1 6-14 Program Locator County Health Health Administration Headline Measures Number of Eligible San Mateo County Residents 80,000 60,000 40,000 20,000 0 Enrolled in Health Insurance Estimate Medi-Cal 60,000 60,927 62,000 63,000 64,000 Healthy Families 6,372 7,074 7,800 8,000 8,100 Healthy Kids 2,850 4,861 5,500 5,800 5,850 Percent of Current Health Partnerships Indicating an Increased Capacity to Address Health Needs 100% 80% 60% 40% 20% 0% 100% Estimate Program Outcome Statement Health Administration promotes and improves the health and well being of the community by providing overall leadership, policy setting, management, and fiscal and administrative support of public health care and services for all programs within the Health Department that provide direct service to the community. Services and Accomplishments Health Administration contributes to the goals of the Shared Vision 2010 commitment to Ensure Basic Health and Safety for All by increasing health insurance coverage rates, engaging the community in health needs and issues, maximizing inter- and intradepartmental program and service coordination, and seeking ways to minimize Net County Cost. Health Administration provides leadership for the Department and the County in meeting health care needs; ensures that all Health Divisions have the capacity to provide needed care and services to residents; and provides support to the Board of Supervisors, County Manager, the public and other agencies. Health Administration oversees the budget for the entire Department; works with the State and Federal government on funding issues; offers needed information for financial audits of the Department; oversees contractual agreements between the Department and independent contractors; provides leadership and central coordination for the Children s Health Initiative (CHI), Information Technology, and the Health Insurance Portability and Accountability Act (HIPAA); and provides Countywide leadership for compliance with the Americans with Disabilities Act (ADA) for County-provided services. The following are major accomplishments in the current year: Provided technical, analytical and planning assistance to the Divisions and other Departments (HSA, SMMC, Probation, Sheriff) for initiatives related to the Correctional Health Services inpatient treatment, Disease Control and Prevention reorganization, Public Health and SMMC labs, psychiatric care at SMMC, and child abuse assessment and treatment services Coordinated the development of the Department s Information Technology Strategic Plan (ITSP) Led a Department financial stabilization initiative to identify additional State and Federal revenue streams Expanded the focus and capacity to provide Department policy, planning, and health promotion services in order to address current health issues and implement the most appropriate public health interventions Supported the Countywide effort by convening the first Health Disparities summit and engaging community members in a process to reduce health disparities in the areas of substance abuse and nutrition and physical fitness Coordinated the CHI, a public and private initiative to provide coverage to all uninsured children from lower-income families Assessed the health of the community culminating in the publication of Healthy San Mateo 2010: Health Status Indicators
2 6-15 for San Mateo County, California and establishment of goals for 2010 Published and distributed the Emergency Preparedness Pocket Guide for all County residents Improved public communication and education about responses to outbreaks and other health issues concerning vaccine shortages and bioterrorism preparation Led the effort in the preparation of the community assessment publication Health and Quality of Life in San Mateo County Began training staff regarding County policies on accessibility of services, as required by the ADA Story Behind Baseline Performance Health Administration continues to lead efforts in identifying individuals who are eligible for health insurance, successfully enroll them in the appropriate program, and assist them in getting needed preventive care. Concerted effort on insurance outreach and enrollment resulted in surpassing Countywide enrollment targets for Medi-Cal, Healthy Families and Healthy Kids, with 75,300 children and adults enrolled in the three programs at the end of the current fiscal year a growth of 2,438 individuals over the prior fiscal year, as seen in Headline Measure 1. A key element of this effort is the Children s Health Initiative, which will have enrolled 5,500 children in the new Healthy