HomeMy WebLinkAboutMINUTES - 02102004 - C57 _....._. ......... ......... ......... ............. ... ...._
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ContraTO: BOARD OF S'UPERViSORS , ; - " �.
FROM: JOHN SWEETEN, County Administrator Costa
DATE: FEBRUARY 10, 2004 County
SUBJECT: AUTHORIZATION TO SUBMIT ENTRIES TO THE NACo
ACHIEVEMENT AWARDS PROGRAM
SPECIFIC REQUEST(S)OR RECOMMENDATION(S)&BACKGROUND AND JUSTIFICATION
RECOMMENDATION:
AUTHORIZE the Chair, Board of Supervisors, to sign applications for submission to the
National Association of Counties for the 2004 Achievement Awards Program.
FISCAL IMPACT:
A$50.00 application fee is required for each of the two entries, totaling $100.00.
BACKGROUND:
The National Association of Counties (NACo) is sponsoring the NACo Achievement Awards
Program for 2004 and Contra Costa County wishes to participate in the program. The County
will nominate the following programs for award consideration:
• Contra Costa County Watershed Atlas (Community development Department)
• Up Front Financial Counseling (Health Services Department)
In submitting these applications, the County agrees to the Program requirements and
responsibilities as set forth by NACo for entering into the awards program.
CONTINUED ON ATTACHMENT: , YES ONO SIGNATURE:
------------—�__._. -----W_ ._-------__—_�--------------_--- -------
v -- ----___ ------—. _-- - --
�2ECOMMENDATION OF COUNTY ADMINISTRATOR RECOMMENDATION OF BOARD f 6MMITTEEy— �-
-4_APPROVE OTHER
SIGNATURE(S).
ACTION OF BO D N �' 'Gt -"APPROVE AS RECOMMENDED OTHER
VOTE OF SUPERVISORS I HEREBY CERTIFY THAT THIS IS A TRUE
s€ AND CORRECT COPY OF AN ACTION TAKEN
UNANIMOUS(ABSENT ) AND ENTERED ON THE MINUTES OF THE
BOARD OF SUPERVISORS ON THE DATE
AYES: NOES: SHOWN.
ABSENT: ABSTAIN:
ATTESTED: FEBRUARY 10,2004
CONTACT: JULIE ENEA (825)335-1077 JOHN SWEETEN,CLERK OF THE
BOARD OF SUPERVISORS AND
CC: COMMUNITY DEVELOPMENT DEPARTMENT COUNTY ADMINISTRATOR
HEALTH SERVICES DEPARTMENT
BY__ :` G f L- .G -'\—J DEPUTY
XW4
(Please refer to"Step One:Completion of the Transmittal Form"for directions on properly completing this form).
i. Program Information(See program category list included in "Step One" of the instructions).
County and State Contra Costa, California
Program Title Up Front Financial Counseling
Program Category Health Services Department
II. Contact information
Name Stephanie R. Bailey
Title Director of Administrative Services, Office of Ambulatory Care
Department Contra Costa Health Services
Address 2500 Alhambra Avenue
Address
City/State/Zip Martinez, CA 94553
Telephone (925) 370-5101
Fax (925) 370-5900
Email sbailev@hsd.co.contra-costa.ca.us
0 Yes! Please add me to NACo's Peer to Peer Network(See Reverse)
11111. Signature of Chief Elected Official
Name Federal D. Clover
Title Char of th Bar Supervisors
Signature
IV. Payment: Please choose one of two payment options listed below
Payment Option i
10 Check Check Number: C., �-
•Money Order Money Order Number:
•Credit Card Credit Card Type: Cl Visa Q Mastercard
Credit Card Number
Expiration Date
Name of Cardholder
Authorized Signature
Member Fee $50 $522,a 0
Non-Member Fee $100 $
Payment Option 2
Q Voucher Voucher Number:
0 Purchase Order Purchase Order Number:
Member Fee $60 $.
