As we continue to reel from the horrific events on Patriot’s Day during our beloved Boston Marathon, we think of the bravery of our race organizers, first responders, medical personnel and bystanders who cared for the injured at the scene and continue to work day and night to help the families and survivors. We send prayers of healing to the families and friends who lost loved ones and all who were affected by this tragedy.

We thank our medical colleagues for their courage and strength and continue to reach out to them in this difficult time as they cope with the trauma of what they have experienced. We have seen the outpouring of love and care for everyone involved with text messages coming from all over the world checking on the safety of family members and friends. We send our support to our colleagues in college health who are caring for those who have lost family members and friends, those who were injured physically and those with emotional scars. It will take a while for us to all heal, but we Bostonians are strong and resilient and our police and security will help make our fair city safe once again. The spirit in Boston will prevail with the theme of the 2013 ACHA Annual Meeting – Service to Others and Compassion for All. We look forward to welcoming all of you to Boston in May.

ACHA 2013 Annual Meeting – Boston, MA

We are in the final planning stages for the annual ACHA meeting to be held in Boston with the theme – Service to Others, Compassion for All to be held from May 28-June 1 at the Marriott-Copley Place – make sure to register and make your reservations soon as we expect a record attendance for a program filled with of great speakers and innovative ideas.  This is the first time in many years that the meeting is being held in our region, allowing many of our staff to attend – we would love to see you there!! To register: www.acha.org/annualmeeting13/

ACHA Board Meeting – Feb. 2013

Joleen Nevers, MAEd, CHES, AASECT (our Region V Representative) and I recently attended the winter ACHA Board of Directors’ meeting in Baltimore, Maryland.  I am happy to say that we had a very successful beginning to our strategic planning initiative.  ACHA is taking this step to focus the organization’s attention on the most important issues for our members.  I hope to report more about the ongoing process after the next board meeting, which will be held in Boston at ACHA’s Annual Meeting.

ACHA 2013 Award Winners

Join me in congratulating John Miner (Williams College) who was selected as an ACHA Fellow, Denise McGoldrick (Amherst College) who was selected to be the recipient of the E. Dean Lovett Award and Barbara McCall (Castleton State) who was selected for the NECHA Affiliate New Professional Award.  We are grateful to those who took the time to send in nominations for these awards.  We have so many talented members – it is so nice to see them recognized.  Please join us for the awards dinner on Thursday, May 30 to celebrate these hard working professionals!

• ACHA Fellow
• John Miner, MD is a psychiatrist and co-director of Psychological Counseling at Williams College in Williamstown, MA. He has been at Williams College since 1997. He has served on the board of NECHA and also has been chair and an active member of the ACHA and NECHA program planning committees for many national and regional meetings. He has been a major force behind mental health programming at both the national and regional level. John has been a major proponent for increased collaboration between counseling and medical services, and has helped many of our colleagues take steps to accomplish this.  He is a superb clinician and is sought after for consultation on difficult cases.  He graciously shares his expertise with others and has been a role model for many.  He most recently was the recipient of the NECHA President’s Award in 2011.
• E. Dean Lovett Award
• Denise McGoldrick, MS, MCHES is a well-respected leader in health promotion and college health and is currently the Director of Health Education and Assistant Dean of Students at Amherst College in Amherst, MA.  She has been an active volunteer in NEHEN, NECHA and ACHA for many years.  She has represented health promotion on the annual conference planning committee for 8 years. She was elected to the NECHA board of directors in 2009 as member-at-large, and has continued as secretary and is now the president-elect of NECHA. Denise is a tireless volunteer and has served on the ACHA credentialing committee and assisted in approving CHES requirements for regional and national conferences. Denise has also been an active member of the New England Health Educator’s Network (NEHEN), a group of health educators from New England that meets twice a year and has an active listserv.
• NECHA Affiliate New Professional Award
• Barbara McCall, MPH, CHES has been the Coordinator of Campus Wellness Education at Castleton State College in Castleton, Vermont since the spring of 2011.  In a very short time, she has transformed the health promotion programming at the college.  She created a “store” in the Wellness Center with discounted health supplies, many tabling and poster campaigns and a wellness website.  She has also developed many evening workshops for students on topics including nutrition, stress reduction, resiliency, sleep, sexual health, smoking cessation and others.  She has provided leadership in her role as co-chair of the Alcohol and Other Drug Task Force, implementing BASICS training for many and e-check up for incoming students. She has made a significant impact on the wellness of the college health community at Castleton State in just two years.

