Grand Jury Report: Santa Clara Valley Medical Center Continuity Update on*

R1

The County should have a written policy to require justification for the annual subsidy from Santa Clara County's General Fund to the Santa Clara Valley Medical Center Enterprise Fund. <b>SCVMC Response:</b> SCVMC concurs in part. The County Executive does have a written process and methodology, approved by the Board of Supervisors, as provided for in the memo dated January 3, 2001, Valley Medical Center (VMC) General Fund Subsidy Target Methodology. The County Executive Office does require justification, on an annual basis, from SCVMC on the level of General Fund Subsidy support. This information is provided and reviewed by the County Executive – Office of Budget & Analysis (OBA) during the annual County budget preparation process.

R4

The County should require Santa Clara Valley Medical Center to continue to take measures to demonstrate improvement in performance as it relates to Health Care Reform Act and the Affordable Care Act. <b>SCVMC Response:</b> SCVMC concurs.

R5

The County should ensure that the Santa Clara Valley Medical Center's Sun accounting and the County's SAP accounting system are coordinated as planned. <b>SCVMC Response:</b> SCVMC concurs. S 34 Gary Graves, COO - 2014-15 Civil Grand Jury Report July 16, 2015

R6

The County should require that the Santa Clara Valley Medical Center produce its own Comprehensive Annual Financial Report and a multi-year financial strategic plan and should post them on the hospital website. <b>SCVMC Response:</b> SCVMC concurs in part. SCVMC produces a monthly and annual financial report specific to the SCVMC Enterprise Fund. This financial report and all accounts are audited and reviewed as part of the County Comprehensive Annual Financial Report. SCVMC will conduct current year and subsequent year (multi-year) budget forecasting and analysis based available information.

R7

The County should require that the Santa Clara Valley Medical Center conduct a cost benefit analysis before expanding the HealthLink system to the 12 lower priority applications. <b>SCVMC Response:</b> SCVMC concurs. The County's agreement with Epic was for an "enterprise" license, meaning that the County is authorized to implement Epic's entire suite of modules at no additional cost for software. The only implementation costs are for infrastructure and labor. Implementing the remaining 12 modules, which include modules for expensive services including Diagnostic Imaging, Pharmacy and Surgery, is estimated to cost $12 million in capital. The County is confident these costs will be offset by increases in revenue capture, as was demonstrated during the initial implementation of 15 HealthLink modules. In terms of patient care, implementation of these additional modules will further enhance the seamless flow of information across the entire continuum of care and further facilitate evidence-based clinical and administrative decision-making. Prior to the implementation of any of the licensed HealthLink modules, a detailed operational and financial impact review is conducted. Approval of the Executive HealthLink Oversight Committee is required. Gary Graves, COO - 2014-15 Civil Grand Jury Report July 16, 2015