Overview To the Local AGENCY Formation Commission lafco September 8 2016 Rebecca Gebhart Interim Agency D irector Health Care Services Agency ALAMEDA COUNTY HEALTH CARE SERVICES ID: 795776
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Slide1
Alameda County Health Care System OverviewTo the Local AGENCY Formation Commission (lafco)September 8, 2016
Rebecca Gebhart, Interim Agency DirectorHealth Care Services Agency
ALAMEDA COUNTYHEALTH CARE SERVICES AGENCY
Slide2ALAMEDA COUNTYHEALTH CARE SERVICES AGENCY2Overview
Alameda County Health Care Services AgencyHealth care definitionsComponents of a health systemAlameda County’s systemPayer mix in Alameda CountyWhat is the safety net?What are the issues facing the safety net?
Slide3Provide fully integrated health care services through a comprehensive network of public and private partnerships that ensures optimal health and well-being and respects the diversity of all residentsHealth Equity through the goals of Healthy People, Healthy Places
, Healthy Policies and Healthy SystemsALAMEDA COUNTYHEALTH CARE
SERVICES AGENCY3
VISION
MISSION
Slide4ALAMEDA COUNTY HEALTH CARE SERVICES AGENCYOffice of the Director Finance & Administration Medical
Director Human Resources Fund Development Policy
Evaluation
Center for Healthy
Schools and Communities
Indigent Health Services/
HealthPAC
Behavioral Health Care
Services
Day Treatment
Referral Services
Support Services
24 Hour Services
Outpatient Services
Public Health Services
Community Health Services
Communicable Disease Control & Prevention
Family Health Services
Administrative Services
Public Health Nursing
Administration
Environmental Health
Services
Outreach
Ancillaries
Emergency Medical
Services
Office of AIDS
Environmental Health
Office of the Director Health Officer
HCSA Administration
/
Indigent Health
Administration
Vector Control
Services
Cross-Departmental
/
Cross-Jurisdictional Health Services
4
Slide5Mandated and Discretionary Services5HCSA DepartmentMandated ServicesDiscretionary Services
Indigent, Cross-Jurisdictional, and Emergency HealthIndigent Health, Medical Services to Youth in Custody, Emergency Medical ServicesSchool Health Services, Children’s Policy, Court Appointed Special Advocates, Youth Centers, Children’s Dental, Health Insurance Enrollment, MAA/TCM, Health Care for Low Income Uninsured, Health Care for the Homeless
Behavioral HealthAlcohol and Other Drug Services, Mental Health Services, Medi-Cal Consolidation
Housing Support for Homeless, Vocational Training, Self-Help and Empowerment, Crisis Support for the Uninsured
Environmental Health
Food/Water/Recreational Safety, Hazardous Materials/Waste Mgmt, Vector Control, Land Use/Septic,
Solid/Medical Waste, Body Arts,
Epidemiological Investigations, Complaints
Green Business/Community Environmental Health Services,
Healthy Nail Salons, Pharmaceutical Safe Take Back, Food Facilities Grading System
Slide6HCSA DepartmentMandated ServicesDiscretionary ServicesPublic HealthHealth Officer, Public Health Nursing, Public Health Laboratory, Public Health Statistics, Health Education, Communicable Disease Control & Surveillance, Disability Prevention, Child Health, Nutrition Services, Diabetes Prevention, Foster Care Health, Maternal & Infant Health, Dental Health, Tobacco ControlAsthma Program, Developmental Disabilities Planning & Advisory, Pregnancy Prevention, Teen Dating Violence Prevention, Home Visiting & Family Support System, Social & Health Equity Programs
Mandated and Discretionary Services6
Slide7Evolving Definitions of Health care7
Slide8Basic Components of a Health Care Delivery System Public Health (including health promotion and disease prevention)Emergency Medical Services (911 and ambulances)Ambulatory Care (primary and specialty)Behavioral Health Services (in-patient and ambulatory)Dental ServicesAcute Care HospitalsLong-term Care (either in-home or institutional care)*Rehabilitation Services
