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Home My WebLink AboutMINUTES - 10221991 - IO.4 1 TO: t� BOARD OF SUPERVISORS Contra FROM: INTERNAL OPERATIONS COMMITTEE / Costa n. S DATE: October 14, 1991 -- Countysrq_coux`� STATUS REPORT ON CCHP ADVISORY BOARDS REPORT ON- AMBULATORY' SUBJECT: CARE ACCESS SPECIFIC REQUEST(S)OR RECOMMENDATION(S)&BACKGROUND AND JUSTIFICATION RECOMMENDATIONS 1 . Express the Board' s appreciation to the Health Services Director, Executive Director of the CCHP, and their staffs for the significant progress which has been made to date in responding to the recommendations which were made by the CCHP Advisory Board in June, '1991. �2. Request the County Administrator to include in the analysis of the cost of rebuilding the County Hospital and financing such a rebuilding, the renovation of, "A" Ward to be used for ambulatory primary and speciality services following the completion of the construction of the new hospital so that when financing is sought, funds will be available to complete this renovation. 3 . Remove this issue as a referral to our . Committee on the basis that future reports on financing mechanisms should be made to the full Board of Supervisors. BACKGROUND: On June 25, 1991, the Board of Supervisors received a presentation from the CCHP Advisory Board on the problems being faced by CCHP members in trying to secure prompt outpatient appointments. At that time, the Board referred the issue to our Committee, the Joint Conference Committee and the County Administrator. CONTINUED ON ATTACHMENyeS YES SIGNATURE: RECOMMENDATION OF COUNTY BATOR RECOMMENDATION OF BOARD COMMITTEE APPROVE SIGNATURE(S): SCHRODER SUNNE WRIGHT McPEAK ACTION OF BOARD ON October 2 2 991 APPROVED AS RECOMMENDED OTHER VOTE OF SUPERVISORS I HEREBY CERTIFY THAT THIS IS A TRUE UNANIMOUS(ABSENT ) 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 V / ` Please see Page 2. PHIL BATCHELOR,CLERK OF THE BOARD OF SUPERVISORS AND COUNTY ADMINISTRATOR 01 BY • ✓ . DEPUTY M382 (10/88) t ' I.O.-4 On October 14, 1991, our Committee met with the Executive Director of the CCHP, Milt Camhi; the Director of Planning for the CCHP, Bobbi Baron; the Executive Director of Merrithew Memorial Hospital and Clinics, Frank Puglisi; , the Medical Director of the CCHP, Dr. William Walker; and the Chair of the CCHP Advisory Board, Jack McGervey. We reviewed again the Executive Summary of the presentation which was made to the Board last June and which is attached to this report: We also received and reviewed a status report from the Health Services Department on the progress which has been made in responding to each of the recommendations in the report. Finally, we received a set of graphs from Mr. McGervey which document the waiting times for various types of appointments in the Health Services Department. It is important in reviewing these charts to note the comments which are attached by the Department. The data which .is shown reflects individuals seeking an appointment for a new condition or a new member seeking an initial. appointment with a physician. This data does not include emergency appointments, urgent care,. scheduled follow-up or continuing, visits-, all. of which are generally less than the waiting time for a new patient or an established patient requesting to be seen for a new condition. It also does not include requests for an appointment with a particular physician, which generally are longer than those shown in' the charts. The Health Services Department is committed to making some $880,000 in modifications available to implement most of the. short-term recommendations of the CCHP Advisory Board. These will have the effect of keeping the waiting timesfrom getting worse over the next few years. They do not resolve the long-term access problems. In order to begin to resolve those longer-term access issues, it is necessary to consider making use of some of the existing hospital space when the new hospital is built. In order to accomplish this in a timely manner, it is necessary to take into account these renovation costs at the time the overall financing of the hospital is undertaken. We are, therefore, asking the County Administrator to factor these costs of approximately $850,000 into his exploration. of financing alternatives. cc: County Administrator Health Services Director Executive Director, CCHP Chair, CCHP Advisory Board (Via Executive Director, CCHP) DeRoyce Bell, Deputy County Administrator IVA ::...................................................................................:........................................................................................................................... ........................................................................................................................................................................................................................... _............