County of Santa Clara Board of Supervisors Supervisorial District Four Supervisor Ken Yeager A. DATE: November 4, Ken Yeager, Supervisor

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1 County of Santa Clara Board of Supervisors Supervisorial District Four Supervisor Ken Yeager A DATE: November 4, 2014 TO: FROM: Board of Supervisors Ken Yeager, Supervisor SUBJECT: HHC Report from October 15, 2014 meeting RECOMMENDED ACTION Accept report from the Health and Hospital Committee relating to the meeting of October 15, (Yeager) REASONS FOR RECOMMENDATION: The Health and Hospital Committee met on October 15, Vice Chair Simitian was unable to attend, so the meeting lacked a quorum. Therefore, with the exception of verbal reports and minutes, all Committee items have been forwarded to full the Board of Supervisors for formal approval. The Committee forwarded items 4, 10, 12, 14, 17, and 18 with limited discussion. Item 16 was held until the November 12 th Committee meeting. Deputy County Executive René Santiago provided a Director s report for the Santa Clara Valley Health and Hospital System (SCVHHS). Mr. Santiago explained that the Social Services Agency (SSA) has worked through the state backlog of Medi-Cal applications for Santa Clara County, and recognized the exceptional effort made to achieve that goal. He announced the recent hiring of two new executive staff members: Behavioral Health Director Toni Tullys, who previously served as Deputy Director of Behavioral Health Care Services for Alameda County; and John Cookingham, who will be the new Chief Financial Officer (CFO) for Santa Clara Valley Medical Center (SCVMC). Mr. Cookingham served as CFO for Cook County s health system. Mr. Santiago also discussed Daughters of Charity Health System s announced proposal to sell their hospitals including O Connor Hospital in San Jose and St. Louise Regional Hospital in Gilroy to Prime Healthcare. He emphasized the conversion of these hospitals from a non-profit owner, with a mission to serve vulnerable populations, to a for-profit owner Board of Supervisors: Mike Wasserman, Cindy Chavez, Dave Cortese, Ken Yeager, S. Joseph Simitian Page 1 of 5

2 is of significant concern to the County. As such, this potential conversion will be monitored very closely. Chair Yeager asked what the timeline might be for the sale and how the Board would remain involved as the process evolves. County Executive Jeff Smith estimated that the State Attorney General's process to evaluate and determine whether to approve the sale and under what conditions would likely take six or seven months. He explained that a closed session report would be provided to the Board relating to the negotiations of the sale, with a subsequent report to the Board in open session at a date to be determined. Bob Brownstein, Chair of the Health Care Reform Implementation Stakeholders Working Group, reported on activities of the Working Group. He explained that members of the Outreach and Enrollment Subcommittee are developing plans to communicate with individuals who are enrolling in Covered California insurance plans about the importance of tracking any changes in their income throughout the year, since income changes can significantly impact the tax liability for families receiving premium assistance. For example, if a family s income rises above 400% of the federal poverty level for the calendar year, they would be at risk for having to repay all of the premium assistance paid on their behalf for that year. Mr. Brownstein also noted that the Group is currently preparing for the second year of open enrollment in Covered California, which launches on November 15 th. Chair Yeager and Mr. Santiago expressed interest in having the County work with community partners to potentially put together an outreach event or events to coincide with the launch. Paul Lorenz, CEO of Santa Clara Valley Medical Center (SCVMC), provided an operational and financial update related to SCVMC. SCVMC s financial performance continues to trend in a positive direction. Total revenue at SCVMC was favorable to budget by $11.1 million for the month of August. In September, billing production at SCVMC was $318 million, which continued a nine month trend of outperforming target levels. Mr. Lorenz also explained that total Accounts Receivable (AR) performance continues to improve. Total AR days has dropped to 76.6, SCVMC s lowest level in many years. Mr. Lorenz noted that traditional Medi-Cal enrollment declined by 4.3% in September, likely due to the timing of discontinuance letters being sent to Medi-Cal clients who did not submit redetermination packets. However, the Medi-Cal expansion population increased by 17.1%, or 4,943 lives, in September. Dr. Jeff Arnold, Chief Medical Officer and Trudy Johnson, Director of Nursing, gave a brief report on patient safety and quality, which indicated that SCVMC is performing above the state and national mean on numerous core measures of hospital quality. Ms. Johnson noted, however, that while substantial progress has been made reducing the median time until admission for Emergency Department patients, more work still needs to be done to reach the state average in that metric. SCVMC is performing comparably with other hospitals in the region, state and country in terms of mortality rates from complications of care. Dr. Arnold highlighted SCVMC s sepsis program, which has reduced the sepsis mortality rate from 16% when the program launched down to 7%. SCVMC is also performing well in terms of national patient safety goals and was recently recognized for nursing excellence in preventing hospital acquired pressure ulcers and falls with injury. Board of Supervisors: Mike Wasserman, Cindy Chavez, Dave Cortese, Ken Yeager, S. Joseph Simitian Page 2 of 5

