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HomeMy WebLinkAboutMINUTES - 09121995 - C146 1 D: BOARD OF SUPERVISORS I.O. -2 y. .. Contra FROM: INTERNAL OPERATIONS COMMITTEE \' Costa o� ,s Count August 7, 1995 - t y DATE: TTq couN{` SUBJECT: REPORT ON MEETING WITH THE HEALTH SERVICES DIRECTOR REGARDING THE PERFORMANCE, ACCOMPLISHMENTS, ISSUES AND FUTURE DIRECTIONS OF HIS DEPARTMENT SPECIFIC REQUEST(S)OR RECOMMENDATION(S)&BACKGROUND AND JUSTIFICATION RECOMMENDATION: ACCEPT this report from the Internal Operations Committee on its meeting with the Health Services Director. BACKGROUND: On June 28, 1994, the Board of Supervisors, at the request of Supervisor DeSaulnier, referred to the Internal Operations Committee a request to develop a procedure which would allow the Internal Operations Committee to meet with each Department Head during the year and report on the Department's activities. A number of Department Heads were heard in 1994. On December 13, 1994, the Board of Supervisors referred this item to the 1995 Internal Operations Committee for the purpose of hearing from the remaining Department Heads. On August 7, 1995, we had the opportunity to meet with the Health Services Director, Mark Finucane. Mr. Finucane presented the attached report to'us and reviewed it with our Committee. While we appreciate the listing of accomplishments provided by the Department, we note that the attached report did not include a number of elements which we have asked all departments-to provide to our Committee, including the financial and human resources which are utilized by the department, a statement of the client profile served by the department, a listing of performance indicators and evidence to support how they are accomplished, a statement of the challenges facing the department and comments regarding the future. In the future, we have asked the County Administrator to identify a standard format and content which is to be followed by every department. CONTINUED ON ATTACHMENT: YES SIGNATURE: RECOMMENDATION OF COUNTY ADMINISTRATOR RECOMMENDATION OF BOARD COMMITTEE APPROVE OTHER SIGNATURE(S): MAR r)eSAI 11 NIF ACTION OF BOARD ON September 12, 1995 APPROVED I)S RECOMMENDED X OTHER X IT IS BY THE BOARD ORDERED that the recommendations of the Internal Operations Committee on the Health Services Department are APPROVED; and the Health Services Director is REQUESTED to report to the Board on September 19, 1995, on the impact in lost revenue to the County as a result of the proposed federal reductions in the Medicare .and Medicaid Programs. VOTE OF SUPERVISORS I HEREBY CERTIFY THAT THIS IS A TRUE X UNANIMOUS(ABSENT I ) AND CORRECT COPY OF AN ACTION TAKEN AYES: NOES: AND ENTERED ON THE MINUTES OF THE BOARD ABSENT: ABSTAIN: OF SUPERVISORS ON THE DATE SHOWN. CC: ATTESTED September 12, 1995 County Administrator PHIL BATCHELOR,CLERK OF THE BOARD OF Health Cervices Director SUPERVISORS AND COUNTY ADMINISTRATOR M382 (10/88) BY DEPUTY I .O. -2 -2- We discussed with Mr. Finucane the net County cost of the Basic Adult Care program, which we understand is about $20 million annually. Supervisor Rogers questioned the extent to which physicians are utilized in the mental health program and urged that their utilization be limited to overall management of the program and prescribing drugs. He indicated that he did not believe it was appropriate for physicians to be doing 1:1 patient therapy. Supervisor Rogers also asked about the status of the new North Richmond Health Center and asked that Mr. Finucane advise him of the location of the new Center. Contra Costa County The Board of Supervisors HEALTH SERVICES DEPARTMENT OFFICE OF THE DIRECTOR Jim Rogers,1st District Mark Finucane, Director Jeff Smith,2nd District WE-SEL o Gayle Bishop,3rd District := =1 _= 20 Allen Street Mark DeSaulnier,4th District ---` Martinez, California 94553-3191 Tom Torlakson,5th District (510) 370-5003 FAX(510)370-5098 County Administrator ,; Phil Batchelor •______ v County Administrator a C61i DATE: August 3, 1995 TO: Internal Operations Ommittee (Supe �isors Sau 'er and Rogers) FROM: Mark Finucane Health Services Director SUBJECT: Health Services Department Accomplishments During the past couple of years, the Health Services Department has faced a number of important challenges. Most significantly, perhaps, is the realization that major changes in the health care industry are occurring faster and more extensively than anyone had predicted. Increased competition,the shift to managed care, and fiscal restraints at all levels of government have made the Department's mission of serving the health care needs of all Contra Costans an increasingly difficult one. As you know, in response to this rapidly changing environment, a few months ago the Department initiated a comprehensive review of it programs and operations to see where changes and improvements were warranted. The committees established to review key elements of the organization and service delivery needs