COUNTY OF SAN MATEO
Inter-Departmental Correspondence
Health System

DATE:

November 4, 2010

BOARD MEETING DATE:

November 30, 2010

SPECIAL NOTICE/HEARING:

None

VOTE REQUIRED:

Four-fifths

TO:

Honorable Board of Supervisors

FROM:

Jean S. Fraser, Chief, Health System

Susan Ehrlich, MD, MPP, Chief Executive Officer, SMMC

Louise Rogers, Director, Behavioral Health and Recovery Services

SUBJECT:

Appropriation Transfer Request for San Mateo Medical Center and Behavioral Health and Recovery Services

RECOMMENDATION:

A. Adopt an Ordinance amending the Master Salary Ordinance adding thirteen positions to support implementation of the Total Wellness Program; and

B. Approve an Appropriation Transfer Request to recognize unanticipated revenues and expenses of $1,375,583.

BACKGROUND:

Recent studies have shown that persons with serious mental illness (SMI) are dying twenty-five years earlier than the general population. The majority of premature deaths for these individuals are caused by chronic medical conditions, such as cardiovascular, pulmonary and infectious diseases. In addition, persons with SMI tend to have more risk factors; for example, a recent study has shown that the seriously mentally ill consume 44% of the cigarettes consumed nationally, which carries obvious health consequences.

Federal healthcare reform in 2014 will introduce new opportunities to improve the delivery of services in San Mateo County. Behavioral Health and Recovery Services (BHRS) has been awarded new grant funding from the Substance Abuse and Mental Health Services Administration (SAMHSA) to start the Total Wellness program. This funding will be supplemented with Mental Health Services Act (MHSA) Innovation and Prevention and Early Intervention (PEI) funds to build upon current efforts to improve health outcomes for persons with SMI.

DISCUSSION:

BHRS is collaborating with the San Mateo Medical Center (SMMC) to implement a new project to target adult clients with SMI and co-occurring disorders to address the issue of access to primary care and specialty medical care. The goal of this project is to help consumers become connected with medical services in the community for their ongoing healthcare, and with wellness groups offered by public and community based organizations. The new program, called Total Wellness, will co-locate primary care and behavioral health providers. Clients will receive primary care services in behavioral health settings, including preventative screenings, appropriate primary and specialty healthcare for chronic conditions. Clients will also be engaged in chronic disease self-management services. It is expected that 1200 clients will receive these new services annually.

BHRS applied for and was awarded a four-year federal grant from SAMHSA to provide Total Wellness services. The total four-year grant amount is $1,994,639, of which $284,743 will be for FY 2010-11. In addition, MHSA Innovation and PEI funding will provide $1,194,746 annually for a three-year period, of which $678,512 will be for FY 2010-11. Additional revenue will be generated through billing third-party payers for services provided. The total new annualized cost for these services is $2,690,834. Program services will begin on February 1, 2011.

The Salary Ordinance Amendment adds 13 new positions (12.5 FTEs) for the Total Wellness Program. Of the new positions, five positions are added to SMMC to staff Primary Care clinics, and eight positions, of which two are unclassified, are added to BHRS. The Appropriation Transfer Request (ATR) includes funding for these positions, as well as operating and contract expenses.

Approval of the ATR contributes to the Shared Vision 2025 outcome of a Healthy Community by enabling BHRS and SMMC to implement the Total Wellness Program. It is anticipated that clients receiving these services will increase their participation in primary and specialty care services. The increase in participation will be measured by an anticipated 12.5% increase in kept appointments.

Performance Measure:

Measure

FY 2010-11
Actual

FY 2011-12
Projected

Increase in clients keeping primary and specialty care (medical) appointments.

n/a*

12.5%

*Baseline data will be collected in FY 2010-11.

FISCAL IMPACT:

The new Total Wellness program cost for FY 2010-11 is $1,242,019, which includes $106,883 appropriated in the FY 2010-11 BHRS and SMMC approved budgets. The ATR includes $1,375,583 in new appropriations for BHRS and SMMC, which includes an intrafund transfer from BHRS to SMMC of $240,447. The program cost is funded by new revenue of $985,019 for BHRS and $390,564 for SMMC. The BHRS portion is funded through SAMHSA ($284,743), MHSA Innovation funds ($565,358), MHSA PEI funds ($113,154), and payment for services from Medicare, FFP for Medi-Cal and other third party payors ($21,764). The SMMC portion is funded through intrafund revenue from BHRS ($240,447) and Medicare, FFP for Medi-Cal and other third party payors ($150,117). There is no new Net County Cost with this program. Similar funding arrangements will be put in place for future budget requests.