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A
B
C
A
On
the
agenda
today
is
a
minutes
from
10
10,
17
and
10
is
17
17
or
so
the
crew
support
any
discussion.
Seeing
none
all
in
favor
opposed
motion
carries
next
we'd
like
Sisson,
but
if
there's
anyone
from
the
audience
who
would
like
to
come
forward
and
address
their
Commission,
that
would
be
the
time
you
step
up
to
the
mic.
I
see.
No
one
will
move
right
out.
The
petitions
and
communications
first
thing
will
be
the
update
on
them.
They
community
health
clinic
for
our
health
director.
Mr.
Strauss.
D
Thank
You
mr.
chairman
today,
I
want
to
take
the
opportunity.
We've
had
questions
in
the
past
about
how
the
BK
health
clinic
formerly
known
as
a
university
clinic,
operates,
and
so
I
really
want
to
give
some
background
and
tell
you
the
details
of
public
partner
with
Saginaw
Valley
State
University,
to
create
an
integrated,
behavioral
health
and
primary
care
clinic
to
deliver
holistic
and
comprehensive
services.
E
D
Of
itself,
although
we
do
charge
fees
and
we
do
charge
and
Sur
insurances,
it's
truly
an
interprofessional
clinic.
It
has
a
full
complement-
nurse
practitioners,
nurses,
social
workers,
medical
assistants,
occupational
therapists
and
pharmacists,
and
they
offer
an
integrated
type
of
care.
That
is
pretty
unique,
not
only
in
public
health.
We
are
the
only
interprofessional
primary
care
clinic,
that's
attached
to
a
health
department
in
the
state
of
Michigan
and
maybe
for
the
United
States
for
that
matter.
But
it's
also
one
of
the
only
interprofessional
clinics
within
the
state
of
Michigan
itself.
D
Patients
are
cared
for
across
the
spectrum
of
their
healthcare
needs
and
the
workers
that
work
in
a
click
play
an
integral
role
in
the
delivery
delivery
of
therapy
to
a
variety
of
patients,
but
many
with
mental
illness.
But
they're
involved
with
all
patients
from
health,
coaching
motivational
interviewing
to
help
them
achieve
optimal
health
and
supporting
the
entire
team
and
management
of
patients
who
may
not
meet
threshold
for
meeting
the
criteria
of
receiving
services
elsewhere.
D
Today's
presentation
I
want
to
talk
to
you
about
three
basic
things:
number
one:
how
the
clinic
came
into
existence
and
talk
to
you
briefly
about
the
challenges
of
providing
healthcare
in
Bay
County.
Second
of
all,
I
want
to
spend
some
time
talking
about
what
the
clinic
has
accomplished,
especially
in
regards
to
the
partnership
that
has
evolved
with
the
University
and
Bay
Area
neck.
Wait
your
neck
behavioral
health
and.
D
D
F
D
Are
pretty
significantly
lower
Saginaw
bought
one
toe
in
2013,
it
was
one
to
one
thousand.
Eleven
hundred
eighty-three
Midland
was
pretty
close
to
one
to
eleven
hundred.
Sixty
two
state
average
was
about
one
to
twelve
hundred
and
seventy
one
people,
but
the
top-performing
counties
in
the
United
States
at
that
time
was
about
one
to
one
thousand
and
sixty
seven.
Those
numbers
have
gotten
better
throughout
the
nation
and
throughout
the
state
and
our
region,
but
those.
C
D
To
nineteen
hundred
residents-
and
this
slide
demonstrates
to
think
number
one
is
bay
county-
is
losing
primary
care
providers
over
time
and
that
we
are
also
in
a
proverbial
rock
and
hard
place,
because
in
order
to
obtain
any
kind
of
automatic
federal
assistance
for
need
of
primary
care
providers,
you
have
to
be
at
a
1
to
3,000
ratio
and
typically
find
those
in
urban
areas
depressed
urban
areas
or
depressed
rural
areas
and
we're
not
close
to
that
and
I.
