Hub & Spoke

La Clínica North Vallejo

I’m pleased to introduce you to our first “guest blogger,” Monique Sims – the manager of La Clínica de La Raza’s brand new community clinic in North Vallejo. The site is part of a groundbreaking community project to relieve hospital ER overcrowding by guiding patients to more appropriate clinic settings.  A couple weeks ago, the Consortium interviewed Monique for our newsletter.  Here, we asked her to introduce the rest of her staff and tell us how things have been going so far.  Thanks for reading!  - Soren

 How exciting! A brand new clinic to meet a serious need in the community for patient access to health care. I was excited to come aboard the La Clínica team at the onset of this important endeavor. The clinic was birthed as a response to a need to redirect avoidable emergency room visits from Vallejo hospitals.

I was able to see the clinic develop from empty walls, to beautiful furniture and the warmest, professional team I have ever had the pleasure to work with. The buzz was in the air… “La Clínica’s New Urgent Care Clinic was Coming Soon!” I was whisked into meetings with project partners including Terry Glubka of Sutter Hospital, Patrick Duterte of Solano County Health and Social Services, and Cynthia Verrett from Kaiser.  I was in awe that so many people and organizations came together to support what came to be known as the “Patient Access Project.”

It wasn’t long before I became very motivated, as site manager, to give my best into striving to accomplish the goals and expectancies for the clinic.  I was soon joined by three providers that shared the same passion for the mission of the clinic.  

• Dr Mark Schwartz joined the team with 25 plus years under his belt as a Kaiser ER doctor.
• Shortly later, Dr. Ruth Shelton-Pyror dedicated her vast, 30- year experience in primary care to the clinic.
• “Nurse Betty” Labastida came aboard with 35 years experience as a nurse practitioner and several years at “Clinic Ole” to complete the provider team.

I felt an angel was watching over this project, but did not anticipate the arrival of “The Clinic’s Angels,” Nichelle, Angela and Norma.  Medical Assistants Nichelle and Angela worked diligently to bring the clinic’s supplies and procedures up to a high standard of excellence.

Hard-working Norma worked feverishly to acquire and organize our registration materials and office. They whipped the clinic into shape. Later, Medical Assistant Akia joined us complementing the team’s expertise with her extensive phlebotomy experience.

Our Health Educator, Ashley, is working feverishly to educate the community about the services provided by the clinic and spreading the news that if you have an urgent medical need that is really not life threatening, and you cannot get an appointment with your doctor, our clinic is here to serve your health needs.

The first day we opened, we were all so excited!  Norma told us, “This is what we’ve been working and waiting for!” With that we were off to a great start. The clinic started out with just 5 people a night showing up for our 3- hour evening clinics, and now we’re up to 13 per night.  None of the staff complain about working Saturdays! They want to be there to serve our clients.  I am enjoying the ride, working with such a great team.

We’re on our way!!! Check out the clinic at our Open House on February 5^th, 2009.

Monique Sims, DrPH, MPH, RD

Site Manager

Shifting Governance of Contra Costa Health Services

My last post (on the most recent budget cuts in Contra Costa County ) set the context for today’s issue: shifting direct control of the County’s Health Department away from the Board of Supervisors to a new stand-alone Authority. 

Today, of course, the Health Department is directly governed by the Board of Supervisors.  But back in April, health director Dr. William Walker suggested to the Board that due to the rising cost of medical care, health services may be in jeopardy unless that governance structure changes:

“The ability of the County to continue to deliver health care to its residents may rest on a change to the governance structure of the Health Department.  A structural change that would realign functions such as physicians, contracting, purchasing and human resources under the Health Agency reporting to a stand-alone Board may provide the vehicle to slow the ever-increasing rise in medical costs.  Alternative public governance structures exist.  They range from health commissions (San Francisco), stand alone Authority (Alameda), to our own local joint powers authority (Doctors Hospital ).”

On September 23^rd, Dr. Walker was back before the Board of Supervisors with more detail.  He introduced Larry Gage, President of the National Association of Public Hospitals, who went through various models of public hospitals and health systems.  Click here for a brief summary of Dr. Walker’s and Mr. Gage’s reports, as well as links to their supporting documents. 

After the presentation, the Board directed Dr. Walker to proceed with an evaluation of different governance options for the Medical Center , Health Plan, and other clinic services. 

So this is a live issue.  And although nothing new has publicly come out on it since September, we assume it will be back before the Board in the near future. In the meantime, given that Alameda County has a stand-alone Hospital Authority that governs its health system, we at the Consortium thought it would make sense to ask our neighbors to the south how it’s going.  Click here for a detailed report of our research. 

One thing we found was that most people we spoke with (County officials, community clinics, etc.) are satisfied with the Hospital Authority model of governance.  Another thing we found was that establishing the Authority probably wasn’t the financial silver bullet that saved Alameda’s once-troubled health system. 

