HomeMy WebLinkAboutMINUTES - 11191996 - D1 1
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THE BOARD OF SUPERVISORS OF
CONTRA COSTA COUNTY, CALIFORNIA
DATE: November 19, 1996 MATTER OF RECORD
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D.l On this date, November 19, 1996, the Board of Supervisors accepted the
Departmental Performance Report on the Health Services Department as
presented by Dr. William Walker, Health Services Director.
THIS IS FOR RECORD PURPOSES ONLY
NO BOARD ACTION TAKEN
cc: County Administrator
Health Services, Administration
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HEALTH SERVICES DEPARTMENT
I DEPARTMENTAL PERFORMANCE
J REPORT
1996
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Table of Contents
Section I DEPARTMENTAL OVERVIEW
7 A MISSION STATEMENT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
B ORGANIZATIONAL STRUCTURE . . . . . . . . . . . . . . . . . . . . . 1
Section II RESOURCES
A FINANCIAL RESOURCES . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
7
B PERSONNEL RESOURCES . . . . . . . . . . . . . . . .. . . . . . . . . . 3
.0 AFFIRMATIVE ACTION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
7 D SICK LEAVE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
E STAFF DEVELOPMENT . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
7 F AUTOMATION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
Section III CUSTOMER SERVICES
A SERVICE DELIVERY SYSTEMS . . . . . . . . . . . . . . . . . . . . . 11
Hospital and Health Centers . . . . . . . . . . . . . . . . . . . . 11
Mental Health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
� Public Health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
�J Community Substance Abuse Services . . . . . . . . . . . . 14
Contra Costa Health Plan . . . . . . . . . . . . . . . . . . . . . . 17
Environmental Health/Harzardous Materials Program . 17
Emergency Services . . . . . . . . . . . . . . . . . . . . . . . . . . 20
B CUSTOMER PROFILE
Hospital and Health Centers . . . . . . . . . . . . . . . . . . . . 20
Mental Health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
Public Health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
l Community Substance Abuse Services . . . . . . . . . . . . 22
" Contra Costa Health Plan . . . . . . . . . . . . . . . . . . . . . . 22
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Environmental Health/Harzardous Materials Program . 22
Emergency Services . . . . . . . . . . . . . . . . . . . . . . . . . . 22
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C CUSTOMER RELATIONSHIPS
I Hospital and Health Centers . . . . . . . . . . . . . . . . . . . . 23
Mental Health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24
Public Health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25
Community Substance Abuse Services . . . . . . . . . . . . 25
-� Contra Costa Health Plan . . . . . . . . . . . . . . . . . . . . . . 26
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Emergency Services . . . . . . . . . . . . . . . . . . . . . . . . . . 26
Section IV ANNUAL PERFORMANCE
A PERFORMANCE INDICATORS
Hospital and Health Centers . . . . . . . . . . . . . . . . . . . . 27
o� Mental Health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27
Public Health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28
Community Substance Abuse Services . . . . . . . . . . . . 28
Contra Costa Health Plan . . . . . . . . . . . . . . . . . . . . . . 29
-� Emergency Services . . . . . . . . . . . . . . . . . . . . . . . . . . 29
B ACCOMPLISHMENTS
Hospital and Health Centers . . . . . . . . . . . . . . . . . . . . 29
Mental Health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30
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Public Health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30
Community Substance Abuse Services . . . . . . . . . . . . 34
Emergency Services . . . . . . . . . . . . . . . . . . . . . . . . 35
Section V CHALLENGES AND NEW DIRECTIONS . . . . . . . . . . . . . . 37
Responding to the
Health Care Finance Revolution . . . . . . . . . . . . . . . . . 37
Community Health Problems . . . . . . . . . . . . . . . . . . . . 40
Striking the Balance . . . . . . . . . . . . . . . . . . . . . . . . . . . 41
Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42
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ATTACHMENTS
A Health Services Department Organization Chart
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R B 1 HSD FY 1996-97 Adopted Budget
h 2 HSD Gross Expenditures - Fiscal year
comparisons
(excluding Homeless Program)
3 HSD County Subsidies - Fiscal year comparisons
(excluding Homeless Program)
C Personnel - Tables
1 Staffing Patterns
2 Affirmative Action Pattern - 1995
a 3 Affirmative Action Pattern - 1991
4 Sick Leave Usage
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D Community Substance Abuse Services
FY 1995-96 Cost/Service Report
D. ti
E Mental Health Crisis Census -
Service, 5150Noluntary, and by Age
F Contra Costa Health Plan
1 Contra Costa Health Plan - Services Provided
2 Insurance Source
3 Current membership
4 Residence of members
5 AFDC Satisfaction Survey
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SECTION I - DEPARTMENT OVERVIEW
A DEPARTMENT RESPONSIBILITIES
Mission Statement
The Health Services Department cares for and improves the health of
all people in Contra Costa County with special attention to those who
are most vulnerable to health problems and their consequences.
Values
• We are an integrated system of health care services, community
health improvement and environmental protection.
• We emphasize quality of services and respect for all who use and
work in our programs.
• We anticipate community health needs and change to meet those
needs.
• We work in partnership with our patients, cities and diverse
communities, as well as other health, education and human
service agencies.
• We encourage creative, ethical and tenacious leadership to
implement effective health policies and programs.
6- B Organizational Structure
The Health Services Department is made up of the following divisions:
Hospital and Health Centers
Mental Health
Public Health
• Community Substance Abuse Services
• Contra Costa Health Plan
Environmental Health/Hazardous Materials Program
Emergency,Medical Services
Finance
Personnel
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Office of the Director
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s The Office of the Director, Finance and Personnel provide centralized
t a administration and policy direction for the operating divisions of the
Department. Personnel renders assistance in the areas of recruitment,
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selection, classification, compensation, benefits, employee health and
employee relations. It also assures adherence to the provisions of the
county's own regulations including memoranda of understanding with the
employee organizations.
Finance manages all fiscal functions including billing, contracts and grants,
utilization review., payroll, data processing, budget, patient and general
accounting, program reimbursement, and special projects and evaluation.
The Office of the Director also includes Department-wide broad policy
initiatives such as the Hazardous Materials Commission, Affirmative Action,
Office for Service Integration and the Women's Advisory Committee.
We engage in numerous partnerships, through contracts, coalitions, and joint
efforts. Specific partnerships are described in the detailed sections which
follow.
An organizational chart for the Department is attached as Attachment A.
4.
Health Service Department- 1996
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SECTION 11 RESOURCES
A FINANCIAL RESOURCES
Health Services Department receives fiscal support through various funding
mechanisms, as defined by individual programs. These include federal and
state monies as well as county fees and taxes.
The recommended budget for 1996-97 is $344.1 million dollars. $224.9 million
F of that budget is for hospital and health centers and Contra Costa Health
{ Plan. For FY 1996-97, total financing is expected to be $306.6 million and
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total NCC is expected to be $34.3 million.
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HSD depends on multiple sources of funding which include Medicare, Medi-
Cal, Private Pay/Insurance, Bond Revenues, Tobacco Tax, SB855, VLF
revenue, interest income, Realignment monies (Hospital and Health Centers,
Y. CCHP); State CCS program (Public Health); federal and state grants, client
fees (Public Health and Substance Abuse); Drug Medi-Cal, federal block
grant, and state allocation (Substance Abuse); conservatorship fees
(Conservator); property, taxes (Emergency Medical Services); Inspection
Fees, Public Health Permits, Hazardous Waste Generator Fees
(Environmental Health/Hazardous Materials Program); Ryan White funding
(AIDS); SAMSHA grant funds, SB910 funding, SSI/SSP (Mental Health);
County General Funds (multiple programs.) .These are summarized in
Attachments 131-133.
B PERSONNEL RESOURCES
Attachments C1-C4 include tables comparing changes in staffing patterns
from 1991 to 1995. The most dramatic change in the staffing (Attachment
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C1/Table 1) occurred in the Contra Costa Health Plan which grew by 27
employees since 1991 due to expansion of the Plan. Further expansion is
a: expected. Relative to the other divisions, the Environmental Health Division
also experienced an increase of 12 staff due to increased responsibilities.
" The greatest decrease in staffing occurred in the Community Substance
Abuse Services Division which lost 35 employees. This is due to the
reduction of funding for the Driving Under the Influence (DUI) Program. The
division also underwent multiple changes since 1991 including a merger of
the previously separate Alcohol and Drug Programs into a combined
Substance Abuse Division.
C AFFIRMATIVE ACTION
It should be noted that the ethnic diversity statistical tables contained in
(Attachment C2-C3/Tables 2-3) are based on the actual staff employed j
effective December 31,1995.
The composition of the Health Services Department staff is reflective of the
workforce in the community. The only minor exceptions are in the areas of
Hispanic and American Indian/Alaska Native employment, which require 1.2%
and 0.3% increases respectively in order to attain workforce parity. As a
means of comparison, Attachment 3/Table 3 lists the Health Service
Department's affirmative action workforce distribution effective in December
31, 1991 (the last year statistics were compiled).