Don't
want
us
to
be
close
to
that.
D
D
In
Bay
County
and
you
need
to
see
a
urologist
well,
you
will
probably
have
to
travel
outside
of
the
region,
because
there
are
no
urologist
that
currently
take
Medicaid.
If
you
have
a
child
with
diabetes
here,
you
can
see
an
adult
endocrinologist,
but
you
cannot
see
a
pediatric
endocrinologist
because
there
are
no
pediatric
endocrinologist
within
our
region
here
as
well,
and
there
are
shortages
in
a
variety
of
other
specialty
areas
as
well.
Now,
one.
C
D
That
has
happened
here
is
that
we
have
really
seriously
cut
the
number
of
uninsured
adults
pretty
significantly
with
Medicaid
expansion
and
on
the
bottom.
There
you'll
see
that
there's
about
19,000
individuals
on
Medicaid
and
about
$25
of
Medicare
beneficiaries.
So
if
you
add
those
up
and
that's
nearly
half
of
our
adult
residents
or
residents
here
in
Bay,
County
are
on
some
sort
of
public
payer
system
at
this
given
time.
Additionally,.
F
D
So
it's
a
challenge
to
provide
care
throughout
the
community.
This,
the
one
thing
and
I
don't
want
to
spoil
the
rest
of
the
thing.
But
in
spite
of
these,
these
disparities,
some
of
the
work
that
we're
doing
at
the
Health
Department
and
throughout
the
county
we've
seen
our
county
health
ranking,
go
up
to
34
out
of
83,
there's
83
counties
and
were
considered
by
the
Robert
Wood
Johnson
Foundation,
the
34th
healthiest
County
saggin
eyes
in
the
lower
70s
and
Midland
is
in
the
top
ten.
But.
D
So
the
clinic
origins
happened
in
in
2013
and
it
happened
as
a
result
of.
We
gave
a
variety
of
different
presentations
on
our
community
health
assessment
in
the
need
for
primary
care,
and
we
were
approached
by
the
folks
at
Saginaw,
Valley
State,
University
College
of
Nursing,
because
they
wanted
to
implement
an
interdisciplinary
style
clinic
system
where
they
could
teach
their
nurse
practitioner
and
nursing
students
and
occupational
therapists
students
in
an
interprofessional
manner.
D
But
they
also
had
the
need
to
place
their
students
throughout
the
community
and
they
had
a
hard
time
doing
that
so
Saginaw
Valley
took
the
lead,
they
submitted
a
grant
to
Persa
and
they
were
originally
awarded
in
2014.
This
first
grant
for
about
a
million
and
a
half
dollars
that
grant
helped
establish
what
was
then
called
the
university
clinic
and
it
had
the
five
main
disciplines
there
of
Nursing
health
science,
social
worker,
pharmacy
and
occupational
therapy.
D
So
a
key
objective
of
this
project
is
to
improve
access
to
care,
delivery
models
that
integrated
both
private
care,
behavioral
health
and
to
judge
the
effectiveness
of
the
efforts
to
meet
the
objectives.
With
the
second
grant.
We
started
collecting
data
at
the
beginning
of
the
project,
which
was
last
July
and
then
again,
this
July
as
well
and
over
that.
So
over
that
span
of
the
year,
we
saw
a
33%
increase
in
patients
from
177
to
236
or
had
established
care.
Now
that
doesn't
mean
that
everybody
that
came
through
the
clinic
is
an
established
patient.
D
Sometimes
we
see
people
just
one
time.
Sometimes
we
see
people
for
a
couple
of
visits,
but
then
they
they
don't
establish
care
with
us.
So
we
have
236
in
an
amount
of
at
the
timeframe
of
July
2017
that
we're
receiving
established
care
within
the
clinic.
That
number
has
risen
significantly.
Since
then,
we've
had
amazing
success
with
community
outreach
events
and
we've
been
heavy
between
ten
and
twenty
new
patients
per
week,
and
much
of
that
growth
was
driven
by
the
close
association
with
Bayer
enact
behavioral
health
at
which
I'll
talk
about
on
the
next
slide.
