1. Contra Costa County Sustainability Audit
Health Management Associates
October 11, 2011

2. Overview Study Purpose Report Contents Barriers to Sustainability
October 11, 2011
Overview
Study Purpose
Report Contents
Barriers to Sustainability
System Strengths
Additional Findings/Discussion
Alternative Governance Structures
Questions/Discussions/Feedback

3. October 11, 2011
Study Purpose
Review the County health care system in order to “…secure the fiscal sustainability…and to ensure the most efficient and effective delivery of medical services to County residents that are consistent with the implementation of health care reform.” (HMA Contract with Contra Costa County)
Important to note that the report is grounded in the assumption that ACA will be implemented as currently enacted

4. Report Contents Stage 1: Information Memorandum
October 11, 2011
Report Contents
Stage 1: Information Memorandum
Medi-Cal and uninsured: demographics and projections
Current and future service capacity, needs
Basic Health Care Program
Data/performance indicators
This report is largely descriptive

5. Projected Population Growth
October 11, 2011
Projected Population Growth
Source: State of California Department of Finance

6. October 11, 2011
Medicaid Enrollment
Source: CA DHCS

7. Reports (cont.) Stage 2: Preliminary Report
October 11, 2011
Reports (cont.)
Stage 2: Preliminary Report
Preliminary strategic analysis
Potential alternative models
Human resources/staffing analysis
Maximizing federal reimbursement
Impact of Low Income Health Program (LIHP)
Primary care medical home (PCMH): preliminary steps

8. Reports (cont.) Stage 3: Final Report PCMH work plan Management review
October 11, 2011
Reports (cont.)
Stage 3: Final Report
PCMH work plan
Management review
Alternative governance structures
Local labor market
Organizational changes
Performance measurement and monitoring options

9. Barriers to Sustainability
October 11, 2011
Barriers to Sustainability
Workforce:
Recruitment
Compensation
Flexibility in work rules (i.e. need more ability to respond to changing demands)
Departmental control over HR, purchasing process
Organizational:
Succession planning
Transparency
Accountability

10. October 11, 2011
System Strengths
The County operates a well-integrated health care system and is taking steps to meet the future challenges presented by health care reform
The Health Services Department has done an excellent job in maximizing federal reimbursement for the system

11. Additional Discussion
October 11, 2011
Additional Discussion
PCMH: The County has made a good start down this path; next steps include performing detailed self-assessment, formulating plan
Instituting an observation unit at CCRMC would address the high percentage of short-stay patients
Length of stay should be addressed
Improving ER utilization with additional urgent capacity is recommended

12. Additional Discussion (cont.)
October 11, 2011
Additional Discussion (cont.)
HSD should also:
Enhance specialty care capacity
Improve the appointment scheduling process
Establish a public performance dashboard
Select and track quality measures that are specific to health centers
Track ambulatory care sensitive hospitalizations

13. Additional Discussion (cont.)
October 11, 2011
Additional Discussion (cont.)
HSD and the County should also:
Conduct an annual formal market survey related to compensation
Implement electronic timekeeping and attendance system
Ensure wider distribution of user-friendly monthly financial reports
Measures of financial performance should include all revenue sources and be delineated by care setting

14. Alternative Governance Structures
October 11, 2011
Alternative Governance Structures
Model Type 1: Retain Current Structure
Model Type 2: “Arm’s Length” Arrangement
Model Type 3: Divestiture
No Governance Change
Public Ownership/Private Management
Separate Non-Profit Entity
Privatization
Health Authority/District

15. Alternative Structures (cont.)
October 11, 2011
Alternative Structures (cont.)
Key Points:
There is no “magic bullet”
Any substantive change is a lengthy process requiring buy-in from a variety of stakeholders
Recommended changes to system, services should proceed irrespective of governance discussion
Costs and benefits need to be weighed (e.g., more capital revenue vs. cutting off public financing opportunities)
Doctors Medical Center situation should be in the mix in any conversation

16. October 11, 2011
Conclusion
Questions
Discussion
Feedback