The Department is expanding our Affirmative Action capacity. The Board
recently approved creation of a full time Diversity Services Coordinator who
will carry out employee Affirmative Action .recruitment and monitoring and
focus attention on creating a culturally competent workforce, one that is well-
prepared to serve our diverse patient and user population. We will be
increasing attention to diversity/cultural competency training for all staff.
Attachment C2/Table 2 notes workforce ethnicity, as collected at this time.
Although an ethnic distribution by job category (i.e. professional, officials-
administrators, technicians) is available, it is not reported due to the current
inability to compare workforce distribution by job category. We are developing
a system to capture this comparison.
Attachment C3/Table 3 indicates that the affirmative action statistics for the
Department were actually better in 1991 when the Department was in perfect
parity with the applicable workforce. The parity deficiencies in the current
statistics do not warrant major concern because the differences are not large
enough to be statistically significant. However, they will be addressed in the
Department's ongoing affirmative action recruitment efforts.
D SICK LEAVE
Attachment C4/Table 4 compares the'amount of sick leave use to the amount
accrued in the 1995 calendar year. Because it was not until recently that data
had been collected relative to sick leave usage, no comparison with past L
years can be made. This table indicates that there is a substantial difference
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in sick usage pattern in Hospitals and Health Centers as compared to the
other divisions in the department. Factors which contribute to this greater
usage of sick leave time can be related to exposure to illnesses which may
be contracted in the typical direct health care environment. The Department
is planning to launch a sick leave monitoring effort with attention to
understanding and improving, where possible, the current usage patterns.
E STAFF DEVELOPMENT
Performance evaluations are distributed to supervisors on a regular basis and
4 required to be submitted in a timely fashion. A new monitoring system will be
implemented in the near future to assure that delinquent evaluations are
submitted.
R The Department is very pleased with the substance of its performance
evaluation instruments, in particular the instruments used for Hospital and
Health Center staff. This is due to the work of a Joint Commission on
Professional Standards which conducted a project to develop competency
and age specific evaluations for Hospital and Health Center personnel. These
evaluations assess health care clinicians in their job-specific duties.
Additionally, they allow the supervisor to define job-specific performance
objectives through which the employee can improve skills.
fThe Department makes available to employees training workshops which
i. qualify for continuing education units where appropriate. This includes specific
clinical training areas such as CPR and How to Manage Assaultive Behavior.
All staff are encouraged during the annual evaluation 'process to identify
training needs and to develop a plan to meet them. A system to register staff
for the offerings of the County Training Institute is in place.
The hospital has developed a number of ad hoc committees which serve to
enhance professional standards. In particular, there is a Continuous Quality
Improvement (CQI) Committee. There is also a Joint Labor/Management
Committee which serves to meet the objectives of both the Department and
f staff in a cooperative manner. With the imminent opening of the new hospital
facility, there will be an even9 reater reliance on ad hoc task forces to ensure
that all concerns are addressed.
Health Service Department-1996
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The Department will be examining how the CQI principles and practices might
be applied in other Divisions.
F AUTOMATION
Information Systems technology plays a major role in supporting medical and
administrative staff activities. With 23 multi-user computer systems, as well
as hundreds of individual personal computers throughout the Department,
each Division has access to modern technology.
The Department Information Systems accomplishments this year:
• Immunization Registry System - A client-server based system was
created to capture and report child immunization information for all
County residents. Kaiser, Planned Parenthood, and other county
providers will share access to this system with HSD. This system can
print a child's record and remind parents by mail and/or automated
phone call when their child is due for immunizations. Implementation is
beginning in rEast county.
• Order Entry and Departmental System - The implementation of these
two Meditech modules allows hospital and emergency department
patient care staff to enter orders for lab, diagnostic imaging, dietary,
cardiopulmonary and rehab.therapy services. After ancillary department
staff enter a completion status, charges are automatically batched for
an electronic interface to the patient billing system. As soon as
transcribers enter physician dictation directly into the system, .staff can
access these online reports through Patient Inquiry Module.
• Quick Registrations for Clinic and Emergency Room - A new
registration process now automatically verifies CCHP, Medi-Cal and
Medicare eligibility. Once verified, the system automatically enters the
appropriate financial information in the registration account for
outpatient and emergency department patients.
• Financial eligibility interface to Appointment System - Daily and
hourly appointment rosters now access current patient financial
eligibility information in the registration account for outpatients and
emergency department patients.
Health Service Department- 1996
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• Electronic Medicare Remittance Advice - Programs were created to
automatically post payments from an electronic remittance advice to
individual patients accounts. Outpatient files, for reimbursement
_ analysis, are also created and delivered in electronic format to
x accounting staff. .
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• COLD Imaging System - An electronic imaging system has replaced
Microfiche as a storage medium for reports from the Hospital and
Health Center's patient accounting system. This system not only
x reduces the cost of storage, it also allows for text-based searches
across multiple report files.
• Automatic PCP Assignment - An automated process was created
to assign Primary Care Providers (PCPs) to Medi-Cal AFDC CCHP
members. Detailed logic is used to make assignments based on
member's age, sex, residence, and prior PCP selection criteria.
CCHP IBNR Reporting Module - An IBNR reporting module was
created for providing computed estimates of liability for incurred and
unreported CCHP member claims.
• Interface BAC Enrollments to CCHP - A nightly interface was created
to update the CCHP eligibility database with new BAC eligible members
from the BAC enrollment system.
Nursing Education Reimbursement Tracking System - This PC
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based application was developed to track continuing education
reimbursements in terms of costs incurred and the time allowed.
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• Public Health Warrant Request System - Modified the warrant
request system created for the Hospital to meet unique requirements of
Public Health.
Health Care for the Homeless System - Enhancements were made
to this in-house developed system to accommodate additional data
elements required for the 340 grant reporting requirements.
• AIDS Program Network - Stand alone PC's supporting a variety of
sm databases used for administration and mandated reporting purposes
Health Service Department-1996
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are now sharing files and communicating electronically in a newly
installed Novell LAN environment.
• Mental Health CASP - Computer Assisted Service Planning software
was implemented for the five adult mental health clinics. Using this
Windows-based software, clinicians can create treatment and service
plans individualized for each client.
• Mental Health ECI The Electronic Client Information Module was
implemented to enable users to define and create electronic forms that
link to clients. CASP documents are made available to all users of the
Mental Health System through this module.
The following is a list of automation projects currently in development:
1. Contra Costa Health Plan
Local Initiative system enhancements:
• Automated claims processing
• Electronic encounter submission for sub-contractors
• State-mandated monthly electronic encounter file submission
• Electronic eligibility file transmission to sub contractors
• Primary care provider-based utilization reporting
2. Merrithew Memorial Hospital and Health Centers
• Creation of a Credentialing System
Pharmacy System
• Conversion from current CCA system to Meditech System
• Interface to the Pyxis medication system
;urgery
Interface to the Keane ADT and billing system
MIS
• Interface to the new Credentialing system
Interface to the Keane ADT and billing system
Medicare
• Electronic billing
3. Conservatorship
• Accounts receivable management system
Health Service Department- 1996
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4. HazMat
• Risk management Prevention Program module for the HazMat
System
• CUPA mandated billing enhancements
5. Substance Abuse
• Development of MIS
6 Mental Health
• Electronic interface for Mental Health bad debt assignments to
Office of Revenue Collections
7 Public Health
• Enhancements to the Immunization Registry System
• Conversion to the new IMI CAREplex Home Health Agency
System
8 Department-wide
• New monthly payroll file reporting system
• Creation of a Health Services E-MAIL network to provide
electronic mail services to all employees with access to a
networked PC or terminal. Using SMTP protocol, all current E-
mail products will communicate to each other and to other
SMTP compliant systems outside the department.
• Ongoing support of an information and referral "Help Desk"
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SECTION III CUSTOMER SERVICES
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A. SERVICE DELIVERY SYSTEM
F.
DEPARTMENT WIDE
HSD is responsible for providing a continuum of health services to county
residents. This includes medical and prevention services as well as
environmental and public health services that protect the well being of the
entire community. HSD works cooperatively with federal, state, regional
and local jurisdictions/programs and the private sector to assure
comprehensive systems of health care and health protection.
HOSPITAL AND HEALTH CENTERS
Merrithew Memorial Hospital and Health Centers consist of Merrithew
Memorial Hospital (MMH), Emergency Care Services, Ambulatory Care
Health Centers, Older Adult Health Centers and Physician Services.
Inpatient care is provided at MMH, a 174-bed general acute care teaching
facility. MMH provides a full range of diagnostic and therapeutic services.
MMH is licensed to provide basic Emergency Care Services. In addition, a
24-hour Psychiatric Emergency Services Unit provides psychiatric
evaluation and treatment. The division is also responsible for the provision
of health care to the adult and juvenile detention population.
Outpatient, specialty, and geriatric care services are provided through a
network of ambulatory care centers. The primary and specialty care
centers are located in Richmond (primary, specialty, and ancillary),
Martinez (primary, specialty and ancillary), Pittsburg (primary, specialty,
and ancillary), Brentwood (primary care only), and Concord (primary care
only). Specialized geriatric outpatient services at the Older Adult Health
Centers, located in Antioch (primary care also located at this site), Concord
(co-located with primary care health center) and El Cerrito. The specialty
care (provided at noted clinics) include dental, rehabilitation, podiatry,
infectious disease, pediatrics, eye, dermatology, orthopedics, urology,
ENT, GYN-prenatal, and Hansen's Disease. New sites in Bay Point and
North Richmond are being developed in conjunction with other parts of the
Department.
