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HomeMy WebLinkAboutMINUTES - 05211996 - C73 73 TO: BOARD OF SUPERVISORS F&HS-01 �:._ . Contra o .o FROM: FAMILY AND HUMAN SERVICES COMMITTEE �'✓�� Costa _ 4o County May 13, 1996 ; DATE: s'A couK`� SUBJECT: REPORT ON THE STATUS OF THE FAMILY MAINTENANCE ORGANIZATION SPECIFIC REQUEST(S)OR RECOMMENDATION(S)&BACKGROUND AND JUSTIFICATION RECOMMENDATIONS: 1. ACCEPT the attached report from the Assistant to the Health Services Director, outlining the status of the work on the Family Maintenance Organization. 2. REQUEST the Health Services Director to provide the Family and Human Services Committee with a further report on the status of the Family Maintenance Organization when the cost study is sufficiently completed that there is additional information to provide to our Committee, but no later than December 9, 1996. BACKGROUND: Mary Foran, Assistant to the Health Services Director, reported on the activities of the Family Maintenance Organization in the past three months. A copy of her report is attached. Ms. Foran reviewed this report with us in some detail, emphasizing that there will not be sufficient savings from health services alone to pay for the preventive services. Thus, it is necessary to turn to other County programs to identify possible savings in the Social Service and Probation Departments. This will be the purpose of the cost study, which will attempt to identify the cost of services provided by the Health Services, Social Service and Probation Departments in the Bay Point area. The cost study will probably focus on not more than 200 families. CONTINUED ON ATTACHMENT: YES SIGNATURE: RECOMMENDATION OF COUNTY ADMINISTRATOR RECOMMENDATION OF B C M I TEE APPROVE OTHER SIGNATURESJTWSMITH ACTION OF BOARD ON May 21, 1996 APPROVED AS RECOMMENDED OTHER VOTE OF SUPERVISORS I HEREBY CERTIFY THAT THIS IS A TRUE _X UNANIMOUS(ABSENT ----------- ) AND CORRECT COPY OF AN ACTION TAKEN AYES: NOES: AND ENTERED ON THE MINUTES OF THE BOARD ABSENT: ABSTAIN: OF SUPERVISORS ON THE DATE SHOWN. ATTESTED May 21, 1996 Contact: PHIL BATCHELOR,CLERK OF THE BOARD OF cc: County Administrator SU S SAND COUNTY ADMINISTRATO Health Services Director - BY F&HS-01 We are all disappointed that we were unsuccessful in obtaining funding for the Family Maintenance Organization from the Robert Wood Johnson Foundation. Our Committee suggested that it might be important to at least try to identify whether we could include in the cost study the costs of the public safety programs operated by the County, including the law enforcement costs, District Attorney, Courts and related costs, in addition to those for the Health Services, Social Service and Probation Departments. We have asked the Department to report back to our Committee in six months or when there has been sufficient progress on the cost study that there may be some useful information to report. -2- Contra Costa County The Board of Supervisors HEALTH SERVICES DEPARTMENT OFFICE OF THE DIRECTOR Jim Rogers, 1st District William B.Walker, M.D. Jeff Smith,2nd District sc Director&Health Officer Gayle Bishop,3rd District ? '_•4� Mark DeSaulnler,4th District ti' 20 Allen Street Tom Torlakson,5th District ;i _ - Martinez,California 94553-3191 County Administrator o! ,;ewu (510)370-5003 _ FAX(510)370-5099 Phil Batchelor '•. County Administrator °os rA-c6uK`� To: Supervisor Mark DeSaulnier Supervisor Jeff Smith Family and Human Services Committee From: Mary Foran Assistant to the Health Services Director Subject: Progress Report on the Family Maintenance Organization Date: MAY 8, 1996 FMO development in the past three months has focused in three areas: 1. Submission of final report on the 20-month planning process to the Robert Wood Johnson Foundation. 2. Progress on the cost study. 3. Examining ways to reconfigure the health activities at the Bay Point SIT to incorporate the FMO program design recommendations. Final Report to Foundation The greatest challenge to developing the FMO has been its ambitious scope -- combining prevention and intervention, health care and social support into one design; focusing on families rather than individuals when existing local data systems have limited or no capacity to recognize families; and proposing a different financial model across multiple programs. Our planning has taken place in a context of multiple efforts to improve outcomes for families in our county. Each effort has been on a different schedule with particular immediate objectives. Largely due to the work of the FMO project, the same broad family health outcome objectives have been adopted by all programs, but the operational melding of the planning efforts across the interagency sectors is still in process. The continued uncertainty of funding for the emerging programs has limited our ability to launch the unified effort. However, we believe the results of the cost study described below will provide additional information to support moving forward. Merrithew Memorial Hospital&Health Centers • Public Health • Mental Health • Substance Abuse • Environmental Health Contra Costa Health Plan • Emergency Medical Services • Home Health Agency • Geriatrics