_...................................................._._................................................................................................................ .................................................................................................................................. _.... ........................................ ...._............._...._.........._............_._...._..........................................................................,.._.................--....... ............................................................................................................................................................................................................................ ........................................................................................................................................ ........................................................................................................................................................................................................................... ............................ ........................................................................................................................................................................................................................... ............................................................................................................................................................................................................................ ............................................................................................................................................................................................................................ .................................................................................................................................................................. ............................................................................................................................................................................................................................ ............................................................................................................................................................................................................................ ........................................................................................................................................................................................................................... :•: :-:- :•:::•::::::::•::::�•::•�:ti•::�i�::::::is ii:::•:: :::::::: ::::::: �cii:(icii:-}};};�i:fici:i:^:•is4iriii::C:i:•i:::•c:-i:}::•:•:-:�:-:r}iir:}?rFiir:ririr::•::rr:6r:•iii:•iiri}rr:is rrir::i::�:•:{}i:�:F'::�•i:i:•i Executive .Summary y 4 . Contra Costa Health Plan Advisory Board June 25, 1991 r 9 Contra Costa Health Plan Advisory Board Findings and Recommendations Ambulatory Care Services The Problem To Be ,solved The lack of access to ambulatory care services is, affecting the quality of outpatient care, and this problem will only grow worse in 1the future. There Is A Serious Problem Now 'There is a 'major deficiency' in the access to outpatient services: a pattern of non- compliance that has the potential to endanger patient care.." Medi-Cal PHP-Site Audit Team, April 1991 'The doctor was thorough and all, but the wait was terribleY County Employee Member, 1991 "Already unacceptable waiting times for appointments and while at health center waiting to see physician have increased in last year and will worsen unless action is taken to increase capacity." . Contra Costa Health Plan Strategic Plan, 1989 Over 50% of Contra Costa Health Plan County employee members who used. the Martinez Specialty Clinic were dissatisfied with the malt to get an appointment. Contra Costa Health Plan Survey, April 199.1 "Once you see the doctor, the care is great; but the wait to get in is horrendous." County Employee Member, January 1991 The Problem Will Get Worse As Contra Costa Health Plan grows, its need for outpatient services increases. ✓ CCHP is projected to grow to 25,000 to 30,000 members in five years. ✓ By 1996, it is estimated that CCHP members will use 9,000 to 11,000 HSID outpatient visits a month, a 34% to 62% increase over current utilization. ✓ By 1996, CCHP visits to Martinez Specialty Clinic will climb to 2,000 visits a month from 1,300 visits per month in 1991, a 54% increase in an already overcrowded facility. In its space planning for the replacement hospital facility, the HSD's consultant (Medical Planning Associates) projects fewer Martinez Specialty Visits for fee-for-service and CCHP members combined than CCHP does for its members only. There