Health Service Department-1996
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MENTAL HEALTH
Adult Services. Mental health services for adults are provided through a
single point of coordination and integration. The delivery system focus is
away from institutional care and toward a community support service
delivery system. In addition to regular mental health services, the following
services are provided either by County or contracted service providers:
Day Treatment, Crisis Residential and Adult Residential, Vocational, Crisis
Intervention and Stabilization, and Case Management/Brokerage.
Children's Services. Children's mental health services are provided
through a newly established System of Care (SOC) or continuum of
services to meet the varied mental health. needs of children, adolescents,
and their families. The SOC (staffed by county-employees, and programs
provided through contracts with community-based organizations) provides
one seamless, coordinated, and collaborative system for delivery of mental
health services county-wide. The current SOC for Children's Mental Health
Services consists of five county-operated programs and 16 contract
programs. Six of the contracts are for residential or hospital-based services
and ten are for less intensive community-based services. Of the five
county-operated programs, three are regional outpatient clinics in Central,
East, and West County and two (YIACT and AB 3632) are interagency
programs which are based in Central County but serve the whole county.
Mental Health Crisis Services. Mental Health Crisis Services are
available to all county residents, regardless of age or payor source. This
service exists as an outpatient, psychiatric emergency and crisis service at
MMH 24 hours a day, and from 8:00 am to 5:00 pm, Monday through
Friday at the West County site. These programs provide immediate access �.
as a mental health drop-in service as well as a "5150" evaluation and
treatment center.
Psychiatric Inpatient and Jail Services. The psychiatric inpatient service
at MMH provides short-term psychiatric hospitalization for adults and older
adults suffering from acute major mental illness episodes. There are 43
inpatient beds; the average occupancy is 36-38 patients; the average
length of stay is 10 days. The services provided to patients include
pharmacological therapy; individual, group, and family counseling;
Health Service Department- 1996
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occupational and vocational therapies; physical health assessment and
treatment; and case management.
The mental health unit of the Martinez Detention Facility provides
assessments, emergency interventions, and psychopharmacological and
other psychiatric treatment and some counseling for inmates with serious
mental and emotional symptoms. The unit serves about 300 clients per
month, providing medications for about 110 per month.
Significant constraints in the Detention Facility Mental Health Unit include
state law and correctional facility policies/laws regarding involuntary
medication of psychotic inmates which can make inmate management
difficult as well as jeopardize safety for staff and other inmates.
PUBLIC HEALTH
Public Health Clinical Services are provided in five clinic sites and
community settings throughout the county. Clinic Services include Well
Child and Primary Care Pediatrics, Family Planning, Sexually Transmitted
Diseases, Tuberculosis Clinics, Immunization, and HIV Testing and
Counseling. In addition, there are,mobile community Clinical Services for
homeless people (Health Care for the Homeless) and for those who do not
present for care (Health on Wheels Mobile Clinic Van). These Clinic
Services are complemented by Community Outreach Workers working in
neighborhoods and community groups on outreach to pregnant women,
children in need of health care, AIDS prevention, TB and STD follow-up
and treatment, and homeless outreach. The Home Health Agency
provided over 29,000 home visits and Public Health Nurses provided
additional home visits and case management for children and families.
Public Health Clinical Services are also brought to the schools through the
Dental Disease Prevention Program and School-Based Public Health
Clinics in Richmond and Bay Point. These Clinic Services are supported
by the Public Health Laboratory, which also provides reference laboratory
services for tuberculosis, parasites, and other communicable diseases to
non-Health Department providers throughout the county.
Health Service Department-1996
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Non-clinical direct services include Women, Infants, and Children's (WIC)
services which provide monthly food vouchers to over 7,000 low-income
women and children, and Senior Nutrition Services which serves hot
lunches to seniors at 19 sites throughout the county and provide Home
Delivered Meals to homebound seniors and people with AIDS. The
George Miller Centers in Richmond and Concord provide therapeutic
services and education for developmentally disabled adults and children.
Community-based prevention services are implemented throughout the
county in partnership with community-based organizations. Those services
include AIDSP revention and education tobacco control and cessation
community and domestic violence prevention, chronic disease control
including nutrition education and active living projects, lead poisoning
prevention, and childhood injury prevention programs. Communicable
Disease Control focuses on preventing the spread of communicable
diseases in the community, especially tuberculosis and sexually
transmitted diseases.
A fundamental role of Public Health is to collect data and assess the health
conditions and needs of the community, and evaluate the effectiveness of
Public Health and community activities to improve the health of county
residents. The Public Health Data and Evaluation staff work with
Communicable Disease Control, Clinic Services, Family, Maternal, and
Child Health, and the Community Wellness and Prevention Program to
develop community health indicators and evaluate program effectiveness.
Many of the Public Health programs are State or Federally mandated with
categorical funding attached to them, which defines populations to be
served and limits services to be provided.
COMMUNITY SUBSTANCE ABUSE SERVICES
The Community Substance Abuse Services Division (CSAS) operates and
contracts for services through a community-based continuum of care that
stresses accountability and outcomes in a culturally competent, client
driven manner. CSAS focuses on three primary areas: Prevention,
Treatment, and Ancillary Services.
Health Service Department- 1996
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Prevention. CSAS provides technical assistance, training, and resources
to regional substance abuse prevention coalitions and grassroots
` organizations; provides staff support to the Community Partnership Forum,
an alliance of local prevention groups that together with the Substance
Abuse Advisory Board (SAAB) implement the county's Substance Abuse
Action Plan.
Other programs with a prevention focus include Alcohol, Drug Abuse, and
Perinatal Task Force (ADAPT) an interagency taskforce developed to
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reduce and reverse the negative consequences of substance use during
pregnancy through service coordination and professional training. In
addition, CSAS works with the Council for Perinatal Health to facilitate
system-wide program planning, policy development, and interventions to
improve perinatal outcomes.
CSAS providers allocate at least 20% of their Federal Block Grant
resources to primary prevention activities. CSAS contracts with
community-basedg agencies to provide information and referral services,
education and refusal skills training, youth alternative activities, school
based education, early intervention, and support groups.
Treatment. CSAS operates three count drug-free outpatient substance
abuse treatment programs and contracts with several outpatient services
throughout the county.
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Residential services are provided by one county-operated residential
treatment facility, Discovery House, in Central County and contracts for
residential treatment and transitional housing services with Sunrise House
in Concord, Neighborhood House of North Richmond, Bi-Belt Corporation
(Diablo Valley Ranch in Clayton, Ozanam Center, the Annex and Gregory
r, Center in Concord), Adolescent Treatment Centers (Thunder Road in
Oakland), Ujima Family Recovery Services (The Rectory in San Pablo and
. La Casa Ujima in Martinez), and Ea4t County Detox (Wollam House in
East County). CSAS also contracts for non-medical detoxification services
with Bi Bett
Corporation (Shennum Center in Concord), East County Detox
`aA (Pittsburg), and Neighborhood House of North Richmond (Hollomon Center
in Richmond).
Health Service Department- 1996
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Residential programs are 24 hours a day, 7 days a week social model
environments that require a minimum of 40 hours per week of counseling
and/or structured therapeutic activities. Most transitional housing services
require clients to be employed, seeking employment or in job training. In
Detox programs the average length of stay is three days, clients are then
referred to other treatment services.
Clients in residential treatment have access to vocational training programs
provided by CSAS contracts with Bi-Bett (cooking school) and
Neighborhood House (Project Pride Literacy and Job Readiness Training).
Ancillary Services: AIDS/HIV Set Aside -- CSAS funds the Bay Area
Addiction, Research, and Treatment (BAART) to provide HIV/AIDS
/CD/HIV pre and post test counseling, education, and referrals to voluntary
confidential HIV testing sites for methadone clients and their sexual
partners.
A contract with the County Office of Education provides instruction and
training to the Family Recovery Project (FRP) staff and clients. The
DEUCE (Deciding/Educating/Understanding/Counseling and Evaluating)
curriculum is taught to individuals and families facing problems associated
with inter-generational substance abuse. This contract also includes adult
literacy classes for clients, and in-service training for staff.
Intensive case management services are provided for clients involved in
specialty populations such as perinatal (Born Free), parolees (Bay Area
Services Network), Ei Pueblo Housing Project (Project Challenge), post-
incarcerated African American males (Family Recovery Project).
For parolees involved with the Bay Area Services Network, Haight Ashbury
Clinics provides comprehensive substance abuse assessments and
treatment, primary care, medical assessments, physical examinations,
administration of appropriate drug therapies, urine toxicology screening,
and all clinical laboratory work.
CSAS services are defined to a great extent, by the funding sources,
State or Federal, which support them.
