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CARING FOR OUR CITIZENS: INNOVATION IN HEALTH CAREALEX BRISCOE ALAMEDA COUNTY HEALTH CARE SERVICES AGENCY DIRECTOR ALAMEDA COUNTY CITIZENS ACADEMY OCTOBER 7, 2015
Health Care and the Public Sector
What is the role of the public sector in health care?
What are the challenges the public sector faces in the post-ACA era?
What is unique about Alameda County?
Learning Goals
Overview of the Health Care Services Agency
Understanding the Social Determinants of Health
Expansion in Insurance Coverage
Innovation in Access to Health Care
Why the Key to Health is a Good Job
MISSIONThe mission of the HCSA is to
provide fully integrated health care services through a
comprehensive network of public and private partnerships that
ensures optimal health and well-being and respects the diversity
of all residents.
VISIONHealth Equity through the goals of
Healthy People, Healthy Places, Healthy Policies and Healthy
Systems
School Health Services
Cross-Departmental/
Cross-Jurisdictional
Health Services
Indigent Health Care Services/
HealthPAC
Behavioral Health Care
Services
Day Treatme
nt
Referral Services
Support Services
24 Hour Services
Outpatient
Services
Administration
Public Health Services
Community Health
Services
Communicable Disease Control &
PreventionFamily Health
Services
Administrative
Services
Public Health Nursing
Administration
Environmental Health Services
U.C. Cooperative Extension
Vector Control Services
Outreach
Ancillaries
Emergency Medical Services
Office of AIDS
Environmental Health
Office of the Director Health
Officer
HCSA Administrat
ion/Indigent Health
Alameda County Health Care Services Agency
Office of the Director Finance & Administration, Fund Development, Human Resources
Medical Director, Policy, Compliance, Evaluation
Final Approved FY 14/15
Final ApprovedFY 15/16
Change from FY 14/15 Budget
Amount %
Appropriation $644.88 $676.66 $31.78 4.93%Revenue $526.45 $554.21 $27.76 5.27%County General Fund $118.43 $122.45 $4.02 3.39%
FTE-Mgmt 483.83 506.40 $22.57 4.66%FTE-Non Mgmt 982.52 1,015.43 $32.91 3.35%
Total FTE 1,466.35 1,521.83 $55.48 3.78%
*Includes Vector Control ($5.87M) & EMS Special District ($24.76M) = $30.63M and Measure A (non AHS) = $29.54M
HCSA FY 15/16Final Adopted Budget* (in millions)
Overview of HCSA Service Delivery System
Works/contracts with a network of approximately 800 providers in 1,200 sites
Serves approximately 222,000 patients
Provides in excess of 1.5 million visits and 425,000 inpatient, residential and day treatment services
Provides direct environmental health services to over 70,000 households or businesses
Social Determinants of
Health
Alameda County, California
Population, 2014: 1,610,921 (CA: 38,802,500)
Land area (square miles): 739 (CA: 155,959)
Persons per square mile, 2014: 2,180 (CA: 249)
College graduates, persons 25 and over, 2014: 42.8% (CA: 31.7%)
Housing units, 2014: 592,393 (CA: 13,901,594)
Homeownership rate, 2014: 51.8% (CA: 53.7%)
Median household income, 2014: $77,214 (CA: $61,933)
Source: Census Bureau 2014 Population Estimates, 2014 American Community Survey.
Place Matters: Health Inequities by where people live
Source: ACPHD CAPE Unit, with data from Alameda County vital statistics files, 2011-2013.