3 Dr. Yvonne Karanas and Jill Sproul highlighted the work of SCVMC s Burn Center which was recently re-verified by the American Burn Association as a pediatric and adult burn center, indicating the highest quality of burn care. They provided an overview of the Burn Center s quality outcome measures, efforts to improve pain management, patient experience awards, and community outreach activities. Dr. Karanas also discussed the Burn Center s expansion plans and needs. She noted that an expansion to 14 beds, including 8 Burn Intensive Care Unit beds would best meet the Center s needs and would also allow for more space for therapy as well as patient families. Currently the Burn Center has 8 beds. Chair Yeager asked about the current process for when a patient comes in and all beds in the burn unit are being used. Dr. Karanas shared that this is common occurrence and explained and that the patient may be sent to one of the other intensive care units. The burn team currently will travel to different parts of the hospital to care for these patients. Chair Yeager asked when the Burn Center was hoping the expansion of additional beds would occur. Dr. Smith responded that, in the next budget cycle, County Administration will be recommending setting aside reserves for the burn unit so that SCVMC can move ahead and begin with the architectural evaluation process related to the expansion. Public Health Department staff then presented their recommendations relating to enforcement of the current restrictions in the County s tobacco retail permit ordinance that pertain to flavored tobacco. Public Health Director Dan Peddycord explained that these restrictions have been in place for nearly four years, but the Board of Supervisors deferred enforcement in 2011 in order to monitor the actions of the Food and Drug Administration and other jurisdictions implementing similar policies; clarify the definition of flavored tobacco products; and develop an implementation plan for enforcement. Bonnie Broderick, Senior Health Care Program Manager, outlined the Department s recommended implementation plan including the proposed definition of flavored tobacco products. She noted that, following Board action, retailers would have 90 days to come under compliance and that restrictions on the sale of flavored tobacco products would not be enforced at adult-only tobacco stores, as the intent of the ordinance is to restrict the sale of such products to youth. The Committee received comments from five members of the public who expressed concern relating to youth marketing of flavored tobacco, noted differences among traditional tobacco products and electronic cigarettes, and requested that restrictions relating to flavored tobacco not be applied to electronic cigarettes. At the request of Chair Yeager, Mr. Peddycord clarified that the implementation plan does not apply to electronic cigarettes. The Committee then forwarded the Department s report and recommendation to the full Board of Supervisors for likely consideration at the November 4 th Board meeting. Dr. Sara Cody, Health Officer, provided a verbal update on County preparations to prevent the spread of the Ebola virus. Dr. Cody first emphasized that there is no Ebola currently in Santa Clara County and the risk to local residents is low. However, in the unlikely event that someone sick with the virus comes to Santa Clara County, the Public Health Department and SCVHHS have been preparing to ensure all necessary protections are in place. Dr. Cody highlighted that the County has formalized an Ebola Steering Committee which is overseeing Board of Supervisors: Mike Wasserman, Cindy Chavez, Dave Cortese, Ken Yeager, S. Joseph Simitian Page 3 of 5

4 the efforts of eight different work groups focused on hospital preparedness, public information and risk communications, planning for surveillance, contact tracing, preparing the EMS system, preparing the public health laboratory, and a response group addressing issues like infectious waste and safe quarantining. Mr. Lorenz and Dr. Arnold then provided an overview of the steps SCVMC has taken related to virus preparation and prevention. Some of these key activities include screening in the Emergency Department; screening in the community clinics; identifying appropriate facilities for placement of patients with risk factors; ensuring appropriate protective equipment is available; and training hospital staff how to identify, isolate, and report any suspect cases. An extensive discussion ensued, the content of which was largely covered in the discussion at the Oct. 21 st Board of Supervisors meeting. The Committee then heard a presentation and status update on the Health Element of the Santa Clara County General Plan. Bill Shoe, Principal Planner from the Department of Planning and Development, provided an overview of the Health Element project history, major milestones, guiding principles, major themes, and the collaborative effort undertaken to develop the draft. Mr. Shoe explained that the Health Element is intended not only to be valuable for Santa Clara County but to also to serve as a model for cities. At the time of this meeting, the public draft Health Element was slated to be reviewed by the Planning Commission at their meetings in late October and late November, with the goal of bringing the document to the full Board of Supervisors for adoption in December Chair Yeager expressed his appreciation for the breadth and depth of the Health Element and noted his strong interest in ensuring the energy and thought that went into its creation can have an ongoing impact. He asked whether there were plans to make presentations before the City Councils, or what strategies were envisioned to engage school districts, key non-profit organizations, and others to disseminate and advance discussion around the issues raised in the document. Mr. Shoe suggested he could engage key city officials through the Santa Clara County Association of Planning Officials and that the County would be disseminating the document itself widely. Chair Yeager requested that staff provide some initial thoughts on the implementation timeline and strategy when the Health Element returns to the Board in December, and also to return to the Health and Hospital Committee next year to report back on implementation. Patricia Cox, CEO of Valley Health Plan (VHP) provided a brief report on VHP operations and progress. Ms. Cox observed that 2014 has been a major growth year for VHP. Since the implementation of the Affordable Care Act in January, VHP s enrollment including both the commercial population and delegated Medi-Cal population has increased by more than 30%. VHP plans to return to the Committee in December with a more detailed financial and utilization report for the Covered California population. Ms. Cox also shared that VHP s recently launched care management program for VHP members with significant health risks has generated participation from 11% of targeted patients thus far. The meeting concluded with a discussion of pending Board items. Mr. Peddycord commended Public Health Department staff as well as grant writer Jean McCorquodale for Board of Supervisors: Mike Wasserman, Cindy Chavez, Dave Cortese, Ken Yeager, S. Joseph Simitian Page 4 of 5

5 successfully securing the highly competitive Partnership to Improve Community Health (PICH) grant from the Centers for Disease Control and Prevention. The grant will provide $1.9 million in first year funding, and likely $5.7 million in total funding, for chronic disease prevention activities. At the suggestion of Chair Yeager, Mr. Peddycord offered to provide a future presentation on the work funded by the PICH grant to the Committee at a date to be determined. LINKS: Linked To: : ATTACHMENTS: HHC Agenda (PDF) Board of Supervisors: Mike Wasserman, Cindy Chavez, Dave Cortese, Ken Yeager, S. Joseph Simitian Page 5 of 5