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HomeMy WebLinkAboutMINUTES - 11281995 - D5 THE BOARD OF� SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA Adopted this Order on _November 28, 1995 by the following vote: AYES: Supervisors Rogers, Smith, DeSaulnier, Torlakson NOES: Supervisor Bishop ABSENT: None ABSTAIN: None ------------------------------------------------------------------------------ ------------------------------------------------------------------------------ RESOLUTION NO. 95/637 SUBJECT: Appointment of the Health Services Director and Public Guardian WHEREAS Mark Finucane, Director of the Contra Costa County Health Services Department and Public Guardian will resign his positions effective January 15, 1996; NOW, THEREFORE, BE IT RESOLVED that the Board of Supervisors of the County of Contra Costa hereby APPOINTS William B. Walker, M.D. , Director of the Contra Costa County Health Services Department and Public Guardian effective January 16, 1996. 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` -(y, 9 9, / 2 y�' Phil Batchelor, Clerk of the Board of Supervisors and County Administrator By Q V //L3�L/�tr' Deputy cc: Health Services Admin. County Administrator RESOLUTION NO. 95/637 ATTACHMENT A List of speakers on the appointment of the Health Services Director: Thurman Gupton, Black Families Association of Central County; 2111 Norse Drive, Pleasant Hill 94523 ; Jim Hicks, AFSCME, 1000 Court Street, Martinez 94553 ; Marie Goodman, 3331 Brookside Drive, Martinez 94553; Loren Freeman, (no street address listed) , El Cerrito; and Henry L. Clarke, Contra Costa Employees Association, Local I, Martinez 94553; TO: OF SUPERVISORS Contra FROM: PHIL BATCHELOR, Costa COUNTY ADMINISTRATOR •�" �;6�-`'�• MARK FINUCANE, HEALTH SERVICES DIRECTOR County DATE: •'sr�--ti�T• November 21, 1995 SUBJECT: ISSUES FACING THE HEALTH SERVICES DEPARTMENT IN THE COMING WEEKS AND MONTHS AND RECRUITMENT OF A NEW HEALTH SERVICES DIRECTOR SPECIFIC REQUEST(S)OR RECOMMENDATION(S)&BACKGROUND AND JUSTIFICATION RECOMMENDATIONS: 1. CONSIDER the feasibility of conducting a strategic review of the impact of the following issues on the Health Services Department: • the implementation of managed care, and • the likelihood of significant changes at the Federal level in.how health care .,for low-income and indigent Americans is defined, financed and provided, and determine how the Health Services Department can best be structured to respond to those changes. 2. DIRECT the County Administrator and Health Services Director to prepare a Request for Information (RFI) which would determine what individuals are familiar with the current and pending changes in the health care field at both the State and Federal levels arid the potential impact of those changes on the public health and medical care system and return a proposed RFI to the Board of Supervisors for further consideration. 3. APPOINT William B. Walker, M.D., as Health Services Director and Public Guardian to help the Department through a number of critical decisions, some of which must be made immediately and others of which need to be implemented in the coming weeks and months and while the strategic review is being conducted. The Board of Supervisors will reevaluate this appointment within a twelve month period. CONTINUED ON ATTACHMENT: YES SIGNATURE: - RECOMMENDATION OF COUNTY ADMINISTRATOR RECOMMENDATION OF BOARD COMMITTEE APPROVE OTHER SIGNATURE(S): ACTION OF BOARD ON November 28 , 1995- _ APPROVED AS RECOMMENDED X OTHER X At the conclusion of the discussion, the Board APPROVED the recommendations of the County Administrator appointing William B. Walker, M.D. , as the Health Services Director and Public Guardian (Recommendation No. 3) of Contra Costa County effective upon the resignation of the current Health Services Director, Mark Finucane; and DIRECTED the County Administrator and Health Services Director to report to the Board in four to six weeks on costs and issues associated with the preparation of a Request for Information (Recommendation No. 2) . In voting no, Supervisor Bishop expressed her preference for conducting a nationwide search for the Health Services Director's position at this time. VOTE OF SUPERVISORS See Attachment A for the list of speakers. I HEREBY CERTIFY THAT THIS IS A TRUE UNANI OU BS NT ) AND CORRECT COPY OF AN ACTION TAKEN AYES: l�V V NOES: III AND ENTERED ON THE MINUTES OF THE BOARD ABSENT: ABSTAIN: OF SUPERVISORS ON THE DATE SHOWN. ATTESTED November. 28 , 1995 Contact: PHIL BATCHELOR,CLERK OF THE BOARD OF CC: County Administrator SUPERVISORS AND COUNTY ADMINISTRATOR Health Services Director William B. Walker, M.D. Personnel Director BY DEPUTY Auditor-Controller 4. If the Board of Supervisors believes that it already has a clear vision of what the operations of the Health Services Department should be, then AUTHORIZE a contract with Norman Roberts and Associates, Inc. to begin recruitment for a new Health Services Director. BACKGROUND: Introduction: On November 14, 1995, the Board of Supervisors expressed its intention to appoint Dr. Walker as Acting Health Services Director and asked the County Administrator for a report on a timeline in terms of what the Board might expect of a nationwide search for a new Health Services Director. While apparently not included in the final motion, there were also suggestions from several Board members that the Board needed to be aware of some of the critical issues the Department would be facing in the coming weeks and months and the decisions that would be required in the immediate future. Timeline for Recruitment: In specific response to the Board's request for a timeline, we asked the executive search firm which did the recruitment for the Health Services Director position in Los Angeles County to provide us with an expedited timeline to recruit a Health Services Director for Contra Costa County. The attached timeline provides for a ten week process to prepare a list of qualified candidates, to be followed by interviews, selection and time for the successful candidate to give notice and relocate. This timeline is consistent with the four to five month timeline suggested to the Board of