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COUNTY OF SAN MATEO
Inter-Departmental Correspondence
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San Mateo Medical Center
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DATE:
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August 2, 2007
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BOARD MEETING DATE:
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August 14, 2007
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SPECIAL NOTICE/HEARING:
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None
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VOTE REQUIRED:
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Majority
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TO:
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Honorable Board of Supervisors
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FROM:
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Dr. Sang-Ick Chang, CEO
Dr. Susan Ehrlich, VP and Medical Director Ambulatory Services
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SUBJECT:
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Addition of Positions for Coverage Initiative – WELL Plus Program
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RECOMMENDATION:
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Adopt an Amendment to the Salary Ordinance adding 57 unclassified positions to implement the Coverage Initiative (SB 1448), and waiver of reading the ordinance in its entirety.
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VISION ALIGNMENT:
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Commitment: Ensure Basic Health and Safety for All
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Goal 5: Residents have access to health care and preventive care.
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The Coverage Initiative creates the WELL Plus Program and contributes to this goal by increasing access to healthcare and enhancing services for low-income patients with chronic diseases through a redesigned primary care model.
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Performance Measures
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Measures
(Radical Redesign Clinic patients vs. patients served in other clinics)
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3-Year Targets
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% reduction in cost per patient due to reduced hospitalizations, Emergency Department visits, and overall patient care costs
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TBD
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Number and % of patients enrolled in Coverage Initiative with improved measures of diabetes, blood pressure, and cholesterol control
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TBD
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Number and % of patients enrolled in Coverage Initiative who complete self-management plans
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TBD
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Number and % of patients enrolled in Coverage Initiative indicating improved satisfaction with clinical experience
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TBD
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BACKGROUND:
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In a survey conducted for the 2004 Community Assessment: Health and Quality of Life in San Mateo County, thirteen per cent of adults between the ages of 19 and 65 years reported being uninsured (approximately 52 - 60,000 adults). Seventy percent (70%) of these adults are estimated to have incomes at or below 400% of the federal poverty level (FPL), and of this smaller population fifty eight percent (58%) are estimated to have incomes at or below 200% FPL(approximately 23,000 adults). On July 24, 2007, San Mateo County Board of Supervisors adopted a resolution to expand comprehensive coverage to qualifying adults at or below 400% FPL, by adopting the recommendations of the Blue Ribbon Task Force on Adult Health Care Coverage Expansion (BRTF).
San Mateo County successfully competed for funds from the State of California Department of Health Services, through the Coverage Initiative, to begin implementing the BRTF recommendations. The Coverage Initiative funds are estimated to be $10.4 million each year for three years beginning September 1, 2007. The accompanying Salary Ordinance Amendment (SOA) provides new personnel required to serve a portion of the needs of this patient population. Depending on the requirements of the contract to be executed with the State Department of Health Services, these individuals will be below 200%of the FPL.
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DISCUSSION:
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As noted previously, San Mateo County has requested and received an annual allocation of $7,564,172 for health care services plus $2,753,600 of administrative costs to implement the following two components of the Coverage Initiative.
• Health Care Coverage: A new coverage program will serve 2,100 low income adults who are citizens or legal residents and are living at or below 200% FPL.
• Enhanced services through Radical Redesign of Chronic Disease Care: Re-engineer primary care for persons with chronic diseases using a model with: 1. interdisciplinary care teams, 2. patients assigned to a primary care team, 3. increased care coordination, and 4. tracking patient goals by electronic disease registries.
Performance targets for the three years funded by the Coverage Initiative will be developed by an established Initiative workgroup and included in the future Board report related to the agreement with the State.
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FISCAL IMPACT:
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The requested allocation from the Coverage Initiative for health care services for 2,100 additional persons and expansion of the redesigned chronic disease care is $7,564,172 per year. This allocation will be claimed through a cost reporting mechanism and requires equal local matching funds. San Mateo County also estimates that it will claim $2,753,600 in administrative costs for each of the three years through a separate claiming mechanism.
The accompanying SOA includes requests for 57 unclassified positions, and totals $5,149,688 (salary plus benefits). During the next three years funds for these positions will come from the Coverage Initiative proceeds. None of these positions will be filled prior to executing a contract with the State Department of Health Services (September-October 2007). The requested positions will terminate in three years. However, there are at least three possibilities for continued funding:
• Extension of Coverage Initiative funding through the State and Federal governments,
• Demonstrated County cost savings that allow for continued County funding of the new positions, and or
• New funding sources for uninsured patients made possible through the Blue Ribbon Task Force.
An Appropriation Transfer Request (ATR) and any additional changes to the Salary Ordinance will be brought to the Board at the same time as the agreement with the State, with the Health Plan of San Mateo and Ravenswood.
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