will be submitting their reports and recommendations by the end of August. These recommendations will be used to develop a strategic plan for the future,which will be presented to the Board of Supervisors at a later date. In the interim, the Department has embarked on an educational campaign to provide employees with important information about this new era of competition and prepare them for the changes ahead. Highlights of the Department's recent accomplishments by Division are detailed in the following pages. Attachment Merrithew Memorial Hospital&Clinics Public Health • Mental Health • Substance Abuse Environmental Health Contra Costa Health Plan Emergency Medical Services • Home Health Agency Geriatrics A-345 (12/94) I HEALTH SERVICES DEPARTMENT HIGHLIGHTS OF ACCOMPLISHMENTS PUBLIC HEALTH Clinical Services • Public Health Clinical Services has expanded the use of Family Nurse Practitioners to expand Public Health Clinics for well and sick children, developed integrated Family Planning and Sexually Transmitted Disease clinics, and expanded services offered by the Health Care for the Homeless Program. This increased use of Family Nurse Practitioners in Public Health Clinics has made these services more available to clients for the Health Services Department throughout the county. To ensure quality to these enhanced FNP-based services, a Quality Assurance Committee, comprised of nurse practitioners and physicians, has been developed to upgrade the clinical protocols and clinician training and evaluation. • A school-based health center at Richmond High School was implemented. The Division is now working with Mt. Diablo District to start a second school-based health center in Bay Point, scheduled to begin around December '95. • The Directly Observed Therapy (DOT) program was expanded to include more tuberculosis patients, improving the completion rates for TB therapy from 65% to 94% overall. A paper on the success of our DOT program in TB management in Contra Costa was presented at an international conference in Seattle. • The Sexually Transmitted Disease Mobile Clinic Van services were expanded to include not only STD diagnosis and treatment but also immunization, TB, and HIV testing and referral services. • The County Home Health Agency decreased its costs from $1.2M to $541,000 over the last two years, while increasing the number of visits from approximately 1,900 to 2,600 visits per month. • The Public Health Laboratory has converted to the most modern genetic probe type of assay for gonococcal and chlamydia infection detection, which provides all clinics in the county with simpler, faster, and more accurate diagnostic technique for these important sexually transmitted diseases. Community and Prevention Activities • With the assitance of Public Health staff, the Public and Environmental Health Advisory Board developed a Chronic Disease Prevention Program for Contra Costa County. In addition, a grant was received from the State Department of Health to form a Breast Cancer Partnership to make the early detection and treatment of breast cancer a community priority. This Partnership also makes us eligible for foundation funding to provide treatment for breast cancer for low income women. Other chronic disease prevention activities include nutrition and exercise programs Health Services Department August 3, 1995 Highlights of Accomplishments Page 2 funded from the CDC through the State Department of Health. • Three violence prevention ballot measures and an Action Plan for Violence Prevention (Measure C) were developed and overwhelmingly endorsed by voters in the November 1994 election. • A three-year CDC-funded project to promote the use of bicycle helmets, particularly focusing on children in the Pittsburg area, was begun. • Over 160 lead poisoned children in Contra Costa County were identified, and provided follow up education and case management. An Anemia Task Force to increase community and physician awareness of anemia and lead poisoning as a health threat for young children was initiated. • Funding to develop and implement an after school program for developmentally disabled adolescents at the George Miller Centers was awarded. • The Division implemented a massive countywide tobacco education program to counter the tobacco industry's misinformation about Proposition 188, a tobacco industry-sponsored ordinance that would pre-empt Contra Costa County's local smoking ordinances. • The Healthy Neighborhoods Project pilot was launched, an innovative capacity and leadership building project in Pittsburg and Richmond to improve community receptivity to health promotion. • An HIV and AIDS Prevention Planning Group was convened to develop a long term plan for HIV prevention efforts which meets the mandates of the State and CDC. This plan will be the basis of future funding for HIV prevention programs. • The Division expanded community locations where education, risk reduction counseling, and HIV testing are