Health Service Department- 1996
Page 16
I s
CONTRA COSTA HEALTH PLAN
CCHP is a staff model county operated state-licensed, federally-qualified
Health Maintenance Organization (HMO). It utilizes Health Services
Department programs for approximately 85% of the health care provided to
its members, including MMHHC, Public Health (immunizations, CHDP
services), Mental Health and Substance Abuse services. (See Attachment
F1).
CCHP uses community hospitals and providers for services not offered
through our own Health Services Department (e.g., open heart surgery)
and as back-up for selected county services (e.g., optometry, dental). In
addition, in emergencies members may use community hospital
emergency facilities.
As a state-licensed, federally qualified HMO, CCHP is subject to both
federal and state requirements for the level of benefits given to members
1 and other financial and reporting requirements.
ENVIRONMENTAL HEALTH/HAZARDOUS MATERIALS PROGRAM
Environmental Health
Environmental Health provides administrative support and oversight to
programs which address the environmental components of health
throughout the county.
These are as follows:
Retail food Protection Program handles routine and complaint
investigations conducted to ensure the safe food handling, sanitation, and
maintenance of 4,000 retail food facilities in the County. These include
restaurants, markets, bakeries, schools, vehicles, and caterers.
Safety/Code Enforcement
Recreational Health Program conducts routine and complaint
investigations to ensure the safety and sanitation of over 1,500 non-private
swimming pools, spas, and water parks.
Construction Plan Check Program: Construction of new and remodeled
— food and pool facilities are reviewed for proper design, ventilation,
plumbing, construction equipment, and auxiliary structures. On-site
Health Service Department-1996
Page 17
Ili I
construction and pre-opening inspections are also conducted to ensure
proper equipment installation and conformance with approved plans.
Evaluations are also done for new food and pool equipment prototypes.
Code Enforcement Program investigates over 1,600 household trash and
garbage complaints annually and provides follow-up corrections.
Land Use and Development
Liquid Waste Program reviews land development projects and is
responsible for inspecting and permitting on-site wastewater disposal {
systems in the unsewered areas of the county. Complaints about broken
sewer laterals and mains are investigated and corrected. The program also
monitors the activities of septic tank and other vehicles for liquid disposal.
Private Well Construction/Abandonment Program prevents disease
and contamination of groundwater supplies by assuring that individual
water wells and groundwater monitoring wells are properly constructed,
maintained, and destroyed.
Small Water System Program is delegated by the State Office of Drinking
Water. It is responsible for public health protection and disease prevention
and assures that water from 160 small public water systems is safe, ■
potable, available in adequate quantity, and protected against
contaminating backflow. This is accomplished through assistance to water
purveyors, plan check, permitting inspections, and bacteriological and
chemical sampling.
Solid Waste
Solid.Waste Facility Program: Environmental Health serves as the
delegated Local Enforcement Agency (LEA) of the California Integrated
Waste Management Board. The Solid Waste Facility Program is
responsible for the permitting and inspection of solid waste facilities
including landfills, transfer stations, material recovery facilities, waste tire
facilities, composting facilities and closed/illegal/abandoned sites.
Medical Waste Management Program is responsible for permitting and
inspecting large and small quantity registered producers of medical waste
1
/n
Health Service Department- 1996
Page 18
t
and enforcing the laws that regulate the generation, storage, and
transportation of medical waste.
Land Application of Sludge Program inspects, permits, monitors, and
enforces the laws regulating the land application of sewage sludge.
Hazardous Materials Program
Hazardous Waste Generator Program monitors facilities to ensure safe
and legal handling, storage, and disposal of hazardous wastes.
Businesses in Contra Costa County that generate hazardous wastes are
regulated by this program. HSD conducts compliance inspections of these
businesses annually.
Underground Storage Tank Program: Underground tanks that store
hazardous materials have the potential of leaking and must be registered,
r
permitted, tested, and inspected. The Underground Storage Tank program
monitors facilities that store hazardous materials. HSD issues permits and
regulates these facilities to ensure that tanks are monitored for leaks to
prevent soil and ground water contamination. In addition, HSD reviews
plans, performs on-site inspections and issues permits for all new tank
-` installations and-tank removals.
Hazardous Materials Release Response and Inventory Program covers
over 1,200 businesses in Contra Costa County, including major oil
k refineries and chemical plants. This program, also referred to as the
k,
. Business Plan Program, requires businesses to submit an inventory of
hazardous materials stored on their site and a map of their facility, showing
the storage location of hazardous materials and emergency equipment.
Facilities are inspected by Hazardous Materials personnel to ensure
compliance with regulations.
Household Hazardous Waste Program provides ongoing weekend
collection events for both recyclable and toxic household waste. These
events are provided free to the public. In addition, the program provides
information about safe alternatives to many products which contain
hazardous materials that may leach from the landfill into the water supply.
Health Service Department- 1996
Page 19
� J
Risk Management and Prevention Program seeks to prevent the
accidental release of "Acutely Hazardous Materials" (AHM) and to prepare
for public protection in the event of a release. Facilities are required to r
prepare detailed, step-by-step hazard analysis to identify ways to prevent
accidental releases of AHMs and to develop Off-site Consequence
Analyses for emergency response planning. r
Incident Response Program Emergency response staff are on-call 24
hours a day to provide technical assistance at chemical spills, illegal drug
labs, pipeline leaks, and illegal dumping of hazardous wastes or chemicals.
They provide identification of unknown substances, health hazardous
wastes or chemicals. In addition, they also initiate the community warning
system which was developed to warn the public in case of toxic spills,
floods, fires and other disasters.
EMERGENCY MEDICAL SERVICES
EMS provides overall direction, planning, and monitoring for the county's
prehospital Emergency Medical Service system. The EMS system consists
of fire, ambulance, and related services which respond to 9-1-1 medical
emergencies. A variety of agencies and organizations work together to
provide persons who experience medical emergencies with a timely
response delivered in a professional and medically appropriate manner.
EMS providers include fire services, ground and air ambulance services,
public safety dispatch centers, law enforcement agencies, and hospitals
with their medical staffs. Supporting the direct service components are
educational and training institutions, citizen and medical advisory groups,
and various other public and voluntary organizations.
B. CUSTOMER PROFILE
HSD clients are defined in multiple ways. For some, we are the provider of
last resort, for others the provider of choice, and,still others, the only
provider for certain unique services.
HOSPITAL AND HEALTH CENTERS
MMHHC offers services to all those who live in the county. The majority of
our patients include those who are on Medi-Cal, those who are not eligible
for any type of federal, state, or private health plan and the statutorily j
L
_:
Health Service Department- 1996
Page 20
required services to the medically indigent under Section 17000 of the
Welfare and Institutions Code of the State of California.
MENTAL HEALTH
Adult/Older Adult Program. - Customers are adults who are functionally
disabled and who are seriously and persistently mentally ill; older adults,
60 years and over, who require specialized services due to functional
impairment or significant changes in behaviors related to a serious,
persistent mental illness; and persons who are in severe crisis or are in
F danger of suicide, hospitalization or becoming seriously and persistently
S
mentally ill.
Children's Services. - Eligibility for services in the public mental health
system is determined by various pieces of state and federal legislation
which govern the use of or access to funds. To be eligible for most mental
health services, a child or adolescent must have a mental health diagnosis
from the Diagnostic and Statistical Manual of Mental Disorders (DSM).
Mental Health Crisis Services. - The customer is generally an individual,
family member(s) or concerned person who is seeking counseling or some
type of psychiatric intervention, including medications for psychiatric
symptoms. These clients may have dropped in, been advised by another
practitioner to come in, or on a W&I Code 5150. (See Attachment E)
Psychiatric Inpatient and Jail Services - See Section A.
PUBLIC HEALTH
The core Public Health programs of community health assessment,
t
Communicable Disease Control, and community-based prevention
t activities such as tobacco control, AIDS prevention, community and
domestic violence prevention, and chronic disease control and prevention
serve the entire county population. Public Health Clinic Services target the
s. Medi-Cal population, the working uninsured, and the indigent population.
Other programs focus on specialized populations: Family, Maternal, and
Child Health on women and children, Senior Nutrition Project on all
persons over 65, and the Miller Centers on developmentally disabled
adults and children.
N
Health Service Department-1996
�. Page 21
COMMUNITY SUBSTANCE ABUSE SERVICES
CSAS is reviewing client data from our 1995/96 data reports. Preliminary
analysis shows no indication of major changes in clients or mix of services
from 1994 data. In 1994, California Alcohol and Drug Data Systems
(CADDS) reported a total of 9,964 people were clients in publicly-funded
alcohol and drug treatment programs in the county. 70.38% were males
and 28.7% were females. For the same period, drugs of choice most
commonly reported by clients were: 56.7% alcohol, followed by heroin
(26.2%), cocaine/crack (7.1%) and methamphetamine (6.8%).
CONTRA COSTA HEALTH PLAN
CCHP is available to Medi-Cal and Medicare recipients, employees of
participating private and governmental employers and individual members
of the general public. It currently serves over 24,000 people Living in Contra
Costa County. (See Attachment F2-F4)
ENVIRONMENTAL HEALTH/HAZARDOUS MATERIALS
The ultimate customers are the general population of Contra Costa County
who rely on appropriate inspection and regulatory activities to protect their
health. More specific customers include the businesses and individuals
whose activities fall under our jurisdiction.
