Community Planning with Equity Lens Proving Expensive - TribPapers

Community Planning with Equity Lens Proving Expensive

These six-month salaries for MAT team members seem a little high.

Asheville – Buncombe County received two grants from the Dogwood Health Trust totaling almost $1 million. The trust donates funds for addressing “social determinants of health,” and these grants will be applied to opioid interdiction. Like federal grants, these didn’t offset costs but expanded hard-to-cut government activity without provisions for ongoing funding.

Buncombe County Director of Health and Human Services Stoney Blevins said he was excited. He reported the county had already been discussing how to spend the $21 million it would receive from the $26 billion national opioid settlement when Dogwood invited it to apply for planning grants. The county requested $496,472, and Dogwood decided to fund the full amount. Funds are expected to become available Jan. 1.

The county would use the funds to support two new positions, a behavioral health manager and a behavioral health analyst, for two years. The new hires would be responsible for, “coordinating and integrating existing county behavioral health/substance use initiatives across county departments, creating a sustainability expansion plan for these efforts, collaborating with community partners in systemwide efforts, providing community education, and tracking and analyzing data for successful trends with an equity lens.”

Addressing Opioid Epedemic

At a previous meeting, Commissioner Jasmine Beach-Ferrara told how the county had already been defining best practices for opioid interdiction. She, too, said she was excited about the “roadmap and timeline up ahead,” which she hoped would include community input and a visioning process.

Buncombe County Emergency Services Director Taylor Jones announced the second grant. Dogwood had awarded another $500,000 to expand the county’s community paramedic team to include a 24-7 medication-assisted treatment (MAT) team and add one Peer Support Recovery Supervisor position.

The MAT would go beyond providing the emergency treatment and transport expected of paramedics. Additional responsibilities would include connecting patients with wraparound government services and providing education and facilitation for following through with regimens. 

Peer support specialists are persons recovering from substance abuse who are engaged as counselors, “at the community level with an equity lens,” for other addicts. There are proverbs about this. A specialist may not know how to make his peers whole, but he can encourage them to enroll in government services. Insufficient information was provided to discern whether the supervisor was also a “peer;” but, if so, the pay would be good enough to incent thoughts of “sinning that grace may abound.”

The grant was described as providing startup equipment and covering six months of MAT with support from MAHEC. The slide covering costs, however, showed four paramedics splitting $172,462, the Peer Team Lead getting $41,472, and four contractors splitting $100,000. Given that paramedic pay in North Carolina ranges from $25,000-$59,0000; one can only wonder if these numbers were for a full year’s competitive wages, and, if not, where the money was really going.

If the pilot MAT proves successful, Jones said Dogwood might support a second team. Jones would like to add a dedicated team for the homeless population and an air truck. 

Beach-Ferrara and Jones accentuated data from the North Carolina Department of Health and Human Services, showing “unintentional” overdose fatalities “of all intents” in Buncombe County numbered 100 in 2020, down from 105 in 2019. This decrease was compared to a statewide increase of 27%. Even so, Buncombe’s death rate was 38.3 per 100,000 residents, compared to the state’s 28.4, leaving it ranked in the “highest” cluster of counties.

In answer to commissioner questions, Jones replied that, unlike other counties, Buncombe did not have a shortage of paramedics. Instead, it had a very high call volume. The source of another $100,000 in funding was not discussed, but Jones said it would support a psychologist to ride along with the paramedics to enroll folks in services, which was preferable to answering calls three or four times a day to resuscitate the same person. Another success was the enrollment of 500 prisoners in a rehab program with a dropout rate of only 6%.

Funding MAT

A slide, entitled “Sustainability – Funding Sources,” listed three one-time infusions for MAT and nothing more. Fiscal responsibility sustains recurring outputs with recurring inputs, but the grants were presented as a model of sustainability. The opioid settlement was one-and-done; nobody’s planning on COVID persisting at levels requiring massive government bailouts, and if it did, the economy would be destroyed beyond recognition; and, while the county is likely to receive future awards from the Dogwood Health Trust, it must reapply for each. Further, Jones said the county’s application for COVID relief (American Rescue Plan) funding was only in the application stage, and any ongoing partnership with Dogwood was “TBD.”

The most obvious source of sustainable funding, the Laffer curve aside, would be to raise taxes. As a rule of thumb, the county garners about $2 million for every penny in the property tax rate, which is currently 52.9 cents per $100 valuation. So, the county could just raise taxes a cent to cover both grants, another cent to cover added capacity, and so on.

On that subject, counting added capacity as an outcome furthers the flawed governmental practice of counting inputs as outputs. Just as counting labor as an output encourages inefficiencies, counting added capacity provides a perverse incentive to never solve a problem. Of course, nobody wants to deprive people in need of help, but it would be nice if, once in a while, a government program would include an exit strategy; that is, how government is going to heal people right and left and work itself out of a job.

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