Orange County Public Health System Assessment 2019 · 2019-10-07 · Orange County Public Health System Assessment 2019 Rev 10/7/2019 Page 2 of 15 The online survey was conducted

Orange County Public Health System Assessment

2019

Rev 10/7/2019 Page 1 of 15

The Orange County Health Improvement Partnership (HIP) guides the community health assessment and planning process that informs the Orange County Health Improvement Plan. The HIP uses Mobilizing for Action through Planning and Partnerships (MAPP) as its planning framework. In addition to three other assessments, MAPP includes the Local Public Health System Assessment, which assess how well the local public health system works together to provide quality public health services. Orange County’s public health system is a partnership promoting a health Orange County that includes residents, health care providers, community and faith-based organizations, schools, business, government entities and others.

The 2019 Orange County public health system assessment included an online survey and an in-person discussion of the strengths, weaknesses, and opportunities to improve Orange County’s public health system. The HIP’s vision for Orange County’s public health system (shown at right) guided the assessment and discussions. The online survey was conducted during April 4-19, 2019 with 65 completed responses. The in-person assessment was conducted on May 2, 2019 and included participation by over 35 stakeholders representing Orange County Health Care Agency, social service providers, health care providers, universities, collaboratives, and others.

https://www.naccho.org/programs/public-health-infrastructure/performance-improvement/community-health-assessment/mapp


2019

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The online survey was conducted during April 4-19, 2019. The survey was sent to the Orange County’s Healthier Together email list with over 350 people and posted on www.OCHealthierTogether.org. Sixty-five (65) completed responses were submitted. Respondents were asked to rate how well the current system compared to the Health Improvement Partnership’s vision of Orange County’s public health system on a scale of 1 (not at all) to 5 (optimal). Of respondents, 33.3% were HIP members, 57.4% were non-HIP members, and 9.3% declined to state. Respondents represented a range of sectors including public health (46.3%), health care (27.8%), local non-profits (25.9%), higher education (18.5%), behavioral health (16.7%), policy/advocacy (14.8%), research (11.1%), transit/transportation (7.4%), education (5.6%), food bank (5.6%), housing (5.6%), public safety (3.7%)religious or faith-based organization (1.9%), and other (9.3%). Respondents also served a range of priority populations including children (53.8%), adults (38.5%), older adults (26.9%), low income individuals (46.%), immigrants and refugees (29.9%), African American or Black (21.2%), Asian American (26.9%), American Indian or Native Alaskan (15.4%), Native Hawaiian or Pacific Islander.

Below is a summary of average overall ratings from the last three public health system assessments. Compared to 2013 and 2016, the average ratings for the public health system has increased. The 2013 and 2016 assessments were conducted in person and included fewer participants. In 2019, there was a concerted effort to elicit broader community input via using an online survey. In addition, the HIP slightly modified the ideal related to best practices.

http://www.ochealthiertogether.org/


2019

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The below charts show the distribution of ratings in 2013, 2016, and 2019 online surveys. As shown, a greater proportion of respondents indicated that the system is moderately or significantly meeting the system ideals.

1 1 1 14

16

7

13

25

1418 16

5 38

40 0 0 0

0

10

20

30

40

Responsive, accessible, andaccountable

Well connected andcoordinated

Data-driven and promotesbest practices and quality

Positioned to anticipate andrespond to health impacts

Nu

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Distribution of Ratings, 2016 (N=42)

1=Not at all 2=Minimally 3=Moderately 4=Significantly 5=Optimally

14 2 1

1512

9

16

23

31

20

2624

14

26

14

0 0 1 00

10

20

30

40



Data-driven and committed toquality


Nu

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0 0 0 2

8 10

17 1520

16

811

15 4 20 0 0 0

0

10

20

30

40



Data-driven and promotesbest practices


Nu

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Orange County Public Health System Assessment 2019

Rev 10/7/2019 Page 4 of 15

I. A system that is “responsive, accessible, and accountable to the communities it serves” The below charts show a summary of responses from the online survey regarding the public health system.

The following provides a summary of discussions at the in-person public health system assessment on May 2, 2019. Two groups

discussed the strengths, weaknesses, and opportunities associated with this system ideal topic including how well the system:

identifies populations that may experience barriers to health services

responds to the needs of the community

links people to needed health services

helps people navigate the health service system

keeps all segments of the community informed about its functions and activities

1

15

23 24

00

10

20

30

40

1Not at all

2Minimally

3Moderately

4Significantly

5Optimally

Nu

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Distribution of Ratings


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Strengths Weaknesses Opportunities for Improvements

(Bold Items were Prioritized for Action)

The system has significant medical care resources

There is good cooperation between the public and private sector, although not strong collaboration

We are all in this together, willing to work together

Awareness that services are available

Good educational programs for the public health workforce (ex. UCI, CSUF)

Partners collaborate to address access

needs/barriers

Programs (OC Links) know certain resources well but may not have knowledge of everything

