Loading...
HomeMy WebLinkAboutMINUTES - 08182015 - C.146RECOMMENDATION(S): APPROVE the response to Grand Jury Report No. 1507, "Opportunities for Change in the County Health and Human Services System" and DIRECT the Clerk of the Board to forward the response to the Superior Court no later than September 6, 2015. FISCAL IMPACT: No fiscal impact, this is an informational report. BACKGROUND: On July 7, 2015, the County received 2014-15 Civil Grand Jury Report No. 1507 entitled, "Opportunities for Change in the County Health and Human Services System". The report was received by the Board of Supervisors and subsequently referred to the Health Services Department on the July 7, 2015 Board of Supervisors agenda (Item No. C.181) who prepared the attached response that specifies: Whether the respondent agrees or disagrees wholly or partially with each finding; If the respondent disagrees with a finding, a statement explaining the portion of the finding that is disputed and the reasons for the disagreement; Whether each recommendation has been implemented, has not been implemented, or requires further analysis; and APPROVE OTHER RECOMMENDATION OF CNTY ADMINISTRATOR RECOMMENDATION OF BOARD COMMITTEE Action of Board On: 08/18/2015 APPROVED AS RECOMMENDED OTHER Clerks Notes: VOTE OF SUPERVISORS AYE:John Gioia, District I Supervisor Candace Andersen, District II Supervisor Mary N. Piepho, District III Supervisor Karen Mitchoff, District IV Supervisor ABSENT:Federal D. Glover, District V Supervisor Contact: Dorothy Sansoe, 925-335-1009 I hereby certify that this is a true and correct copy of an action taken and entered on the minutes of the Board of Supervisors on the date shown. ATTESTED: August 18, 2015 David J. Twa, County Administrator and Clerk of the Board of Supervisors By: Stephanie L. Mello, Deputy cc: C.146 To:Board of Supervisors From:David Twa, County Administrator Date:August 18, 2015 Contra Costa County Subject:Response to Grand Jury Report No.1507 "Opportunities for Change in the county Health and Human Services System" BACKGROUND: (CONT'D) If the recommendation requires further analysis, a statement explaining the scope and parameters of the analysis or study, and a time frame, not to exceed six months, for the matter to be prepared for discussion. CONSEQUENCE OF NEGATIVE ACTION: In order to comply with statutory requirements, the Board of Supervisors must provide a response to the Superior Court no later than August 27, 2015 (90 days after receipt). The Board must take action no later than the August 25, 2015 meeting in order to comply with the statutory deadline. CHILDREN'S IMPACT STATEMENT: Not Applicable ATTACHMENTS Response to Grand Jury Report No. 1507 Page 1 BOARD OF SUPERVISORS RESPONSE TO GRAND JURY REPORT NO. 1507: OPPORTUNITIES FOR CHANGE IN THE COUNTY HEALTH AND HUMAN SERVICES SYSTEM FINDINGS 1. Contra Costa Health Services managers have developed a comprehensive health system. Response: Respondent agrees with this finding. 2. Healthcare systems compete for patients by reducing costs and improving services. Local hospitals are merging to create stronger systems. Response: Respondent agrees with this finding. 3. According to Health Management Associates Sustainability Audit of the Contra Costa Regional Medical Center and Health Centers, the County will be adding 32% more people in the next 20 years. Response: Respondent agrees with this finding. 4. After losing $18 million annually, Doctors Medical Center in San Pablo closed permanently on April 21, 2015. Response: Respondent agrees with this finding. 5. Pursuant to Section 17000 of the California Welfare and Institutions Codes, counties are to provide healthcare for those who are indigent and poor. Response: Respondent agrees with this finding. 6. The county hospital, the Contra Costa Regional Medical Center (CCRMC), receives low Medi-Cal reimbursement rates that do not offset actual costs. Response: Respondent agrees with this finding. 7. The County annually provides $30 million in general funds to augment the budget of CCRMC (the Contra Costa Regional Medical Center). Response: Respondent partially agrees with this finding. The County budget provides $26,672,488 in general funds to CCRMC for both the 2014-2015 fiscal year and the 2015-2016 fiscal year. The County also provides $3,736,288 in both fiscal years to the Contra Costa Health Plan, for a total of $30,408,776. Page 2 8. Grand Jury interviews revealed that CCRMC must partner for certain medical specialties. Response: Respondent cannot confirm what was discussed during confidential Grand Jury interviews; however, respondent agrees that CCRMC must partner for certain medical specialties. 9. The County commissioned a Sustainability Audit of the County hospital and health centers which was presented to the Board of Supervisors in September 2011. Response: Respondent agrees with this finding. 