HomeMy WebLinkAboutMINUTES - 05061997 - C117 C 117
F&HS-02
TO: BOARD OF SUPERVISORS ---------S-- . Contra
FAMILY AND HUMAN SERVICES COMMITTEE s -`"
FROM: �`` Costa
April 28, 1997
DATE: County
°O.sTa'co'uK'�
REPORT ON STATUS OF HEALTH SERVICES INTEGRATION A ARIOUS
SUBJECT:
SITES THROUGHOUT THE COUNTY
SPECIFIC REQUEST(S)OR RECOMMENDATION(S)3 BACKGROUND AND JUSTIFICATION
RECOMMENDATIONS:
1. ACCEPT the attached report from the Health Services Department on the
status of the integration of health services at various sites throughout the
County.
2. AGREE to postpone action on the inter-agency cost study feasibility but
REQUEST the Policy Forum to discuss the need for this type of cross-agency
cooperation and to make recommendations to the Family and Human
Services Committee on steps which can be taken to accomplish the type of
cross-agency comparison of the volume, type and cost of services being
provided to families in Bay Point and elsewhere in the County.
3. ADOPT the attached Resolution expressing the commitment of the Board of
Supervisors to open and staff the Center for Health in North Richmond and
DIRECT the Health Services Director to send copies of the Resolution to the
West County Mayors and Supervisors Association and to the Mayors of the
cities of EI Cerrito, Richmond, San Pablo, Hercules and Pinole.
4. DIRECT the Health Services Director to coordinate closely among the County
Health Services Department, Mt. Diablo Unified School District, City of
Concord and Supervisor DeSaulnier's Office on plans to locate a health center
in the Monument Corridor of the City of Concord.
CONTINUED ON ATTACHMENT: YES SIGNATURE:
-RECOMMENDATION OF COUNTY ADMINISTRATOR RECOMMENDATION OF BOARD CO ITTEE
APPROVE OTHER
SIGNATURES
MARK DeZALILWIER DONNA C,'FR ER
ACTION Of BOARD ONMay 6, i997 APPROVED AS R MM ENDED OTHER
VOTE OF SUPERVISORS
�UNANIMOUS(ABSENT r
I HEREBY CERTIFY THAT THIS IS A TRUE
_ 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.
cc: County Administrator ATTESTED May 6, 1997
PHIL BATCHELOR.CLERK OF THE BOARD OF
Health Services Director SUPERVISORS AND COUNTY ADMINISTRATOR
Mary Foran, Assistant to the Health Services Director
M382 (10/88)
BY C. "ti ' ,DEPUTY
F&HS-02
5. DIRECT the Health Services Director to make a further report to the Family
and Human Services Committee on this subject in September, 1997.
BACKGROUND:
On December 17, 1996, the Board of Supervisors approved a report from the 1996
Family and Human Services Committee which included the following
recommendations:
1. ACCEPT the attached report from the Health Services Department on the status
of the integration of health services in the Bay Point area.
2. DIRECT the Health Services Director to make a further report to the 1997 Family
and Human Services Committee during the month of April, 1997 on the status
of the Bay Point Community Wellness Center and on the status of the inter-
agency data-gathering effort to expand this effort to other services and
departments.
3. DIRECT the Health Services Director to include in that report the feasibility of
expanding the concept of a Wellness Center to the Richmond area and the
Monument corridor area of Concord.
4. REMOVE this subject as a referral to the 1996 Family and Human Services
Committee and instead REFER it to the 1997 Family and Human Services
Committee.
In response to this direction, our Committee met with the Health Services Director,
Dr. Walker, and his assistant, Mary Foran, on April 28, 1997. Ms. Foran reviewed
the attached report with our Committee.
We are disappointed that it does not appear to be feasible at any reasonable cost
to provide the type of data we had requested on the volume and cost of providing
services by multiple County departments to families in a defined area like Bay Point.
While we recognize the limitations which make this a very questionable prospect at
this time, we would like to ask the Policy Forum to look at this proposal and work in
the direction of insuring that this type of data is available in the future so we can
measure the cost of providing services and the effectiveness of providing those
services.
We are pleased with the work which has been accomplished in Bay Point and
encourage the Health Services Department to continue on the course they have set
at this location.
We are also encouraged by the work which is underway to establish the Center for
Health in North Richmond. We have been assured by the Health Services Director
that staffing the Center will come from existing staff at the Richmond Health Center.
Because of questions which have been raised by officials in West County, we are
recommending that the Board adopt the attached Resolution which sets forth the
Board's commitment to staff and maintain the Center for Health in North Richmond
when the building is ready.