A-345 (1/96) The desire to create a funding model which would shift costs from one part of the health and human service system to another required us to start with what is --we examined individual health status measures and existing individual/household health care utilization patterns. We found that despite the inadequacies of our current publicly- funded health care system, it has several key features which make it relatively more efficient than most. It is family practice, not specialty-based; outpatient-driven rather than inpatient-driven; it already includes advice nurses and some attention to managing our individuals who are very high utilizers. Our utilization analysis supports the contention that there is room for cost shifting by reducing emergency room use and better management of chronic health conditions. However, the pilot area for the project is small; projected savings would be modest. An initial analysis suggests savings could support the proposed family-focused prevention activities but would not be sufficient to add the health intervention services -- substance abuse treatment and community mental health services --which are not available now. In summary, the potential for shifting funds to invest in prevention by reducing inappropriate utilization may be somewhat limited in a system which has already reduced the most expensive forms of inappropriate utilization. The current reality in public systems is fiscal reductions in the face of mounting social problems. We challenge ourselves to restructure to be able to do more with the same, but frequently fewer resources. The FMO design requires a long term commitment to investing in prevention for families when all systems are facing reductions and great uncertainty in the structure of future funding. The design of the FMO recognizes the non-health system determinants of family health. Besides affecting how funds are allocated in the health system, the FMO should create savings in the non-health care sectors of the County -- Child Protective Services, Juvenile Justice and education. The amount of such savings must be estimated for the potential it may create to support the substance abuse and family mental health services. To do so requires implementing the FMO cost study. Finally, it may be that our desire to fold together prevention of common family health issues with amelioration of the consequences of the more severe family health problems of chronic disease, substance abuse, domestic violence and child abuse is not tenable in the current political and fiscal climate. Our planning process revealed the basic unavailability of resources to assist families in great distress. A cost effectiveness argument alone may not show that there are sufficient current resources to invest in prevention and address serious current problems. Again, the cost study will allow us to tease out both the prevention and intervention sides of the equation. 2 We may find that the FMO needs to be two programs -- one that integrates the resources for supporting families in the community -- the community-based prevention approach; and the other which combines the resources for high risk, high utilizing families across the medical care - substance abuse - mental health - protective services -juvenile justice programs. Cost Study In line with the approach of viewing the FMO as two closely related programs, and after assessing the quality and availability of the needed data, we have broken the cost study into two pieces. The first segment will estimate the total health expenditures for family health prevention activities and primary medical care in Bay Point. Few programs are able to identify services specific to Bay Point and many programs are not automated. Thus, we will be limited to creating educated estimates of current prevention/primary care expenditures. Sixteen programs will be included. The purpose of aggregating these expenditures is to highlight the amount of funds being invested and to examine the opportunities for program consolidation to reduce categorical fragmentation and administrative duplication. The second element of the cost study will be an in-depth analysis of programs providing intensive intervention services to families in Bay Point. The analysis will require integration of data from Health Services, Social Service and Probation. It will go beyond the "data-match" conducted 3 years ago, which launched the SIT, to examine the cost, type and, if possible, sequence of services provided. The purpose of this part of the cost study is to identify the opportunities for pooling of funds and creation of a more efficient funding mechanism. SIT and FMO Our plan to begin implementation in March of the parent outreach and education elements of the FMO within the Bay Point SIT were put on hold due to internal personnel changes. We are in the process of reconfiguring our health team. This team will be responsible for melding together the various health activities in Bay Point into a coherent whole which will complement the Healthy Start, Family Preservation Support Program, school-based health center and SIT initiatives. cc: William Walker, M.D. MPF:kn a:progress.hno 3