Hub & Spoke

An Ounce of Prevention Is Worth...5 Days of Cure

Have you ever walked by a sign that says, "free flue vaccine!" and thought to yourself, "Self, I've decided that the 5 minutes it would take me to get vaccinated today are way more valuable than the 5 days that I will spend next week coughing, lashed in sweat, and popping Advil like M&Ms as I fight to regain enough strength to return to work."

We're betting this actual internal monologue has not been a frequent refrain of yours this flu season.  And yet, if you haven't gotten vaccinated yet, you've been acting as if it were.  

That old chestnut, "an ounce of prevention..." should particularly ring true for those in the healthcare sector, and yet we know that about 1/2 of healthcare workers don't get vaccinated for the flu, which isn't so great.  

With plenty of flu shots to go around this season, and the CDC recommending that pretty much everyone get one, there's really no excuse not to, and again that's especially true for those working with vulnerable populations.  

Therefore: the Consortium is partnering with Contra Costa Health Services and the Contra Costa Child Care Council on a campaign to Put the Kibosh on Vaccination Procrastination.  (Don't worry, that's not the official slogan.)

Check out the site that CCHS set up for the "5 Minutes vs. 5 Days" campaign - it's got a ton of great materials to get the word out.  Among these: the rockin' rendition of "A Bad Case of Lovin' You" re-worked into "A Bad Case of Havin' the Flu" by none other than CCHS staff physician Alan Siegel and his band.  Here's the audio.  It's worth a listen, even if you've already got the shot. 

To the future, and beyond!

Mark your calendars, oh denizens of Richmond!  Saturday, September 25th is the When.  The What?  A community meeting for residents to weigh in on a weighty question: 

Assuming resources to make lasting improvements in health, safety, wealth, and education in Richmond, what do we envision for the future of our city?  

It's a provocative question.  It acknowledges that Richmond struggles in some major ways to provide its residents with opportunity.  

Yet implicit in the question is also the idea that we, the people and businesses of Richmond, love our fair city, and feel strongly that it's worth transforming into the place we believe it can be.

Of course, many readers probably didn't get beyond the "assuming resources" part of the question.  Without resources to make change, it can't happen.  And who's got resources these days?

Richmond does!  Or, at least, it probably will, thanks to what appears to be a massive (though as-yet undetermined) investment in the community by The California Endowment, a foundation aiming to make deep and sustained change in 14 cities throughout the state over the next decade.  

By focusing its investment in specific places, the Endowment's acting on the common-sense (and research-supported) idea that the health and well-being of a community depends on a broad range of factors that goes well beyond simply whether the community has access to hospitals and clinics.  Schools, safety on the streets, career opportunities, parks, streets, clean air - all these and more obviously impact the health of a city's residents.  

Perhaps most importantly, the Endowment has made clear that the most fundamental goal of its community investments will be to empower residents themselves with the skills and knowledge to push for improvements in their cities.  

In other words, the idea is to enable change from within, following the community's own priorities and naturally sustaining itself far into the future.  

The buzz-word for this is Systems Change.  The tool for this is Advocacy.  The people whose energy, creativity, and ideas we'll be relying on for this are the Youth of this city.  (For more, visit the Healthy Richmond website here.)

So the Endowment has spurred community members in Richmond to come together to map out a course for reinvigorating the city.  

A Steering Committee made up of stakeholders from the non-profit, business, and local government spheres formed about a year ago, and have been working diligently to develop the first draft of this roadmap.

Now it's time for the broader community to come to the table and jointly develop a plan.  

Which gets us back to September 25th, the next "community engagement" meeting - which will be held at 9:30am-2:00pm at Grace Lutheran on Barrett.  Lunch will be served, and space is limited, so call the number on this flyer to reserve your spot!

We plan to be there.  We hope you will, too!

Success Story

Just a quick post today with an update on the fantastic success of the "lemonade from lemons" program that community clinics and Contra Costa Health Services set up in the wake of the April, 2009, Board of Supes' decision to close Basic Health Care coverage for undocumented immigrants.