G
D
D
So
it's
well-known
that
individuals
with
serious
and
persistent
mental
illness
have
higher
morbidity
and
mortality
in
part
due
to
poor
management
of
their
chronic
health
conditions
for
persons
with
SP
mi
areas.
Persistent
mental
health
mental
illness
generally
tend
to
live
18
to
25
years
shorter
than
the
average
person
does
so.
D
Establishing
this
integrated
clinic
was
to
directly
address
this
disparity,
the
work.
The
goal
of
the
work
is
to
work
with
behavioral
health
and
other
community
partners
to
identify
those
with
sbmi
that
had
comorbid
chronic
conditions
that
hadn't
seen
a
primary
care
provider
in
the
past
12
months.
Obviously,
these
are
individuals
who
are
at
the
greatest
risk
for
complications
and
overuse
of
health
resources.
Hypertension
and
diabetes
are
the
two
health
conditions
that
we
chose
to
focus
on
this
project
and
we'll
talk
about
some
of
the
things
that
we've
been
able
to
accomplish
with
that.
So
what.
D
What
we're
looking
at
here
is
a
direct
result
of
the
partnership
that
with
babka
forgiveme
behavioral
health,
when
recognizing
that
as
a
patient
is
without
a
primary
care
provider
that
they've
been
funneling
them
to
our
clinic
to
establish
care.
So
when
we
initially
established
a
clinic
about
a
quarter
of
new
patients
had
not
seen
a
primary
care
provider
in
the
past
twelve
months.
But
now
because
of
the
success
to
connect
SP
mi
patients
with
their
primary
care.
D
So
one
of
the
major
accomplishments
that
we
were
able
to
achieve
in
one
year's
time
was
to
reduce
the
number
of
our
clients
that
have
type
hypertension
and
her
diabetes,
with
ER
visits
in
a
12
month
period
and
then
went
significantly
down.
46
percent
reduction
from
41
percent
to
19,
so
in
our
SPM
I
patients
who
have
either
diabetes
or
hypertension.
We've
had
considerable
success,
reducing
this
over
usage
of
the
emergency
room.
D
41%
of
our
visits
had
at
least
one
inappropriate,
ER
visit,
and
one
year
later,
this
is
down
to
19%
some
more
it's
in
a
very
important
measure
in
degrees
measure
of
success
in
terms
of
safe
saving,
valuable
health
care
dollars.
His
emergency
services
are
very
expensive
and
I'll
talk
to
you
two
later,
as
we
go
on
in
the
presentation.
Why
we're
hoping
to
see
some
benefits
with
the
reduction
in
health
disparities
here.
D
D
We
integrated
in
the
clinic
was
to
initiate
Universal
screening
for
depression
and
substance
abuse.
We
have
quite
a
number
of
folks
that
do
come
into
the
clinic
in
the
air'
shopping
for
drugs,
as
you
all
know,
we're
in
the
midst
of
the
opioid
crisis
here,
and
we
have
a
lot
of
residents
and
people
that
could
be
potential
clients
that
are,
quite
frankly,
shopping
for
drugs
a
week.
We
screened
them
right
away.
We
don't
turn
people
away.
We
try
to
help
manage
their
pain,
but
we
will
not.
D
We
will
not
fill
controlled
substances
requests
just
to
just
to
continue
the
addiction
that
is
taking
place,
we'll
try
to
get
these
people
into
treatment
at
baseline.
No
one
received
screening.
One
year
later,
80%
of
the
patients
now
receive
Universal
screening
we're
almost
there
at
a
hundred
percent,
but
not
everybody
that
comes
through
the
doors.
Is
it's
quite
eligible
for
this,
but
once
screen
the
social
workers
are
integral
to
follow-up
for
those
with
mild
to
moderate
depression
and
substance
abuse.