Non-Member Fee $110 $
ii xwU&w for aitcbrl al �,al a srury r3, zov
Contra Costa County
Contra Costa Health Services Consolidated Appointment and Financial Counseling Project
1. Abstract of the Program
Contra Costa Health Services created a unique approach to a problem faced by public health
systems across the state and nation. To deal with acute budget shortfalls, we looked for ways to
generate more revenue in Ambulatory Care by streamlining our appointment system and financial
counseling process.
To concentrate our available resources on those who are our primary responsibility-people
who live in Contra Costa who are most vulnerable due to low income or lack of insurance and to
provide priority access to those eligible patients we are currently seeing,we moved our financial
screening process up front and centralized it.We also began utilizing an innovative information
technology approach to determining eligibility for care and maximizing the efficiency of the process.
Our new program began,July 1,2003 and we have already seen a reduction in private pay(no
pay) visits and an increase in Medi•Cal visits. In the first six months of operation,this project
increased our net revenue by approximately$2,500,000. Full year revenue increases of$5,200,000
are projected.
2. The Problem/Need for the Program
The Ambulatory Care system of Contra Costa Health Services consists of 10 geographically
diverse health centers. Primarily staff at our Central Appointment Unit schedule medical
appointments. Prior to implementing our project,patients received primary care appointments,if
available, on a first-call-first-served basis. For patients without health insurance or program
coverage to pay for their visit,the financial counseling process began on the day they arrived for
their appointment.
Like other public health systems facing reduced revenue from federal,state and local levels,
in fall of 2002 we knew that the only way to maintain access in our Ambulatory Care system through
these tight budgetary times was to find a way to maximize revenue. Approximately 11%of our
311,000 Ambulatory Care visits were by patients determined to be"private pay. In FY 2002/2003,
we had nearly 38,000 visits by patients who either didn't qualify or didn't apply for program
coverage or enrollment in the county's medically indigent program for adults and children. We
received very little, if any, revenue from these visits.
1
Contra Costa County
Contra Costa Health Services Consolidated Appointment and Financial Counseling Project
Our system was too "open" for anyone seeking care and, as a result,we were serving
patients who were enrolled in other managed care plans— patients who were not Contra Costa
County residents and higher income patients who,oftentimes,didn't pay their bills. While we were
filling appointment slots with "ineligible" patients, we also had"eligible" patients denied
appointments because our demand of appointments exceeds supply nearly every day.
3. Description of the Program
Beginning July 1,2003,we accomplished two major changes: (1)we centralized and moved
our financial counseling process to the "front end"; and (2) Cour Information Technology
department created an Enterprise-wide Master Person Index (eMPI). The telephone call
distribution system is interfaced to the eMPI to automatically determine patient eligibility for
appointments and route calls accordingly.When someone calls our Central Appointment Unit for a
medical appointment,they're now asked to use their touch-tone phone to enter a unique identifying
number.It may be a medical record number,a health plan ID number or a Medi-Cal[MEDS]ID
number. This now allows only"eligible"patients to schedule appointments and requires others to
receive financial screening as a first step.If the financial status determines eligibility,then the call is
instantaneously(and seamlessly)directed to the queue to speak with an appointment scheduler. If
the patient's record indicates expired or no eligibility,then the call is immediately directed to the
queue to speak with one of fifteen financial counselors. If the financial counselor takes a Medi-Cal
application,an application for our county medically indigent program(known as Basic Health Care
or BHC}or otherwise finds the patient to be eligible,the call is then transferred to the appointment
scheduler. For patients determined not to be eligible for care in our system,they are advised to seek
care in the appropriate county or health system.
Eligible patients include those who are members of the County owned and operated HMS?,
those who qualify for our county medically indigent program known as the Basic Health Care,or
BHC,and those who are Medi-Cal and/or Medicare recipients not enrolled in a managed care plan
other than ours. Contra Costa County residents are eligible for our BHC program if they have an
income less than 300% of the federal poverty level.
An important component of our program was the creation of an appeals process that will
ensure that no patient's health is permanently adversely affected by this program.. A process was
developed whereby a patient or a provider may appeal a particular case and financial counselors,
2
Contra Costa County
Contra Costa Health Services Consolidated Appointment and Financial Counseling Project
working together with a patient services representative and,when appropriate,a'physician executive
may grant an exception to continue care for a defined period of time.