Kids insurance program by the end of FY Health Administration also provides oversight for the Department s work on developing a Community-Oriented Health System (COHS), working in partnership with community organizations to identify health needs of specific populations and increase community involvement. Success is indicated by Headline Measure 2, which shows that of current health partnerships indicate an increased capacity to address health needs. Due to a reduction in available grant funding and an increased demand for resources by partnership communities in Daly City, South San Francisco, and the Coastside, the number of partnerships in the community has decreased to five and is projected to remain at this level in FY. Major challenges over the next two years will be: To implement the Department s IT Strategic plan To develop and implement a plan to transition the CHI out of Administration and to sustain the initiative beyond the County s five-year funding commitment To continue mobilizing and engaging the community to implement strategic initiatives that address disparities in health To develop financial and programmatic strategies that ensure the Department can provide needed care to residents, especially as State, Federal, and local funding decreases To continue a collaborative approach to providing health and behavioral health care with SMMC, Probation, the Human Services Agency, and the Sheriff s Office To develop strategies for health care access in response to major health care safety net changes, such as the State s planned Medi-Cal redesign Program Priorities Health Administration will meet performance targets by doing the following: Enroll an Additional 1,500 Children and Adults in Health Insurance Plans and Increase Retention Rates Continue to work with all school districts, community-based organizations, and County agencies to provide easily accessible gateways to enrollment Work with HSA to enhance the One-e-App so that community based organizations can use it to assist all family members to enroll in health coverage Implement retention strategies that increase contact with families and improve their understanding and use of benefits Ensure at least of Health Partnerships Indicate an Increased Capacity to Address Health Needs Involve staff from all Divisions in community partnerships Improve coordination among partnerships to improve community health indicators Implement initiatives related to the Health Disparities summit Continue to be Proactive and Responsive to Changing Trends in Healthcare Monitor and advocate healthcare-related legislation and administrative reform efforts such as state-wide coverage for all children and Medi-Cal Redesign Monitor ongoing changes in the community s health and the County s healthcare system and propose solutions Seek Ways to Minimize Net County Cost Develop and implement cost reduction/containment initiatives Continue to review, modify, and strengthen strategies to maximize funding programs including Medicaid Administrative Activities (MAA) and ed Case Management (TCM) Develop and coordinate grant funding proposals Maximize Inter- and Intra-Departmental Program and Service Coordination Improve the Department s ability to use and expand technology resources to more efficiently provide services Lead efforts to integrate data systems across Health Divisions and between other County Departments Enhance the Department s OBM implementation by leading efforts to improve data collection and usage to manage programs more effectively
3 6-16 Performance Measures Summary Table Performance Measures FY FY FY Estimate FY FY What/How Much We Do Number of eligible San Mateo County residents enrolled in Health Insurance: - Medi-Cal - Healthy Families - Healthy Kids TOTAL 60,000 6,372 2,850 69,222 60,927 7,074 4,861 72,862 62,000 7,800 5,500 75,300 63,000 8,000 5,800 76,800 64,000 8,100 5,850 77,950 Number of community events held to address healthcare and develop strategies to increase utilization of health insurance and healthcare services (1) How Well We Do It (Quality) Number and percent of County jurisdictions involved in health-related partnerships 8 / 36% 5 / 23% 5 / 23% 7 / 32% 9 / 41% Percent of stakeholder survey respondents rating services good or better: (2) - Internal - External 98% 100% 93% 98% Is Anyone Better Off? (Outcome) Percent of current health partnerships indicating an increased capacity to address health needs 100% (1) Reflects increased activity related to Children s Health Initiative. (2) Beginning in FY a Countywide standard of has been established for customer satisfaction.
