HomeMy WebLinkAboutMINUTES - 12171996 - C99 TO: BOARD OF SUPERVISORS F&HS-02 ....... Contra
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FROM: FAMILY AND HUMAN SERVICES COMMITTEE Costa
��• .,:,,::-,:E.. 40� County
Op '•._-_ _ ''GPS
DATE: December 9, 1996
SUBJECT: OVERSIGHT OF THE DEVELOPMENT AND IMPLEMENTATION OF THE
FAMILY MAINTENANCE ORGANIZATION
SPECIFIC REQUEST(S)OR RECOMMENDATION(S)&BACKGROUND AND JUSTIFICATION
RECOMMENDATIONS:
1. ACCEPT the attached report from the Health Services Department on the
status of the integration of health services in the Bay Point area.
2. DIRECT the Health Services Director to make a further report to the 1997
Family and Human Services Committee during the month of April 1997 on the
status of the Bay Point Community Wellness Center and on the status of the
inter-agency data-gathering effort to expand this effort to other services and
departments.
3. DIRECT the Health Services Director to include in that report the feasibility of
expanding the concept of a Wellness Center to the Richmond area and the
Monument corridor area of Concord.
4. REMOVE this subject as a referral to the 1996 Family and Human Services
Committee and instead REFER it to the 1997 Family and Human Services
Committee.
CONTINUED ON ATTACHMENT: YES SIGNATURE:
RECOMMENDATION OF COUNTY ADMINISTRATOR RECOMMENDATION OF BO D O I TEE
APPROVE OTHER
SIGNATURE(S): MARK DeSAULNIER J F
ACTION OF BOARD ON December 17, 1996 APPROVED AS RECOMMENDED X _ OTHER
VOTE OF SUPERVISORS
I HEREBY CERTIFY THAT THIS IS A TRUE
X 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.
ATTESTED December 17, 1996
Contact: PHIL BATCHELOR,CLERK OF THE BOARD OF
cc: County Administrator SUPERVISORS AND COUNTY MINISTRATOR
Health Services Director
Mary Foran, Assistant to the Health Services Director DEPUTY
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F&HS-02
BACKGROUND:
On May 21, 1996, the Board of Supervisors approved a report from our Committee
which included the following recommendations:
1. ACCEPT the attached report from the Assistant to the Health Services Director,
outlining the status of the work on the Family Maintenance Organization.
2. REQUEST the Health Services Director to provide the Family and Human
Services Committee with a further report on the status of the Family
Maintenance Organization when the cost study is sufficiently completed that
there is additional information to provide to our Committee, but no later than
December 9, 1996.
On December 9, 1996, our Committee met with Mary Foran, Assistant to the Health
Services Director, who reviewed the attached report with our Committee.
We are pleased to see that a complex of services are now available in the Bay Point
community. We would like to see whether there is a potential to extend this same
integration of health services to Richmond and the Monument corridor area of
Concord. In order to demonstrate financial savings, we need to see a decrease in
the inappropriate use of the emergency room and a decrease in the need for
treatment of severe dental caries in the children in the area.
Ms. Foran noted that obtaining the necessary data from all departments is going to
be the next challenge. It will be difficult and expensive to determine whether it is
even feasible to obtain this information. Within the next four months, the Department
should be in a position to advise the Board of Supervisors on the feasibility of
obtaining this information.
We are, therefore, asking that the above recommendations be approved and that the
1997 Family and Human Services Committee be provided a further progress report
in April 1997.
