HEALTH CARE SERVICES AGENCY Alex Briscoe, Agency Director BOS - - PowerPoint PPT Presentation

ALAMEDA COUNTY HEALTH CARE SERVICES AGENCY

BOS Budget Hearing  June 23, 2014 

Alex Briscoe, Agency Director

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The Mission of the HCSA is to provide fully integrated health care services through a comprehensive network of public and private partnerships that ensures optimal health and well-being and respects the diversity of all residents.

HCSA MISSION STATEMENT

School Health Services Cross-Departmental/ Cross-Jurisdictional Health Services Indigent Health Care Services/ HealthPAC

Behavioral Health Care Services

Day Treatment Referral Services Support Services 24 Hour Services Outpatient Services Administration

Public Health Services

Community Health Services Communicable Disease Control & Prevention Family Health Services Administrative Services Public Health Nursing Administration Environmental Health Services U.C. Cooperative Extension Vector Control Services Outreach Ancillaries Emergency Medical Services Office of AIDS

Environmental Health

Office of the Director Health Officer

HCSA Administration/ Indigent Health

Alameda County Health Care Services Agency

Office of the Director Finance & Administration, Fund Development, Human Resources Medical Director, Policy, Compliance, Evaluation

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HCSA FY 14/15 VBB Summary* (in millions)

Final Approved FY 13/14 VBB FY 14/15 Change from FY 12/13 Budget Amount % Appropriation $682.91 $642.30 ($40.61) (5.95%) Revenue $571.95 $523.70 ($48.25) (8.44%) County General Fund $110.96 $118.60 $7.64 6.88% Use of one-time savings (recycled County General Fund) $15.00 $14.00 ($1.00) (6.67%) Continued County General Fund Support $95.96 $104.60 $8.64 9.00% FTE-Mgmt 460.42 478.83 18.41 4.00% FTE-Non Mgmt 975.88 982.83 6.95 0.71% Total FTE+ 1,436.30 1,461.67 25.36 1.77%

* Includes Measure A appropriation & offsetting revenue = $28.68M + Does not include TAP and Contracted personnel of approximately 3,553 FTE

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HCSA FY 14/15 VBB

HCSA closed the $23.7 million reduction target in the following manner:

• Use of FMR = $14 million
• Increase in revenue = $6.3 million
• Reduction in appropriation of contracts, contract right

sizing, and reductions in services and supplies = $1.1 million

• Institution for Mental Diseases reductions= $1.1 million
• One-time use of FY14/15 Measure A revenue to cover

Primary Care indigent health CBO contracts = $.5 million

• Reduction in AHS (ACMC) indigent contract = $.5 million
• Elimination of 2 FTEs = $.2 million

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Agency Admin./ Indigent Health $95.68M 14.90% Public Health $127.13M 19.79% Environmental Health $27.09M 4.22% Behavioral Health Care Services $392.40M 61.09%

HCSA FY 14/15 VBB By Department $ 642.30M*

*Includes Measure A appropriation = $28.68M

HCSA FY 14/15 Alameda Health System Contracts

FY 13/14 Final FY 14/15 Change from FY 13/14 Alcohol & Drugs $851,856 $881,117 $29,261 Community Health $11,075 $160,000 $148,925 Emergency Medical $5,671,383 $5,661,383 ($10,000) HIV/AIDS Services $389,083 $610,000 $220,917 Indigent Health $88,674,988 $34,040,728 ($54,634,260) Mental Health $35,101,573 $35,955,605 $854,032 Public Health Nursing $10,000 $25,500 $15,500 TOTAL $130,709,958 $77,334,333 ($53,375,625)

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Agency Admin./ Indigent Health $38.95M 7.44% Public Health $100.46M 19.18% Environmental Health $24.56M 4.69% Behavioral Health Care Services $359.73M 68.69%

HCSA FY 14/15 VBB

Summary of Revenue by Department $523.70M Revenue = 81.5% of Budget

Revenue covers  91.7% of BHCS Budget  40.7% of Admin/Indigent Budget  79.0% of PH Budget  90.7% of EH Budget

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Revenue Generated by HCSA Departments $523.70M 81.54% County General Fund $118.60M 18.46%

HCSA FY 14/15 VBB Total Budget = $642.30M General Fund = $118.60M Generated Revenue = $523.70M

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Agency Admin./ Indigent Health $56.74M 47.84% Public Health $26.66M 22.48% Environmental Health $2.53M 2.13% Behavioral Health Care Services $32.67M 27.54%

General Fund covers  8.32% of BHCS Budget  59.30% of Admin/Indigent Budget  20.98% of PH Budget  9.33% of EH Budget