EMERGENCY MEDICAL SERVICES (EMSJ
EMS serves county residents and all other persons working or temporarily
in the county who need the assurance that an emergency medical
response system is available should the need arise in the event of day-to-
day emergency or disaster. These include: victims of sudden medical
emergencies needing the rapid response of trained emergency medical
providers to perform emergency treatment and to provide transportation to
the appropriate hospital emergency facility; patients subject to interfacility
transfer; as well as emergency response personnel, advanced life support
(ALS) program managers who need program approval by the EMS Medical
Director; EMT-I and paramedic training program managers; and EMS
providers and other emergency responders who rely on a well organized,
professional EMS system as one component of the county's overall
emergency response system.
1
Health Service Department- 1996
Page 22
JJ /
C. CUSTOMER RELATIONSHIPS
Each division has a unique blend of relationships with clients as evidenced
in outreach and utilization. Programs vary in their ability to choose clients.
Some programs have very specific eligibility requirements, while others are
open to all who come for services.
g
HOSPITAL AND HEALTH CENTERS
The majority of our patients use our service because we are the health
' services of choice. For some, such as indigents enrolled in Basic Adult
Care, we are the only available option in the county. Patients are informed
about our services through a variety of formal and informal mechanisms.
{ Formal mechanisms include marketing materials developed by CCHP,
Q notices posted in other county-wide departments, e.g. Social Service;
4
relationships with a host of county-wide community-based organizations,
service organizations, religious organizations and numerous public guides
to services. Informal mechanisms are primarily "word of mouth." Those
enrolled in CCHP are given orientation and marketing materials which
describe the services, hours of operation, and points of contact. In the past
several years, MMHHC has established evening clinics in the three large
h clinics (Richmond, Martinez, and Pittsburg) as well as Saturday clinics in
Richmond and Pittsburg in order to increase access to services.
r
f..
The division has developed inpatient and outpatient satisfaction surveys.
For inpatient services, staff assist patients in completing a survey that
F
focuses on their care and stay at the hospital. We currently receive an
average of 400 surveys a month. These are analyzed and incorporated
into the division's strategic plan where appropriate operational
E;.
interventions are developed and implemented to correct problems
identified by our patients.
4-
For those using Ambulatory Care Health Centers, we have conducted
several similar patient surveys. Overwhelmingly, our patients identified
g
waitin time for appointment and inability to gain access to their primary
s.. care provider as key problems. These responses provided the impetus for
developing the Patients' Choice program. We re-survey our patients
periodically, to insure that the operational interventions developed and
implemented have been effective in the eyes of the patients.
Health Service Department- 1996
Page 23
D,
MENTAL HEALTH
Adult/Older Adult Program. - The reorientation of the program to more
community-based services should result in a number of system changes.
Services will become more available in the community involving natural
support systems. Staff will become more familiar with natural support
structures, build stronger relationships with local businesses and citizens,
and become part of community organizations that they can influence on
behalf of clients. A standardized client satisfaction questionnaire will be
administered regularly in 1996/97.
Children's Services. - Target population children and youth are identified,
screened, and referred at various "portals of entry" into the system of care.
Fees are charge using a statewide system and are based on ability to pay.
A significant proportion of clients are on Medi-Cal and thus, pay nothing for
services directly. For court dependents, entry is through the Emergency
Placement System (EPS), which is comprised of a number of emergency
foster group homes. For special education (SED) students, the portal of
entry is initially the school, and secondarily the screening unit of the
AB3632 Program. Other SED youngsters may enter the system via one of
the three regional clinics, the County Psychiatric Emergency Services Unit
(E-Ward), or one of the local acute inpatient units. Administration of a f
parent satisfaction survey will begin in 1996/97 as part of statewide
implementation of performance outcomes in Children's Mental Health
Services in California.
Mental Health Crisis Services. - Those requesting services are evaluated
and treated or given recommendations and referrals to the appropriate
service for care. Customers access services through look-up telephone
directories, hotlines, consumer publications, information and referral line
through CCHP, advice nurses and other triage personnel in various
hospitals and clinics, police departmiants and other public agencies. We
are preparing a Satisfaction Survey to be given to all clients receiving crisis
services.
Psychiatric Inpatient and Jail Services. - Consumers of these services
are involuntary to one degree or another. They are a diverse population,
economically, ethnically, and geographically. Access is not an issue since
Health Service Department-1996
Page 24
transportation is provided by ambulance or by police and sheriff deputies
when necessary.
The psychiatric units participate in regular patient satisfaction surveys
through MMHHC. The level of satisfaction is remarkably high considering
the involuntary nature of services. There is also a hospital ombudsman
who handles patient (and patient's `families') complaints. Furthermore, the
psychiatric service has begun field testing its own patient satisfaction
survey.
PUBLIC HEALTH
Public Health clients gain access to Public Health services through the
clinic and service sites throughout the county. In addition, Public Health
Outreach Workers find clients in the communities, including IV-drug users
with AIDS and homeless persons. Public Health services are also brought
to community settings through Health Care for the Homeless, Health on
Wheels Mobile Clinic Van, Home Health Agency, and Public Health
Nursing. Public Health prevention programs are implemented through
partnerships with community-based organizations throughout the county.
The Homeless Ombudsperson evaluates client satisfaction with homeless
services county-wide. The Public and Environmental Health Advisory
t Board and community partnerships provide feedback on community-based
t services.
COMMUNITY SUBSTANCE ABUSE SERVICES
Clients are required to pay for treatment services. However, no client is
denied services based on ability to pay. Payment is based on a sliding fee
scare which assesses total household income.
Most clients gain access to services simply by applying to community or
county operated programs, provided the primary problem is substance
abuse. Criminal Justice Treatment Program clients are constrained by
goveming DUI, Diversion, Federal and State probation laws such as CFR
42. Pregnant and parenting women are referred by outreach staff, case
managers, and county-wide provider coalitions with specific goals to
improve perinatal outcomes.
Health Service Department- 1996
Page 25
f
Services are located regionally throughout the county. CSAS staff C
coordinates with many community and county agencies to provide service
to individuals affected by substance abuse.
A formal method to measure customer satisfaction was not used during
1995/96, however beginning 1996/97, a customer satisfaction
questionnaire has been institutionalized in all of the county operated
programs and will be required of all contract providers. In addition, CSAS
has implemented a Customer Services Telephone Line in its administrative
office that will allow clients to anonymously voice complaints and make
recommendations for better services.
CONTRA COSTA HEALTH PLAN
CCHP regularly surveys its members. The most recent survey was
conducted of AFDC members in January 1996. Over 80% of the
respondents are very satisfied or satisfied with CCHP. Another measure of
members' satisfaction is the rate of those who disenroll voluntarily. That
numbers is 33% lower in fiscal year 1996 than last year. Satisfied
members spread the word about their experience with the program,
providing an effective marketing tool to attract new members.
CCHP also considers medical providers as customers. It will be conducting
provider satisfaction studies of both staff providers and the new community
provider network.
Accessibility to specialty care is a major focus of attention for both
customers and providers of managed care. CCHP patients are routinely
referred to out-of-plan specialists if a Health Center appointment is not
available within the time specified by providers. Additionally, CCHP has
taken steps to enhance its members' access to specialty services with the
Health Services Department Health Centers.
EMERGENCY MEDICAL SERVICES
EMS service is available countywide. Property owners pay annual
assessment to CSA EM-1 to maintain availability of enhanced EMS
services. Victims of sudden medical emergencies pay fees for emergency
ambulance service; Medi-Cal, MediCare, and private insurance covers the
majority of patients; services are provided to all without regard to ability to
pay or insurance status.
i
Health Service Department- 1996 '
Page 26
SECTION IV ANNUAL PERFORMANCE
: A PERFORMANCE INDICATORS
The approach to performance indicators is changing. Most used to focus
on the program/system/institutional measures of inputs -- how many visits
provided, shots given, permits approved. Some of those measures remain
relevant, but we are moving also toward identifying the outputs, or
outcomes of the activities, focusing on the effects on
patients/clients/customers. This process is complex. Each Division,
especially those with multiple programs, is looking at what should be
measured. In addition, many programs are directed by regulatory
agencies which specified the desired measures.
f Some HSD programs lend themselves to the development of performance
indicators more readily than others. Divisions which have made great
strides in this area are highlighted below.
HOSPITAL AND HEALTH CENTERS The division has developed multiple
indicators and outcomes. Some are determined by regulatory agencies,
g.
such as the State Department of Health Services, State Department of
Health Services Licensing Division, and the Joint Commission of
Accreditation of Healthcare Organizations. Examples include:
• Medical and nursing staff quality assurance monitoring
• QA monitoring by ancillary departments
• Average length of stay
• Patient satisfaction
Emergency Department utilization
• Cost per patient per day
MENTAL HEALTH
Adult/Older Adult Services - A Performance Outcome Study was initiated
in 1994 and results analyzed recently by the Mental Health Commission.