D
One
hundred
percent
received
a
same-day
full
assessment
using
validated
screening
tools
and
appropriate
interventions
that
were
planned,
including
perhaps
antidepressant,
medication
and
brief
intervention.
If
a
patient
is
thought
to
have
severe
persistent
mental
illness,
a
full
assessment
is
conducted
by
social
workers
quite
quickly,
usually.
H
D
D
For
diabetes
outcomes
with
for
folks
that
have
serious
and
persistent
persistent
mental
illness,
we
have
seen
quite
a
reduction
here,
we're
focusing
specifically
on
one
of
the
two
targeting
conditions
which
is
diabetes
and
all
diabetes.
Diabetic
patients.
We
have
a
very
specific
clinical
benchmarks
for
that
that
we
try
to
achieve
and
that's
a
reduction
in
the
a1c
so
on
the
Left
we're
looking
at
how
diabetic
patients,
who
are
also
spm,
I
stacked
up
to
those
compared
to
these
benchmarks.
D
The
national
benchmarks
for
each
of
these
measures
is
50%,
and
so,
as
you
can
see,
as
you
see
here,
we've
exceeded
national
measures
in
all
areas
of
diabetes
care,
except
the
annual
eye
exam.
When
this
was
determined
to
be
an
external
problem
in
that
patients
are
unable
to
get
appointments
with
an
ophthalmologist
for
an
eye
exam.
So
here's.
D
Of
a
specialty
condition
that
is
currently
having
shortages
within
the
area,
but
we
continue
to
make
strides
in
all
of
these
areas
on
the
Left
we're
looking
at
clinical
outcomes
of
diabetic
patients
who
are
considered
to
be
in
Port
Control
and
the
kind
of
benchmark.
Is
you
don't
want
to
have
anyone
your
anyone
with
diabetes,
having
an
hemoglobin
a1c
greater
than
9%
and
of
the
40s
BMI
patients
who
have
diabetes
and
received
care
at
Bay,
Community,
Health
Clinic?
D
So
the
key
objective
of
this
initiative
is
to
provide
a
unique
training
ground
for
future
health
professionals
and,
as
part
of
an
interprofessional
team.
The
nurse
practitioners
work
with
Social
Work
students,
along
with
students
from
nursing,
occupational
therapy
pharmacy
and
health
science.
Students
learn
critical
critical
skills
to
facilitate
a
patient-centered
team
approach
and
to
this
day
over
sixty
students
from
SVSU
Ferris,
State,
University,
Michigan,
State,
University
and
State
University
have
had
a
clinical
immersion
experience
at
the
Bay
Community
Health
Clinic
and
after
graduation
they
are
able
to
apply
these
valuable
skills
at
their
new
practice.
D
About
future
growth
and
opportunities
and
some
of
the
challenges
that
we
have
as
far
as
future
growth
and
opportunities,
I'm,
proud
to
say
now,
thanks
to
the
hard
work
and
efforts
of
my
staff,
is
that
we
are
fully
credentialed
for
Medicare.
So
we're
now
able
to
see
folks
with
Medicare,
especially
folks,
that
have
both
Medicaid
and
Medicare
so
we're
both
able
to
leverage
those
funding
sources
as
well.
D
D
The
challenges
are
pretty
significant,
though
in
Michigan
Medicaid
expansion
will
reach
its
four-year
birthday
in
2018
and
in
April
of
2018
beneficiaries
will
be
required
to
start
paying
co-pays
deductibles
and
must
submit
to
program
requirements
that
reflect
work,
status,
etc
or
be
dropped
from
the
rolls
of
Medicaid
and
that's
a
pretty
significant
amount
of
the
population.
We
see
a
pretty
steep
increase
within
2014
and
2015.
Currently.
I
D
Are
very
little
to
no
incentives
for
the
managed
health
plans
to
maintain
in
areas.
So
that's
one
of
the
challenges
ever
facing
on
this.
We're
also
also
facing
challenges
within
funding
cuts
at
the
state
in
the
national
level
and
what
happens
in
Washington
will
no
doubt
flow
directly
here
to
Bay
County
to
the
state
of
Michigan
and
intubate
County.