Supervisors on November 14, 1995. It is also well to recall that the recruitment for the Health Services Director in Los Angeles County took from the date Mr. Gates announced his retirement in May, 1995 until Mr. Finucane reports to work in Los Angeles on January 15, 1996, a period of eight months. It is not possible to make public a list of the finalists or other candidates for the Los Angeles County Health Services Director's position. These individuals are generally already working at highly responsible positions and do not necessarily want their present employers to be aware that they are seeking other employment unless and until an actual employment offer is made or the individual is at least among a small group of finalists. One of the key benefits of using an executive search firm is that the firm often has to contact potential applicants who may not be openly seeking other employment and convince them to allow themselves to be considered for a position. These are often the most qualified and highly sought after candidates. However, they are not generally going to respond to an advertisement fora position unless they are unhappy in their current situation and are actively looking for alternative employment. This is why the use of the term "executive search" is particularly appropriate. To get such an executive to allow himself or herself to be considered for a new position may require several contacts from the executive search firm and the passage of a certain amount of time. There simply isn't a stack of resumes which one can flip through to see whether one sees a candidate one likes. In addition, trying to compress the timeline too much makes it difficult to do proper background checks on the candidates. Background checks are an important tool in eliminating candidates from further consideration. In addition, it is important that the executive search firm have a clear idea of what the position is and what type of candidate is being sought. The potential employer needs to be able to define the position rather clearly, including the scope of the responsibilities for the position. It is not clear that we necessarily know what the short-term or long-term future holds in the health care field generally, but particularly for health care operated by the public sector. There are a number of short-term and long-term issues which will confront the County and its Health Services Department over the coming weeks and months which need to be catalogued, assessed and reviewed carefully for their impact as -2- r a part of defining what the organization and operation of the Health Services Department should look like as we move rapidly toward the 21 st Century. Short-term Issues and Deadlines: • There remains a possible budget problem of between $6.0 million and $8.0 million for the current fiscal year. This potential deficit needs to be addressed and resolved within the next few weeks in order to insure that the Department's budget remains balanced for the remainder of the current fiscal year. This may involve another round of substantial reductions in Substance Abuse services. This may also require further reductions of at least 5% in the Department's work force. • In addition, as part of resolving the current year budget problems, the future of the Home Health Agency needs to be addressed, leading to either reorganization or possible elimination of the Agency. • Within the next 90 days, the Health Services Department will need to submit to the State Department of Corporations a material modification to the County's license in order to allow the number of Medi-Cal enrollees in the Contra Costa Health Plan to be increased from 15,000 to 40,000. This expansion is necessary to accommodate increased enrollment in the Medi-Cal Managed Care Local Initiative. • The County must submit to the State its application for implementation of the Local Initiative by December 31, 1995. This requires that certain arrangements and decisions related to the application -- such as negotiating and executing provider contracts -- be finalized prior to the deadline. • In addition, by June, 1996, the County must demonstrate its readiness to serve the expanded enrollment in the Local Initiative by having in place all operational details, including the complex authorization system. • Within the next six months, the County must decide whether or not it will bring up the Social HMO (SHMO), a key factor in establishing a foothold in the Medicare market. To meet the target date of June, 1996, issues related to implementing the SHMO, such as case management systems and staff models, among other things, will need to be settled promptly. • Health plan open enrollment for County employees, currently underway, will return during the month of January. Given that the majority of members in the Contra Costa Health Plan (CCHP) are County employees, it is critical that the Department be able to project strong, experienced, and stable leadership if the CCHP expects to retain current employees and attract new members. The Department cannot afford to be perceived as having a "leadership vacuum" in the organization. In the midst of the debate over the hospital replacement project, many potential members felt apprehensive about joining a health plan whose future configuration was undecided. Uncertainty regarding the management of the entire health care system could similarly drive away the Department's strongest potential client base. • The Department is presently engaged in separate and independent negotiations with Kaiser, Brookside Hospital and with John Muir Medical Center regarding the possible establishment of collaborative arrangements. These negotiations are rooted in long-standing personal relationships and are founded on a trust which has developed out of a growing understanding and familiarity with the Department and the philosophy of its leaders. A decision to bring in someone from outside the organization would, at best, stall or, at worst, destroy continued progress in these important negotiations. • Physician contract negotiations reopen in January, 1996. It will be important for someone with substantial background on the issues involved to be