As always, if you have thoughts or information that you’d like to share, please leave a comment. 

- Soren

Budget Cuts in Contra Costa County

Today the Contra Costa Times features an article about yesterday’s Board of Supervisors vote to cut $18.5 million out of the County budget, including elimination of 203 staff positions. 

The vast majority of the cuts fall on the Employment and Human Services Department. Except for some relatively modest cuts to the California Children Services program, and some other cuts noted below, the Health Department was spared from this round of budget reductions. 

But of course many of yesterday’s cuts have a direct impact on the health of Contra Costa residents.  Here are some of the grimmest:

• Hardest hit in terms of staff layoffs: the Children and Family Services program.  According to a County memo, the elimination of 119 positions will translate to “higher caseloads for Child Welfare staff, resulting in longer delays in conducting child abuse investigations and reduced monitoring of children in foster care.” 

• Aging and Adult Services also fell under the axe, including layoffs of In-Home Supportive Services social workers, “resulting in longer wait times for new cases and new referrals.”  In another program area, Adult Protective Services will respond to cuts in its budget by “triaging referrals to focus primarily on life-threatening situations, with less time left over to investigate financial abuse cases.” 

Cuts affecting Medi-Cal:

• Elimination of a community outreach aide in Aging and Adult Services.  According to County documents, “This position assists Medi-Cal applicants in completing their application process.  Elimination of this position will result in having no resources to assist clients beyond the standard interview process conducted by an Eligibility Worker.”

• Elimination of 5 Medi-Cal ELCs in Aging and Adult Services.  “Elimination of these positions will severely impact Medi-Cal intake functions department wide.  The department will experience significant delays of Medi-Cal application processing….  All units will experience significant delays in processing applications for Medi-Cal and [food stamps] applicants.”

Mental health reductions:

• Reduction in mental health services MOU with the Health Department.  The $106,000 reduction “may result in a delay in the time it takes for children and parents to receive referrals for mental health services.”

A silver lining?

The County has had some difficult decisions on its plate this year – having cut about $111 million out of the 2008-09 budget so far.  And County Administrator David Twa suggested that the County will probably find itself back in the red next year.  Come February, we’ll likely see the Board of Supervisors deciding whether to make another series of mid-year cuts or to roll the cuts into the 2009-10 budget. 

One silver lining in this storm cloud is that the Board of Supervisors has so far taken a strategic approach to its budgeting.  Instead of across-the-board cuts that fall on all departments regardless of their funding sources, the Board is trying to preserve services that draw down significant state-federal dollars. 

In fact, Employment and Human Services appears to be planning to add 15 new positions to Medi-Cal, which is one of those programs that pulls down large amounts of state/federal funds.

A County memo says that “Additional State revenue can be generated by redirecting efforts towards providing Medi-Cal services.  There are services which could be provided to additional clients in this program for which there is funding available.”

So: mostly bad news, with some glimmer of optimism.  If you have more information on this topic, or if you have an opinion on yesterday’s cuts, please add a comment. 

Also, in my last post, I promised to write about discussions underway in Contra Costa County to move some of its Health Services programs under a separate hospital authority.  Look for that update to come towards the end of the week. 

Thanks for reading!

Soren

Photo by SqueakyMarmot (http://www.flickr.com/photos/squeakymarmot/), distributed under a Creative Commons Attribution license.

Welcome to Hub & Spoke

On behalf of the Community Clinic Consortium, I’m happy to welcome you to the first post on Hub & Spoke. 

Hub & Spoke is your one-stop-shop for info and updates on local health care issues. 

The focus of our blogging will be Contra Costa and Solano Counties, but we’ll also write about events at the state and federal levels that affect the region.

It’s our job at the Consortium to have our fingers on the pulse of the local health care scene.  We regularly attend board of supervisors meetings to keep up with budget items.  We scour documents written by county health departments to stay on top of program changes.  We track state and federal regulations that affect how health care is delivered on the local level.    

It occurred to us that we could be sharing this sort of information with you, our community.  In turn, we want to solicit your feedback, news, and questions so there’s a free exchange of ideas. 

So we’re setting up this blog as central information source (a hub!) for all the members of the local health care community to be connected together (like spokes!). 

As the Consortium’s policy director, I’ll be doing most of the writing on this site.  My intent – sensitive to your time – is to post only when I find health care issues of clear interest to the local community.  I hope you’ll check back for updates or sign up to be notified of changes automatically -  via email or RSS feed. 

Next week, I’ll be writing about a possible change in the governance structure of Contra Costa Health Services.  Discussions are under way about spinning off parts of the department to its own Authority, separate from the Board of Supervisors.  It’s an interesting topic, and the Consortium has a good deal of information to make available. 

Thanks for reading, and stay tuned.

- Soren

Soren Tjernell is the Consortium’s Director of Government and Community Affairs.  Email him at policy@clinicconsortium.org