offered to county residents. These new sites include community colleges, parole offices, and detention facilities, as well as medical providers. HOSPITAL AND HEALTH CENTERS • Merrithew Memorial Hospital and Health Centers completed a successful survey by the Joint Commission in May 1995. Surveyors commended Merrithew and staff for its quality monitoring program, the nursing/physician relationship, the nursing/administration relationship, the commitment to quality, and the system's Health Services Department August 3, 1995 Highlights of Accomplishments Page 3 demonstrated concern for patients. • The expansion of evening and weekend hours at the Pittsburg and Richmond Health Centers was implemented. • A new computerized appointment system was implemented, making it easier for patients to make appointments at the hospital and health centers. A "fast track" appointment system operating within the Emergency Department was also developed. This allows patients with routine and non-emergent medical problems to be seen quickly. • Remodeling of the nursery and the labor and delivery room to accommodate emergency C-sections was successfully completed on the Perinatal Unit. • Installation of TB isolation tents, donated by hospital volunteers, allowed the establishment of a TB control plan for Hospital and Health Centers. • Evaluations for all classifications within Hospital and Health Centers were revised and a classification specific performance competency assessment was developed. • Staff was awarded by the California Association of Public Hospitals for the Management Enrichment Program. • Mission, Vision, and Value Statements were developed and implemented. In addition, the Division developed a strategic plan with staff input. Inpatient and outpatient surveys addressing a variety of concerns from the patient's-perspective were developed and/or redesigned. Over 2,000 responses to patient surveys were received. • Finalized the remodeling and relocation of Specialty Center South, and the remodeling and expansion of Wing 4 at the Pittsburg Health Center. • A Hansen's Disease clinic was opened serving residents throughout Northern California. • A Continuous Quality Improvement team, focusing on patient waiting times, was established. • An extensive provider orientation program was developed and has been conducted twice. Health Services Department August 3, 1995 Highlights of Accomplishments Page 4 CONTRA COSTA HEALTH PLAN (CCHP) • CCHP's revenue from its Medi-Cal, Medicare and Commercial groups was $28 million in 93/94 and totalled almost $30 million in 94/95. New ventures and grants brought in an additional $1.4 million in revenue. • CCHP's premium revenue matched its expenses in both years. CCHP's non-BAC has operated in the black for the past five years. • CCHP was one of six HMO's nationwide to be awarded a developmental grant from HFCA for a Medicare Social HMO Demonstrating Project combining acute medical and community-based services in one managed care setting. • CCHP, the County's Knox-Keene licensed,federally qualified HMO is developing the Local Initiative under the State's plan for Medi-Cal managed care. • CCHP continued its participation in State programs serving vulnerable populations including the "under-insured, uninsured and the uninsurable": • Small business health insurance purchasing pool. (HIPC) • Program for non-Medi-Cal eligibles, low income pregnant women and their infants. (AIM) • Major risk medical insurance program for individuals denied coverage for poor health reasons by commercial plans. • CCHP expanded its Advise Nurse Program to serve fee for service as well as health plan members; acquired a computerized advice program which includes standardized protocols of care and marketed the advice nurse program to other entities. For the past year CCHP has had an advice nurse contract with Solano County to serve their Medi-Cal managed care eligibles. • In support of the Mental Health Division, CCHP established a Psychiatric Authorization Unit in 1995 which performs utilization review on all Medi-Cal psychiatric inpatient and partial hospitalizations. The unit also manages the mental health and referral line for all County residents. • Since January 1995 and on their own time, CCHP employees have raised over $2,500 for a variety of worthwhile charitable causes including providing camperships for needy CCHP members children, participated in the American Cancer Society's "Daffodil Days", and Cerebral Palsy "Casual Day" fundraisers. Health Services Deparbnent August 3, 1995 Highlights of Accomplishments Page 5 MENTAL HEALTH • Over the past two years, the Mental Health Division has decreased its reliance on County dollars and increased its Medi-Cal funding. Medi-Cal reimbursements for FY 94/95 were projected at $8,380,000; for FY 92/93 they were $5,556,000. Because of the Division's aggressive billing for Medi-Cal services, it is the fourth highest county in the state in collection of federal Medicaid