providing input from the Department to the County's negotiators. -3- Long-term Issues and Deadlines: • Under impending Congressional reforms in the Medicare and Medicaid (Medi-Cal) programs, according to the Chief Financial Officer for the Department, the Health Services Department stands to lose approximately$600,000 to $700,000 of existing Medicare funding in the first year of implementation. This will total approximately $5.9 million to $7.4 million over a period of seven years. The Department currently receives approximately $15.9 million annually in Medicare funding. Medi-Cal losses are estimated to range from a low of$2.0 million to $4.0 million to as much as $13.0 million annually. The Department currently receives a total of approximately $60.3 million in Medi-Cal funding from all sources. It is assumed that these losses will not begin until the 1997 Federal Fiscal Year (October 1, 1996). • If Congress is successful in restructuring the Medicaid Program to a block grant, it is likely that the State will alter eligibility standards, limit services covered under the Medi-Cal benefit package, and reduce payments to providers. Because it is not clear at this point how the State would implement those changes, it is difficult to predict with precision the fiscal impact of such action. Clearly, someone already especially familiar with the County's system will be in the best position to protect its assets under what are guaranteed to be increasingly difficult conditions. Organizational and Operational Ability to Respond: It should be obvious from the above listing of issues and decisions which will confront the Department in the next six months and the longer term issues with which the County and the Department must deal that it is essential the Department be structured in a manner that optimizes its ability to address and respond to these issues quickly, professionally and in an efficient manner. Running the Contra Costa County Health Services Department is a vastly more complex job than most health care jobs in the private sector. One need only compare even as sophisticated an organization as Mt. Diablo Medical Center or John Muir Medical Center with the County's Health Services Department to see the challenges facing a new Health Services Director. As the organization stands now, a new Health Services Director will be expected to be: ❑ Building a replacement hospital on the grounds of the current facility while keeping the present major general acute care hospital operational . ❑ Operating a full range of general medical and speciality outpatient clinics. ❑ Operating a Federally qualified Health Maintenance Organization. ❑ Operating directly or through contract a full range of residential and outpatient substance abuse services. ❑ Operating directly or through contract a full range of mental health services. ❑ Overseeing the provision of health and mental health services to jail inmates. ❑ Providing a full range of public health services to the entire community, including communicable disease prevention, services to the developmentally disabled, and community health education and prevention. ❑ Providing a full range of environmental health services to the entire community, including restaurant inspections, solid waste enforcement, water quality inspections, land use and development, and retail food protection. ❑ Providing a full range of hazardous materials and hazardous waste inspection, prevention, and emergency response services to the entire community. -4- I ❑ Coordinating and overseeing the emergency medical services system for the entire community, including the emergency medical response system and trauma center designation. ❑ Serving as the provider of last resort for the medically indigent throughout the County. The following questions come to mind in reviewing these issues: How do the changes in the health care field affect the existing structure of the Health Services Department? What organizational and operational changes would most likely position the Health Services Department to be in the strongest position to respond positively to these changes? What executive positions are needed in the Health Services Department in order to most effectively manage these changes? What qualifications are most important for each of these positions? Unless and until the Board of Supervisors is convinced that it has appropriate answers to these and many more questions, it is difficult if not impossible to define what the role of the next Health Services Director should be, what range of programs should continue to be managed by the Director and how the Department should be structured to respond to the challenges which now face the Department. Summary: As a result, we are suggesting that the Board of Supervisors identify individuals knowledgeable about these pending changes and the general field of public health and medical care and consider selecting one of them to: • expand on each of these issues, • explore the implications of each, and • provide the Board of Supervisors with some recommendations for how the County can best respond to them, both organizationally and operationally. Obviously, if the Board wishes to go in this direction, someone has to be in charge of the Department in the meantime to make the critical decisions which have been detailed above that have to be made in the coming months. We are, therefore, suggesting that: • Dr. Walker be appointed as the Health Services Director, subject to review by the Board of Supervisors within the next twelve months, • that Dr. Walker be provided the full backing of the Board of Supervisors and the County Administrator to make those decisions that need to be made in the near future and to make those changes in the Department that are needed in connection with those decisions, • that we outline an RFI for a strategic review of the Health Services Department and bring it back to the Board of Supervisors before the end of December, and • that we not contract at this time with an executive search firm until the Board has a clear idea of what the job of Health Services Director is going to be in the future and has reviewed the work that results from the RFI. -5-