The health care system is difficult to

navigate even for those within the

system

It is unclear if access is well distributed to

all populations

Not all populations are identified pro-

actively – most managed care patients

are likely to be identified pro-actively

Communication and marketing of

services and resources

Many segments of the community are

not informed about the system’s

functions or activities

Linkages are inconsistent – particularly

between physical and mental health

It is unclear how to access services and

with what regularity they should access

them

Public policies that impact health are not

always responsive to the community

Without a government hospital and clinic

system, many communities do not have

access to primary care that is convenient

Dental services are largely not accessible

for many population groups

It is sometimes challenging to determine

accountability for outcomes – is it the

1. Have data around access and how to

measure access (quality measures)

2. Utilize technology, marketing, and

communication to help people navigate

the health care system and

communicate about the system to

increase accessibility to preventive

services for all populations, especially

high needs

3. Ensure financial resources are allocated

to demonstrate cost-savings of focusing

on preventive care

4. Develop strengthen navigation support.

Single point of entry to access services

(one-e-app).

5. Utilize technology to help people

navigate the health care system and

communicate about the system

6. Increase resources to implement and

support strategies identified. Develop

strategies for implementation.

The HIP has done a nice job establishing

goals but resources are not tied to the

strategies making it difficult for the goals

to be achieved

Develop a county-wide plan for primary

care clinics and other services


Rev 10/7/2019 Page 6 of 15



medical provider, the insurance

company, the network, etc.?

Access to specialty referrals/specialty

care can be challenging

Barriers for undocumented (DACA and

their families)

Barriers for homeless population

Cost of medication

• Limited knowledge of frontline staff on resources

• Limited resources to implement coordinated entry into system of care

• Funding limitations (silos)/staffing role requirements = barriers to coordinate/one point access

• Difficult to maintain current info on the various services

• Data sharing restrictions and limitations can halt coordination

• Providers have limited time, capacity, and funding or reimbursement to dedicate to navigation needs

• Potential loss of navigation/referral expertise with expansion to “all” available service

Marketing/communication

How providers can participate

Provider referrals (patient navigation)

Increase accessibility to preventive

services for all populations, especially

high needs

Increase funding for points of entry

Access is available, but need to improve

navigation

Increase workforce for navigation

services (navigators)

Better integration of support systems

Increase provider knowledge about

services/resources

California AG work and support to

address known barriers


Rev 10/7/2019 Page 7 of 15

II. A system that is “well-connected and coordinated across various sectors”

The below charts show a summary of responses from the online survey regarding the public health system.



coordinates the delivery of health and resource information to the community

coordinates the delivery of health services to the community

shares information between agencies

ensures that resources are put to best use

works together towards common goals

4

12

31

14

00

10

20

30

40

1Not at all

2Minimally

3Moderately

4Significantly

5Optimally

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Rev 10/7/2019 Page 8 of 15



Delivery of health and resource

information is coordinated with certain

populations only – e.g. capitated

capitated managed care

Be Well is beginning to develop a system

for mental health that is well connected

Whole person care pilot “whole person

care safety connect”

Community referral network

HIP & other collaboratives bring together

partners

County organized health systems (Medi-

Cal/CalOptima) helps with coordination

Bridges connect entry – home visiting;

prenatal – 3 services (no wrong door)

DSN (developmental screening network)

& Children’s Registry to look for

developmental delays

OC Women’s Health Project

There is a gap in sharing information

between medical and social services

County behavioral health does not link

seamlessly with medical services – too

siloed

While the HIP has established common

goals – not all sectors see them as a

priority

OC lacks a true health information

exchange to share information

Lack of awareness of services available

and what they are eligible for

Misunderstanding of Drug Medical and

dual diagnosis among clients, provides,

and county

Lack of vision services

Community not aware of

services/connection

Seems disconnected from outside coming

in

May need to standardize agency to

agency connections

Agencies not promoting services internal

and external

1. Raising awareness and clarifying: What

services are available; What are the

eligibility requirements; Public vs.

private

2. Develop stronger public/private

partnerships to coordinate care

3. Strengthen navigator’s capacity

4. Coordinated outreach plan with

marketing strategies

5. Better leveraging 2-1-1 OC

6. Encouraging warm hand offs and 360

connections

OC needs a health information exchange

that will allow for sharing of medical and

social information

Mental health and social services to be

available at primary care settings

County Behavioral Health to deliver

services where the clients receive other

services

HIP priority areas should be vetted with

funders to see if there is support to work

on these issues

Leverage funding, political will, structure

and momentum of Be Well


Rev 10/7/2019 Page 9 of 15



Open forums for community/partners to

ask questions

Increase participation from other sectors

Greater use of social media

Expand marketing education including

use of videos, Instagram, Twitter, and

other social media

Post hours of operation for services

Offer walk score or mapping services for

communities


Rev 10/7/2019 Page 10 of 15

III. A system that is “driven by data and committed to quality through learning, innovation, and use of best

practices”


