County Behavioral Health Services – a State of Mind

The County budget website lacks HSA Financial data visible to the public to ensure transparency of programs and funding efficacy. __ AGREE __ PARTIALLY DISAGREE _X_ DISAGREE Response explanation (required for a response other than Agree): The award-winning County budget website (Proposed Health Services Agency 2024- 25 Budget) contains financial data viewable in several different ways; by revenue/ expenditure type, division, and service. A service is defined as an operational unit within a department aimed at accomplishing a major governmental purpose or supporting the Operational Plan. The operational plan, a collection of objectives: measurable, time-bound, and inclusive tests of change that reflect the County’s major work towards creating a healthy, safe, more affordable community, links budget appropriations to each service and is available on the County website. A PDF of the County Proposed 2024-25 Budget in Brief is also available.

The County has limited staff to analyze the data for identifying trends which would allow focusing resources more effectively. __ AGREE _X_ PARTIALLY DISAGREE __ DISAGREE Response explanation (required for a response other than Agree): The County has Analysts and other qualified staff with skills and tools necessary to analyze data, trends, and form recommendations to effectively allocate limited resources. Not all data is accessible to the County, but data sharing initiatives are advancing within County departments, which have the potential to improve resource allocation efficiencies, as well as advance care coordination, inform decision-making, and improve service delivery outcomes. A significant number of population health reports and analysis can be found online at the Health Services Agency Website: Population Health Data (santacruzhealth.org)

Zip code data can pinpoint areas of “High Need,” which can direct data- driven funding for better health outcomes and give a better “Return on Investment.” __ AGREE _X_ PARTIALLY DISAGREE __ DISAGREE Response explanation (required for a response other than Agree): Zip code data can pinpoint areas of “High Need,” which can direct data-driven funding for better health outcomes and give a better “Return on Investment”, The BHD is responsible for the administration of the Specialty Mental Health and Drug Medi-Cal Health Plans and the provision of care to Medi-Cal beneficiaries who meet health criteria, based on individual need, under these health plans. Often, these beneficiaries are living with life-long diagnoses and improvement is measured by maintenance or improvement in functioning and self-reported metrics.

The 95076 zip code has an extraordinarily high number of patient transfers to outside the county compared to other zip codes of Santa Cruz county. This indicates a major lack of healthcare facilities and services to serve the community. __ AGREE _X_ PARTIALLY DISAGREE __ DISAGREE Response explanation (required for a response other than Agree): The County is committed to retaining the existing health care facilities and services that support all County residents, including 95076 zip code residents, and has committed to expanding the availability of facilities and services. The County has made significant investments with its community partners to purchase and keep open Watsonville Community Hospital and has recently purchased a building to establish an in-County youth crisis stabilization facility. In addition, the County relocated services at Westridge, increasing accessibility to South County. If the finding is only related to Behavioral Health transfers, then the data referenced in the Grand Jury report is too broad, as that data appears to include all patient transfers for any health need, not only behavioral health, regardless of insurance provider. The County is responsible for the payment of hospital services only for patient transfers for inpatient psychiatry for Medi-Cal beneficiaries. Due to Federal legislation, inpatient psychiatric facilities that are not attached to an acute care hospital are capped at 16 beds. As a result, Santa Cruz County has only one inpatient psychiatric health facility (also known as the PHF) of 16 beds located at 2250 Soquel Ave, Santa Cruz. The County Specialty Mental Health Plan contracts with Telecare to deliver the health services in that facility. If this finding is regarding lack of healthcare facilities and services to Medi-Cal beneficiaries, the responsibility and the data is held by the Medi-Cal Managed Care Plans (MCPs). In Santa Cruz County, the MCPs are the Central California Alliance for Health (CCAH) and Kaiser Permanente, which are accountable to the State of California’s Department of Health Care Services (DHCS) for maintaining network adequacy requirements. If this finding is regarding lack of healthcare facilities and services to private insurance members, the responsibility and the data is held by the Managed Care Plans (MCPs). There are many MCPs that provide health care coverage for Santa Cruz County residents, such as Anthem, Blue Shield, Kaiser Permanente, and others. The non-Medi-Cal MCPs are accountable to the State of California’s Department of Managed Health Care (DMHC) for maintaining network adequacy requirements.

A study of socioeconomic indicators of the 95076 zip code, compared to other zip codes of Santa Cruz county, reveal a dire need to improve the following: Homelessness Low Preschool Enrollment Poor Health Care Access Unemployment Support for Single Parent Households _X_ AGREE __ PARTIALLY DISAGREE __ DISAGREE Response explanation (required for a response other than Agree): Santa Cruz County’s DataShareSCC provides dozens of indicators related to community health and well-being. https://www.datasharescc.org/ The data shows similar findings. The Public Health Division-led Community Health Assessment (CHA) will be published in August 2024, and preliminary results also show findings that concur.

The ECM programs are currently at capacity and have waiting lists. More providers are needed to expand the program further to transition more residents to independent living. __ AGREE __ PARTIALLY DISAGREE _X_ DISAGREE Response explanation (required for a response other than Agree): The County does not have data on waiting lists or patient need for the Enhanced Care Management (ECM) program. The Enhanced Care Management is a Medi-Cal entitlement that is the responsibility of the Medi-Cal Managed Care Plans (MCPs) and administered through the MCPs. In Santa Cruz County, there are two Medi-Cal MCPs – Central California Alliance for Health (CCAH) and Kaiser Permanente. Those organizations are responsible for the ECM programs, not the County. The County Health Services Agency is merely one of many contractors to CCAH to provide the ECM program to some Medi-Cal beneficiaries. The waitlist information would be the responsibility of the MCPs.

Though there is evidence that managed care programs like ECM are effective, lack of data leaves doubt in the public’s mind. Data supporting the success rate of ECM programs would ensure stronger public support. __ AGREE __ PARTIALLY DISAGREE _X_ DISAGREE Response explanation (required for a response other than Agree): The County does not have data on the effectiveness of the Enhanced Care Management (ECM) program at this time. The Enhanced Care Management is a Medi-Cal entitlement that is the responsibility of the Medi-Cal Managed Care Plans (MCPs) and administered through the MCPs. In Santa Cruz County there are two Medi-Cal MCPs – Central California Alliance for Health (CCAH) and Kaiser Permanente. Those organizations are responsible for the ECM programs, not the County. The County Health Services Agency is merely one of many contractors to CCAH to provide the ECM program to some Medi-Cal beneficiaries. Effectiveness information would be the responsibility of the MCPs.