4. Use of Technology
Our Information Technology department created an Enterprise-wide Master Person Index
(eMPI). The telephone call distribution system is interfaced to the eMPI to automatically determine
patient eligibility for appointments and route calls accordingly.Based on the number the caller enters
when they call Central Appointments,the eMPI database is searched and the patient's financial
status that day is located.This connection between the eMPI database and the telephone automatic
call distribution (ACD) system is the single most important element of the Lip Front Financial
Counseling program. The eMPI database was designed to be a central repository of information
about people who have received or are eligible to receive health care services from five different
databases,including the Medi-Cal[MEDS]system. Based on information the eMPI receives from
these databases,it calculates a code known as"Today's Financial Class"representing an individual's
insurance coverage. Also required was the design and implementation of telephone software which
captures an ID number keyed into a touch-tone phone by a caller,uses the eMPI to identify the
caller (based on the number entered), and routes the phone call according to the individual's
"Today's Financial Class."
5. Cost of the Program
Development of the eMPI database and design and implementation of the telephone software
required a one-time expenditure of$100,000.We also increased our financial counseling staff with
an annual expenditure increase of$200,000.
6. The Results/Success of the Program
After six months of operation under this new program, the data indicated that we have
successfully achieved our goal of increasing revenue. Compared with FY 2002/2003,our 2003/04
year to date numbers show:
• The number of"private pay" visits dropped from 11%to 6% of total visits;
3
Contra Costa County j
Contra Costa Health Services Consolidated Appointment and Financial Counseling Project
• The number of Medi-Cal visits increased from 25% to 30% of total visits;
• The number of BHC visits increased from 12% to 15% of total visits'
If the remainder of the fiscal year continues to reflect a similar financial mix of patient visits in
Ambulatory Care,we expect to increase our annual revenue by an estimated$5,24,000. We did
increase our financial counseling staff with an annual expenditure increase of$200,400 and invested
$144,004 in onetime costs for software and systems development. This leaves us with an estimated
net revenue increase of$5,000,444. In addition,more patients have been enrolled in Medi-Cal and
in our Basic Health Care program. This kind of positive outcome will allow us to preserve our
Ambulatory Care system and provide better access to care to our eligible patients in difficult
budgetary times.
7. Worthiness of an Award
At a time when public agencies are facing severe budget crisis and are fighting to maintain
services,this project dramatically increased revenue. The project utilizes technology to immediately
identify patients who have no insurance coverage and route them to a financialcounselor to begin
the insurance application process. While the project has been implemented thus far only in the
county's 10 Ambulatory care centers, it has the potential to be expanded to mental health and
substance abuse operations as well, generating even more revenue and utilizing no additional
technology.
4
(Please refer to 'Step One: Completion of the Transmittal Form" for directions on property completing this form),
1. Program Information (See program category list included in "Step One"of the instructions).
County and State Contra Costa CountV
Program Title
Program Category
If. Contact Information
Name John KopQhik
Title Principal Planner
Department
Address 651 Pine Street 4th Floor North Win
Address
City/State/Zip Martittez�, CA 945_5 _,,_
Telephone 925--335-1227
Fax �..... 225-335-1299
Email ko @cd.cccounty.us
D Yes! Please add me to NACo's Peer to Peer Network(See Reverse)
Ili. Signature of Chief Elected Official
Name Federal D. Glover _
Title Chair of th Bar u ervisors
Signature
IV. Payment; Please choose one of two payment options fisted below
Payment Option #
*Check Check Number:6L!! &(06`�Z
G Money Order Money Order Number:
*Credit Card Credit Card Type: Q Visa 0 Mastercard
Credit Card Number
Expiration Date
Name of Cardholder
Authorized Signature
Member Fee $50
Non-Member Fee $100 $
Payment Option 2
G Voucher Voucher Number:
iD Purchase Order Purchase Order Number:
Member Fee $60 $
Non-Member Fee $110
t
Program/Project Title:
Contra Costa County Watershed Atlas
1)Abstract of the Program
Contra Costa County is home to almost one million people, beautiful landscape, and important natural
resources including, 1,350 mires of creeps that weave through 465,000 acres of watershed land and feed
into the San Francisco Bay-Delta Estuary. Yet a 2002 Contra Costa Resource Conservation District
Survey of creekside residents revealed that only about 25% of respondents were aware of their
proximity to the creek. Recognizing that creeks are a primary connection between people and the
natural environments, in 1991 community and local non-profit groups joinedwith local government
agencies to form the Contra Costa Watershed Forum (CCWF). To assist with public education and
awareness about the importance of creeks and watersheds, as well as to provide public policy makers
and community groups with 'a consolidated resource on the 28 major watershed in the county, the
CCWF produced the full color, 150-page book entitled "The Contra Costa County Watershed Atlas."