But
despite
all
that,
we've
been
able
to
accomplish
this
without
spending
$1
of
general
fund
general
funds,
and
it's
one.
D
Accomplishments
here
at
the
Health
Department,
but
I
do
want
to
specifically
thank
the
county
executive,
Jim,
Barcia
and
the
board
commissioners
yourselves
for
supporting
this
project.
I
also
do
want
to
give
my
thanks
to
Saginaw
Valley,
State,
University
and
Dean
Judi
rule
and
dr.
Kathryn,
Shakman,
and
especially
Chris
chesty,
who
came
aboard
in
the
last
few
months
and
has
really
provided
some
much-needed
assistance
and
leadership
within
the
clinical
setting
itself.
And
finally,
the
partnership
wouldn't
be
complete
without
bein
at
behavioral
health
authority
as
well.
J
Yeah
a
chance
that
the
Health
and
Human
Services
Committee
meeting
of
Mac
to
talk
about
our
program
and
nobody
else
have
a
program
what
you
say.
So
some
of
the
other
economy
seem
interested,
I
mean
they
have.
Universities
are
there
and
their
companies
also
that
they
could
do
the
tech
program.
So
I
think
it's
and
I
agree
about
the
Medicaid
finding
providers.
We
have
to
some
people
down
the
flips
and
Detroit.
Sometimes
for
especially
dermatology
is
one
of
them.
I
know
Flint.
We
have
to
send
a
lot
of
them
down
that
way.
E
With
that
president
down
the
sand
was
I,
think
recognizing
kind
of
the
efforts
that
all
of
you
have
made
and
a
truly
is
a
collaboration
with
Saginaw,
Valley,
State,
University
and
Bay
County
and
truly
is
unique.
So
I
applaud
the
Board
of
Commissioners
for
in
yourself
for
launching
it
in
Bay
County,
and
it
certainly
is
recognized
an
absolutely
phenomenal
program
for
our
residents
and
it's
a
win-win
for
the
students
as
well.
E
The
Health
and
Human
Services
Sciences
student
centers,
for
you
have
an
opportunity
to
interact
with
with
real
patients
and
and
to
gain
that
valuable
experience
before
they
complete
their
degrees
and
go
out
into
the
job
market
in
the
healthcare
field.
So
Thank
You
Joel
for
the
tremendous
job
in
your
leadership
and
all
of
the
dedicated
staff
to
health
department
and
really.
E
D
A
Thank
You
Joel
is
great,
congratulate
mr.
Barstow
congratulations.
This
is
a
lot
of
work
and
the
staff
is
great
he's
going
to
great
job.
Thank
you.
So
much
any
motion.
Your
seat,
please
University
support
discussion.
All
in
favor
motion
carries
next
up.
We
will
have
an
update
on
the
Wellness
Center
from
my
Jeanne
decorate
another
one
of
our
projects
that
you
work.
Somebody
works
hard
on.
F
Thank
you.
Look.
We
just
want
to
give
a
brief
update
on
the
walnut
Center
and
how
everything
is
going
over
there.
As
you
know,
we
implement
it
in
2014
and
it
is
still
under
agreement
with
the
Pats
into
a
family
health
care.
Our
goals
continue
still
to
be
a
preventative
health
care
that
would
be
getting
people
to
go
to
the
doctor.
As
you
know,
we
did
change
our
plan,
so
we
do
not
require
people
to
go
to
have
the
lower
deductible
plan.
We
change
that
in
2016.
So
now
people
are.
F
On
their
own
annually,
so
that
has
been
a
very
positive
outcome
of
the
Wellness
Center
also
routine
event.
Here
people
can
go
to
the
Wellness
Center
for
colds
stitches.
They
can
have
always
checked
that
kind
of
thing
and
that
keeps
people
out
of
Urgent
Care
in
the
ER.