We are also encouraged by the cooperative work which is underway to locate a
health clinic in the Monument Corridor area of the City of Concord. It is essential,
however, that work in this area involve close cooperation and collaboration with the
City of Concord since this is the one site in which we are planning to locate a health
clinic within an incorporated city. We are, therefore, asking that special efforts be
made to keep the City of Concord, the Mt. Diablo Unified School District and
Supervisor DeSaulnier's Office involved in planning for this site.
-2-
THE BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA
Adopted this Order on May 6, 1997 , by the following vote:
AYES: Supervisors Rogers, Uilkema, Gerber, Canciamilla, and DeSaulnier
NOES: None
ABSENT: None
ABSTAIN: None
Resolution in support of the Center)
for Health in North Richmond )
RESOLUTION NO. 97/ 218
WHEREAS, planning for a center in North Richmond began in 1994 when the County received
$600,000 from the General Chemical settlement for "the construction and equipping of a Health
Clinic in the greater Richmond area." (Page 4 of General Chemical Agreement), and
WHEREAS, following the receipt of the initial funding through the General Chemical agreement,
the Board of Supervisors created the Center for Health Advisory Board in April, 1994 to work in
partnership with the Health Services Department to design the Center and provide continuing
oversight and advice regarding program operations, and
WHEREAS, the Advisory Board adopted the concept of creating a "Center for Health", where
medical services would be provided, as well as community health improvement activities, with the
overall goal of measurably improving the community's health status, and
WHEREAS, the project area for the Center for Health is six census tracts in West County including
North Richmond, Parchester Village, the western part of San Pablo and the Iron Triangle
neighborhood of the city of Richmond, and
WHEREAS, the initial program planned for the Center for Health, based on extensive analysis of
epidemiological information and a detailed community survey process, includes the following
components:
• Family practice medical care for all ages, including health education and coordination of
specialty care
• TB prevention and treatment
• HIV/AIDS prevention and treatment
• Preventive dental services and dental health education
• Youth activities to reduce violence, prevent teen pregnancy and increase involvement in
health careers, and
WHEREAS, the Center for Health will be a site for the Contra Costa Health Plan; both enrollees in
the Medical Managed Care Local Initiative and those who remain in the fee for service system will
be served, and
WHEREAS, concurrent with the planning for the Center, the Department has launched two other
initiatives in the same geographic area- the Healthy Neighborhoods Project, which uses community
asset mapping to build the capacity of local residents to determine their health priorities and
implement approaches to improve the quality of life in their neighborhoods; and Partners in Health,
a project funded by the California Wellness Foundation, which is engaging the large civic institutions
(cities, business, school district, health care providers) and neighborhood residents to design and
implement a community health improvement plan whose priorities are job readiness, violence
prevention and teen pregnancy prevention; and
WHEREAS, the layering of these three efforts - the Center for Health, Healthy Neighborhoods and
Partners in Health- creates the opportunity and the momentum to bring to life a new model for public
provision of health care and health improvement which will be more efficient and more effective, and
WHEREAS, we have identified nearly $1.2 million in outside funds, including the $600,000 from
General Chemical, $25,500 from CDBG, $2,400 from the Rose Foundation, $2,400 in individual gifts
and $550,000 from Chevron to build the Center, and
WHEREAS, the Chevron funding is the result of a vigorous community advocacy process, which
convinced the Richmond City Council on February 25, 1997 to recommend to Chevron that they
allocate $550,000 to the Center, and
WHEREAS, Chevron indicated they would be guided by the City Council's recommendation, and
WHEREAS, the Richmond City Council recommendation stipulated that the County had to build
and open the Center within 18 months of their recommendation or the funds would revert to another
purpose,
NOW THEREFORE BE IT RESOLVED by the Board of Supervisors of the County of Contra
Costa that the County of Contra Costa is committed to constructing the Center for Health,
contingent upon receipt of$550,000 from Chevron Corporation, and to staffing and maintaining
the operation of the Center for Health once it is built.
I hereby certify that this is a true and correct copy of an
action taken and entered on the minutes of the board of
supervisors on the date shown.
attested May 6, 1997
Phil Batchelor, Clerk of the Board
of Supervisors and County Administrator
by '''
Deputy
Orig: Mary Forna- 370-5010
cc: County Administrator
Health Services Director
Contra Costa County
The Board of Supervisors HEALTH SERVICES DEPARTMENT OFFICE OF THE DIRECTOR
Jim Rogers,1st District ti_s LWilliam B.Walker, M.D.