are restrictions on State and federal sources of money for capital expansion: Funds that are earmarked for inpatient facilities may be unavailable for new outpatient construction or modernization. Recommended Solution Facilities: "it is essential that ALL County clinics/health centers be included in planning for the replacement hospital, since the resultant plan will guide the delivery of Contra .Costa County health care for many years." Contra Costa Grand Jury Report, 1989 'To ensure accessibility to high quality service with increased membership, Contra Costa Health Plan supports an integrated ambulatory and inpatient facility expansion strategy linked to greater access to a wider range of providers." Contra Costa Health Plan Strategic Plan, 1989 Financina: The County must identify alternative sources of funding for constructing and/or modernizing ambulatory care facilities including using a portion of the growing Health Plan premium revenues. There is a possibility of outside funds for new outpatient construction or conversion of inpatient space to ambulatory care space. Financing must be secured as an integral part of the initial hospital financing. HMO Advisory Board June, 1991 Systemwide Improvements The Contra Costa Health Plan Advisory Board in consultation with the Health Services Department recommends: . . Immediate.Action 1, Contra Costa Health Plan to immediately contract with community providers for specialty care to meet today's clinical needs. .. 2. The Health Services Department to increase Health Plan members' accessibility within the existing County clinic system. ✓ Have a special-telephone number dedicated just for Health Plan members to make appointments. Initially pilot to commercial and senior members. ✓ Develop capacity to dedicate certain appointment times in each of the health centers for primary and specialty care just for Health Plan members, e.g. 8-9 a.m.; 1-2 p.m. ./ Increase the availability of Advice Nurses during peak load periods, e.g.:Monday mornings; after holidays. ✓ Increase by 50% the number of urgent care appointments in East County available to Health Plan advice nurses. Additional urgent care appointments to be linked to expansion of clinic capacity. 3. The Health Services Director, together.with the chair of the HMO Advisory Board, to make a progress report by September, 1991 on immediate actions taken and their effect on improving access to ambulatory care and to make quarterly progress reports thereafter. July - September 1991: The Health Services Department to increase ambulatory care accessibility in East and Central County: ✓ Relocate Concord Older Adult Clinic and reallocate space for medical clinics. Use expanded space for primary and selected specialty care for Health Plan members ($75,000). J V Lease space on the"Los Medanos Community Hospital LMCH campus for a Health Pian only primary and urgent care center with weekday evening and/or weekend hours pending proposal from LMCH (cost to be negotiated). , ✓ Establish new East County Older Adult Clinic:. (grant offset) East/Central County ✓ If Los Medanos is not available or financially Contingency Plan feasible, expand hours in the Pittsburg and/or. Brentwood Health Centers to include nights and weekends. AND/OR ✓ Contra Costa Health Plan contracts with. community providers in East and Central County as needed for primary.and/or urgent care. September - December 1991: The Health Services Department to increase ambulatory care accessibility in West County: Help Martin Luther King Center (MLK) to re- open ($50,000). Use MLK as a primary and urgent care center with weekday evening and/or weekend hours for Health Plan members. West County, ✓ If Martin Luther King is not available for after Contingency Plan hours care for health plan members, eland hours in Richmond Health Center to include weekday evenings and weekends. AND/OR . ✓ Contra Costa Health Plan contracts with community providers in West County as needed for primary and/or urgent care. Martinez Ambulatory Care Improvements The Health Services Department to provide modernized and expanded ambulatory care facilities on the Merrithew Memorial Hospital site. Immediate Action: ✓ Increase space for pharmacy through purchase of trailers ($125,000). September 1991 -April 1992: ✓ Renovate current Merrithew Memorial Hospital administrative office space and convert into expanded Specialty Clinic space: Remodel "C" Street house; purchase trailers; relocate .administration ($360,000). Remodel administrators' space for specialty clinic use ($270,000). Specialty Services ✓ If renovations projected to be completed Contingency Plan after April 1992, immediately lease space in the Martinez area for selected specialty services and/or explore space currently on hospital campus (e.g. F and G Wards). 