Report to Los Angeles County Executive Office And Los Angeles County Health Services Agencies Summary of Key Questions for Stakeholders February 25, 2015

The Community Partners in Care Council was asked to provide responses to the Los Angeles County Executive Office (LAC CEO) concerning reorganization and potential realignment of Los Angeles County health services agencies under a central health authority. Brief notes from the February 4, 2015 CPIC Council and stakeholder meeting were provided on February 13, A full report was provided on February 25, This presentation summarizes main points. Report to Los Angeles County Executive Office Summary of Key Questions for Stakeholders Background

Advantages of Potential Integration Vision of a public health system attending to the “culture of health” spanning prevention and attending to social determinants of health through enhanced community and patient engagement/outreach (DPH) with healthcare agencies (DMH/DHS). Improved coordination and integration of services Improved services access through “multiple ports of entry” Increased integration of care services leading to a “system of care,” rather than three distinct systems of care Potential for one electronic health record system as opposed to separate systems Consolidation of administrative functions such as human resources, data infrastructure, billing/financing, and operations Report to Los Angeles County Executive Office Summary of Key Questions for Stakeholders Disadvantages of Potential Integration Limited history of successful integration of behavioral health services in California Perceived limited impact and authority of community stakeholders in decision to integrate Potential to overlook needs of severe behavioral health clients and high-risk social conditions in an integrated system Potential for poor understanding of patient conditions/needs and limited training to treating behavioral health clients in non-specialty sectors Need to Integrate social and rehabilitation with clinical services for behavioral health patients Potential for conflicting cultures across DHS, DMH, and DPH given distinct given diversity in organization and delivery of services between DHS, DMH, and DPH Alignment of scope differs for DHS, DMH, and DPH with regard to health plan functions Scope of practice and funding authority differences for DMH arising from MHSA funding Upcoming decisions for Medicaid waivers between LAC and California affect proper implementation. What advantages or disadvantages exist, or could exist in the integration of the three health departments under one umbrella organization?

How can the disadvantages be mitigated? Creation of an overall community council and local councils that have a meaningful role in supporting and monitoring the accountability of an integrated health authority as well as supporting functions and integration of systems Community Centers of Excellence Build capacity for the separate and/or integrated systems to address behavioral health needs through evidence-based models that are appropriate for different age groups, levels and types of need, and social/community context (e.g., trauma) Behavioral Health Capacity Building Develop community health homes that span healthcare sectors, as well as provide leadership and portals of entry that are appropriate for populations, which may mean for some high-risk populations a specialty sector leads some health homes Community Health Homes Prioritize utilization of evidence-based models of services delivery and integrated care systems for behavioral health clients within and across sectors that also include as appropriate community-based agencies and portals of entry Models of Integrated Services for Behavioral Health Clients Develop meaningful indicators of progress and success for integrated services for vulnerable populations. Document challenges in enrollment, meeting needs, limitations in access, and quality of care for ongoing review by healthcare and community stakeholders Accountability and Evaluation Report to Los Angeles County Executive Office Summary of Key Questions for Stakeholders Community stakeholders recommend Community Centers of Excellence and meaningful council coalition as an enhancement to an agency director and distinct reporting departments.

Report to Los Angeles County Executive Office Summary of Key Questions for Stakeholders Centralization Strategy for Administrative Agency Functions and Service-Related Functions Centralized functions should take into account the full range of functions of the three agencies, and their distinct features and how to blend and optimize scale and scope Planning is needed to anticipate how a reorganized agency relationship can strengthen other agencies and what the implications are for lines of funding and responsibility Nominations by agencies for the functions that they believe could be centralized would be an important activity for identifying an overall consolidation strategy Additional information is needed for communities to understand common service-related functions in order to comment on how these may be combined, as administrative operations and functions are often not transparent for community stakeholders Centralization of Administrative Agency Functions and Service-Related Functions What should not be centralized? It is possible that administrative functions related to distinct funding authorities may be difficult to centralize; such as the distinct funding of the DPH preparedness division by CDC, or the MHSA authority of DMH and Medicaid plan functions.

Address disparities in services access, quality, and outcomes specific to local communities. Los Angeles is a highly diverse set of communities. There are multiple disparities in services availability, quality, capacities for evidence-based programs, and outcomes within and across communities. These disparities should be tracked and address for greater health equity. One of the most common themes for our community partners is that given the importance of successfully handling this transition, the planning seems rushed. This haste is of particular concern for the consumer advocacy groups. It is important to get this right. Thank you for the opportunity to contribute our voices. Report to Los Angeles County Executive Office Summary of Key Questions for Stakeholders Additional comments on implementation timeline and process We are here to help. The CPIC Council and its stakeholders, which is expanding through partnering with the Los Angeles County Health Neighborhood Initiatives, can assist with community engagement, establishing structures, matching community engagement and community input to evidence- based strategies, and working with business plan considerations for sustainable partnership in improved county services for safety-net clients and families. WE ARE HERE TO HELP.