Contra Costa County Grand Jury • 2014-2015 • Agency Response
Response to: Compliance and Continuity Committee Review of 2014-2015 Reports 1601

Recommendation(s):*

Published: August 18, 2015 7 pages
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Note: Missing finding numbers detected: F10

Findings and Recommendations 20 findings

F1
Contra Costa Health Services managers have developed a comprehensive health system. Response: Respondent agrees with this finding.
Related Recommendations (1)
R1
The County should consider merging or partnering the healthcare system with a larger private or public healthcare system that would provide administrative oversight, broader access to physician specialists, clinics and hospitals, and increased healthcare options. Response: This recommendation is continuing to be explored.
F2
Healthcare systems compete for patients by reducing costs and improving services. Local hospitals are merging to create stronger systems. Response: Respondent agrees with this finding.
Related Recommendations (1)
R2
If the County is successful merging the healthcare system, the County should consider merging the two primary departments that would remain in Contra Costa Health Services - Public Health and Behavioral/Mental Health - with the Employment and Human Services Department, creating a Health and Human Services Department. The county should find funding to commission a report outlining the full benefits and detriments of merging EHSD with Public Health and Behavioral/Mental Health Services. Response: This recommendation will require further analysis if a merger of the healthcare system were executed and successful.
F3
According to Health Management Associates Sustainability Audit of the Contra Costa Regional Medical Center and Health Centers, the County will be adding 32% more people in the next 20 years. Response: Respondent agrees with this finding.
Related Recommendations (1)
R3
If the County is successful merging the healthcare system, the county should consider merging CCHS' Environmental Health and Hazardous Materials Program with the Department of Conservation and Development and merging Emergency Medical Services with the Contra Costa Fire Protection District. This recommendation will require further analysis if a merger of the healthcare Response: system were executed and successful.
F4
After losing $18 million annually, Doctors Medical Center in San Pablo closed permanently on April 21, 2015. Respondent agrees with this finding. Response:
No recommendations for this finding
F5
Pursuant to Section 17000 of the California Welfare and Institutions Codes, counties are to provide healthcare for those who are indigent and poor. Response: Respondent agrees with this finding.
No recommendations for this finding
F6
The county hospital, the Contra Costa Regional Medical Center (CCRMC), receives low Medi-Cal reimbursement rates that do not offset actual costs Response: Respondent agrees with this finding.
No recommendations for this finding
F7
The County annually provides $30 million in general funds to augment the budget of CCRMC (the Contra Costa Regional Medical Center). Response: Respondent partially agrees with this finding. The County budget provides $26,672,488 in general funds to CCRMC for both the 2014-2015 fiscal year and the 2015-2016 fiscal year. The County also provides $3,736,288 in both fiscal years to the Contra Costa Health Plan, for a total of $30,408,776.
No recommendations for this finding
F8
Grand Jury interviews revealed that CCRMC must partner for certain medical specialties. Respondent cannot confirm what was discussed during confidential Grand Jury Response: interviews; however, respondent agrees that CCRMC must partner for certain medical specialties.
No recommendations for this finding
F9
The County commissioned a Sustainability Audit of the County hospital and health centers which was presented to the Board of Supervisors in September 2011. Response: Respondent agrees with this finding. The Sustainability Audit of the County hospital and health centers underscored the Grand Jury's
No recommendations for this finding
F11
As part of a five-year renewable program that pays public hospital systems to reach defined goals, CCHS management secured $32.55 million in annual funding from the Delivery System Reform Incentive Program (DSRIP). Respondent agrees with this finding. Response:
No recommendations for this finding
F12
CCHP has met certain goals set by DSRIP, including (1) expanded access to physicians through telephone appointments (that increased the person-to-person appointments by 281/week); (2) increased capacity for the North Richmond Center for Health (58 exam rooms) and constructed a new 10,000 sq. foot George and Cynthia Miller Wellness Center in Martinez; and (3) ensured that 100% of Full Scope Medi-Cal and Low Income Health Plan patients have a primary Care Provider. Response: Respondent partially disagrees with this finding. DSRIP goals are related to CCRMC, not CCHP.
No recommendations for this finding
F13
DSRIP funding is not permanent and is only meant to provide seed funding. Response: Respondent agrees with this finding.
No recommendations for this finding
F14
DSRIP funding will be extended for another five years. Respondent partially disagrees with this finding. Renewal is contingent on Response: Centers for Medicaid and Medicare approval in October 2015.
No recommendations for this finding
F15
Sixteen of the 58 counties in California have merged Health and Human Services departments. Respondent agrees with this finding. Response:
No recommendations for this finding
F16
San Diego County, which is three times larger than Contra Costa County and is the largest California county with a merged Health and Human Services Department, was able to reinvest $230 million in funds over a 10 year period by reducing overhead, decentralizing offices and emphasizing prevention and intervention with community partners. Response: Respondent cannot independently confirm this statement.
No recommendations for this finding
F17
If the county were to combine the current healthcare system, the CCHS programs and EHSD, there would be 5,800 employees in a Health and Human Services Department. Response: Respondent agrees with this finding.
No recommendations for this finding
F18
If the healthcare system merges with a larger system, four programs would remain in CCHS. Emergency Medical Services could merge with the Contra Costa Fire Protection District while the Environmental Health and Hazardous Materials Program could merge with the Department of Conservation and Development. Response: Respondent disagrees. It is much more protective of Contra Costa residents' health and safety to have these divisions affiliated with the Public Health Division.
No recommendations for this finding
F19
The two CCHS program, Behavioral Health and Public Health, have a combined 856 employees. Merging these two programs with social services, the Employment and Human Services Department (1,800 employees) would create a Health and Human Services Department that is smaller than CCHS' current number of 4,000 employees. Response: Respondent agrees with this finding.
No recommendations for this finding
F20
There are more than 20 CCHS and EHSD programs that rely on each other to provide comprehensive services Response: Respondent agrees with this finding.
No recommendations for this finding
F21
Child welfare workers under EHSD and mental health specialists under CCHS are developing strategies to comply with a new settlement agreement, Katie A. v. Bonta, that mandates mental health and child welfare systems provide intensive services for foster children in need of mental health services. EHSD and CCHS are mandated to coordinate services. Response: Respondent agrees with this finding.
No recommendations for this finding

* This report's PDF did not contain easily extractable text and required Optical Character Recognition (OCR) for analysis. There may be minor errors in the extracted findings and recommendations due to OCR limitations with scanned documents.