The Atlas was prepared by the Contra Costa County Community Development Department, which
serves as staff to the Watershed Forum. AddiTional support and assistance was provided by the County
Public works Department and members of the Watershed Forum,. The Atlas is a powerful public
education tool providing maps, statistics, and descriptive text about Contra Costa's major watersheds
and creeks.
2)The Problem/Need for the Program
Data Centralization and Data Inventory
Data on creeks and watersheds is spread among Federal, state and local agencies. Additional data is
stored at-academic and research institutions. Previously there was no centralized location or inventory
of the existing data on the creeks and watersheds of Contra Costa County. Inventorying the existing GIS
data made clear where data needed to be acquired, updated or augmented.
Specifically, data on the conditions and locations of creeks was lacking. Volunteers, with guidance from.
county staff, developed and used a GPS data collection program to map creek channels and conditions.
The coordination opportunities and relationships realized between different stakeholders made a
complete data inventory and evaluation possible.
Information Availability
The effective presentation and translation of data into information that is accessible to the lay-person
and useful to the resource manager was not widely available in Contra Costa County. In the Atlas,creek
and watershed information is displayed alongside physical political, transportation, and landuse
information data in a comprehensive and detailed reference volume. The Atlas also displays current and
historical photographs to help connect readers with actual features described by the maps.
Public Awareness
In Contra Costa County, 1,350 miles of creeks weave through 465,000 acres of watershed land. The
County is also home to over 948,000 people. The county has grown by 150,000 people in each of the
past two decades and urbanization is impacting the upland hydrologic system. However, a 2002 survey
by the Contra Costa Resource Conservation .District of creekside residents in one watershed revealed
that only 25%of respondents were aware of their proximity to their backyard creek.
It was apparent that there was a need to find a coordinated way to raise public awareness of the
surrounding natural environment. The Atlas is an education tool that can help people explicitly locate
The Contra Costa County Watershed Atlas
Contra Costa County,CA
their residence and local creek, identify local resources, and understand basic hydrologic concepts in
relation to their environment.
Coordination of Conservation and Restoration
Coordination of education, restoration, mitigation and conservation projects throughout the region is
difficult. The Atlas provides a list as well as a map of current and on-going projects(from creek clean-
up events to creek bank stabilization projects). The funding status of each project is also listed. This
restoration projects is a tool for strengthening partnerships through collaborativecoordinated restoration
efforts.
3) Description of the Program
The Contra Costa Watershed Forum (CCWF) is an outgrowth of the first countywide Creek and
Watershed Symposium held in 1999. The Forum is an open committee, staffed by the County, of some
fifty organizations including federal, state, and local agencies; local governments, professional
watershed research organizations; local non-profit environmental and education organizations;
community volunteer groups, and private citizens. This diverse group of stakeholders is united by their
concern for the watersheds of Contra Costa County. The work of CCWF participants is premised on the
notion that actions in a watershed are inter-related and, therefore, an informed public, broad
participation and cooperation are needed to protect our natural resources. The members of the CCWF
work together to find common approaches to keeping our water resources healthy, functional, attracting
and safe community assets.
The full Watershed Forum meets every other month and various working committees meet regularly as
well. The Forum has spearheaded a number of innovative Creek and Watershed programs that work to
educate the public, coordinate watershed restoration activities, and monitor local creek conditions. In
November 2003, the Forum hosted the 2"d Creek and Watershed Symposium titled: Progress,
Opportunities and Challenges in the Watersheds of Contra Costa County.
