COUNTY OF SAN MATEO

Inter-Departmental Correspondence

County Manager’s Office

DATE:

October 17, 2008

BOARD MEETING DATE:

October 28, 2008

SPECIAL NOTICE/HEARING:

None

VOTE REQUIRED:

Majority

TO:

Honorable Board of Supervisors

FROM:

John L. Maltbie, County Manager

SUBJECT:

Health System Redesign Initiative Implementation Update

RECOMMENDATION:

Adopt a Resolution accepting the Health System Redesign Initiative implementation update for the period March 2008 through October 15, 2008.

VISION ALIGNMENT:

Commitment: Ensure basic health and safety for all

Goals 8 and 22: Help vulnerable people – the aged, disabled, mentally ill, at-risk youth, and others – achieve a better quality of life.

This Resolution contributes to this commitment and goal by providing the County with an update on activities implemented to address key priority areas within the local health system in which the County can achieve greater effectiveness.

BACKGROUND:

On March 25, 2008, your Board approved a twelve-month implementation plan for the Health System Redesign Initiative (Redesign). This plan was developed in follow-up to the in-depth assessment of the County’s role in healthcare delivery completed by Health Management Associates (HMA), accepted by your Board on February 5, 2008, and as the final planning phase recommendations of the Blue Ribbon Task Force on Adult Health Care Coverage Expansion (BRTF), approved by your Board on May 20, 2008. To ensure appropriate leadership and focus on the important policy and programmatic issues identified by these efforts, the County Manager initiated the two-year Redesign initiative involving the senior executives leading San Mateo Medical Center (SMMC), the Health Department (HD) and Health Plan of San Mateo (HPSM). The Human Services Agency Director, Human Resource Director, and County Counsel have also led the participation of their staff.

DISCUSSION:

The attached report details accomplishments in the seven areas for priority focus during the Redesign Initiative’s first year:

1.

Eligibility and Administration

2.

Chronic Disease Management and Care Coordination

3.

Integration Across Levels of Care

4.

Physician Leadership, Structures and Accountability

5.

Community Health Network for the Underserved

6.

Long-Term Care

7.

Strategic and Operational Financial Improvement

For each of these areas, Redesign team members and leaders across the participating organizations developed workplans and initiated cross-Department workgroups to lead the operational changes prioritized to achieve positive client impact and financial improvement. The Redesign oversight group has met regularly to oversee these efforts, identify and act on competing priorities, recommend and implement necessary organizational changes, and ensure unified resource direction aligned with the County’s long-term goals.

There have been significant achievements accomplished through this cross-County and unified County work with community partners. The involvement of senior executives from each of the major healthcare delivery systems serving San Mateo County has enabled the completion of the first steps in creating a “Community Health Network for the Underserved.” This network involves a role for each delivery system in meeting the healthcare needs of the uninsured and underserved.

The Redesign team has also initiated an external evaluation, through the engagement of a research team from the Urban Institute approved by your Board on July 8, 2008. Information from the first six months of the evaluation will be incorporated in a March 2009 update to your Board and the BRTF, detailing the key accomplishments of the first twelve months of Redesign.

FISCAL IMPACT:

There is no Net County Cost associated with adoption of this implementation update. Staff and consultant costs associated with Redesign have been included in the Health Department’s FY 2008-09 Adopted Budget. The Redesign Initiative supports $6.65 million in expected cost savings and revenue enhancements included in the FY 2008-09 Adopted Budget for the San Mateo Medical Center which incorporates no increase in General Fund contributions over FY 2007-08.