dollars. • Beginning January 1, 1995, all Medi-Cal Fee-for-Service dollars statewide were moved into the counties' Mental Health budgets. The Division has managed the inpatient costs well within its budget for the first six months, for a 34% savings. • The State Department of Mental Health recently conducted a Short-Doyle/Medi-Cal audit under the new regulations for the Rehabilitation Option and Targeted Case Management. The audit covered 9 County outpatient programs and 10 contract programs. Total disallowance was only .2%. The County's medication Monitoring System was commended, as was the level of client and/or family involvement in treatment planning. • The Oak Grove Treatment Facility was opened in February to provide short-term crisis residential care and intensive day treatment services for youth ages 8 through 17. Both of these services were vitally needed in the county. This is a complex program, involving funding from a variety of sources and serving children and adolescents who are referred from the Probation Department, Social Service Department and two other counties: Alameda and Solano. This program is a fine example of interdepartmental collaboration and coordination of services. • Two consumers have one full year of experience employed as Mental Health Community Support Workers in the clinic setting. Two additional consumers were hired in October as Mental Health Residential Community Support Workers at Kirker Court and River House. Their job responsibilities include: peer counseling, crisis intervention, community public relations, case management, and group facilitation. • The Division contracted with Mental Health Consumer Concerns to operate a client- run and directed Community Center in downtown Martinez. The Center offers clients scheduled social activities, support groups and educational classes. Despite early opposition from Martinez merchants and city officials, the Center is now an accepted part of the community. • A Mental Health Division Ethnic Services Committee was recently appointed. The 13 member Committee will review all current and future Mental Health services for Health Services Department August 3, 1995 Highlights of Accomplishments Page 6 cultural competency, considering the bicultural and bilingual needs of the clients in our system, and make recommendations to the Division Management Group regarding these issues. SUBSTANCE ABUSE • In July 1994 the women's substance abuse services formerly in the Office for Service Integration and Merrithew Memorial Hospital and Health Centers were transferred to the Community Substance Abuse Services as a Women's Services Unit. The unit includes three outpatient, two intensive day treatment, two case management, and four residential programs to serve women, pregnant women, and women with children aged 0-12 years. • CSAS developed a substance abuse impact evaluation measure to track 10 secondary drug and alcohol related indicators over a five year period -- from 1989 to 1994. Ten indicators, selected through a community feedback process in which more than 120 people reviewed 30 indicators, are currently being developed as a Substance Abuse Indicator Index. The bilingual (English/Spanish) index, which will include 1994-95 data and new indicators, will be developed as a user-friendly community education and planning tool. • The CSAS Division convened a Dual Diagnosis Conference (Spring 1995) to examine gaps in services for individuals who have a mental health and alcohol or other drug abuse problem. The Conference generated a report with recommendations to improve coordination of and access to services between the Mental Health and Substance Abuse Services Divisions. An Oversight Committee was also established to maintain an ongoing dialogue, analyze existing services, determine need for new services, and facilitate implementation of recommendations. • The Bay Area Services Network Project (BASN), a treatment program for parolees, developed a system to monitor monthly utilization rates by treatment provider. This has resulted in a 100% utilization rate and the. ability to document the need for increased funding. • The Family Recover Project -- a substance abuse treatment program serving post- incarceration West County African-American males with children under 18 years of age -- held an Open House, established an Elementary School Outreach Program in Richmond, developed a Job Placement Component, and recently participated in a Drug Court Grant application to the Department of Justice. • In FY 94/95 the Driving Under the Influence (DUI) Diversion Program established Health Services Department August 3, 1995 Highlights of Accomplishments Page 7 a goal to develop a more consumer-oriented approach to service delivery through increased staff/client interaction, and to enhance the program's relationship with the Bay Court District. Only two consumer complaints during the entire year were made, demonstrating significant progress in the area of