Gayle B.Uilkema,2nd District =
Donna Gerber,3rd District Director&Health Officer
Mark DeSaulnier,4th District 20 Allen Street
Joseph Canciamllla,5th District 0. 0a q,. ,, Martinez, California 94553-3191
w . -_
CountyAdministrator - ��� (510)370-5003
_ _ r+ '
_ FAX(510)370-5099
Phil Batchelor osrA cooK`t i
County Administrator
To: Family and Human Services Committee
Supervisor Mark DeSaulnier, Chair
Supervisor Donna Gerber, Member
From: Mary Foran
Assistant to heAdea Se ices Director
Subject: Status Report on Health Services Integration
Date: April 28, 1997
In December of 1996 we provided the Family and Human Services Committee with a status
report on implementing integrated health services in Bay Point, as well as our plans for carrying out
an inter-agency cost study of County expenditures in Bay Point. We are reporting to you today on
the following topics:
1. Feasibility of inter-agency cost study
2. Status of integrated health services in Bay Point
3. Status of integrated health services in North Richmond
4. Status of integrated health services in Concord
Inter-Agency Cost Study Feasibility
The purpose of the inter-agency feasibility study was to determine whether identifying information
and detailed service and cost information could be tied together across agencies -- either electronically or
manually--in order to analyze the volume, type and cost of services provided to families in Bay Point. The
short answer is that such a study would have to be done manually (for most agencies involved) and would
have to rely on estimating average costs, rather relating costs to specific services.
C:\OFFICE\W PWIN\WPDOCS\MEMOS\HSREPORT.MEM
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 (2/97)
The following table summarizes the results of interviews which were conducted with Department heads,
program managers and information system analysts in order to identify the availability of specific data elements
necessary for the inter-agency cost study.
..
...Dept degree of data elements ease of data retrieval costs associated w/data capture and
automation are clearly analysis
defined how records lept
Health medium somewhat-need to moderately easy moderate-would require assignment
Services- currently in the determine of ad hoc systems programmers and
Mental process of definitions for
Health
implementing MIS case intake and additional software
for outcome closure and cost 70% computerized;
measures assigned to cost expenditure estimate: $6,000
individuals information is manual
Health low- somewhat-need to moderately difficult- Moderately high-at this time the
Services- information is determine no automation of State does not have census tract
Communitytransmitted to the definitions for
case intake and clinical information data available; study would require
Substance State who has a closure and cost within Health all East County providers to
Abuse centralized data assigned to Services; rely on State manually pull all case files and
Division base; State only individuals to write ad hoc review; high mobility of this client
provides
aggregate reports population
a
a rega estimate: RFP for new MIS is in
reporting currently all manual
process; data will not be available
except for what is
reported to State-in for 18-24 months
process of implementing
MIS system
Sheriffs low-medium not at all- difficult-some data very high; automated systems are not in
Department minimally elements are not place
currently captured estimate: technical assistance to define
data elements and outcomes; labor to
manually extract charts,programmer
time for additional data capture(most not
many data elements not currently captured),patrol car laptops to
captured at all; log in all cases(not all logged at this
minimally would need a time)software cost for mainframe
paper system in place census tract translation table; computer
space to perform report
estimate: $100,000+
C:\OFFICE\WPWIN\WPDOCS\MEMOS\HSREPORT.MEM 2
Dept degree of data elements ease of data retrieval costs associated wl:data capture.and
automation are clearly analysis
_. __
defined how records kept
Probation medium somewhat- difficult-some data high;most cases would have to be
multiple elements are not manually reviewed
definitions exist currently captured estimate: technical assistance to define
data elements and outcomes; labor to
manually extract charts,programmer
about 50%of records are time for additional data capture,
maintained manually software cost for mainframe census tract
translation table;computer space to
perform report
Social medium in flux; moderately difficult; high
Services impacted by many programs are estimate: technical assistance to define
Welfare Reform manual, some are data elements and outcomes; labor to
automated through manually extract data in some areas,
categorical funding programmer time for additional data
sources therefore not capture, software cost for mainframe
amendable to census tract translation table; computer
progranuning alteration space to perform report
about 50%of records are
maintained manually
School low somewhat very difficult-no cost moderate to high
Systems association is made at each School District will need to be
present; aggregate only individually contacted; needs to include
information is currently modifications in program structure at
in place School District level; labor involved in
about 25%of the data retrospective review of all foster youths
elements are available
from computer data base
Conclusions and Recommendations
The original purpose of the cost study was to fuel changes in the systems of services for families. More
specifically, it was requested by the Robert Wood Johnson Foundation as a prerequisite to considering support for
the Family Maintenance Organization (FMO.) In the meantime, we have been able to move ahead with some
elements of the FMO. In addition, welfare reform and managed care are driving new service delivery changes.