In preparation for'the Symposium, members of the Watershed Forum combined forces to create a public'
education, reference resource, and outreach document: The Contra Costa County Watershed Atlas
(Atlas).
The Contra Costa County Watershed Atlas (Atlas) is a large format, full color, 150-page book of maps,
statistics and text about the 28 major watersheds in the County. Though focused on the state of natural
ecosystems on the watershed scale,the Atlas also provides information about the human community and
the county as and eco-region.
The first chapter provides an overview of the county including statistical data, ',text, and base maps.
Additionally, the Atlas includes the complete CCWF Creek and Wetland Enhancement Project'
Database, samples of GPS data collected by community groups on creeks, as well as resources and
volunteer opportunities for people looking to become more involved locally. Maps provided at a
countywide scale include: watersheds, creeks, political boundaries (cities, spheres of influence and
unincorporated communities), planned land use, demographic data, topography, hydrology, earthquake
fault lines, flood plains, soils, aspect, slope, vegetative cover, temperature, rainfall, impervious surface,
historical and current steelhead trout populations and color aerial photographs.
Page 2
The Contra Costa County watershed Atlas
Contra Costa County,CA
Subsequent chapters focus on individual watersheds and include text, lists of resources and active
community groups, statistical data and maps including: aerial photographs, creeks, watersheds, political
boundaries, population density, planned landuse, protected lands and restoration projects.
The Atlas was the catalyst for these groups to collaborate to create a resource for education and
outreach, resource restoration coordination, and data centralization. This 'project demanded that
organizations, agencies and volunteers come together to centralize, create, and share GIS data;
consolidate databases; and contribute text and photographs. These efforts ,were realized at many
different levels, each representing important developments in the outreach and cooperation necessary for
effective watershed management.
o Strong community volunteer groups surveyed miles of creeks using a Global Positioning System
(GPS)data collection program launched by the CCWF;
a Governmental, regulatory, and local agencies fostered relationships to share Geographic
Information System (GIS)data; and
o Restoration project databases were consolidated to provide a vision of activities in the County.
The Atlas was presented at the November 2003 Symposium, and sold out within a week. A second
printing was completed in January 2004. The Atlas has already demonstrated its utility as community
groups have reported that they have been contacted to assist with identifying mitigation projects, county
planners use the Atlas in advising projects; and environmental education programs have integrated the
Atlas into their curriculum.
[An entire Contra Costa County Watershed Atlas is submitted with this application. Two pages from the
Atlas (reduced to fit on 8.5 x I I pages) are attached to this application.]
4)Use of Technology
In addition to current office technology, the completion the Watershed Atlas required intensive use of
cartographic, GIS data manipulation and publication layout software. All technical work was completed
in-house: from the creation of new map layers and collection of GPS data to cartography, document
design and layout.
This program employed the following software/technology:
Geographic Information System(GIS): ArcGIS and affiliated software applications
Global Positioning Systems(GPS): Trimble GPS Units running Pathfinder Office software
Book Layout: Adobe InDesign 2.0 software
5)Cost of the Program
The development of the Watershed Atlas was funded in part by a CALFED grant and a Prop 13 State
Water Resources Quality Control Board grant. Additional funds were provided' by the Contra Costa
Fish and Wildlife Propagation Fund, the Contra Costa County GIS Policy Committee, the Contra Costa'
County Community Development Department, and the Contra Costa County Flood Control and Water
Conservation District. .Money from the sale of the Atlas helped pay for some of the printing costs.
Staff time: $80,000 - Paid for by the above-mentioned grants. This included public outreach and
involvement, program development, book layout, GIS data synthesis, cartography; development of data
charts and other graphics and text.
Page 3
The Contra Costa County Watershed Atlas
Contra Costa County,CA
Printing: $45,000 - Each Atlas costs approximately $75 to print. The;price to the public was
heavily subsidized by grants. The first printing sold for $15 a copy. Not as much grant money was
awarded for the second printing, and the Atlas is made available to the public for $25. Digital copies on
DVD will be available later this year for$5. To date we have printed 600 copies,'ofthe Atlas.