The 20-second version is that the program, which streamlines patients who would have been eligible for BHC into appropriate primary care at their choice of community clinic, has been operating at record levels of demand in 2010.  Click here for a fact sheet with more detail.  

And as we take the opportunity to point out every time we see a Supervisor, problems that popped up within the program's first year are starting to come under control due to strong efforts by community clinics and the County.  

A little while ago, the Consortium kicked off a series of meetings between La Clinica and CCHS providers aimed at creating a forum for working out patient transfer protocol - particularly complex when a patient is discharged from County care but still in need of specialty care services not offered by community clinics.  

One great development so far: CCHS instituted a policy to allow 30 days of post-hospitalization coverage for undocumented patients discharged from CCRMC.  This is huge.  

Also: telecommunications technology is coming to the rescue: La Clínica providers now have a CCHS provider contact list that allows them to connect directly with each other in a timely manner.  And CCHS providers have access to a messaging service at La Clínica where they can leave messages for clinic providers about prospective patients that will be handed-off fromone system to the other.

In short, things are Working.  And that, when it comes to the health care world, is a pretty big deal.  

“Serving Contra Costa, Together” Candidates Forum This Week

Elections in Contra Costa County are approaching.  Elections for what, you ask?  Sheriff and County Supervisors, to name two!  Come learn more about four of the candidates at a forum this week (sponsored by the Human Services Alliance and CompassPoint).  Details below.  

Four candidates.

Two races.

One county.

"Serving Contra Costa, Together"

Contra Costa County 2010 Candidates Forum

Focus on Partnerships between County Government and Nonprofit Organizations

You are invited to meet:

County Supervisor District IV candidates Mike McGill and Karen Mitchoff

County Sheriff candidates Brian Kalinowski and David Livingston

And discuss:

• How nonprofits and local government can team up to confront the county’s biggest challenges
  
• Opportunities for creative partnerships between law enforcement and social services
  
• Ideas for moving Contra Costa County through difficult budget times
  

Thursday, May 20^th, 5-7pm

John F Kennedy University

100 Ellinwood Way, Pleasant Hill

Sponsored by the Human Services Alliance of Contra Costa and CompassPoint Nonprofit Services

Seating will be available on a first-come basis, and RSVPs are strongly encouraged. To RSVP, click here.

For more information, e-mail Mariana Moore or Liz Callahan. 

Operation Access' Success & Growth Speak to Huge Demand

Here's one of the countless reasons it really stinks to be poor and in need of healthcare services: medical schools today graduate massively disproportionate numbers of specialists (so disproportionate that only 30% of docs do primary care), but if you're uninsured and low-income, finding a specialist who will see you is a virtual 'Where's Waldo' hunt.  

Mainstream news reports bemoan the glut of specialists and what it means for the cost of healthcare in the US, but if you're poor and uninsured these news stories are a sort of bizarre slap in the face.  There is no glut of specialists in low-income communities; just the opposite.

Three cheers, then, for Operation Access - the program that in Contra Costa County and throughout the Bay Area connects the uninsured and indigent to outpatient surgical and specialty services provided pro bono by volunteer doctors, nurses, and hospital systems.

In 2009 alone, OA estimates that these volunteer medical professionals donated $1.8 million in charity care, representing a lifeline for community clinic patients and others who wouldn't otherwise have a place to turn for orthopedic care, hernia surgery, and other outpatient specialty surgeries.

On the 17th of this month, OA held its first GI diagnostic event - providing much-needed non-routine colonoscopies to 4 community clinic patients.  For our part, the Clinic Consortium, under a Specialty Care Access grant from Kaiser, last year surveyed clinics throughout the county and found hurdles to diagnostic GI services a major problem for our patients.  These are services that community clinics don't provide in-house, but that patients have tremendous difficulty finding on referral.  This spring, we spent days behind the scenes coordinating the community clinic and OA systems in preparation for the GI event. By all accounts it was a rousing success, and hopefully the first of many!  

Certainly there's no shortage of demand by low-income uninsured patients for specialty services.  OA's pool of volunteers has shot up 317% since early 2009, but it's still nearly at capacity, bursting at the seams as community clinics and others refer patients in need.  