1996 ✓ As part of the initial hospital replacement construction: Renovate "A" Ward (currently maternity) for ambulatory primary and specialty services ($850,000). Secure renovation financing as an integral part of initial hospital financing. Martinez Ambulatory Care ✓ Continue to explore other funding for Contingency Plan building new ambulatory services facility (estimated $11.5 - $12 million). 2.1 ' HEALTH PLAN ENROLLMENT GROWTH 1. CGRPenrollment has grown to 20,000 members serving Medi-Cal, :Medicare, Medically Needy, County employees , small businesses, Indliwiduals, single parent families, and children. 20 In the past five years, Plan enrollment has increased by over 12,000 members, an increase of 156 percent. 2.2 HEALTH PLAN REVENUE GROWTH . 1. CCHP is expected to bring in close to $20 million in revenue to the County this year as compared to only $637,000 in 1980/81,. its first year of operation. 2. Io the past five years, Plan revenue has increased by over $12 million, an increase of 164 percent. 3. In 1991, Medi-Cal premium revenue will be almost $11.5 million. Medicare revenue will be almost $2 million and Commercial premium revenue will be over $5 million. 2.3 HEALTH PLAN 1. Contra Costa Health Plan's premium based programs are now self supporting: In . 1990/91 the income in the Medi-Cal, Medicare, and Commercial programs is projected to be greater than the expenses. 2. Contra Costa :Health Plan has made a financial turnaround in the past five years. In 1986/87, there were losses of almost $1 million. 3.1 Contra Costa Health Plan Outpatient Utilization Rates Groups in the Health Plan have differential outpatient utilization rates. ✓ Each Medicare member has about 11 medical. visits a . year. ✓ Each BAC has over six outpatient visits a year. ✓ Medi-Cal members who are disabled or over 65 average 5-6 visits a year. ✓ Each . Commercial and AFDC member makes about 2.5 outpatient visits in a year. 3.2 Contra Costa Health Plan Specialty Clinic Utilization Rates Groups in the Health flan have varying_ utilization rates of the specialty- clinics. ***" . Medicare members have an outpatient surgery clinic utilization rate that .is almost five times greater than the AFDC rate. ./ Commercial members utilization- rate of GYN clinic is higher than that for AFDC and Medicare members. V AFDC members utilize the Ear, Nose, and Throat (ENT) specialty services more often than commercial but J about half as much as our Medicare members. 33 Increase in Outpatient Visits By Contra Costa Health Plan Members 1. Since 1985/86 the total. average monthly outpatient visits by Contra Costa ' Health Plan members has. -gone from 5,500 visits a month to 7,500 a month, a 36% . increase. 2. Since 1.985 /86 the average monthly Martinez Specialty Clinic visits has gone from 600 to . 1,300 a month, a 117% increase. 4.1 Medical Planning Associates Projected Demand Medical Planning Associates projects an 18% increase in emergency room - visits, and a 20% increase in -Martinez Specialty and in Martinez Family Practice visits in the year 2000. ti 4.2 Contra Costa Health Plan Projected Demand 1. Contra Costa Health Plan staff projected .the demand for ambulatory services in 1996 using a method that projected CCHP enrollment growth by group and current utilization rates by group. The lower use estimates are based on an enrollment of 25,000 members; the higher estimate in an enrollment of 30,000 members in 1996 (a 6% to 13% annual growth). .✓'The total number of outpatient visits by Contra Costa "'Health-Plan members is projected to increase by 34% to. 62% going from 7,000 visits in' a .month in 1991 to between 9,200 and 11,200 visits a month in 1996. ✓The number of regular health visits is projected to increase from 4,800 a month in 1991 to between 6,400 and .7,800 a month in 1996. ✓The number of visits to the emergency room is projected to increase by 38% to 50% by the year 1996. ./Contra Costa Health Plan visits to Martinez Specialty Clinic are projected to increase from 1,300 a month in 1991 to between 1,800 and 2,100 visits a month in 1996. 2. The MPA projections for ambulatory services in Martinez underestimate the need. MPA projects in the Martinez Specialty Clinic fewer visits for FTS and Contra Costa Health Plan members combined than Contra Costa Health Plan does for its members only. 5.1 Medi-Cal Audit Findings 1. Contra Costa Health Plan has just received its annual Medi-Cal audit. . TheState audit team noted: "Contra Costa Health Plan has . the best quality of_all the plans surveyed when and if 'the member can get access." I The audit team was . so concerned about . accessibility, it is citing Contra Costa Health Flan for a m ' r defimiency. in outpatient access. 5.2 Wait To Get An Appointment In all clinics, except Concord, it can take over six weeks -to get an appointment. 