HCSA FY 14/15 VBB

Summary of County General Fund by Dept $118.60M CGF = 18.5% of Budget

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Behavioral Health Care FY 14/15 VBB Summary* (in millions)

Final Approved FY 13/14 VBB FY 14/15 Change from FY 13/14 Budget Amount % Appropriation $385.46 $392.40 $6.94 1.80% Revenue $351.01 $359.73 $8.72 2.48% County General Fund $34.45 $32.67 ($1.78) (5.19%) Use of FMR $4.42 $4.13 ($.29) (6.67%) Continued County General Fund Support $30.03 $28.54 ($1.49) (4.97%) FTE-Mgmt 189.33 190.92 1.58 0.84% FTE-Non Mgmt 387.27 384.67 (2.60) (0.67%) Total FTE+ 576.6 575.59 (1.02) (0.18%)

* Includes Measure A appropriation & offsetting revenue = $7.52M + Does not include CBO, ACMC, TAP and other contracted FTEs

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Day Treatment $34.55M 8.8% Outreach Programs $8.54M 2.2% 24 Hour Services $73.72M 18.8% Support Services $13.86M 3.5% Prevention Services $14.17M 3.6% Administration $41.28M 10.5% Outpatient Services $183.65M 46.8% Referral Services $7.94M 2.0% Innovation $6.07M 1.5% Ancillary Programs $1.20 0.3% Narcotic Treatment Program $7.42 1.9%

*Includes $7.52M in Measure A appropriations

Behavioral Health Care FY 14/15 VBB

By Major Programmatic Spending Category $392.40M *

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Adult Services $225.82 57.5% Older Adult Services $11.43 2.9% Children's Services $143.80 36.6% Transitional Age Youth Services $11.34 2.9%

Behavioral Health FY 14/15 VBB By Population Served $ 392.40M *

*Includes $7.52M in Measure A appropriations

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The FY14-15 2011 Realignment budget is currently flat; there may be changes during the FY14-15 year which will be budgeted as an adjustment.

FY13-14 VBB Budget FY14-15 VBB Budget Variance

Women & Children’s Residential Treatment $687,665 $687,665 Drug Court $1,062,586 $1,062,586 Non Drug Medi-Cal Substance Abuse Treatment $281,694 $281,694 Drug Medi-Cal $6,013,339 $6,013,339 Healthy Families $417,514 $417,514 New Katie A $1,677,959 $1,677,959 EPSDT Base $37,911,718 $37,911,718 Mental Health Managed Care $5,001,628 $5,001,628

Total

$53,054,103 $53,054,103

Behavioral Health 2011 Realignment (aka Public Safety Realignment)

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Public Health FY 14/15 VBB Summary* (in millions)

Final Approved FY 13/14 VBB FY 14/15 Change from FY 13/14 Budget Amount % Appropriation $125.82 $127.13 $1.31 1.04% Revenue $99.17 $100.46 $1.29 1.30% County General Fund $26.65 $26.67 $.02 .08% Use of FMR $3.61 $3.37 ($.24) (6.65%) Continued County General Fund Support $23.04 $23.3 $.26 1.13% FTE-Mgmt 209.92 223.92 14.00 6.67% FTE-Non Mgmt 427.22 434.60 7.38 1.73% Total FTE+ 637.13 658.52 21.38 3.36%

* Includes Measure A appropriation & offsetting revenue = $4.09M + Does not include TAP and Contracted personnel of approximately 190.61 FTE

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Emergency Medical Services $31.22M 24.6% Family Health Services $37.04M 29.1% Community Health Services $19.45M 15.3% Communicable Disease Control & Prevention $22.61M 17.8% Public Health Nursing $7.57M 6.0% Administrative Services $6.63M 5.2% Office of Director $2.61M 2.1%

*Includes $4.09M in Measure A appropriations

Public Health FY 14/15 VBB

By Major Programmatic Spending Category $127.13M

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Administration/Indigent Health FY 14/15 VBB Summary* (in millions)

Final Approved FY 13/14 VBB FY 14/15 Change from FY 13/14 Budget Amount % Appropriation $146.01 $95.68 ($50.33) (34.47%) Revenue $98.65 $38.94 ($59.71) (60.53%) County General Fund $47.36 $56.74 $9.38 19.81% Use of FMR $6.69 $6.24 ($.45) (6.73%) Continued County General Fund Support $40.67 $50.50 $9.83 24.17% FTE-Mgmt 32.17 34.00 1.83 5.70% FTE-Non Mgmt 35.83 39.00 3.17 8.84% Total FTE+ 68.00 73.00 5.00 7.35%

* Includes Measure A appropriation & offsetting revenue = $17.07M. + Does not include TAP and Contracted personnel of approximately 463.93 FTEs.