The work goes on.  In the mean time, if you see one of those news stories pondering the overabundance of specialists, consider taking a moment to drop a letter to the editor.  Tell 'em what's really going on in our communities, and pass on OA's phone number.  

County Budget Subplots

Contra Costa County released its Recommended 2010-11 Budget late last week, and let me tell you, this is 428 pages of the most riveting, edge-of-your-seat, nail-biting reading that you will ever dare do.

Okay, not really.  It's a budget, after all.  Turns out it's got more charts and figures than cliff-hanging subplots.  

For Health Services, a $7.2 million reduction breaks down into a $3.2 million (3 FTE) cut to the hospital, a $1 million hit to public health, and a $1.5 million blow to mental health.  Not the stuff of a Stephen King classic, rest assured.  

But actually, if you kinda turn your head and squint your eyes and use your imagination, it's possible to pull out some themes from this unwieldy tome.  Here are the ones that popped for me:

Banking on "Lean" production practices.  Around $650,000 in projected savings to the county hospital would come from applying "lean methodology" to cardiac, surgical, and behavioral health services.  This is something that CCRMC CEO Anna Roth has been spearheading: taking the sort of fat-cutting, end-product focused production strategies that Toyota brought to the car industry and applying them to hospital operations.  

Flattening the administration.  Exactly $600,000 in savings would come from eliminating 4 administrative positions at the health plan and redistributing their work to remaining staff.  Ditto $300,000 in mental health.  This seems in line with what County Administrator David Twa has been talking about when he promotes flattening the county's organizational structure to make it less administratively top-heavy.  

Mental health service cuts: Many of the actual reductions in patient services seem to fall in the mental health category.  These include increased wait times for medication visits for the seriously mentally ill; decreased access to after-hours care at mental health sites; increased wait times for medication for children; and reductions in the number of authorized mental health visits to private outpatient providers.  

Modest shift of general purpose revenue away from health/social services.  On page 7 of the budget the CAO catalogs changes in the percentage of general purpose revenue dedicated to each department.  Health Services went down from 29.1% to 28.6%.  Employment and Human Resources from 6.2% to 5.8%.  Modest but noticeable decreases.  On the other hand, the Sheriff-Coroner climbed from 19.6% to 20.4% and the DA from 3.7% to 4.3%.  

So there's the budget as I see it.  Pulp fiction it is not, but you have to give it credit for being so well foot-noted.  And, despite what are sure to be slow sales and low readership, there will of course be a sequel, due out sometime after May, provisionally entitled, "Other stuff we have to eliminate because the state is in even worse financial shape than the county is, and they're down-streaming their cuts to us."  

That one, I'm afraid, really might be Stephen King scary.

$7 Million Cut to CCHS

At Supervisor Susan Bonilla's budget town hall last night, Health Services Director Dr. Bill Walker gave the total tally for his department's cutbacks in the 2010-11 budget year: $7 million.

That's of course not the final number - just the initial target from the county administrator's office.  Final numbers come after the Board of Supes deliberates on April 20th.  And then a second round of cuts are probably in the offing - after the State passes its budget cuts sometime this summer (or fall, or winter, or, you know, whenever 2/3 of the legislature can agree on Anything). 

This year's $7 million cut target (out of a total County deficit of $50 million) appears to be less than last year's actual cuts.  By early March 2009, the department had already proposed $10 million in service reductions through a Beilenson notice, which included $6 million in savings from cutting services to undoc. immigrants. 

Not that $7 million is anything to shake a stick at; it's real money.  What programs will Health Services scale back?  The public won't know until - I assume - shortly before the budget hearing April 20th. 

But I wouldn't be surprised to see something about an attempt at greater efficiencies/governance changes for the County hospital.  County Administrator David Twa made clear last night that the $43 million/year in support that the County gives to CCRMC operations is unsustainable.  He also made clear that something's got to be done about it between now and 2014, when national health reform arrives in earnest and the uncompensated care burden for the County (presumably) plummets.  

To which Dr. Walker suggested, "Maybe the County can just give us a loan until then."  To which Twa and the audience responded by laughing. 

To which I say, the best jokes are funny because they're true. 