Eleven of the'performance outcome measures were used as key
indicators. In Contra Costa County, only two of the six domains showed
results significantly different from the state-wide average: living situation
(below) and engaging in productive daily activity (above). In
addition, we will be looking at performance outcomes such as state
hospital beds, IMD beds, acute hospital beds, improvement in living
situation, educational activities, work status, and decreases in alcohol
and/or drug use.
Children's Service Program - Legislation requires that all counties report
data on performance measures adopted by the California Mental Health
Planning Council of the State Department of Mental Health. A multi-
method approach has been adopted to meet these requirements. The
outcomes to be measured fall into two general categories: 1-system Level
measures and outcomes, and 2-consumer level measures and outcomes:
Many standardized instruments are used to measure, assess and suggest
treatment goals.
Psychiatric Inpatient and Jail Services - Performance indicators for
these programs include length of stay; re-admission rate; episodes of
violence toward self, others and property; length of time spent in seclusion
or restraints.
PUBLIC HEALTH
Public Health evaluates performance by looking at community health
indicators such as infant mortality, utilization of early prenatal care, and
tuberculosis rates. Clinical Services are evaluated by process measures
including number of clients served, cost per unit service, and staff
productivity measures. The Public Health Data and Evaluation Unit has
been charged with developing more targeted outcome evaluations of
Public Health programs, especially Family, Maternal, and Child Health
programs and the county's programs focusing on the homeless.
COMMUNITY SUBSTANCE ABUSE SERVICES
Each CSAS program develops performance indicators which are germane
to the population served. These reports are due within 60 days of.the close
of the fiscal year. While the reports for 1995/96 are not available at this
time, the division's NNA Dedicated Capacity Summary Report to the
Department of Alcohol and Drug Programs for this year is provided in
Attachment D.
Health Service Department- 1996
Page 28
s
Treatment outcomes and retention studies are based primarily on a study
conducted three years ago using CADDS data compiled from 1991 to
F 1993. CSAS is conducting another study for the period from 1993 to 1996,
but the results will not be available until April 1997.
Highlights of the data collected previously show that less than half (43.2°/x)
leave treatment with "unsatisfactory progress," 17.7% leave with
"satisfactory progress" and 11 .5% are transferred to other treatment
providers.
CONTRA COSTA HEALTH PLAN
CCHP regularly monitors utilization and enrollment trends for each of its
major groups and reports results on a monthly basis to the Managed Care
Commission. See Attachment F1 for a list of services reported on a regular
basis
EMERGENCY MEDICAL SERVICES
Emergency Medical Services statistics are monitored in five areas:
ambulance services and air ambulance services (primarily patient
`F stabilization and transport systems); trauma services and first responder
defibrillation services (triage, "saves" and trauma services), and inter-
facility patient transfer review services (general oversight of patient
transport). Utilization statistics and trends are compiled for each area on a
regular basis, including the number of units dispatched, average response
times, number of patients transported and the number and type of "saves."
B. ACCOMPLISHMENTS
The highlights of each Division's accomplishments follow here.
HOSPITAL AND HEALTH CENTERS
Implemented "Patients' Choice Program " a major shift for
operations. Patients are now scheduled for same/next day
x, appointments instead of having to wait up to several weeks for an
appointment. While operational issues are still being addressed, the
system is providing greater access to primary care providers for our
patients. This change was implemented with a 6 months lead time,
compared to 12 months planning time for other systems which have
adopted it.
Health service Department- 1996
Page 29
Received a full three-year evaluation from JCAHO. Hospital was
commended on the QA program and the manner in which primary
care and specialty outpatient services are delivered.
► Full three-year accreditation of cancer program.
► Three-year accreditation for Family Practice Residency Training
Program.
► Accreditation from the State Board of Corrections for medical
services provided at the main detention facility in Martinez.
MENTAL HEALTH
Children's Services
► Expansion of children's mental health services through receipt of
EPSDT (Medi-Cal) funding.
► Received $1 million to initiate planning to implement A133015, the
California System of Care Contract to reduce group home
placements in the county.
► Established a partnership with Regional Center, Department of
Social Service and County Office of Education to develop an
Intensive Residential Treatment Program for dually diagnosed
adolescents.
PUBLIC HEALTH_
Senior Nutrition 7
► Added one Home Delivered Meals route in Pleasant Hill/Concord
area. Expanded scope of HDM provider contract to include AIDS
patients. Raised $40,000 in public contributions to purchase meals
for homebound elders.
George Miller Centers - East & West
► Implemented an after school program at both centers January 1,
1996 which is a social recreation and day care program serving
those with special needs between the ages of 11 and 22 years.
Health Service Department- 1996
Rage 30
Dental Program
Opened Parkside Healthy Start school-based Dental Clinic in
partnership with the Healthy Start Program, the Pittsburg Unified '
- School District, and the Contra Costa County Dental Association, to
provide dental exams and sealants. In the first two months 34
children were discovered to have 136 cavities, and 85 sealants were
given to 34 children with an in-kind value of over $5,000.
Four free sealant clinics were held in Central and West County which
provided 853 free sealants to 187 children at an in-kind value of over
$34,000.
Women Infants & Children (WIC) Program
► Received award of recognition from the California WIC Association in
the categories of: "Monumental Program Growth," and "Innovative
Outreach."
► Received multiple state authorized caseload increases throughout
the year taking the caseload from 13,400 to 16,500 at year end, a
23% increase, based on demonstrated successful outreach and
expansion performance after each incremental increase during the
year.
► Implemented on-line communication with the state WIC computer
system in December, inputting 10,000 client family records. System
includes performing client certifications and appointment scheduling
on line.
Public Health Laboratory
► Started performing TB tests for Martinez Veteran's Clinic and Mt.
Diablo Hospital.
Public Health Clinic Services
► Implemented school-based community health center at Riverview
School in Bay Point.
Developed a Teen Health Care Program at Richmond High School.
Health Service Department- 1996
Page 31
z
�n 1
► Expanded number of Immunization Clinics and clinic sites with more
comprehensive accessibility to the community. In addition, held C
weekly employee immunization clinics.
► Initiated weekly Breast Screening Clinics in East and West County.
► School districts assisted to apply for and receive funding for two
additional Healthy Start Grants, one for the Monument Blvd. corridor
in Concord, and the other for East County.
► Expanded the number of Family Planning and Child Health
Screening clinics in Central and East County in response to
increased demand for services.
C
► Added seven new Health Care for the Homeless screening sites.
► Increased surveillance on identified health problems from PAP C
reports.
C
► Initiated Breast Cancer Screening outreach and follow-up on
identified problems. C
► Established & implemented training for low income youth on health
related issues. L
1
I
► Developed comprehensive integrated treatment protocols for Ll
Sexually Transmitted Disease, Family Planning and Child Health
Screening.
C:
► Developed a Quality Assurance Program for Public Health Clinic
Services. L
Acute.Communicable Diseases
► Immunization Registry - Developed a system including a software L
program which will register immunizations received for children ages
0-2 and eventually.0-21. This system will include data for Kaiser, C
Planned Parenthood, Merrithew Hospital and Clinics and for all
Public Health Clinics as well as private providers who give L
immunizations to children and elect to enroll in the system.
L
Health Service Department- 1996
Page 32
r Immunization Outreach Cooperative Project - Developed to insure
r; that immunization services for children are coordinated and that
�.
parents know which immunizations their children need and where
and when to go to get them.
► Mobile Clinic Services - Provides a mobile clinic for West county
residents four days a week. Services include: limited primary care,
r
STD services, Family Planning, HIV testing and counseling, TB
testing and immunizations. This clinic is provided through a
cooperative agreement with Kaiser and Brookside Hospital.
Home Health Agency
► Increased agency productivity by 37%, reducing annual program
costs (i.e., county subsidy) by over $100,000 while increasing patient
visits by 2%.
COMMUNITY WELLNESS & PREVENTION PROGRAM
Healthy Neighborhoods Project
► Obtained start-up funding to initiate project in selected areas to
identify and address community health concerns. _
Tobacco Prevention Project ,
► Made significant strides in institutionalizing tobacco control efforts,
including assumption by the Environmental Health Division of
smoking ordinance compliance checks.
Lead Poisoning Prevention Project
► Applied for and obtained funding to identify, train and fund eight
community-based organizations to conduct lead-related outreach and
education to neighborhoods; schools, day care and child care
centers, and places of worship throughout the county.
Bicycle Head Injury Prevention Project
► Distributed more than 3,700 helmets to Pittsburg children. In one
year the helmet use rate among elementary school age children rose
from 21 .5% to 32.9%, the highest rate of increase among the nine
CDC funded projects in the nation.
Health Service Department- 1996
Page 33
Breast Cancer Partnership
► Formed this year with state funding. Several hundred at-risk women
have been reached with information on prevention and screening. In L
addition, efforts within the provider community have resulted in
adding several new providers to the Network. r
Violence Prevention Project
10. Released report of the Firearm Injury Reporting, Surveillance and L
Tracking (FIRST) which analyzed 613 gun deaths and injuries in the
year ending June 1994.
► Finalized and distributed to all HSD staff copies of the Guidelines for
Domestic Violence Screening and Reporting, to ensure HSD
compliance with Laws outlining the health care provider's role in
addressing domestic violence.