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CONTRA COSTA COUNTY
- HEALTH SERVICES DEPARTMENT
MEMORANDUM
December 5, 1996
TO: Supervisor Mark DeSaulnier
Supervisor Jeff Smith
Family and Human Services Committee
FROM: Mary Foran
Assistant to the Healt Services Director
SUBJECT: Status Report on the Family Maintenance Organization
In May of 1996 we provided the Family and Human Services Committee with a status report on the
Family Maintenance Organization. We are here today to give you an update on our progress toward:
1) Implementing the FMO program in Bay Point
2) Estimating the total County health expenditures in Bay Point
3) Implementing an inter-agency study of County expenditures in Bay Point
Implementation of the FMO Program in Bay Point
Due to funding limitations and the presence of several complementary initiatives in Bay Point, it is
not appropriate any longer to talk about the FMO as if it were a separate program. However, it is
most appropriate to think of the FMO as an organizing concept which is driving the development
of a comprehensive, integrated, family-focused, community-based system of public services in Bay
Point.
Since July, the Health Services Department has been working intensively with the Mt. Diablo
Unified School District to bring up a number of health care programs at the Bay Point Community
Wellness Center, located at the Riverview School in Bay Point. The following services are in place
or soon to become operational:
• WIC—one day each week and an additional half-day twice a month
• Child Health Screening/Pediatric Care—two half days each week
• Children's Mental Health Services (EPSDT)—twelve hours each week
• Family Practice Primary Care—two and a half days each week beginning December 16,
1996
• Preventive Dental Services for Children—resources being identified for Spring 1997 start
date
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As a result of this work, the following service integration results have been achieved:
• The clerical and on-site management for these services is nearly completely integrated
across the programs.
• The separate records traditionally maintained by Public Health Clinic Services and
Ambulatory Care have been melded into one unified medical record.
• The previously independent automated systems for patient care have been "networked" so
that staff can gain access to all of them through one terminal.
• As a result of creative fundraising spearheaded by the Mt. Diablo Unified School District,
a position of Program Coordinator/Health Educator has been jointly funded by Pacificare
Foundation,Mt.Diablo Unified,the Health Services Department,and,hopefully,one other
organization. This new coordinator will be responsible for managing the continued
integration of the Bay Point Community Wellness Center health service programs with
each other and with the SIT in Bay Point. In addition,the coordinator will develop parent
education programs,teen health activities,and a community advisory group to guide future
Center activities and priorities. These additional program efforts reflect the same areas
previously slated for development by the FMO.
In summary, the past five months of intensive work have brought into being a new integrated site
for health care services and ongoing community health improvement activities, designed and
implemented in collaboration with the local school district. These services are available to the entire
community, including enrollees in the Medi-Cal Managed Care Local Initiative coming up in
February.
Estimating County Health Expenditures in Bay Point for "FMO Basic" Services
Last May we proposed to conduct an FMO cost study which would help us push the development
of the FMO to another level. Specifically,we proposed to conduct the cost study at two levels. The
first level, called "FMO Basic," would analyze the costs of primary medical care, health education
and support services to address family health problems among families receiving services from our
Health Services Department. (The services currently being implemented at the Bay Point
Community Wellness Center form the core of the "FMO Basic" constellation of services,which will
be enhanced by further development.) The second level, called "FMO Enhanced," would analyze
the costs of providing intensive support and intervention services to address complex medical and
social problems among families using more than one County-funded program.
The first level of analysis is complete. Appendix A displays the results of our review of available
data sources in order to estimate the amount of funds currently being invested by the Health Services
Department to provide "FMO Basic" services to Bay Point residents. We estimate that 10 primary
care and prevention programs are expending $2,190,252 per year in Bay Point.
There are all kinds of caveats which must be attached to this estimated total. The detail provided
in Appendix A highlights the limitations of the data. Most programs could not identify actual
counts for Bay Point. Six of the ten programs are not automated. Records are not organized by
geographic origin, so even hand tallying was not feasible. As a result, estimated percentages are
used. Budgeted expenditures are used to estimate most program costs. In the case of medical care,
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charges for visits by Bay Point residents occurring in 1994 are used because of the existence of an
earlier in-depth study conducted for the FMO. Despite the roughness of the estimate, we are
comfortable that the total figure gives a reasonable picture of current expenditures for the current
"FMO Basic" constellation of services.