10. The Sustainability Audit of the County hospital and health centers underscored the Grand Jury’s findings that county hiring is challenging and patients have difficulty obtaining timely appointments. Response: Respondent agrees with this finding. 11. As part of a five-year renewable program that pays public hospital systems to reach defined goals, CCHS management secured $32.55 million in annual funding from the Delivery System Reform Incentive Program (DSRIP). Response: Respondent agrees with this finding. 12. CCHP has met certain goals set by DSRIP, including (1) expanded access to physicians through telephone appointments (that increased the person-to-person appointments by 281/week); (2) increased capacity for the North Richmond Center for Health (58 exam rooms) and constructed a new 10,000 sq. foot George and Cynthia Miller Wellness Center in Martinez; and (3) ensured that 100% of Full Scope Medi-Cal and Low Income Health Plan patients have a primary Care Provider. Response: Respondent partially disagrees with this finding. DSRIP goals are related to CCRMC, not CCHP. 13. DSRIP funding is not permanent and is only meant to provide seed funding. Response: Respondent agrees with this finding. 14. DSRIP funding will be extended for another five years. Response: Respondent partially disagrees with this finding. Renewal is contingent on Centers for Medicaid and Medicare approval in October 2015. 15. Sixteen of the 58 counties in California have merged Health and Human Services departments. Response: Respondent agrees with this finding.   Page 3 16. San Diego County, which is three times larger than Contra Costa County and is the largest California county with a merged Health and Human Services Department, was able to reinvest $230 million in funds over a 10 year period by reducing overhead, decentralizing offices and emphasizing prevention and intervention with community partners. Response: Respondent cannot independently confirm this statement. 17. If the county were to combine the current healthcare system, the CCHS programs and EHSD, there would be 5,800 employees in a Health and Human Services Department. Response: Respondent agrees with this finding. 18. If the healthcare system merges with a larger system, four programs would remain in CCHS. Emergency Medical Services could merge with the Contra Costa Fire Protection District while the Environmental Health and Hazardous Materials Program could merge with the Department of Conservation and Development. Response: Respondent disagrees. It is much more protective of Contra Costa residents’ health and safety to have these divisions affiliated with the Public Health Division. 19. The two CCHS program, Behavioral Health and Public Health, have a combined 856 employees. Merging these two programs with social services, the Employment and Human Services Department (1,800 employees) would create a Health and Human Services Department that is smaller than CCHS’ current number of 4,000 employees. Response: Respondent agrees with this finding. 20. There are more than 20 CCHS and EHSD programs that rely on each other to provide comprehensive services Response: Respondent agrees with this finding. 21. Child welfare workers under EHSD and mental health specialists under CCHS are developing strategies to comply with a new settlement agreement, Katie A. v. Bonta, that mandates mental health and child welfare systems provide intensive services for foster children in need of mental health services. EHSD and CCHS are mandated to coordinate services. Response: Respondent agrees with this finding.   Page 4 RECOMMENDATIONS 1. The County should consider merging or partnering the healthcare system with a larger private or public healthcare system that would provide administrative oversight, broader access to physician specialists, clinics and hospitals, and increased healthcare options. Response: This recommendation is continuing to be explored. 2. If the County is successful merging the healthcare system, the County should consider merging the two primary departments that would remain in Contra Costa Health Services – Public Health and Behavioral/Mental Health – with the Employment and Human Services Department, creating a Health and Human Services Department. The county should find funding to commission a report outlining the full benefits and detriments of merging EHSD with Public Health and Behavioral/Mental Health Services. Response: This recommendation will require further analysis if a merger of the healthcare system were executed and successful. 3. If the County is successful merging the healthcare system, the county should consider merging CCHS’ Environmental Health and Hazardous Materials Program with the Department of Conservation and Development and merging Emergency Medical Services with the Contra Costa Fire Protection District. Response: This recommendation will require further analysis if a merger of the healthcare system were executed and successful.