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Indigent Health Services $62.72M 65.5% Cross- Dept./Cross- Jurisdictional Services $21.87M 22.9% Leadership, Administration & Finance** $11.09 11.6%

Administration/Indigent Health FY14/15 VBB

By Major Programmatic Spending Category $95,683,653*

* Includes Measure A appropriation = 17.07M; also includes Human Resources **Human Resources is included in Leadership, Finance & Administration

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HCSA 14/15

1991 Realignment

$55.6 $52.3 $52.3 $51.7 $49.4 $40.3 $9.7 $0 $10 $20 $30 $40 $50 $60 $70 FY08/09 FY09/10 FY10/11 FY11/12 FY12/13 FY13/14 FY14/15 Realignment Funding ($M)

1991 Realignment Funded Indigent Health (81%) and Non-Indigent Health (19%)

Non-Indigent Indigent

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Environmental Health FY 14/15 VBB Summary* (in millions)

Final Approved FY 13/14 VBB FY 14/15 Change from FY 13/14 Budget Amount % Appropriation $26.36 $27.09 $.73 2.77% Revenue $23.87 $24.56 $.69 2.89% County General Fund $2.49 $2.53 $.04 1.61% Use of FMR $.28 $.26 ($.02) (7.14%) Continued County General Fund Support $2.21 $2.27 $.06 2.71% FTE-Mgmt 29.00 30 1 3.45% FTE-Non Mgmt 125.56 124.56 (1) (.8%) Total FTE+ 154.56 154.56 0%

*Includes Vector Control Special District = $5.76M

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Environmental Health Services $18.04M 66.6% Vector Control $5.76M 21.3% Administration $3.01M 11.1% UC Cooperative Extension $0.28M 1.0%

Environmental Health FY 14/15

By Major Programmatic Spending Category $27.09M

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HCSA FY 14/15

Measure A Revenues & Appropriations Included in VBB Budget $28.68M

BOS Allocation $ .75M Admin/Indigent Health Services $16.32M Primary Care CBOs $5.62M Non County Hospitals $3.00M Youth and Family Service Hubs $2.49M School Based Health Centers $2.49M Fire Station Health Portals $.75M Juvenile Justice Medical Services $.50M Admin/Infrastructure Support $.40M Health Enrollment for Children $.30M Health Services – Day Labor $.26M Direct Medical Support (Oakland) $.21M Center for Elders Independence $.05M Fremont Aging & Family Services $.05M City of San Leandro Senior Services $.05M Center for Early Intervention on Deafness $.05M Alameda Boys & Girls Club $.10M

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HCSA FY 14/15 VBB Budget Summary

Measure A Revenues & Appropriations Included in VBB Budget $28.68M (continued)

Behavioral Health $7.521M BH AOD Providers $.229M Detox/Sober Station $2.040M Adult CJ Screening/In-Custody Services $4.306M Juvenile Justice Mental Health Costs $.360M Newcomers and Immigrants Mental Health Costs $.077M MOE Providers $.509M Public Health $4.089M PH Prevention Initiative $3.135M EMS Corps $.603M Alameda County Dental Health $.151M Alameda County Asthma Start $.100M Adult and Aging – SIPP $.100M

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HCSA FY 14/15 VBB Overview of HCSA Service Delivery System

HCSA works/contracts with a network of approximately 800 providers located in 1,200 sites throughout the county. HCSA serves approximately 222,000 patients (duplicated count) and provides in excess of 1.5 million visits and 425,000 inpatient, residential and day treatment services. Environmental Health provides direct service to over 70,000 households or businesses throughout the county. These services result in millions of pounds of chemical waste being properly disposed of, restaurants and food stores inspected for food safety, vector complaints evaluated and resolved, and businesses such as gas stations inspected to prevent environmental contamination.

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HCSA FY14/15 Health Care Environment

• Cost of health care continues to rise
• After 4 years of no COLA, the structural deficit facing our

provider network has increased. FY14/15 COLAs are insufficient to meet the growth in need.

• Critical to position the safety net to be viable in a post

reform economy

• Hospital viability
• Increased primary care and behavioral health

capacity to accommodate newly eligible, indigent, and residual uninsured

• Collaboration with SSA on eligibility & enrollment

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HCSA FY14/15 Major Initiatives

• Affordable Care Act Implementation
• Collaboration with other County

departments

• HCSA cross agency collaboration
• Hospital viability
• Efficiency, Quality & Revenue Initiatives

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HCSA FY14/15 Challenges

• Viability of safety net hospitals in a post reform

economy

• AHS cash flow due to $55M County funding

reduction

• Re-Envisioning the HCSA, AHS and AAH

partnership

• Impact of multi-year provider cuts not mitigated
• Leadership transitions and building the new

team

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Health Care Services Agency FY 14/15 Budget Presentation

Questions