The following provides a summary of discussions at the in-person public health system assessment on May 2, 2019. Two groups discussed the strengths, weaknesses, and opportunities associated with this system ideal topic including how well the system:

captures, shares, and utilizes accurate and up-to-date health data

keeps up with best practices in community health

applies best practices in public health to provide quality services

evaluates the effectiveness and quality of its services and interventions

participates in research and innovative programs

2

9

20

26

1

0

10

20

30

40

1Not at all

2Minimally

3Moderately

4Significantly

5Optimally

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Rev 10/7/2019 Page 11 of 15



OC Healthier Together is a great source

The community is knowledgeable about

best practices in public health

UCI has Clinical Translational Research

designation

CalOptima has lots of data

Quality services (dense expertise) – high

number of collaboratives

Early Development Index (EDI) – data

from kindergarten schools. Only county

with it.

Coalition of OC Community Centers have

innovative studies and pilots

Health systems obligated to do

assessments every 3 years

Various reports (aggregated data); e.g. Conditions of Children Report, OC Indicators

Wealth of data collected/available

There is a gap in sharing information

between medical and social services

Quality and effectiveness evaluation is

spotty (e.g. encounter vs. claims data)

Best practices are more often discussed

but not broadly implemented

CalOptima data is not always available

Data is not always available at the census

tract level in a timely manner

“Guesstimations” for hard to reach

populations (e.g. homeless,

undocumented, refugees)

Data that is available is not being utilized

Data not used objectively due to political

issues

1. Use data to increase knowledge

regarding the importance of using data

in decision making, service delivery

objectively

2. Expand data sharing (public and private)

and identify ways to gather PHI for data

collection and sharing

3. Establish value-based incentives to drive

accountability for better health care

measures

4. Increase data partnerships to have

integrated and coordinated assessments

5. Provide technical assistance for

organizations that lack quality

improvement infrastructure

6. Improve access to data

Work with CalOptima and other payers to

aggregate outcome data race, ethnicity

Integrate and coordinate assessments

Create “Meta records” for individuals

Expand collaborative research (schools,

community)

Use same data collections tools

Expand data around social determinants

of health to improve understanding

Create a unified plan for data collection


Rev 10/7/2019 Page 12 of 15



Need to drill down on political barriers

Better coordination of defining terms (EBI

vs. value-based)


Rev 10/7/2019 Page 13 of 15

IV. A system that is “positioned to anticipated and respond to current and future challenges and opportunities

impacting health”




understands the current health status of the community

identifies current and future opportunities and threats to health

understands the current composition and competencies of the workforce

plans for the future needs of its public health workforce

works to develop a plan for a healthier community

1

16

26

14

00

10

20

30

40

1Not at all

2Minimally

3Moderately

4Significantly

5Optimally

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Rev 10/7/2019 Page 14 of 15



HIP brings together people and Plan

provides focus

Overall County Health ranking is in top

10% of state

The current HIP is part of a larger effort

to create a healthy community

Planning is data driven

Rich in data

HCA is open to adding new metrics

Good alignment, consistent with other

needs assessments/plans

Agreement on priorities

Good job trying to engage other sectors

(housing, transportation…)

MHSA funds workforce training (law

enforcement, religious leaders)

Mental Health performance health

project United Way (United to End

Homelessness) – there is a coordinated

effort

OC Health Access & Enrollment Task

Force

Small enough to share resources and work together

The racial and ethnic composition of the

workforce is not clearly understood, nor

are there substantial plans to address

gaps in the workforce

The threat of the growing number of frail

elderly is not viewed as urgent

The current HIP plan does not have

specific goals to address social

determinants

Funders have not aligned their funding to

respond to future health challenges that

impact health

Community input and accountability

Need to increase awareness about data,

Healthier Together

Lack of knowledge/awareness of

workforce

Gaps in knowledge/ limited data related

to workforce (not detailed enough)

Disconnect between jobs and need

(pipeline)

Disparities within OC including for older

adults

1. Complete a workforce analysis including

by race/ethnicity and older adults to

look at building capacity across the

county and plan for the future

2. Expand engagement of partners and

potential partners across sectors

including funders, especially around HIP

priorities

3. Make OC Health Improvement

Partnership and Orange County’s

Healthier Together the hub for

collaboratives

4. Create a strategic engagement and

communication plan to share key and

consistent messaging (“The HIP exists

and you can join,” “There is a HIP and

you can help plan, “Data is available to

tailor to sub-county geographic region.”)

5. Conduct planning for older adults

including updating the Older Adult

Health objectives and strategies

6. Provide training and technical assistance

Establish targets to improve the social

determinants of health

Engage communities at the local level


Rev 10/7/2019 Page 15 of 15



Create opportunities to elevate

intersectional trainings regionally

Conduct meetings to share resources

Documents

Orange County Public Health System Assessment 2019 · 2019-10-07 · Orange County Public Health System Assessment 2019 Rev 10/7/2019 Page 2 of 15 The online survey was conducted