5.3 MEMBER SATISFACTION SURVEY RESULTS Member -satisfaction surveys taken mi 1986, 1990, and 1991 show increasing dissatisfaction with outpatient accessibility. of whereas in 1986, over 85% of all members were satisfied with the wait to get an appointment, in 1990 only 72% were satisfied. ✓ Commercial members ' • satisfaction with wait in the clinic dropped from-75% in 1986 to 65% in 1990. ✓ Members in East County evidenced the greatest decrease in satisfaction. Brentwood Clinic members' 95% satisfaction with the wait to get an appointment in 1986 dropped to only a 67% satisfaction level in 1990. ✓ New County employee members in a 1991 survey praised the excellent care while condemning the -waits both to gel an appointment and the seemingly endless waits in the clinic. 5.4 Pharmacy Survey Results A February, 1991 survey of Health Plan members who used the. outpatient pharmacies showed some problem areas: ✓ over half the members who used the Pittsburg or Martinez. pharmacy were dissatisfied with the wait ✓ almost 40% of members who used the Martinez pharmacy reported they waited over an hour for their prescription to be filled 6.1 Grand Jury Recommendations The May 26, 1989 Grand Jury Report called for enhanced clinics/health centers as an integral part . of replacement -hospital planning. The report said special consideration should be given to upgrading facilities and equipment, expanding clinic hours, and making urgent care services available at all health centers. 6,2 Contra Costa Health Plan Strategic Plan A` major goal stated in Contra Costa Health Plan's: 1989 Strategic Plan is to maximize access by expanding and enhancing the. ambulatory* care system: L Increase percentage of health plan appointments 20 Expand hours of operation I, Open additional ambulatory care centers 6.3 ADVISORYBOARD TESTIMONY f The CCHP Advisory Board testified at the February 12,' 1991 Board of Supervisor Workshop in favor of an "option 4". which includes outpatient facilities in the first - phase of the hospital replacement project.. 1. The Health Plan must 'guarantee access to outpatient facilities. 2. The Health Plan must continue to grow. 30' Outpatient services are less expensive than inpatient services. 6.4 ADVISORY BOARD PROGRESS REPORTS The. HMO Advisory Board repeatedly has made recommendations to the Health Services Department on needed improvements in ambulatory care.. On a regular basis, the Advisory Board monitors actions taken to implement these recommendations. Major recommendations are to: 1. Improve access without increasing , total' clinic capacity. 2. Use community providers. 3. Increase capacity in current health centers. 4. Physically expand or modernize existing regional health -centers. 5. Open additional ambulatory care facilities. 6. Replace Martinez outpatient facility in Phase One,of hospital replacement proj ect. 0 6.5 Dedicated Clinic :Hours Contra Costa Health ]Plan staff has formed an External Task Force . to investigate system problems and make recommendations addressing these problems. The External Task Force a has recommended dedicating clinic hours for County employees . Employees would use less sick leave, saving the County money, increasing productivity and. member satisfaction. Q CONTRA COSTA HEALTH PLAN INTER OFFICE MEMO To: Claude Van Marter, Date: October 7, 1991 Assistant County Administrator From: Milt Camhi,�` � Subject: CCHP Advisory Board Executive Director Ambulatory Care Services Progress Report The attached report was prepared at the request of the Advisory Board for consideration by the Internal Operations Committee at its October 14th meeting. Jack McGervey, Advisory Board Chair, who has been out of the country, is expected back later this week. He may want to elaborate on the report at his presentation to the I-O Committee on Monday. MSC:BB/lmb Enclosure cc: Jack McGervey L21:ACS Contra Costa Health Pian Advisory Board Recommendations and Progress To Date Ambulatory Care Services The Contra Costa Health Plan's federal and state regulators have determined there is a serious problem now. Medi-Cal PHP 1991 Annual Medical Audit - May, 1991 "There is a major deficiency in accessibility: a pattern that has the potential to endanger patient care." State of California Department of Corporations - August. 1991 "Unless the corrective action ameliorates the major deficiency given the area of accessibility, the Department may conduct a targeted- audit of this area." HCFA Medicare Audit - June, 1991 "Contra Costa Health Plan does not meet the reasonable promptness requirement with respect to primary care providers...Contra Costa Health Plan should continue to seek additional facilities to accommodate its current and growing membership." AMBULATORY CARE ACCESS PROGRESS REPORT Systemwide Improvements IMMEDIATE ACTION Recommendation Progress to Date 1. Contra Costa Health Plan (CCHP) 1. CCHP has contracted with to immediately contract with community providers for community providers for specialty ophthalmology, optometry, dentistry, care to meet today's clinical needs. and allergy services. 