4 6-17 Resource Allocation Summary Revised Change Salary Resolution (1.0) 20.0 Funded FTE (1.2) 19.8 Total Requirements 2,438,830 4,347,626 7,142,983 6,467,879 (675,104) 6,467,879 Total Sources 2,324,474 4,820,130 7,014,321 6,467,879 (546,442) 6,467,879 Net County Cost 114,356 (472,505) 128,662 (128,662) NCC Breakdown COLAs for Providers 128,662 (128,662) Program Net County Cost This program has no Net County Cost. Its operations are fully funded by Intrafund Transfers from other Health Divisions for which it provides services. FY Program Funding Adjustments The following are significant changes from the FY Revised to the FY : 1. Adjustments to Provide Current Level of Services Budget adjustments have been made to meet performance targets: inclusion of merit increases; reductions to retirement contributions; annualization of mid-year position changes and negotiated labor increases; reductions in contract expenses; reduction in ISD automation charges; and a reduction in outside funders share of of the Children s Health Initiative (CHI) program. Funding for the Community Access Program (CAP) has been discontinued. In addition, a cross-program staffing adjustment has been made to facilitate the development of professional and management capacities in several Health Divisions, with no change resulting at the Department level in either total positions or Net County Cost. (740,258) (282,240) (34,331) 0 423, Establishment of New Health Policy, Planning, and Promotion Budget Unit The reorganization establishing a new Health Policy, Planning, and Promotion unit supports program priorities of ensuring at least of health partnerships indicate an increased capacity to address health needs and enabling the to continue to be proactive and responsive to changing trends in healthcare (see the following section for a complete description of the new budget unit). Four positions have been transferred out of Health Administration to the new budget unit: one Health Services Manager I, one Management Analyst III, one Administrative Assistant I, and one Medical Program Director. 0 (512,423) 0 0 (512,423) (4)
5 Extra Help Conversion for Children s Health Initiative (CHI) Conversion of one Extra Help Patient Services Assistant II position to permanent status supports meeting performance targets by addressing operational requirements and also facilitates achievement of the program priority to enroll an additional 1,500 children and adults in health insurance plans and increase retention rates by supporting the CHI effort to enroll additional children from Mental Health. Costs are covered by Medi-Cal Administrative Activities (MAA) funding and CHI grants. 60,267 60, Transfer of Medical Library to SMMC The Medical Library, including one Medical Librarian II, is being transferred to the Medical Center to reflect greater usage of the Library by SMMC. The will reimburse SMMC for approximately 25% of the costs, based on usage. (97,965) (137,891) 0 0 (39,926) (1) 5. Executive Director for Health Plan of San Mateo (HPSM) Addition of one Executive Director U position supports the program priority to increase insurance enrollment and retention rates by promoting interagency collaboration on Medi-Cal issues of mutual concern. This position was previously approved by the Board of Supervisors on March 29, 2005 and is on loan to HPSM. The County will be fully reimbursed by HPSM for expenses incurred. 231, , TOTAL FY PROGRAM FUNDING ADJUSTMENTS (546,442) (640,773) (34,331) 0 (128,662) (1) FY Program Funding Adjustments The following are significant changes from the FY to the FY : 6. Adjustments to Provide Current Level of Services Budget adjustments have been made to meet performance targets: inclusion of merit increases, annualization of negotiated increases, and higher benefit costs; and increased Intrafund Transfers from operating Divisions that fund the Health Administration program. 0 64,680 (64,680) 0 0 0
6 6-19 General Fund FY and Budget Unit Summary Revised Change SOURCES Intergovernmental Revenues 742, , , ,959 (360,478) 634,959 Charges for Services 92,045 63,000 63,000 63,000 63,000 Interfund Revenue 185, , ,633 44,668 (97,965) 44,668 Miscellaneous Revenue 724,880 3,702,490 5,576,075 5,488,076 (87,999) 5,488,076 Other Financing Sources 565,101 Total Revenue 2,309,329 4,820,130 6,777,145 6,230,703 (546,442) 6,230,703 Fund Balance 15, , , ,176 TOTAL SOURCES 2,324,474 4,820,130 7,014,321 6,467,879 (546,442) 6,467,879 REQUIREMENTS Salaries and Benefits 1,886,398 2,386,844 2,727,376 2,411,958 (315,418) 2,476,638 Services and Supplies 2,271,171 6,018,100 8,877,727 8,655,822 (221,905) 8,655,822 Other Charges 945, , , ,489 (103,450) 887,489 Gross Appropriations 5,103,008 9,105,586 12,596,042 11,955,269 (640,773) 12,019,949 Intrafund Transfers (2,679,323) (4,757,960) (5,484,532) (5,518,863) (34,331) (5,583,543) Net Appropriations 2,423,685 4,347,626 7,111,510 6,436,406 (675,104) 6,436,406 Contingencies/Dept Reserves 15,145 31,473 31,473 31,473 TOTAL REQUIREMENTS 2,438,830 4,347,626 7,142,983 6,467,879 (675,104) 6,467,879 NET COUNTY COST 114,356 (472,505) 128,662 (128,662) 0 AUTHORIZED POSITIONS Salary Resolution (1.0) 20.0 Funded FTE (1.2) 19.8