client satisfaction. Moreover, revenue collection increased, delinquent accounts decreased, and the program had a slight surplus of funds. CSAS installed an E-Mail hookup that has facilitated communication with the Bay Court District which has strengthened collaboration between Court and Program administrative staff. • During FY 94/95 the Community Partnership Project sponsored a number of activities aimed at preventing substance abuse through an approach that values diversity, respects differences and empowers the community through capacity building, leadership development, and advocacy, including: hosted a Youth Summit attended by 250 high school age youth and over 60 youth providers; convened four community forums to provide information on proposed local ordinances and to recruit volunteers interested in a policy approach to substance abuse prevention; and recruited a group of 16 high school age youth for leadership training. • CSAS distributed an updated Substance Abuse Services Resource Guide, a listing of treatment, health care, and children's services in Contra Costa County. EMERGENCY MEDICAL SERVICES • The EMS Message Transmission Network -- the computer dispatch link for EMS dispatching -- was expanded to include CCC Fire, AMR Ambulance, and Contra Costa County Sheriff. Work is in progress to include Richmond Police, Pinole Police, San Ramon Valley Fire, and Alameda county Sheriff. When completed, this network will include all medical and public safety dispatch centers in the county. This will also provide a source of data for EMS responses, including both first responder and ambulance. • A joint EMS/fire training program to provide EMT-I training and certification to fire service personnel was established within the EMS Agency. Draft Standard for Enhanced First Responder Programs at the EMT-I, AMT-I Advanced Airway, and paramedic levels were developed. • Funding was obtained from the state to upgrade the role of the Contra Costa County Health Officer as the Regional Disaster Medical/Health Coordinator for the Northern California Coastal Region. The upgraded role will include coordination of medical/health mutual aid within the region. State funding is now providing a 0.8 FTE staff position in the EMS Agency for staffing and coordination. Health Services Department August 3, 1995 Highlights of Accomplishments Page 8 • The EMS Agency provided oversight and medical direction for the County's first responder defibrillation program. Under this program,all firefighters countywide are trained and equipped in the use of automatic defibrillators to provide electric shock to heart attack victims. During 1994, 428 patients were evaluated for treatment, 123 treated, 21 saved for hospital admission, and 7 discharged from the hospital. Funding from the State EMSA was obtained to fund special projects, including an evaluation of poison control center alternatives, the Highway Injury Record Linkage Software (HIRLS) project and the Firearm Injury Reporting, Surveillance and Tracking (FIRST) project. • Ambulance services under contract responded to 44,473 emergency requests in 1993. Of these, 31,332 resulted in patient transport to a hospital emergency department. • 3,438 trauma patients were evaluated under field criteria established by the EMS Agency. Of these, 1,092 were transported under County trauma protocols to a designated trauma center, usually the County-designated John Muir Trauma Center. • A pilot program at San Ramon Fire Dispatch to evaluate Medical Priorities computerized ProQA medical dispatch system for potential implementation countywide was initiated. ENVIRONMENTAL HEALTH General Program • The Retail Food Protection staff conducted inspections of 3,738 food facilities. The Division provided services free of charge to 361 of these facilities. In addition, staff received and responded to 735 complaints in 1994, and to 481 complaints against food facilities so far this year. • A Management by Objectives policy was implemented for all Environmental Health technical staff. • The Statewide Environmental Evaluation Program System (SWEEPS) service codes were streamlined to accurately track field work. The SWEEPS database was also updated to include plan check services. • The Division provided crucial testimony to the state regarding the need for regulation to insure that solid waste and recycled materials are appropriately separated in the interest of public safety. Health Services Department August 3, 1995 Highlights of Accomplishments Page 9 • The Land Use Program generated $415,000 in FY 94/95, compared to $248,000 in FY 92/93. Approximately 1,300 domestic and environmental well permits and 175 septic system permits were processed during this period despite the sluggish economy that dictates land use team demands. The program is reevaluating the current well and septic ordinances and regulations, and meetings have been held with industry/consumer representatives and the Board of Supervisors and their