Hunger, Nutrition & Physical Activity Projects
► Provided Nutrition Education Workshops/Training to more than 200
people.
► The Food SecurityProject increased participation in SHARE a '
1 P P �
cooperative food buying program where participants pay in cash or
food stamps and community service to receive a food package worth ,
twice what they pay) by 13% in West County.
► four low
Completed data collection for food resource maps foru
income neighborhoods throughout the county.
COMMUNITY SUBSTANCE ABUSE SERVICES
Women's Unit
► Initiated SB 2669, a county-wide approach to address the high
prevalence of maternal substance abuse during pregnancy, through
implementing a "perinatal substance screening and assessment tool"
in all of the seven private and public hospitals in Contra Costa
County. CSAS's quality assurance standards, education and
technical assistance to all women's substance abuse services has
1 T
i.y.
Health Service Department- 1996
Page 34
i
t
moved providers toward philosophical consensus and a "standard" of
care (i.e., assessments, length of stay, focused treatment planning,
services linkages, etc.).
Criminal Justice Treatment Programs (CJTP)
► This unit was created recently to combine the court/parole/probation
mandated substance abuse intervention and treatment programs
within the Division.
► This year, the unit established the Cooperative Plan in Bay Municipal
Court, the largest in the County. The Cooperative Plan is an
agreement that permits defendants who fail the DUI Program for
relatively minor reasons to opt for automatic reinstatement to the
program, by avoiding court costs.
► CJTP has improved DUI program representation at Bay Court,
helping to speed the flow of DUI defendants through the costly court
processes.
► CJTP also established the pilot PC-1000 program and obtained
concurrence from the judges and the Probation Department on the
plan for a drug diversion program for Contra Costa County.
► Another CJTP program, the Family Recovery Project, provides
services to African American post-incarcerated males, their spouses,
children and other family members directly involved in co-parenting.
EMERGENCY MEDICAL SERVICES
► A new EMS system plan for Contra Costa County was approved by
the Board of Supervisors and the California EMS Authority. This plan
adopts standards, identifies objectives and sets priorities for the
county's emergency medical services system.
► The EMS Agency established and maintains "1-800-GIVE-CPR" to
make available information regarding citizen CPR training to the
public.
r
Health Service Department-1996
Page 35
Y'.
k
► Funding was obtained from the State to support the role of the
Contra Costa County Health Officer as the Regional Disaster
Medical/Health Coordinator for the Northern California Coastal
Region. A draft Interim Emergency Plan was written and distributed
to the 16 coastal counties in the region.
I-,
► The EMS Agency provided oversight and medical direction for the
county's first responder defibrillation program.
► A second year of funding from the State EMSA was obtained for an
evaluation ofoison control center alternatives.
s.
► Ambulance services under contract responded to 46,969 emergency
requests in 1995. Of these, 33,056 resulted in patient transport to a y
hospital emergency department.
► A pilot program at San Ramon Fire Dispatch to evaluate Medical
Priorities computerized ProQA medical dispatch system for potential L
implementation countywide was completed and determined to be a
success. Dispatchers in the San Ramon Fire Dispatch Center use
L
this medical dispatch system to determine the appropriate
fire/medical response to an emergency request and to provide
CPR/first aid instructions to the caller until fire equipment or
ambulance arrive at the scene.
k
Health Service Department- 1996
Page 36
r
t
SECTION V CHALLENGES AND NEW DIRECTIONS
y
In this final section of the Health Services Department's Performance Report,
we will focus on the challenges and new directions facing us as an entire
Department.
The key challenges which we face are four-fold.
1. The health care industry financing environment is changing
dramatically, affecting how we are paid for physical health, mental
health, substance abuse and even emergency medical services. This
reality is requiring us to transform both our programs and our
organization in order to survive.
2. Pushed by the necessity to survive, we must consider how new
affiliations with other health care institutions can strengthen our
competitive advantage and help us to fulfill our mission.
3. Despite the loss of financial resources, the demands on us have not
abated. The risks to community health posed by violence, tobacco use,
chronic disease and chronic poverty persist and demand more effective
remedies.
4. In addition to the health care financing changes brought by managed
care, the implementation of welfare reform is likely to bring another
round of changes. We anticipate more people without insurance turning
to us for care, both due to welfare reform and to the continuing growth
of uninsured individuals and families in California.
In the face of these policy and fiscal challenges, the Department must chart
a course which insures our ability to provide a broad array of health care
services to our most vulnerable populations, while continuing to improve the
overall health of all Contra Costans.
RESPONDING TO THE HEALTH CARE FINANCE REVOLUTION
The shift to managed care in health care financing means that CCHP and
MMHHC must compete for 60,000 Medi-Cal patients with Foundation Health,
#' a private corporation with enormous financial capacity. Our Local Initiative,
r
which offers the choice of MMHHC, Kaiser, Planned Parenthood clinic and a t 7
private physician must become the plan of choice for patients if we are to
survive.
The challenge to make care more effective and to manage the costs of care
extends to the Mental Health and Substance Abuse systems as we implement
outpatient Mental Health managed care in mid-1997. In addition, the _
Emergency Medical System must adapt to a managed care market place.
In the context of becoming more competitive, and more attractive to current
and potential patients, we began in July to offer Alta Bates hospital as a
delivery site for our West County prenatal patients in addition to Brookside
Hospital. We continue to offer inpatient medical care at Brookside by our �.
physicians and will hopefully expand that option to Kaiser Richmond.
We have a decade of partnership with John Muir Hospital in assuring the 1--'
viability of the Trauma Center and Trauma System. We will soon expand that -
partnership to include neonatal intensive care for our patients. We hope to
work with the developing Mt. Diablo/John Muir affiliation to address other
community health needs and support prevention efforts. (
C�-
We continue to partner with Kaiser in a variety of areas including the Local
Initiative, Community Prevention Programs and EMS programs. ,
We are in final negotiations with Planned Parenthood for the expansion of
both family planning and primary care services in East and West County.
Hospital contracts for specialized services with John Muir and Delta Memorial
are undergoing final review. Discussions with Los Medanos continue
regarding the potential use of the first floor for Ambulatory Care services. In
the event the discussions do not result in a plan of action in the near future, C
the Pittsburg Health Center will be remodeled to address patient flow issues
and the general appearance of the Center. C
For all parts of our care system, the cost of services must decrease while we r
grapple with increased demand and declining revenues. We are examining L
how to achieve such reductions in full knowledge of the acute and chronic
needs of our patients, clients and customers.
Health Service Department- 1996
Page 38
a We believe the solutions lie in effectively combining the following kinds of
approaches:
r
• Increasing efficiency through consolidating parallel functions such as
appointment scheduling, credentialling, medical records, quality
assurance etc.
• Increasing efficiency through adoption of technologies which increase
the ability of clinicians to focus on patient care, and which allow all staff
to work more efficiently. Examples include the new Meditech system
which allows quick access to laboratory ordering and results and the
Care Coordinator role newly established at Pittsburg Health Center and
Richmond Health Center.
• Creating alternative models of service which meet patient and client
needs in a more effective manner at a lower cost such as the new
CCHP Case Management/Care Coordination Unit.
• Creating new kinds. of contracts with community based agencies which
specify performance expectations within the context of new managed
care reimbursement levels.
In light of these approaches we anticipate changes during the next 12 to 24
months in the following service areas:
• Implementing the Social HMO in mid-1997 to create a model of care for
frail elderly and disabled people as a way to better manage resources
for long term care.
• Expanding the System of Care for Children's Mental Health to provide
community and family support instead of out of home placement.
• Expanding housing alternatives for people who are seriously and
persistently mentally ill in order to reduce need for repeat crisis
intervention and hospitalization.
• Creating smaller integrated health service sites where clinical services
and community health improvement activities are combined to improve I
Health Service Department- 1996
Page 39
.r
health in specific neighborhoods. Current initiatives include the Bay
Point Community Wellness Center and the Center for Health in North �-
Richmond.
•
Engaging
g g ng in point efforts with other County Departments, as well as
community based organizations and the private sector, in order to
create more effective responses to unmet health care needs. "
• Identifying the essential educational, counseling and care management ,
functions to be integrated into cur health care system.
Continued implementation of computer efficiencies.
• Conducting processes to re-bid services provided by contract agencies
in order to build a community based services system which can
succeed in the new context of managed care.
COMMUNITY HEALTH PROBLEMS
The role of our public health system reaches far beyond the provision of
health care to affect the conditions which enhance or endanger the health of
the entire population. In addition to maintaining the critical population health
protection functions of Environmental Health, Hazardous Materials, Acute and
Communicable Disease and Public Health Laboratory, for example, we will be r
continuing our tradition of recognizing new areas for attention and forging L
successful solutions.
We address the community health improvement crafting 'on many fronts.
Issues of continuing concern include HIV infection, tuberculosis,
immunization, perinatal health, breast cancer, violence prevention, hunger
and nutrition, lead poisoning, youth tobacco use, childhood dental disease, .
chronic disease, and substance use. The issues are numerous and the C.
resources are limited. In the Public Health and Community Substance Abuse
Services Divisions, the following methods to increase effectiveness and
stretch the available resources are being implemented:
• Usingmini rants to contract with communis based organizations to do L
9 community
outreach and education on issues affecting particular populations or
neighborhoods. The Lead Poisoning Prevention and Breast Cancer
Prevention programs are examples of this approach.