So
that's
saved
a
lot
of
money
for
our
staff,
as
well
as
the
County
diabetes
management,
hurt
conditions
any
go
there
and
talk
to
every
Wednesday.
F
Generic
medications
continue
to
be
free
and
those
have
increased.
It's
pretty
much
all
generic
medications.
Now
the
ones
that
people
would
have
to
pay
for
would
be
the
higher-end
medications.
There
is
four
locations,
the
base
city,
one
averin
Midland,
and
now
there
is
Saginaw,
and
that
opens
this
year.
The
biggest
utilizers,
of
course,
are
Bay.
City
and
Auburn.
Midland
did
change
providers,
but
there's
been
quite
a
few
people
starting
to
go
out
there
as
well
and
Saginaw
increase
their
hours.
They
began
this
year,
so
they
have
a
full-time
provider
out
there
for
anybody.
F
In
that
area,
you
can
utilize
that
facility
now
extended
hours.
We
do
see
most
of
the
people
that
go
go
anywhere
from
12
until
7
in
various
days,
I
know
Wednesday's
for
sure
the
long
centers
open
and
be
City
until
7
o'clock,
so
I
do
track
all
of
the
hours
from
the
reports
that
they
send,
and
that
is
the
main
time
that
people
is
between
the
hours
of
12
and
7,
and
Monday's
is
the
biggest
day
that
people
seem
to
go
to.
F
The
Wellness
Center
they're,
like
I,
had
mentioned
that
health
counseling
may
refer
people
out,
one-on-one
you're,
basically
in
the
room
with
the
physician,
and
you
are
free
to
talk
about
whatever
you
need
she's,
not
in
you
out
like
you
can
be
in
there
for
a
half
an
hour.
If
you
need
to
they're
shorter
wait
times
in
the
waiting
room.
I
know,
I've
had
a
lot
of
comments
about
that.
F
F
For
our
health
insurance,
we
might
have
some
across
here.
The
system
in
terms
of
the
office
visits,
preventive
labs
and
the
person
scription
still
go
through.
Eh
I
am,
but
those
are
on
a
lower
rate.
We
have
a
separate
plan
with
them
for
the
Wellness
Center
we
did
implement
in
the
Auburn
practice
and
dot
physicals
for
anybody
that
has
a
trip,
driver
or
needs
that
on
their
drivers
license.
So
that
is
free.
Where
is
outside
of
the
loan.
The
center
be
up
to
120
dollars
to
pay
for
that
sports.
F
Also,
and
the
biggest
thing
is
the
employees
do
not
pay
anything
on
the
backend
for
the
Wellness
Center.
Thanks
to
you,
we
don't
have
that
again
this
year.
So
this
is
where
we're
at
through
September
of
this
year
and
as
you
can
see
about,
267
employees
have
went
69
of
the
365
eligible
retirees,
119
dependents
and
the
98
spouses,
so
the
spouses
are
old,
retiree
spouses
and
eligible
and
employee
spouses.
F
Our
new
appointments
and
return
appointments,
as
you
can
see
the
first
year,
there
was
a
lot
of
new
appointments
in
regards
to
people
going
initially
and
then
it
has
since
decreased
off
the
return
appointments
last
for
27
teams
just
through
September.
So
that's
why
that
may
look
a
little
bit
lower.
We
do
see
an
increase
in
people
going,
the
bouquet
dough
over
$14,000
for
their
files,
and
that
is
the
$18
flat
fee
for
every
new
patient.
F
F
So
this
is
our
office
visit
in
our
clinic.
Compete
for
our
employees
is
$30
for
office
visits,
no
matter
where
they
go,
except
that
alone
this
summer
and
for
non
preventative,
routine
visits
where
you
might
go
for
a
cold
or
structural
or
something
like
you
might
have
her
condition
going
on.
You
would
normally
pay
$30
outside
of
the
one
last
Center,
so
we
have
saved
the
employees.
F
G
F
C
F
F
F
The
contents
by
location
I
only
did
a
figure
on
this,
just
to
kind
of
show
you
that
maybe
the
other
30
percent
are
going
to
the
Wellness
Center
concei,
don't
necessarily
live
in
a
convenient
location,
324.