staff. The tentative date for bringing a new set of ordinances and relations on-line is March 1996. • The Environmental Health Solid Waste Local Enforcement Agency (LEA) underwent its semi-annual state evaluation conducted by the California integrated Waste Management Board. The LEA has been recertified, meeting Title 14 Certification Requirements serving Contra Costa County and 17 cities. Hazardous Materials Program • The following major efforts to streamline inspections were undertaken: • Implemented a 'one-stop shopping" unified inspection effort to perform over 450 inspections of underground storage tanks. • Served as lead agency in ten interagency inspections with the Hazardous Materials Interagency Task Force. • Improved the site remediation protocol at major oil company underground storage tank problem locations to expedite the process while reducing oversight and management cost to the companies. • Instituted a new inspection form for hazardous waste generators that has received favorable comment from inspectors and the regulated community. • The Haz Mat Program worked with the State and the County's District Attorney to improve collection of claims and delinquent fees regarding underground storage tanks and hazardous waste generators. • In calendar year 1994, the Haz Mat Program conducted over 450 underground storage tank inspections; over 750 hazardous waste generator inspections; and over 800 'Business Plan" inspections to help ensure safe chemical use, storage, and reporting. The Program handled nearly 1200 complaints, incidents, and notifications concerning releases of hazardous materials. • Haz Mat responded to six major incidents and developed action items to help prevent similar incidents in the future. Health Services Department August 3, 1995 Highlights of Accomplishments Page 10 • Haz Mat Program staff provided support to the development of the Industrial Land Use Ordinance being prepared by the Hazardous Materials Commission. • The Program played a key role in the planning and implementation of the Community Warning System through membership on the System's Board and participation in several working committees. • The inventory of chemical storage throughout the county was incorporated into a database and is now available on-line. OFFICE FOR SERVICE INTEGRATION (OSI) Family Maintenance Organization • Nearly eighteen months of planning has resulted in a detailed plan for implementation which will be submitted to the Robert Wood Johnson Foundation for funding by the end of August. We are hopeful of a positive funding decision. The FMO will provide parent education and support in homes and community settings for families receiving medical care from our Hospital and Health Centers system. It will also provide intensive assistance to families with complicated medical and social situations. All FMO activities are designed to help families help themselves and to increase the attractiveness and efficiency of our health care system. Service Integration Teams • OSI has fostered the collaboration of the Health Services Department with the CAO, Social Service, Probation and local school districts in creating and implementing the Service Integration Teams in North Richmond and Bay Point. OSI technical participation has focused on specification of program goals, outcomes and indicators, as well as formulating a project evaluation plan. The Health Services Department is providing the following services in the SIT sites: • Substance Abuse Services: Consultation to SIT staff regarding individual and family substance abuse issues; assessment and early intervention with individuals and subsequent referrals to treatment sources; coordination with in-school substance abuse program activities and substance abuse treatment programs. • Mental Health Services: Brief intervention and referral for individual client problems; short term crisis therapy (including groups); consultation to SIT staff. Health Services Department August 3, 1995 Highlights of Accomplishments Page 11 • Public Health Services: Home visiting to families in the target area; coordinating local child health screening and immunization clinics; linking families to medical care resources including problem solving around access and financial coverage concerns. Promoting Healthy Births • Training and technical assistance are key strategies for continuing Contra Costa's progress in reducing infant mortality, especially the excessive mortality of African American infants. OSI provides training to medical providers and outreach and other support programs for pregnant women through the CPSP Roundtable, the Council for Perinatal Health and in collaboration with other programs such as WIC. The training activities encourage the adoption of best practices by exposing staff to the latest research findings, as well as educational materials and strategies for promoting healthy births. Training topics cover such issues as tobacco cessation, HIV education and