Pharmacy, medical devices and equipment8
*Not covered as a safety net service
Slide9Sources of Health DataHealth insurance breakdown information from California Health Interview Survey (CHIS): 2015 updates coming in late October Hospital Utilization Data from OSHPD (Office of Statewide Health Planning and Development): 2015 updates coming in mid-September 9
Slide10What is the Payer Mix in Alameda? 10
Slide11What is the Payer Mix in Alameda County? 2013 vs 201411
Slide12Health care System in Alameda County Major ProvidersHospitals and Hospital SystemsKaiserSutter HealthSutter Health East BayEdenAlameda Health SystemValleyCare HospitalWashington HospitalSt Rose HospitalFremont HospitalUCSF Benioff Children’s HospitalLarge
Medical GroupsSutter HealthHill PhysiciansStanford Children First Medical GroupCommunity Health Center Network (CHCN)
VA Outpatient12
Slide13Inpatient Visit Payer Source:Alameda County Acute Care Facilities, 2014Source: OSHPD, 2014: http://report.oshpd.ca.gov/*Data is incomplete for Kaiser Hayward/Fremont, which is included in Kaiser Facilities (½ year of data available only, so multiplied by 2 to estimate full year) 1313
Slide14What are Safety Net Services?Services for Medi-Cal and UninsuredPublic Health (including health promotion and disease prevention)Emergency Medical Services (911 and ambulances)Ambulatory Care (primary and specialty)Behavioral Health Services (in-patient and ambulatory)Dental ServicesAcute Care HospitalsRehabilitation Services
Pharmacy, medical devices and equipment14
Slide15Alameda County Safety Net Relationships1980 The CountyAlameda Health Consortium*
Health Care Services Agency
Contract $
Contracted Providers
(FQHCs)
*
AHC is a membership organization of the clinics that does policy and advocacy work
15
Slide16Admin and Indigent Health
Public Health
EMS
Behavioral Health
Alameda County Safety Net Relationships
1996
The County
Contracted Providers
Alliance
Alameda Health Consortium*
Health Care
Services
Agency
Contract $
ACMC
Highland
Fairmont
John George Psych
Clinics
Community Health
Center Network CHCN
Medi
-Cal Managed Care Plan
Moms and kids
16
Slide17Admin and
HealthPAC
Public
Health
EMS
Behavioral Health
Alameda County Safety Net Relationships
2016
The County
Contracted Providers
Alliance
Alameda Health Consortium*
Health
Care
Services
Agency
Contract $
AHS
Highland
Fairmont
San Leandro
Alameda
Clinics
Community Health Center Network CHCN
Medi
-Cal Managed Care Plan
Moms, kids, disabled adults and new, expansion
Medi
-Cal
Environmental Health
17
Slide1818
Slide19Medi-Cal and theRemaining UninsuredAlameda County 2016Medi-Cal in managed care (as of 8/1/16) 316,518Medi-Cal fee for services (estimate) 79,000Undocumented Children Eligible for Medi-Cal 8,000 Medi-Cal Total 403,518Uninsured:Not Eligible due to Immigration Status
65,000 Eligible for Medi-Cal < 5,000 Eligible for Subsidies through Covered CA
< 5,000 Non-subsidy Eligible Citizens & Lawfully Present Immigrants 17,000 Total Uninsured
84,000
Total Safety Net population
approximately 487,518
Uninsured data source:
Preliminary
CalSIM
v 2.0 Regional Remaining Uninsured Projections
August 2016
19
Slide20Efforts to Meet DemandPlanning for Additional Senior ServicesFocus on prevention and social determinants of health such as:HousingNutritionExerciseSpecial Services for Frequent Utilizer GroupsHealth homes via the managed care plansWhole person care20
Slide21Health Care ChallengesAging PopulationCost of Health InsuranceLow Medi-cal ReimbursementsPent up Demand for Health Care ServicesHospital ClosuresIntegrating Mental Health and Substance Abuse Treatment into Primary CareTransition to Electronic Health Records
Availability of and Access to Primary Care21
Slide22QUESTIONS?22