COUNTY OF SAN MATEO

Inter-Departmental Correspondence

Health Department

DATE:

September 26, 2006

BOARD MEETING DATE:

October 17, 2006

SPECIAL NOTICE/HEARING:

None

VOTE REQUIRED:

Four-fifths vote

TO:

Honorable Board of Supervisors

FROM:

Glen H. Brooks, Jr., Director, Human Services Agency

Charlene A. Silva, Director, Health Department

Nancy Steiger, CEO, San Mateo Medical Center

SUBJECT:

Healthier Outcomes Through Multi-disciplinary Engagement (HOME) Team Positions and Funding from Peninsula Community Foundation

RECOMMENDATION:

1)

Adopt an ordinance amending the Salary Ordinance adding four positions to support implementation of the Healthier Outcomes Through Multi-disciplinary Engagement (HOME) Team;

2)

Approve an Appropriation Transfer Request (ATR) for Peninsula Community Foundation revenue in the amount of $58,500, Aging and Adult Services Realignment Funds of $109,900, and Human Services Agency contribution of $58,500; and

3)

Adopt a resolution authorizing the President of the Board to execute a grant agreement with Peninsula Community Foundation for the period December 1, 2006 through November 30, 2007 for an amount not to exceed $100,000.

VISION ALIGNMENT:

Commitment: Ensure basic health and safety for all

Goal(s): 8. Help vulnerable people -- the aged, disabled, mentally ill, at-risk youth, and others -- achieve a better qualify of life.

Performance Measure(s):

Measure

FY 2005-06
Actual

FY 2006-07
Projected

Number of frequent Emergency Department users engaged in HOME TEAM case management*

--

60

* We anticipate that long-term case-management through the HOME Team will lead to a 50% reduction in ED use per client.

BACKGROUND:

In November 2002 staff of the Health Department, San Mateo Medical Center (SMMC), and Human Services Agency formed a workgroup to address the challenges facing a group of patients who were frequently relying on the SMMC Emergency Department (ED) for routine healthcare. There are 1,030 individuals using the ED more than four times per year. Thirty-five percent of ED visits made by these patients are charged to the WELL program. Because of the complex issues experienced by these clients the workgroup decided that a system-wide approach was necessary. Even though these clients repeatedly use the ED and the County’s system of care, they continue to have a very weak link to existing nonemergency services, consistently unable, or refusing, to comply with medication and treatment regimens. The limited case management options within our current system of care contribute to frequent ED users experiencing relapse and repeat cycles of ED use and hospitalization. This pattern contributes to less than optimal outcomes for these clients as well as increased operational and financial challenges for the ED.

DISCUSSION:

To improve access to care for these clients the workgroup proposed development of a HOME Team to carry out the necessary case management. The proposed HOME Team is a case management team made up of a Social Work Supervisor, Community Worker, Public Health Nurse, and Social Worker. The goal of the HOME Team is to improve access to care by connecting the frequent user population to appropriate primary care, achieve improved client well-being through better management of complex health and social needs, and reduce some of the demands on and costs faced by the SMMC ED.

The total annual cost for the HOME Team program is $388,378. Staff costs represent $366,578, and the remaining $21,800 will pay various operating costs. Recognizing the HOME Team as a promising program to improve our system of care for some of our most vulnerable clients with complex needs, the Peninsula Community Foundation awarded the County $100,000 in year one with the potential for a continued commitment based on successful project implementation. The Human Services Agency made a further commitment of $100,000, and the Aging and Adult Services division of the Health Department is providing $188,378. The contribution of the San Mateo Medical Center will be in-kind and has been formalized through a Memorandum of Understanding with the Health Department. These commitments represent an inter-department and community dedication to realizing the implementation of the HOME Team program.

The Salary Ordinance Amendment adds four new positions to provide services proposed in the HOME Team project. The ATR includes funding for these positions for the seven-month period December 1, 2006 – June 30, 2007. The four new positions are a Social Work Supervisor, Community Worker, Public Health Nurse, and Social Worker.

The grant agreement has been reviewed and approved by County Counsel.

FISCAL IMPACT:

The total expense included in the ATR is $266,900, which includes the cost of the four positions for the seven-month period December 1, 2006 – June 30, 2007. These costs will be met with $58,500 from the Peninsula Community Foundation grant, Human Services Agency Intra-Fund Transfer of $58,500, and Health Department Aging and Adult Services Realignment Funds of $109,900. There is no Net County Cost. The balance of funds committed for the first year of this project will be included in the FY2007-08 Recommended Budget.