The
contracts
that
can
go,
live
in
Bay,
County
and
then
outside
of
the
county
is
about
E
and
that
doesn't
count
the
kids
that
are
at
college.
The
husband's
that
work
out
of
town,
a
child
of
8
at
the
parent
in
a
different
city
that
discounts
that
our
employees
at
us
for
that
contract.
F
E
F
C
F
Month
but
our
initial
plan
was
to
pay
for
a
hundred
and
twenty-five
in
January,
regardless
of
50
people
went
or
of
125
people
went
so
then
in
2015,
our
agreement
with
this
contract
was
200
and
then
in
2016
our
agreement
was
250
contracts.
So
in
2016
we
paid
a
minimum
of
ten
thousand
five
hundred
and
sixty
two
dollars
a
month,
just
to
say
that
many
people
were
gonna,
go
our
new
negotiate.
Our
new
agreement
with
total
family
health
care
and
dr.
F
Patz
is
a
hundred
and
fifty
a
month
and
it's
a
flat
rate
throughout
the
whole
year.
So
of
175
employee
contracts
go
in
July.
We
still
are
only
paying
150
for
the
rest
of
the
year,
so
that
save
just
over
four
thousand
dollars
every
single
month.
So
it's
about
a
fifty
sixty
thousand
dollar
savings
per
year.
Just
for
the
new
agreement
with
the
kind.
C
F
Just
on
a
side
note,
with
how
the
contracts
work
week,
a
42
255
a
month
per
contract,
so
say
I'm,
my
family
of
four,
we
paid
forty
to
25
for
my
family,
regardless
we
all
go
or
I
fell.
Does
that
make
sense?
Okay,
as
I
had
to
explain
that
to
some
people
and
I
just
wanted
to
make
sure
everybody
understood
how
that
worked.
So
now,.
K
F
Paying
the
6330
thirty
seven
dollars
and
fifty
cents
per
month
for
the
contracts
for
our
next
three
years
so
2017
through
2019,
is
what
we
have
agreed
with
the
Wellness
Center.
So
there
won't
be
a
staggered
amount
of
contracts
now,
so
that
has
been
a
supermarket
savings
and
with
that
42:25
it's
January
through
December.
So
if
I
don't
go
until
July,
then
we
only
pay
for
me.
My.
F
F
So
feedback
from
employees
they're
really
happy
with
the
providers
the
ease
of
getting
in
and
out
of
the
Wellness
Center
they
took
walk-ins.
That's
when
a
significant
thing,
the
wait
times
and
the
last
word
one
of
the
occurrences
we
have
been
coming
to
the
Wellness
Center
for
a
couple
of
years.
I
invited
myself
and
our
daughters
are
pleased
with
the
proper
professional
service.
F
So
we
do
get
a
lot
of
feedback
each
month
from
them
on
the
center
because
they
do
provide
us
with
reports
and
they
send
members
you
folks
as
well
and
I
do
have
many
spreadsheets
if
you
guys
are
ever
interested
in
seeing
day
of
the
week
times
what
they're
being
referred
for.
You
know
anything
like
that.
If
you
want
to
see
it
all
on
one
sheet,
rather
than
looking
at
every
single
moms'
reports,
I
would
be
happy
to
share
that
with
you
as
well.
I
want
to
thank
you
for
your
continued
support.
F
A
No
questions,
gee
I
just
wanted
to
say
a
lot
of
people
don't
realize
they
I
mean.
We
know
the
Wellness
thing
that
you
do,
but
all
the
other
things
that
go
on
in
the
building.
You
know
for
the
employees
that
I
don't
know
it's
all
over,
but
I
know
it's
here.
I
mean
you
got
stair
walkers,
you
got
the
also.
You
got
special
food
days.
You
know
that
come
up
and
but
you're
always
trying
I
mean
I
know
you
promote
a
healthy
lifestyle,
all
the
employees
in
the
county
and
that's
a
great
thing.