Race Matters: Life Expectancy and Race
Life Expectancy at Birth by Race in Alameda County
Source: ACPHD CAPE Unit, with data from Alameda County vital statistics files,1960-2013
60
65
70
75
80
85
Lif
e E
xpect
ancy
at
Bir
th (
Years
)
African American
White
20
1 3
6.6 years
4.0 years
Compared to a White child in the affluent Oakland Hills, an African American born in West
Oakland is…1.5 times more likely to be born premature or low
birth weight
7 times more likely to be born
into poverty
2.5 times more likely to be behind
in vaccinations
4 times less likely to read at
grade level
5 times more likelyto be
hospitalized for diabetes
2 times more likely to die of heart disease
INFANT CHILD ADULT
Cumulative impact:15 year difference in life expectancy
Race, Income, and PlaceImpact Health
Source: Bay Area Regional Health Inequities Initiative
Socio-Ecological
Medical Model
UPSTREAMSocial factors
DOWNSTREAMHealth status
Neighborhood ConditionsEnvironment Social PhysicalResidential segregation3
Institutional PowerCorporationsBusinessesGovt. agenciesSchools
Social InequalitiesClassRace/ethnicityGenderImmigration status
Risk BehaviorsSmokingNutritionPhysical activityViolence
Disease & InjuryInfectious diseaseChronic diseaseInjury (intentional & unintentional)
MortalityInfant mortalityLife expectancy
Individual Health Knowledge
Health Care Access
Genetics
Health Equity Framework
LIHP Transition and Coverage Expansion
Success in LIHP Enrollment
At its peak, there were almost 90,000 people in HealthPAC
Over 40,000 enrollees automatically transferred into Medi-Cal on 1/1/14 91% were assigned to the Alliance 9% were assigned to Anthem Blue Cross
Alameda County far exceeds any other County in terms of percentage of LIHP enrollees
HealthPAC After the LIHP
Decrease in Enrollment
Decrease in funding to County (loss of Federal Funding and Realignment)
AB85 Board of Supervisors approved an increase
of General Fund to support remaining uninsured – funding went to FQHCs
Alameda County HealthPAC: Change in Funding Post-ACA
Dec 31, 2013 Jan 1, 2014
HealthPAC Enrollee Transitions
HealthPAC County0-200% FPL| Ineligible for other
programs41,000 Enrollees
(47% of current HealthPAC)
Clients who may be eligible for Covered California or Medi-Cal
(LPRs ‹5 years, pending Medi-Cal disability, or on share of cost
Medi-Cal) will be identified.
0-138% FPL: HealthPAC County and Restricted Medi-
Cal139-200% FPL: HealthPAC
County
HealthPAC HCCI 133-200% FPL| Citizen or LPR › 5
years7,000 Enrollees
(8% of current HealthPAC)
Clients must go through eligibility determination with Covered
California.
133-138% FPL: Medi-Cal139-200% FPL: Exchange
Clients who are exempt or can't afford the Exchange will be eligible for HealthPAC
County
HealthPAC MCE 0-133% FPL| Citizen or LPR › 5
years40,000 Enrollees
(45% of current HealthPAC)
Clients were converted to Medi-Cal on Jan 1, 2014 through a
transition process facilitated by HCSA.
Medi-Cal
Increase in Medi-Cal Enrollment
Adult/Children
Number of Individuals on
Medi-Cal December 2013
Number of Individuals on
Medi-Cal December 2014
Increase in Medi-Cal
% Increase in Medi-Cal
Total Adults 101,722 180,542 78,820 77%Adult Males 33,534 69,573 36,038 107%Adult
Females 68,188 110,969 42,781 63%Children 122,790 142,458 19,668 16%Total 224,512 323,000 98,488 44%
Alameda County Health Care Enrollment
Program Name December 2013
(Pre-ACA)
February 2015
Medi-Cal Managed Care1 185,503 290,173
Covered California N/A2 78,0003
HealthPAC – Health Program of Alameda County
90,000 34,0004
1 http://www.dhcs.ca.gov/dataandstats/reports/Pages/MMCDMonthlyEnrollment.aspx#2014
2 Covered CA plans started in January 2014.
3This number doesn’t fully capture the number of Alameda County residents on commercial insurance because it just captures those with Covered CA plans.
4The number of residents in HealthPAC significantly decreased from December 2013 to February 2015, because in January 2014, approximately 42,000 HealthPAC members transitioned to Medi-Cal, in calendar year 2015, 7,000 HealthPAC members were disenrolled from HealthPAC because they were eligible for Covered California.
Alameda County – Remaining Uninsured (2014 estimates)
At this time, we do not have an accurate count (or at least reliable source) of the remaining uninsured in Alameda County post-ACA implementation. However, the University of California Center For Health Policy (UCLA) recently released the 2014 results from their California Health Interview Survey (CHIS). Based on their 2014 results for Alameda County, approximately 8.5% of the population (roughly 132,000 individuals) remains uninsured. This is a decrease from 12.9% who reported being uninsured in 2013 through CHIS. Note, the following data
considerations until more accurate information on the remaining uninsured is available:• CHIS results indicate this
measure (along with those for “Other Public” and “Medicare only”) to be “statistically unstable”.
• This estimation may have undercounted uninsured county residents due to potential misidentification of health insurance coverage. For example, those enrolled in the Health Program of Alameda County (HealthPAC) may have either indicated being “Uninsured” or having “Other public” coverage. Since HealthPAC is a public program but not insurance, selection of the latter option would result in misidentification of having health insurance.
Innovation in Access to Care
HealthPAC Utilization – Primary Care
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
80.0%
0
5000
10000
15000
20000
25000
30000
Total HealthPAC Enrollees with No Primary Care Visit in Last 12 Months(FY 14-15)
Data source: MICRS, 2015
# of
enr
olle
es%
of total enrollment
During FY14-15, the percentage of HealthPAC enrollees who had not had a primary care outpatient visit in a 12-month period improved significantly (70% in July 2014 to 26% in June 2015).