2. The Health Services Department to increase Health Plan members' accessibility within the existing County clinic system.. ✓ Have a special telephone number ✓ Equipment has been ordered and dedicated just for Health Plan plans made to implement special members to make appointments. phone number for Commercial Initially pilot to Commercial and and SeniorHealth members to SeniorHealth members. make appointments. Implem- entation due to be completed January 1, 1992. ✓ Develop capacity to dedicate ✓ No progress certain appointment times in each of the health centers for primary and specialty care just for Health Plan members, e.g. 8-9 a.m.; 1-2 P.M. ✓ Increase the availability of Advice ✓ Effective July 1, 1991 Advice Nurses during peak load periods, Nurse staffing was increased to e.g. Monday mornings, after provide additional•coverage during holidays. peak load periods. ✓ Increase by 50% the number of ✓ Urgent care appointments in East urgent care appointments in East County increased by 50% effective County available to Health Plan August 1, 1991. advice nurses. Additional urgent care appointments to be linked to expansion of clinic capacity. 3. The Health Services Director, 3. Progress report prepared for I.O, together with the chair of the HMO Committee review on October 14, Advisory Board, td make a progress 1991. report by September, 1991 on immediate actions taken and their effect on improving access to ambulatory care and to make quarterly progress reports thereafter., • EAST AND CENTRAL COUNTY IMPROVEMENTS July - September, 1991 Actions Recommendation Progress to Date The Health Services Department to increase ambulatory care accessibility in East and Central County: ✓ Relocate Concord Older Adult Clinic ✓ The Concord Older Adults clinic is- and reallocate space for medical moving to Pleasant Hill in January, clinics. Use expanded space for 1992. primary and selected specialty care for Health Plan members ($75,000). ✓ The best use of the Concord Health Center space, including specialty services, is under review. ✓ Lease space on the Los Medanos ✓ CCHP and HSD are meeting with the Community Hospital (LMCH) campus new CEO of Los Medanos to discuss for a Health Plan only primary and space arrangements. urgent care center with weekday evening and/or weekend hours pending proposal from LMCH (cost to be negotiated). ✓ Establish new East County Older ✓ The geriatrics program is working with Adult Clinic (grant offset). the community in East County to open a clinic in that area. ✓ The City of Antioch has dedicated $25,000 in community development funds for purchase of medical equipment. Contingency Plan ✓ If Los Medanos is not available or financially feasible, expand hours in the Pittsburg and/or Brentwood Health Centers to include nights and weekends. ✓ "Family practice clinics in East County will be opening at new sites." (HSD AND/OR Activity Report, September, 1991) ✓ CCHP contracts with community providers in East and Central County as needed for primary and/or urgent care. WEST COUNTY IMPROVEMENTS September - December, 1991 Actions Recommendation Progress to Date The Health Services Department to increase ambulatory care accessibility in West County: ✓ Help Martin Luther King Center ✓ MLK has opened for two half (MLK) to reopen ($50,000). Use days a week MLK as a primary and urgent care center with weekday evening and/or weekend hours for Health Plan members. Contingency Plan ✓ If MLK is not available for after ✓ No progress hours care for Health Plan members, expand hours in Richmond Health Center to include weekday evenings and weekends. AND/OR ✓ CCHP contracts with community ✓ HSD has entered into a joint providers in West County as venture with Brookside Hospital needed for primary and/or urgent to provide OB services to West care. County women. MARTINEZ AMBULATORY CARE IMPROVEMENTS Recommendation Progress to Date IMMEDIATE ACTION ✓ Increase space for pharmacy through ✓ The purchase of trailers is going purchase of trailers ($125,000). forward; floor plans are being developed. Trailers to be in place early 1992: September, 1991 -April 1992 ✓ Renovate current Merrithew Memorial ✓ -The renovation project is to go to bid' Hospital administrative office space in next 60 days. and convert into expanded Specialty Clinic space: ✓ Remodel "C" Street house; purchase trailers; relocate administration ($360,000). ✓ Remodel administrator's space for specialty clinic use ($270,000). Specialty Services Contingency Plan ✓ If renovations projected to be ✓ "Family practice and specialty clinics completed after April, 1992, in Martinez will be increased." (HSD immediately lease space in the Activity Report, September, 1991). Martinez area for selected specialty services and/or explore space ✓ Arrangements for specialty space in currently on hospital campus (e.g. F Martinez area are under consideration. and G Wards). ✓ Plans are underway to move selected specialty services to F Ward on the hospital campus. 