A
You
know
the
Wellness
Center
has
worked
out
well,
for
you
know
everyone
involved,
I
mean
it's
been
a
good
things.
That's
the
board
got
involved
in
a
few
years
ago,
and
you
know
we
even
though
health
care
has
gone
up,
it
hasn't
gone
up
as
much
as
it
could
have
it.
We
didn't
have
the
Wellness
Center,
you
know.
So
it's
been
a
great
it's
a
kind
of
great
money-saving
for
the
county
in
general.
But
thanks
for
all
you
do
mr.
Barr,
sir,
did
you
want
to
say
something
yeah.
E
I
just
like
to
add
the
Chairman's
remarks
and
commend
the
Board
of
Commissioners
for
initiating
the
Wellness
Program
years
ago
and
say
again
like
like
the
clinic
and
also
this
coming
spring.
Hopefully
in
2018
the
dental
services
that
will
be
offered
to
many
residents
in
Bay
County.
What
you've
done
with
a
wellness
plan
for
county
employees
recognizes
tremendous
and
I
hear.
E
A
G
Michelle
:
I
got
ways
and
means
I
asked
you
could
get
the
previous
year's
grants
and
maybe
dn
I
mean,
if
they're
not
going
to
provide
it
to
us,
which
I
think
we
should
see.
Maybe
when
they
provide
that
information
to
you,
you
can
say,
get
us
last
year's
as
well.
So
as
a
board,
we
can
see
what
the
plasters
was.
What
this
and
just.
G
L
L
L
L
L
L
E
L
A
I
H
C
A
C
K
The
experts
in
the
field
of
animals
and
animal
care
and
treatment
and
our
local
experts
that
contributed
so
much
to
our
efforts.
So
hopefully,
you'll
have
an
opportunity
to
look
at
we've
accomplished
what
we
talked
to
yet
accomplished
and
are
saving
like
animals
within
our
community
and
the
outreach
efforts
that
we
are
making.
A
Move
to
receive
I
just
watched
an
ayah.
I
read
that
I
read
it
today.
I
read
the
whole
thing
today
because
of
that,
just
because
I
needed
to-
and
it's
very
it's
very
interesting
and
there's
a
lot
there's
a
lot
of
information
there.
You
know
and
there's
I
can
I
know
all
the
work
that
you
put
into
this
thing.
Yeah
I
realized.
Then
you
spend
a
lot
of
time
on
this
project,
says
mister
Barcia.
You
know,
there's
a
and
a
whole
bunch
of
other
people
that
I
don't
even
know,
but
I
thought.
A
You
know,
I
see
you
two
all
the
time,
but
you
know
there's
a
lot
of
good
stuff
in
there
and
you
know
to
implement
the
whole.
The
whole
project
is,
is
that's
the
next
space,
so
you
know
everything's
done
I
paid
for
now.
I
know
it's
one
piece
at
a
time.
That's
a
great
thing.
Anyone
else
know
what
caused
all.
A
J
Want
to
report
the
Michigan
Association
of
counties
board
of
directors
met
with
Governor
Snyder
last
Tuesday.
They
had
some
questions
for
our
just
briefly.
County
revenue
sharing
is
number
one.
He
says
the
budgets
gonna
be
tight
next
year.
Don't
expect
any
raises
extra
money
floating
around
so
personal.
J
Is
still
an
issue,
some
counties
got
quite
a
bit
back
more
than
more
than
they
had
lost
so
they're.
Looking
at
personal
property
tax
redistribution,
Tiffa
TIF
is
still
out
there.
I
think
in
horror.
Senator
Horan
has
a
bill
pending
about
the
tifa's
and
the
concerns
about
the
special
millage
--is,
going
to
some
of
the
tips
like
libraries
and
whatever
take
a
look
at
that,
and
also
have
the
county's
more
say
in
the
tipless
change
to
change
the
process.
And
then
broadband
was
the
last
issue.
They
brought
up.