Health Service Department- 1996
Page 40
f
4'
• Acting as a convener for issues, providing training and technical
assistance to community members, both youth and adults, to assume
the leadership to define and act on critical issues. Our efforts to reduce
teen violence and adolescent substance use are prime examples of this
training and community development approach.
These approaches underscore the importance to the Department of
continuing and expanding our partnerships with public and private entities in
the county. We also emphasize partnership with ordinary people living in
Contra Costa County. Our Healthy Neighborhoods Project and Partners in
Health are initiatives funded by the East Bay Community Foundations and
The California Wellness Foundation, respectively. These initiatives represent
a very different approach to improving community health.
t
The Healthy Neighborhoods Project engages residents of neighborhoods with
multiple health problems in mapping their neighborhoods' strengths and
assets and then becoming involved in making the improvements they desire.
Partners in Health, which focuses in the Center for Health service area in
West County, is bringing together neighborhood residents and key institutions
to create a community-owned health improvement plan which will be
implemented during the next four years. We believe these projects are
teaching us how to be more effective in improving the overall health status of
Contra Costans.
STRIKING THE BALANCE
{
We are preparing to meet many challenges during the coming year. We are
in the midst of major organizational change. We know we must adapt to the
managed care environment and the reality of declining fiscal resources. We
must adopt new efficiencies and make harder choices. We must continue to
balance the demands of our twin responsibilities -- providing health care and
improving community health.
There are also several unknowns on the horizon which may exacerbate the
financial pressure on our programs. Financing for our environmental
health/hazardous materials programs may be compromised if the state's
CUPA process dismantles the current unified responsibility for inspection and
n regulation by a single county agency. Federal welfare reform and state policy
changes will likely end the Medi-Cal coverage for legal and illegal immigrants,
Health Service Department- 1996
', Page 41
many of whom come to us for care. In addition, the implementation of welfare
reform will sever the link between AFDC status and Medi-Cal which could
mean that fewer people enroll in Medi-Cal and/or enroll only when they are -
very ill. Either result will negatively affect the health status of many residents. I
CONCLUSION
We have serious challenges before us. We have initiated some of the ( I
changes necessary to meet them and are crafting other strategies necessary -
to survive. The Department's management and line staff are equal to the I
task. We look forward to a year of hard work and hard-won success.
I
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Health Service Department-1996
Page 42 1
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ATTACHMENTS
A Health Services Department Organization Chart
B 1 HSD FY 1996-97 Adopted Budget
2 HSD Gross Expenditures - Fiscal year
comparisons
(excluding Homeless Program)
3 HSD County Subsidies - Fiscal year comparisons
(excluding Homeless Program)
C Personnel - Tables
1 Staffing Patterns
2 Affirmative Action Pattern - 1995
3 Affirmative Action Pattern - 1991
4 Sick Leave Usage
D Community Substance Abuse Services
FY 1995-96 Cost/Service Report
E Mental Health Crisis Census -
Service, 5150Noluntary, and by Age
F Contra Costa Health Plan
1 Contra Costa Health Plan - Services Provided
2 Insurance Source
3 Current membership
4 Residence of members
5 AFDC Satisfaction Survey
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Attachment G1
PERSONNEL
Table 1
Staffing Patterns
Unit of Measure June 1992 May 1996 % Change
Total Staff 21102.60 2,243.10T +6.7%
Staff by Division
Director's Office 21.58 17.47 -19.0%
Contra Costa Health Plan 37.68 64.33 +70.7%
Emergency Medical Svs 8.22 6.04 -26.5%
Environmental Health 60.15 72.61 +20.7%
Finance 149.60 160.47 +7.3%
Hospitals and Clinics 1 ,193.25 1 ,267.51 +6.2%
r Mental Health 148.04 155.70 +5.2%
Public Health 380.69 431.26 +13.3%
Substance Abuse 103.39 67.71 -34.5%
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Attachment C2 -D. i
PERSONNEL
Table 2
Affirmative Action Pattern - 1995
Total Positions 2348
Funded
Total Positions 2065
Filled
Total Positions 283
Vacant
:. ..........:......:
Total 2065 100%
Male 483 23.4%
Female 1582 76.6% 45.2% 45.2% 0
White 1253 60.7% 55.6% 55.6% 0
African American 311 15.1% 7.8% 7.8% 0
Hispanic 195 9.4%, 10.6% 10.6% 1 .2%
Asian/Filipino/ 285 13.4% 9.3% 9.3% 0
Pacific Islander
American 21 1.0% 0.7% 0.7% 0.3%
Indian/Alaskan
Native
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Attachment C3 �, i
PERSONNEL
Table 3
Affirmative Action Pattern - 1991
Total Positions 2301
Funded
Total Positions 1923
Filled
Total Positions 378
Vacant
ceak ` :::><:::>:<`:> < ::>:> <: <<�`` << :«�<< « :« <:::>`:'` ><: <�:: < :>:;::
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Total 1932 100%
Male 461 23.9%
Female 1471 76.1% 42.4% 0
White 1223 63.3% 0
African American 289 15.0% 7.6% 0
Hispanic 163 8.4% 7.7% 0
Asian/Filipino/ 107 5.5% 5.4% 0
Pacific Islander
American 13 .7% .6% 0.3%
Indian/Alaskan -
Native
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Attachment C4
PERSONNEL
Table 4
Sick Leave Usage
S/L Used S/L Accrued Value of S/L
1/95 to 12/95 1/95 to 12/95 Used
Hospital, Health 90,606.73 14.654.84 $ 581 ,705.00
Centers &
Detention
Public Health 28,138.29 339483.07 $ 581 ,705.00
Mental Health 10,559.40 12,067.05 $ 272,980.00
Substance Abuse 5,883.06 5,819.22 $ 126,633.00
Environmental 5,590.40 5,819.22 $ 126,633.00
Health
CCHP 2,810.70 3,080.701 $ 54,807.00
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F..Y .19:95 ,199 6 .PERFORIONCE REPORT
Alcudget IInits
Support Svcs Hours $1, 136,000.00 16000 $71.00
Primary Prevention Hours $1, 167,242.00 36696 $31.81
Secondary Prevention Hours $351,774.00 10817 $32.52
Non-Residential Hours $829, 482.00 23388 $35.47
Residential Bed Days $2, 624,801.00 61583 $42.62
Ancillary Hours $360,551.00 11083 $32.53
DUI (fee offset) Clients $1, 446, 185.00 2624 $551.14
Total $7, 916,035.00 162191 $48.81
Paroiae
Support Svcs Hours $63, 953.00 900 $71.06
Non-Residential Hours $86, 477.00 2381 $36.32
Residential Bed Days $229,220.00 5517 $41.55
Ancillary Hours $25, 8°5.00 840 $30.82
Total $405, 535.00 9638 $42.08
Perssatal punch ng
Support Svcs Hours $360,355.00 5000 $72.07
Non-Residential Hours $67,097.00 1835 $36.57
Non-Residential Visits $427, 565.00 6051 $70.66
Residential Bed Days $800, 994.00 13055 $61.36
Ancillary Hours $485,214.00 14491 $33.48
Total $2, 141,225.00 40432 $52.96
Drug Medi-Cal;Approved-Rate' . flap Units Cost/IInt
Perinatal Residential $70, 629.00 947 $74.58
Outpatient Methadone $1,726.58 160735 $10.74
Outpatient Drug Free:
Group Treatment $118, 142.00 1014 $116.51
Individual Treatment $87,255.00 1126 $77.49
Face-to-Face Contact 5454 $21.66
10
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/`1ltC11�1 I[1 1Ct ll C
MHCRISIS SERVICES CENSUS
1995 AND 1996
750 . j
700
' i
Z650
,' I f 1995
U 600
O 550 i
�t 500 r I
450
JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC
MMH-MARTINEZ AND WEST COUNTY SITES
C MHCRISIS SERVICES CENSUS 5150s vs VOLS
JANUARY-JUNE, 1996
2500 -
2000 L j
Z i i
w 15001 s 5150
1000 ; O VOL i
j 0 500
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MMH-MARTINEZ AND WEST COUNTY SITES
H
MHCRISIS SERVICES CENSUS BY AGE
JANUARY-JUNE, 1996
Y;
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i (9.0%) M 0-17
(3.8%) I
(87.3%) 0 18-59
m 60+
MMH-MARTINEZ AND WEST COUNTY SITES i
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Attachment F1 0-
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1AContra Costa Health Plan
Services Provided
1.
CCHP members receive the full range of health care services including:
Durable Medical Equipment
Emergency Medical Treatment
Family Planning
Hearing Tests
Hemodialysis-Acute
Home Health Services
1 Hospitalization
Inoculations
Maternity Care
Mental Health- Inpatient& Outpatient
Outpatient Visits
Perinatal Exams
Prescription Drugs
Preventive Care
Physical Exams
Refractions
Supplies - Disposable
Therapy - PT, OT, & Speech
Transportation - Emergency or medically necessary
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