Inter-Departmental Correspondence

County Manager’s Office



March 30, 2009


April 14, 2009







Honorable Board of Supervisors


David S. Boesch, County Manager


Health System Redesign Initiative Implementation Update



    1. Adopt a Resolution accepting the Health System Redesign Initiative implementation update for the period of November 2008 through March 2009.

    2. Adopt a Resolution acknowledging the organizations that have developed the Community Health Network for the Underserved.



Commitment: Ensure basic health and safety for all

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


These Resolutions contribute 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.



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 the Health System 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 staffs.



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



Eligibility and Administration


Chronic Disease Management and Care Coordination


Integration Across Levels of Care


Physician Leadership, Structures and Accountability


Community Health Network for the Underserved


Long-Term Care


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. This network will be vital to meeting the vision of access to healthcare for all of the County’s uninsured and publicly covered residents.


As the Health System has aligned all County health functions within a single department, its leadership team, with the partnership of HPSM, is embedding key aspects of the Redesign Initiative into ongoing structures and planning efforts. The 2009-10 budget development reflects the initial phases of this work.



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 System’s FY 2008-09 Adopted Budget. The Redesign Initiative supports $7.75 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. The Redesign efforts contribute to on-going reductions in General Fund contributions to SMMC.