Both program and information systems staff are devoting the bulk of their attention to the demands created by
these policy initiatives. Staff are also responding to system change projects coordinated by the CAO including the
Children's Budget and the outcomes development activities.
C:\OFFICE\WPWIN\WPDOCS\MEMOS\HSREPORT.MEM -�
Significant investment in time and technology would be required to conduct the cost study. Most programs
are capturing of the data elements to match clients across programs, at least manually. However most programs
would be hard pressed to associate costs with clients or their services and significant work would be needed to
define common definitions of case closure and categories of service provision. A number of factors contribute to
the difficulty in assigning client-specific costs to our programs. Many of the programs which would be involved
in the study are categorically funded. The focus of current accountability systems has been on volume of service
delivered, not the efficacy of the actual service delivery. Thus, the systems in place are not designed to examine
changes in clients or to permit tracking of clients over time and across systems. Current computer systems do not
"talk" among agencies. Changes are coming but will require significant investment to re-tool or install new
information technology.
The study could be done manually, but it would be forced to rely on cost estimates, because of the general
lack of client- specific cost data, and it would require retaining additional staff to conduct it. This expense might
be justified if we were conducting the study as part of an evaluation or in order to secure major new program
funding. The recommendation is to that we put the cost study on hold until such time as a specific program
purpose emerges from the systems change activities being conducted through the Policy Forum or as a result of
welfare reform and managed care implementation.
Bay Point Community Wellness Center
The activities at the Bay Point Community Wellness Center are being implemented in collaboration with
the Mt. Diablo Unified School District. Child Health Screening clinics began in August of 1996. WIC began
serving families in October of 1996. In December we began offering family practice primary care 20 hours per
week, and the Children's Mental Health counselor began seeing clients shared with the Bay Point Service
Integration Team at the Center.
We received confirmation of a $30,000 grant from PacifiCare Foundation in April, as well as approval to
create 1.5 positions within the Health Services Department (Public Health Division) to oversee program operations
and develop community health education activities. We are recruiting for positions now. Funds will be pooled
from the School District, Public Health and the PacifiCare grant to support the positions.
We have adopted an integrated management structure to maintain the interdisciplinary, inter-program
approach to services. A site operations group meets monthly to facilitate inter-program problem solving. A Policy
Team meets quarterly to set overall program directions, agree on adding programs or changing schedules, and to
resolve any inter-program problems which have not been settled by the staff at the site.
A service statistics report shows that the volume of services is realizing a steady increase which can be
attributed to the growth in community awareness and center visibility. During the first quarter of 1997,
approximately 400 primary care visits, 100 well child check-ups, and 100 children's mental health counseling
sessions have been provided. The WIC nutritional program has provided 2400 visits during the quarter and
nutrition education sessions for close to 500 clients. In total, the WIC program serves 850 families in the Bay Point
area.
C:\OFFICE\WPWIN\WPDOCS\MEMOS\HSREPORT.MEM 4
Center for Health in North Richmond
The model we have implemented in Bay Point will be expanded for implementation in North Richmond.
As you may recall, planning for a center in North Richmond began in 1994 when the County received $600,000
from the General Chemical settlement for "the construction and equipping of a Health Clinic in the greater
Richmond area." (Page 4 of General Chemical Agreement) These funds are held in trust by the Auditor-
Controller, and if not expended by December 31, 2004 for the defined purposes must be returned to General
Chemical. The funds cannot be diverted to another purpose or to another entity without violating the terms of the
agreement.
Following the receipt of the initial funding through the General Chemical agreement, the Board of
Supervisors created the Center for Health Advisory Board (April, 1994) to work in partnership with the Health
Services Department to design the Center and provide continuing oversight and advice regarding program
operations. The Advisory Board quickly adopted the concept of creating a"Center for Health", where medical
services would be provided, as well as community health improvement activities, with the overall goal of
measurably improving the community's health status.
The project area for the Center for Health is six census tracts in West County including North Richmond,
Parchester Village, the western part of San Pablo and the Iron Triangle neighborhood of the city of Richmond.
The project area is home to 32,000 people, nearly 45% of whom live on incomes less than 200% of the federal
poverty level. The population is multiethnic with a large number of recent immigrants.