1996 ✓ As part of the initial hospital ✓ By end of 1991, HSD will submit final replacement construction: recommendations to Board of Supervisors on rebuilding County Renovate "A" Ward (currently Hospital. maternity) for ambulatory primary and ✓ County has been in discussion with specialty services ($850,000). Secure renovation financing as an integral Veterans Administration (VA) part of initial hospital financing. regarding some.type of joint venture .either leasing land for a new County Hospital or a joint County/VA facility. Martinez Ambulatory Care Contingency Plan ✓ Continue to explore other funding for . ✓ Potential sources include CAL building new ambulatory services Morgage, Health Facilities Financing facility (estimated $11.5 - $12 million). Authority, 17.32 funding, SB855 funding. L19:RAP 9/19/91 � O cJ d cr- ..•� "'1e' Z cr �c a- Too 0 cC '.:. ......... ........ To 0 4 oo Too , �t, 2 TOO c6o ILO do y d 'Fd' X C7 `� N V 2!gs 10000 CDI d �� CS tf) d Qw , d} a w Y, O- � U Z t-- TOO o .... low WO—O* WOO CIO N cfl co V �d Vo Ll� oon N o CD wroo U Q3 �Z W O r ad)pool o �a6 N o , � m m a w zWtl, � F- LLJ L)J Z � W WL) .� U a UweCD Q c W o cr. z Q LLOC � U � Z Q F-- °� W _ LL Qa LOL Q N 0 00 co - -o- N 0 V, V 2 C3 tta r" Too d , ul Too 1 Cr, o► owo-00 10 0 op Q C3 2 � aqo- y d. o W- t000 0 wo 00 0 :04 . 4 �,,.- 0 � -) o � N �4 J 4 C� V►.� v i� VJ s woo Too 3� z "OoY 44;a—,r, Vo 2 d Clo w 2 � Tia � ts�, a � r N CC) Contra Costa Health Plan Access Systems Emergency services Existing and New Patients . Members ate triaged and are seen based on the urgency of their condition. Those with the most critical conditions are seen immediately. The Plan has agreements In place with area. hospitals to provide evaluations and emergency treatment to Health Plan members who present at their Emergency Rooms. Urgent Care Existing and New Patients Urgent care is provided on a same say or next day basis at each of-the Plan's Health Centers. The Plan's Advice Nurses have urgent,care appointment slots available for their exclusive use, and drop-in patients are seen as well. At those times when urgent care is busiest-and access the most difficult, patients are diverted to local ERs for care. Family Practice Existing Patients Members who are established patients with Family Practice Physicians have priority access to certain appointment slots. They can, therefore, getan appointment with their doctor well within existing standards. Physical exams such as school, sports and camp physicals,'and class ill driver's. license physicals occasionally require a longer lead time. New Patients New patients are able to access initial appointments within existing standards in each of the Health Centers. Physical exams such as school, sports and camp physicals, and class III driver's license physicals occasionally require a longer lead time. in cases where a timely appointment is not available at any Health Center, the member is offered an appointment at an alternate Health Center. Follow-up Appointments New & Existing Patients Members who need follow-up care are always accommodated by our system. One and two week follow-up appointment slots are designated In each Family Practice Clinic. In addition, each clinic may be overbooked on request from the Family Practice Physician. Referrals / Specaiyt Many Specialty Clinics in our system have appointments available well within the six week standard; others do not. The Pian has developed out-of-Pian networks to back up in-Plan services with excessive waiting times. Agreements are in place with dentists in east, west and central county to provide urgently needed care and primary care to Plan patients who cannot access in-Plan care in a timely mariner. Referrals are being made to our existing network of out-of-plan optometrists for refractions as well as glasses. We have also developed agreements with allergists and ophthalmologists to solve clinic backlog problems. RTH:smp 23-A52 .: V .� ........... .. L N N Efl m� C ++ cu. C ............ ... ............. ....... .......... ...............- .................... ............ `� CL .� LLL 0 C I � ................. ............................... O L � ........ ................. - U U O a N ................................. � ............... .............. O i (n �+ \/ ........... ............................... ............. ................. ............ .......... ................. ................... .................... .............. .................. ........... 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