Volunteer hours: More than 1,000 hours of volunteer time - Community members, staff at the
county and other local organizations volunteered time. Tasks included: training volunteers in evenings
and weekend field work mapping creeks using GPS units, proof-reading map data layers, extensive
meetings and interim review to guide development of Atlas.
6)Results/Success of the Program
In the two months the Atlas had been in circulation, it has proven its utility as community groups have
reported that they have been contacted to assist with identifying mitigation projects, county planners use
the Atlas in advising projects, and environmental education programs have integrated the Atlas into their
curriculum. Some examples are provided below.
Demand for Copies of the Atlas
The Atlas was presented at the November 2003 Creek and Watershed Symposium. Within a week, the
first printing of 300 copies sold out. A second printing was completed in January 2004 with over 150
copies pre-ordered by county agencies, non-profits, schools, community groups, regulatory agencies,
consultants,and landscape architects.
Resource for Public Education
The Atlas takes a variety of complex concepts and detailed data and makes it accessible to people by
presenting it as useable information. County Supervisor Gayle Ulkema commented "Oftentimes books
and resources like this that are interesting and have valuable data are not attractive. You have to plow
through the data in order to get to something that is really meaningful and it requires really a dedication
�to do research. In this case, you have overcome that hurdle ... this is the kind of beautiful illustration,
[holds up the Atlas] that really makes you want to look and wants you to study. It's readable and so
therefore I don't think that the challenge of overcoming a research phobia is necessarily going to be
present with the readers of these documents.
Local newspapers have already used the Atlas to assist with public understanding;of creeks, watersheds'
and fish. On January 11, 2004, the Contra Costa Times ran a story about the 'resurgence of salmon
returning to Walnut Creek. The article cited data and provided a map (modified to be more appropriate;
for a newspaper printing)from the Watershed Atlas.
Environmental Education in Schools
The Contra Costa County Watershed Atlas has been integrated into a youth environmental education
program: Life Garden's City Creeks Program: Botany, Ecology, and Watershed Management. This
program is designed to help youth understand the connection between what they do at home and the
health of the natural world. It is active in Central County Intermediate Schools and plans to expand. The
Atlas is as a resource and reference for teachers and students.
Environmental Restoration Coordination
Page 4
The Contra Costa County Watershed Atlas
Contra Costa County,CA
By providing a resource for groups that work in the county, the Atlas empowers groups to coordinate
mitigation, restoration and conservation efforts. The community was quick to take advantage of the
resource and connections have already been made in the Pinole Creek Watershed. Writes Nicholle
Fratus, Program Coordinator, Friends of Pinole Creek: `°I also want to thank you for doing such a
fantastic job on the atlas. It is a wonderful resource. Good has already come from it. Friends of Pinole
Creek Watershed has been contacted by a consulting firm that is looking for a suitable location on
Pinole Creek for a mitigation project). They want to assist or team with us to do a linear restoration on
Pinole Creek. This is an exciting opportunity for us. They founts out about us from the Atlas!!"
Tool for Planning Professionals
Resources managers, land use planners, and others actively working in Contra Costa County have a new
tool to assist them in talking about, locating, and understanding the regional implications of various land
use decisions. County Supervisor John Gioia commented "Once we realize what we have, we are better
able protect it and we are better able to snake sound decisions on land use and l planning. I think this
(Atlas) is going to be a very valuable tool for land use issues in Contra Costa."
7)Worthiness of an Award
The "Contra Costa County Watershed Atlas" is not simply a placeholder on a bookshelf. It is a practical
and powerful resource for the public as well as policy makers, community groins and water resources
professionals. The project engaged local stakeholders and generated the momentum to continue work
on creek and watershed issues. The Atlas represents the committed and coordinated efforts from all the
community, non-profits and local governments. Effective and meaningful 'partnerships between
stakeholders were developed through this process.
For the meaningful collaboration fostered by its creation, as well as the powerful resource created, the
"Contra Costa County Watershed Atlas"' warrants the National Association of Counties Achievement'
Award for Civic Education and Public Information.
Page 5
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