The basic program for the Center for Health, based on extensive analysis of epidemiological information
and a detailed community survey process, includes the following components:
• Family practice medical care for all ages (from prenatal care through geriatrics), including health education
and coordination of specialty care.
• TB prevention and treatment.
• HIV/AIDS prevention and treatment.
• Preventive dental services and dental health education
• Youth activities to reduce violence, prevent teen pregnancy and increase involvement in health careers.
• A special resource center for health education and environmental health information and education.
The Center for Health will be a site for the Contra Costa Health Plan. Both enrollees in the Medical
Managed Care Local Initiative and those.who remain in the fee for service system will be served.
Concurrent with the planning for the Center, the Department has launched two other initiatives in the same
geographic area-the Healthy Neighborhoods Project, which uses community asset mapping to build the capacity
of local residents to determine their health priorities and implement approaches to improve the quality of life in their
neighborhoods; and Partners in Health, a project funded by the California Wellness Foundation, which is engaging
the large civic institutions (cities, business, school district, health care providers) and neighborhood residents to
design and implement a community health improvement plan. The priorities for this plan are job readiness, violence
prevention and teen pregnancy prevention. The layering of these three efforts - The Center for Health, Healthy
Neighborhoods and Partners in Health - creates the opportunity and the momentum to bring to life a new model
for public provision of health care and health improvement which we believe will be more efficient and more
effective.
C:\OFFICE\WPWIN\WPDOCSUIEMOS\HSREPORT.NIEM 5
As you might imagine, we have had to develop new funding resources to support these three interrelated
initiatives. Both Healthy Neighborhoods and Partners in Health are supported by special foundation grants. The
Center for Health will cost over$1.8 million to build and equip. We have identified nearly $1.2 million in outside
funds, including the $600,000 from General Chemical, $25,500 from CDBG, $2,400 from the Rose Foundation,
$2,400 in individual gifts and $550,000 from Chevron..
The Chevron funding is the result of a vigorous community advocacy process, which convinced the
Richmond City Council on February 25, 1997 to recommend to Chevron that they allocate $550,000 to the Center
from funds remaining on an earlier commitment to the now bankrupt Martin Luther King Jr. Family Health Center.
Chevron indicated they would be guided by the City Council's recommendation. However, Chevron also has
indicated that they intend to delay commitment of the funds until the Martin Luther King Jr. Health Center
bankruptcy is complete. The Richmond City Council recommendation stipulated that the County had to build and
open the Center within 18 months of their recommendation or the funds would revert to another purpose.
We are in conversation with Chevron to secure a commitment of the funds so that we can stay on schedule
by breaking ground for the Center in August of this year. During the time the building is being constructed we will
be working with the Advisory Board and Health Services staff to create an effectively integrated, community
responsive model. The Center will work closely with the other key resources in the surrounding neighborhoods,
including the Service Integration Family Resource Center, Healthy Neighborhoods Project, Partners in Health,
Family Preservation Support Program, the School District, other health care providers, community based
organizations and residents. The Center for Health is scheduled to open for services in July, 1998.
Monument Corridor/Concord
Health Services staff has been working closely with the Mt. Diablo Unified School District Healthy Start
staff and planning group to identify the health issues and appropriate responses to them for the three schools in the
"Monument Corridor" in Concord. A Public Health Nurse from the Public Health Clinical Services program and
an analyst from the Office for Service Integration have assisted in gathering data and planning the implementation
of the schools'Healthy Start project.
Plans are still being developed. A site at Loma Vista Adult School has been identified for provision of
health services. Unfortunately, it is smaller than the Bay Point site which will require that critical choices be made.
However, while the specifics are being worked out, additional resources are already being made available to the
children and their families. The Public Health Nurse is assisting the Healthy Start Community Aides with follow
up on health problems identified among the school population. In addition, Kaiser (Stockton) is providing their
mobile clinic van for use once a month. The van is staffed by Public Health. It was first used in March. During
a four hour time period, 55 patients were seen.
We will continue to develop the health component in conjunction with the School District and Kaiser which
is an interested partner in the effort. The priorities at this point include bringing together various health resources
in order to increase the connections between and among providers and residents; exploring ways to hire residents
to do outreach and basic health education in their neighborhoods; assessing the extent of the uninsured population
in the area as a prelude to developing resources to serve them; and renovating the site for clinical services -- this
time it's an old auto shop, instead of a metal shop!
cc: William Walker, M.D.
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