Other news from the ACHA Board meeting:

• ACHA is considering drafting a statement in support of same sex marriage.  Two members of the Board were charged with developing a statement – stay tuned for more information about this.
• The board continues to discuss restrictions on speakers who stand to benefit financially from speaking at the national conference.
• ACHA has replaced the former “consultation” services that they offered with a new program called “Peer Review Assistance Program” – see details on the ACHA website.
• The Board members participated in a 12-hour strategic planning exercise as they reviewed the former strategic plan, goals and objectives, and developed the beginnings of a new strategic plan.  This plan will continue to be developed at the next board meeting in Boston in May with hopes that soon a strategic plan will soon be in place – one which is a “living document”, responsive to the needs of the organization members and the changes in society.

The Affordable Care Act has been ruled constitutional by the Supreme Court. Now what?

The Supreme Court’s decision on the Affordable Care Act has paved the way for continued enactment of this historic legislation… unless the upcoming election doesn’t go President Obama’s way or some other roadblock is devised. What does this mean for college health? At this stage, it looks like the major changes we’re facing have to do with the scope and structure of student health insurance packages and how they dovetail with our service structures. As I understand it, the changes apply to policy years that start on July 1, 2012 or after. The future is now.

We have a golden opportunity to utilize the changes ACA brings to cement the value of our health centers to our institutions. I recently spoke with an executive from a major, very advanced primary care system in Boston. He described the three pillars of primary care as population focus, access, and cost effective. I think we are competitive in each of these arenas.

The ability to deliver population-focused medical care is perhaps our strongest suit. The transition away from Women’s Health as a major objective of college health has been accelerating in recent years. Changes in Pap testing guidelines have made Paps (but not gynecologic/sexual health care) unnecessary for most of our students. Cultural mores around contraception have many young women coming to college already on contraception instead of needing special help to access it. College health at many of our centers has become adolescent medicine more broadly, enhanced by invaluable local knowledge. We bring compassionate expertise in communicating about, diagnosing and treating this population along with an understanding of our specific college environments and skills in helping students optimize available resources to succeed. In addition, we treat at the population level by acting as public health agencies for our campuses, managing anticipated events like H1N1 and smaller scale episodes such as outbreaks of scabies, head lice, Norovirus, mumps and other communicable diseases.

While trying to carve out an identity as something other than a walk-in center continues to bedevil many of us, there is little doubt in my mind that we succeed at access much better than do most local office practices, if only because so few of our patients schedule their visits ahead of time. Students that are sick or injured can often be seen the same day and evening and weekend hours are common.

Where it really gets interesting is the question of cost effectiveness. In the open market, and in this emerging era of patient-centered medical homes and accountable care organizations, the challenge is to achieve the best outcomes for patients at the lowest cost. Providers are urged to meet preventive care benchmarks, manage illness and complications in the outpatient arena, prevent re-hospitalization, etc. While I think many college health providers deliver a highly cost-effective style of evidence-based care, how does this play out for those of us not billing insurance for our services? Against whom are we competing and on whose behalf (The students’? The institution’s? Our own?) Will insurance companies continue to accept our prescriptions, radiology orders and referrals without our being “participating providers” in their networks? While we provide primary care, are we really Primary Care Providers? Even when student health centers are open year-round, most students live in close proximity for only eight months out of the year. So what are we? We’re experts at treating college-aged students enrolled in and living at college. Is there a place for us in the new health care landscape?To frame it another way, what is the institution getting in return for our salaries? I would argue the answer is great care that leads to increased student retention and success, but these are hard to prove. We used to be a value-added service for which a fee was charged. Can an institution still charge a student health fee when insurance is mandatory? Do those of us not billing insurance have any way to generate income or are we providing evaluation and consultation services for free? What about revenue streams from OCP’s and other medications. It appears that the ACA will lead to student health insurance plans that offer coverage more commensurate with private insurance, a good thing in isolation from cost implications. But now that, for example, birth control must be covered by insurance, we can no longer directly sell OCP’s to students. Does this mean we should no longer carry OCP’s or that we have to figure out a way to charge them to insurance? How does this apply to other pharmacy services we provide? Is the answer the same for all students or is there one system for students on the student health insurance and a different one for other students?How do we evaluate and modify the services and products we offer so as to be able to continue to offer great care to students and ensure that we remain essential to the people that sign our paychecks? To whom do we turn for answers and guidance in these uncertain times? The answer, friends, as usual, is us: our colleagues in college health and higher ed more broadly with help from ACHA. Remember, this is an opportunity. We need to pull together as a community of professionals to help one another weather this storm. I suspect we’ll look back on passage of the Affordable Care Act as a major turning point in college health. I think we’ll come out of this stronger and more relevant than ever, but it’s going to take work, courage, creativity and patience.Davis Smith, MD
NECHA President, 2011-2012
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