screening,solving breastfeeding problems,substance use,and domestic violence intervention. • The Perinatal Care Guidance program has served approximately 600 pregnant women in the past 2 years making home visits to assist clients into prenatal care, then tracking them monthly to assure that these women stay in care. During the home visits, women are given health education materials, resources, and referrals not only about pregnancy related issues but family concerns as well. The goal in PCG is to remove those barriers that prevent pregnant women and their families from achieving optimum birth outcomes and family wellness. In the past 2 years, of the 270 births to women that have been followed.by the PCG program, 258 were infants weighing over 5 lbs. i.e., 95% of women case managed by PCG delivered infants over 5 lbs. In addition, during this time period, women in the program averaged a total of 10 prenatal visits to the doctor. • The Comprehensive Perinatal Outcome project was launched -in July 1993 with funding from Prop. 99 Tobacco Tax Initiative. The project employed some unique and innovative strategies to engage the community in efforts to raise awareness about healthy pregnancy including house parties, baby showers, door-to-door canvassing, and resource stations. House parties were conducted by trained community health advocates (CHA's) as an informal, safe means of gathering women, their partners, and children in their homes to present health education, resources, and referrals. Using the Tupperware party approach, "hostesses" were given small gifts such as toasters or baby supplies as an incentive for having the party. In turn, another "hostess" would volunteer to have the next party. Before long, there were 4 and 5 parties at a time that the Health Services Department August 3, 1995 Highlights of Accomplishments Page 12 CHA's were "booking" with plenty of enthusiasm and anticipation from the participants. The baby showers, held in community sites, were also used as a means of gathering pregnant women in a festive atmosphere to deliver health messages and educational materials. During the length of the CPO project, there were 18 house parties and baby showers that included 366 participants. Street outreach in the form of door knocking and other one-on-one contacts resulted in 5,522 contacts. Sudden Infant Death Syndrome • Sudden Infant Death Syndrome (SIDS) is responsible for 19% of Contra Costa's infant deaths each year. Our SIDS Program which gives support to parents after such a death, has become more visible this year through launching a local version of the statewide 'Back to Sleep" campaign. Back to Sleep encourages everyone caring for infants to place them on their back or side to sleep. Research in other countries suggest that SIDS deaths decrease significantly as a result in this change in sleeping position. • Contra Costa's SIDS program also assists hospitals and paramedics to improve their response to SIDS deaths, and has become quite visible at the State level through our advocacy of culturally competent training in grief support for families. SIDS strikes African American infants twice as often as white infants. FINANCE • The maximum Medi-Cal Disproportionate Share Hospital (SB-855) funding of$31.5 million was secured. • The maximum Round #7 Medi-Cal Voluntary Donation Program (SB-1255) funding of $7,000,000 was secured. • A Medi-Cal contract amendment to secure $8.5 million of Round #8 Medi-Cal Voluntary Donation Program (SB-1255) funds was negotiated. • $1.5 million of State SB-90 funds was secured to reimburse the County for Mental Health expenditures made from FY 89-90 to FY 93-94 for"Special Education Pupils." $1.7 million of Federal SLIAG funds (State and Local Immigrant Assistance Grant) was secured for medical services provided during FY 89-90 to FY 92-93. • A contract to provide Solano County Health Plan enrollees 24-hour telephone access Health Services Department August 3, 1995 Highlights of Accomplishments Page 13 to CCHP Advice Nurse services was entered into. • Cash flow, i.e., cash balance as of July 7, 1995, was a positive $28.7 million; in July of 1986 the amount was a negative $17.2 million. • Periodic Interim Payment status with the Medicare Program was maintained, thereby stabilizing cash flow. • Approval of Distinct Part Unit "exemption from PPS" status for the hospital's 43 psychiatric beds was maintained. The resulting cost-based reimbursement from Medicare will exceed the alternative DRG-based payments. • Contra Costa was selected as one of the thirteen California counties to participate in the State's Medi-Cal Managed Care Initiative. • The hospital has successfully undergone standard audits of Medi-Cal, Medicare, Short-Doyle (psychiatric), Grand Jury, California Medical Review (professional review organization), and the State Department of Corporations. • The hospital maintained direct management of Dietary Department (formerly contracted out). Annual savings $50,000. • Electronic submission of all Home Health Agency Medicare billing was maintained, resulting in accelerated cash flow to the department. • Conversion of billing system procedure codes to Hospital Common Procedure Coding System (HCPCS) for Medicaid billing services was completed. • Electronic billing and payment processing of all hospital Medi-Cal billings was maintained, resulting in accelerated cash flow to the department. • Financial and program management responsibility for all inpatient psychiatric services required by Medi-Cal (Medicaid) eligible residents in the county was successfully assumed, effective 1/1/95. • United States Public Health Services named Merrithew Memorial Hospital and Clinics the Northern California Regional Center for Hansen's Disease and awarded a grant to fund treatment of the approximately 300 eligible clients. • Participation in Amerinet, an international purchasing group, was begun. Expect annual savings of $150,000 on purchases of IV solutions, surgical supplies, capital equipment, etc. Health Services Department August 3, 1995 Highlights of Accomplishments Page 14 • Contra Costa Health Plan began participation in Pharmaceutical Care Network (PCN) rebate program. Expected annual rebates of $100,000 have begun being received. INFORMATION SYSTEMS • A Department-wide General Ledger System was implemented, creating interfaces from the County's mainframe data for import into the new system. • A PC-based time study system was designed, programmed and implemented to capture and report categories of administrative time spent for SB910 reimbursement. • Using extracted detail records from the Keane Hospital Information System, a reporting database and custom reports for comparing patient and provider utilization patterns were created. • A PC-based system, called the Patient Accounting Reconciliation System (PARS), which automates the reconciling of payments posted to the cash clearing account for Medicare and Medi-Cal was created. The system performs standard activity reporting and audit detail for pinpointing out-of-balance conditions. • A PC-based system, called the Medi-Cal CPT On-Line Database, that allows access to CPT code reimbursement data was created. • A PC-based system was created for the "Help Desk" to allow access to information on over 750 County run and Non-County run programs. • Various enhancements were made to the Health Care for the Homeless System to allow for access to the help desk database and to allow referral tracking. This stand alone system was moved to a multi-user platform that has the ability to contain the records of all homeless clients and allows modem access by authorized staff. • A Novell Networked multi-user quality management system was designed, programmed and implemented for the hospital's quality management unit: to track and report medical treatment appropriateness. Part of the Hospital's CQI effort. • The CCHP Accounts Receivable module was enhanced and implemented to produce member statements for monthly premiums which were previously being outsourced to ORC. Custom reports were created for each monthly cycle. • The Novell Networked multi-user system for the CCHP Advice Nurse system was Health Services Department August 3, 1995 Highlights of Accomplishments Page 15 implemented along with the custom interfaces from the Global Appointment System, the Keane Hospital Information System and the Solano Partnership System. • The new registration process for Health Centers and the Emergency Room now automatically verifies CCHP eligibility and quickly allow registration for all known outpatient and E.R. patients. • The decentralized Global Appointment system was implemented along with the custom interfaces from the Keane Hospital Information System and various custom reports. The system allows providers at clinics to book return and referral appointments for their patients, view their workload, and provides information to Administration for maximizing efficiency in setting providers schedules. • The Meditech Pathology and Blood Bank modules were implemented. • An enhancement was implemented on the CCA Pharmacy system that allows for automatically printing patient drug education information for processed prescriptions. • The HazMat system was converted to the FoxPro database product from individual databases on various PCs. Custom programming now allows for an integrated system that links programs to a central business file and standardized the user interface. A new underground tank module was designed and implemented for inspection and invoice management. • A Custom interface was written to automatically create CCHP insurance policies in the PSP Mental Health System. • Using current networking system components and software, all of the multi-user data center based computer systems are now electronically linked. Interfaces no longer require tape-to-tape processing and users can be allowed access to multiple platforms from a single terminal or PC.