analysis; Department of Health Management and Policy, College of Public Health, University of Iowa

Opportunities for Building Partnerships that Create and Sustain Healthy Counties

One of the most critical elements of creating Accountable Care Communities is building partnerships to achieve goals. CBS EcoMedia, a Healthy Counties corporate sponsor, will discuss how they partner with counties and the private sector to fund WellnessAd projects.
  • ​Moderator: Hon. Joan Garner, Commissioner, Fulton County, Ga; NACo Healthy Counties Advisory Board Vice Chair
  • Ms. Janice Sakamoto, Vice President, Strategic Partnerships and Public Affairs, CBS EcoMedia

Optional Innovation Tour – Access2Health Center​

The County of San Diego Health and Human Services Agency (HHSA) first developed a comprehensive call center in 2010 to address increasing demand for Supplemental Nutrition Assistance Program (SNAP) benefits. Having this enhanced capability perfectly positioned San Diego County to manage increased enrollment volumes as Medi-Cal expanded under the Affordable Care Act.

This tour will highlight the center’s activities and will include a presentation on HHSA’s Knowledge Integration Program and the private, public, and non- profit collaboration currently developing health and social service information exchange for San Diego County.


Centers for Disease Control and Prevention’s National Healthy Worksite Program
The National Healthy Worksite assists employers, including counties to promote evidence-based wellness programs. More information can be found here.  To learn about counties selected for the National Healthy Worksite Program, please click here

The Rural Assistance Center
The Rural Assistance Center is a U.S. Department of Health and Human Services “information portal.” Information regarding programs and funding can be found here​.

The American Public Human Services Association’s A-87 Exception Toolkit for Human Service Agencies
This toolkit provides information and guidance on the use of federal funds for enhancing eligibility and enrollment systems and the integration of health and human services system

Fostering Sustainable, Integrated Medical and Behavioral Health Services in Medical Settings
A peer-reviewed article written by Dr. Manderscheid, Executive Director of the National Association of County Behavioral Health and Developmental Disabilities Directors, discusses creating and implementing a sustainable integrated behavioral and primary care services model.