In addition to showing cost estimates, Appendix A also displays the many similarities in desired
outcomes across programs, which highlight opportunities for program integration. Several key
program integration issues are being addressed by the new staffing configurations at the Bay Point
Community Wellness Center and the integrated management structure being developed. Others will
be addressed through further program development activities.
The assembling of the currently available expenditure data for"FMO Basic" services, in conjunction
with previously assembled FMO data, allowed us to identify which program costs might be most
likely to change as a result of the reconfigured and enhanced services in Bay Point. It is important
to note that 90%of the total estimated expenditures is for acute medical care and 10%for prevention
and support programs. With this reality in mind, we believe the following services would be the
most important ones to track in order to assess whether savings or rather shifts in costs occur over
time at Bay Point:
1) Use by Bay Point residents of the Merrithew Memorial Hospital Emergency
Department
2) Treatment of severe dental caries in Bay Point children
Not only are these costs preventable by improving access and providing prevention services,but they
are also trackable through existing data systems and should be significantly affected by the programs
coming into being at Bay Point. Depending on the order in which parent and community health
education programs are implemented at Bay Point, the one other cost outcome which might be
considered for inclusion in an evaluation of this effort is hospitalization of Bay Point children for
conditions which should be treated on an outpatient basis.
The implementation of the first phase of the FMO cost study has told us roughly what we are
spending for a specific set of services and helped define two or three cost measures to be included
in an evaluation. While we do not have the resources at this time for an extensive evaluation, we
are discussing with Mt. Diablo Unified School District which Health Services outcomes might be
included in their Healthy Start evaluation.
The Inter-Agency FMO Cost Study for "FMO Enhanced" Services
The second level of the FMO cost study is to estimate the costs of intensive services provided by
multiple departments to Bay Point families. For the Health Services Department, this includes
Mental Health and Substance Abuse services and case management for complex medical conditions.
We also include in this category Child Welfare,Probation,public safety programs and special school
programs. Appendix B displays the results of assessing the availability of expenditure data only
from the Health Services programs. The results are not impressive. Gaining access to data for Bay
Point would require special programming in the Mental Health system and hand searches through
Substance Abuse program records. This inaccessibility of information in our own Department has
delayed our aggressively pursuing data from other Departments. It is causing us to reassess the
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feasibility of our original plan which was to assemble key identifier information, service
chronologies and costs for 200 families in Bay Point which are currently receiving multiple services.
We are exploring two possible courses of action, which might be alternatives to each other or done
in sequence. The first would be to use the same methodology employed for the "FMO Basic"
analysis which, if successful, would yield a rough distribution of expenditures across program and
department categories. This information could be used to compare expenditures across programs
and between Bay Point and the County as a whole. It would provide little insight into the overlaps
or parallel provision of services to specific families. Nor would it help us understand which services
were needed but not provided.
The second course would be to design a smaller, more focused study of Bay Point families which
seeks to trace their use of services. This approach would not give a global sense of expenditures,
but again, if successful, should give us a deeper understanding of the range, sequence, amount and
cost of services provided to our high cost families, and where the addition of appropriate
interventions might decrease, or at least shift, costs and improve outcomes. This approach could be
made more manageable by restricting the number of families to be studied and/or by restricting the
number of programs to be included.
Both approaches face formidable barriers, including gaining cooperation from multiple agencies,
developing definitions of many different units of service, determining costs per units of service,
negotiating numerous confidentiality barriers, and making a major investment of staff time. The
payoffs could include quantifying our investments in the various current strategies,creating baselines
for evaluating future changes in allocation of expenditures, elucidating potential areas for cost
savings or shifting, and providing information which would help define more precisely the different
services which might change the current patterns of utilization.
We are committed to pursuing these questions—which become more complex the more we work
with them; to finding our way to some answers; and to continuing to report to you on our progress.
Our goal is to design a study, or rather, a series of efforts which will yield useful information for
making progress toward focused systems change.
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