Investment Opportunity of a Lifetime

Loyal readers, have I got a deal for you!  

If you give me a mere $870 at the start of the year, I'll give you an impressive $1,430 - yes, you heard right: $1,430 - at the end of the year.  That's a 64% return on investment.  

I will do this year after year, for as long as you invest in Bank of Soren.

Sound too good to be true?  Consider this: 

Many of you know that La Clinica de La Raza is planning a new clinic site for the Monument Corridor in Concord.  When up and running at capacity, it will be the medical home to nearly 15,000 patients in one of the most underserved areas of the county.  

It's also set to be a major economic engine in the region.  

According to the consulting firm, Capital Link, when running at full pace (by about 2015) the new clinic will be providing $8.7 million in services per year, largely paid with state and federal funds.  

Thanks to the multiplier effect, whereby dollars spent in an economy spur on further spending and growth, that $8.7 million will generate an additional $5.6 million in economic activity in the local area - for a total of $14.3 million in economic impact.  

Per year! 

That $14.3 million includes $10.4 million in income gains that will accrue to households in the area, and represents just over 100 jobs.  Here's the two-page Capital Link report for more details.  

So this is a reminder of how good an investment community clinics are for local, state, and federal funding.  Medi-Cal funds that go to pay for clinic services, for example, do more than pay for services.  They also channel through the clinics into local economies for a multiplier effect of about 60%.  That's your tax dollars at work.  That's a stimulus package!

Now you see why my Bank of Soren example isn't as crazy as it seems at first blush.  

But really, please don't send me any money, at least not with the expectation you actually get any of it back.  

Photo by David Paul Ohmer, distributed under a Creative Commons Attribution license.

You know it's bad when all you're asking for is to be cut just as much as everybody else

If you haven't read it yet, Contra Costa Crisis Center director John Bateson's column in the CC Times is most definitely worth a gander. 

The basic idea is that in 2010 health and social services are at risk of a huge budget whack.  If past is precedent, they'll be slated for a bigger hit than other programs (think total elimination of Healthy Families).  

This despite the fact that health and social services represent popular community priorities, like public safety, criminal justice, and education.

John's got great examples of this, including the idea that a suicide prevention hotline - while falling within the "social services" category - could just as easily fall under the banner of "public safety" and should be understood by the voting public as such.  

Of course, that gets to another point.  That voters and those we elect to represent us sometimes doesn't see health and social services as sharing equal stature with education and public safety because those who directly benefit are the least likely to speak out on their own behalf - they're the voiceless and the disenfranchised.  

We at the Consortium responded with a hearty "hear hear!" to John's article when we read it.  We've been part of an ad hoc coalition called 'Partners in Public Safety,' shopping a very similar message to the CoCo Board of Supervisors this year (with good reception so far!).  We understand cuts to health and human services will happen because the economy's bad, and tax revenues are worse.  But we believe cuts to County programs should be fair, and should not fall more heavily on one government sector than another.

Health and human services are vital to the community no matter how they are categorized.  But politically speaking, there's another point to be made.  These services, when properly categorized, also fall within program areas like education and public safety that are the most widely popular among voters.  

It's up to us advocates to keep pointing that out.

New Planned Parenthood Clinic at El Cerrito Plaza Shopping Center

VERY happy to be able to write about and promote Planned Parenthood's brand new location at El Cerrito Plaza, in west county Contra Costa.  

It's a beautiful 4-room clinic located in the breezeway in between Joann Fabrics and behind the Wing Stop - which, it turns out, is evidently THE epicenter of after-school hanging-out for area teens.  In other words, it couldn't be in a better place. 

Clinical hours are half-time (Tuesdays/Thursdays 1:00-5:00) for now (they'll expand to full business hours in the near future) but the phones are always on.  Call or stop by for birth control, breast & cervical cancer screenings, STI testing and treatment, emergency contraception, and services for men, too!  

I got a tour of the new site this morning from center director Rachelle Rohrer, and - what can I say - it was awesome.  Spacious, brand-spanking-clean, adorned with interesting artwork, and staffed with people who are way friendlier than I am.  

Words do a poor job of describing it, so I shot some video.  Check it out and let us know what you think!