School Health Centers
Service coordination Medical services Mental health services Health education Youth development
24School Health Centers
15 high schools
7 middle school
1 elementary school
1 community college
2 new sites in planning
8 school districts
School-Based Behavioral Health
Initiative Promotion of positive
social-emotional development
Behavioral health services Family supports Service coordination &
capacity building Crisis Response
150+ School-based behavioral health school sites
9 School district consultation and capacity building programs
24 School health centers
Local Systems Building
Align shared vision & framework
Maximize & expand services
Leverage resources Integrate health and
learning supports Develop tailored
strategies11InitiativesBerkeley 2020 VisionEmeryville School Health InitiativeFremont School Health InitiativeHayward Full Service Community
SchoolNew Haven School Health InitiativeNewark School Health InitiativeOakland Community Schools
InitiativeSan Leandro School Health ServicesSan Lorenzo School Health InitiativeTri-City FSCSN InitiativeTri-Valley School Health Initiative
School Health Services
Staffing Director Receptionist Billing & Data Entry
Assistant Medical Provider Mid-Level (x4) Medical Assistant Triage Nurse Mental Health
Provider(s) Health Educator(s) Volunteers & Interns
Operational Hours Medical Services
20 to 40 hours per week
Behavioral Health20 - 40 hours per week
Health Education20 - 40 hours per week
Staffing & Operational Hours
Health Care for the Homeless and New TRUST Clinic
What the TRUST Clinic will do
Provide a transitional health home
Primary Care Behavioral Health Case Management Housing Legal Advocacy
Clinical Staff:
MD, Psychiatrist, PNP, NP, RN, LCSW, Psychologist, 4 Social Workers, CHOW, LVNs, HITs
Admin Staff:
Clinic Director, Social Work Supervisor, Admin Spec, Admin Ass’t, Spec. Clerks, Billing Technician,
Firehouse Clinic
Staffing in the 1st Year:
General Practitioner (MD)
Nurse Practitioner Medical Assistants (x3) RN Care
Coordinator/Center Manager
Reception Operator Panel Navigator/Panel
Manager Eligibility Clerk Health Coach
Operational Hours Medical Services –
8 am-8 pm, Mon-Fri
60 hours per week (at full operation)
Behavioral Health20+ hours per week
Health Care Navigation and Education20+ hours per week
Staffing & Operational Hours
Workforce Pipeline Pilar
Collaboration Matters: Pathways to Health and STEM
Careers
Founded in 2007 Purpose: Create “seamless” health career
pathway and enhance collaboration/communication among health pipeline programs in Alameda County
The Alameda County Health Care Services Agency serves as the facilitator of the consortium
Today, 12 active programs and 40 Industry Advisory Council members
Annually, serving 1000+ youth with a focus on young men of color (video if time allows)
History
High School
Community College and Training Programs
CSU and UC SystemGraduate School
Healthcare Jobs
Coordinated Health Pathways
Opportunities for 2500+ students
Health Pathway Systems and Collective Impact*
Common agenda and shared vision change for health pathway development in the area including clear objectives, the problem and joint activities.
Shared measurement of pathway program and systems outcomes supported by data collection and reporting.
Mutually reinforcing activities among different pathway programs and with employer and education partners coordinated through a mutually reinforcing plan of action.
Continuous communication among pathway programs and partners to build trust, assure mutual objectives and appreciate common motivation
Backbone organization with dedicated staff and systems with the skill, expertise, capacity and trust to coordinate pathway system efforts.
EMS Corps
Mission To increase the number of underrepresented emergency medical technicians through youth development, mentorship, and job training
EMS Corps is a highly selective, rigorous academy that prepares minority males who are from the community and ready to serve for careers in Emergency Medical Services.
EMS Corps Program Components
Life Coaching : A Cognitive Behavioral Change Model that focuses on:
Cognitive Restructuring Cultural Realignment Character Refinement
Mentorship Case Management Community Service Health and Wellness EMT Training
This chart is for the number of students who completed the EMS Corps program and submitted an update to their job status at a point in time (n=99) . Most of the program’s participants have become EMT’s, work as Medical Technician’s at local hospitals.
EMS Corps Outcomes
8 cohorts completed with 135 graduates
Alameda County Health Coach Program 8 coaches ages 18-24 years
old This innovative program is
the first to provide health coaching directly from the Emergency Department with young people
Coaches provide: Health education Home Visits Health insurance navigation
and enrollment Connection to Resources
Health Coach Testimonies
YMOC in the Health Workforce
Questions
Alex Briscoe, Agency Director
https://www.acgov.org/health/
