County of Santa Clara Health & Hospital Committee Supervisor Liz Kniss, Chairperson. Supervisor Ken Yeager, Vice Chair.

Transcription

1 Committee Agenda Health & Hospital Committee, County of Santa Clara March 21, 2011 County of Santa Clara Health & Hospital Committee Supervisor Liz Kniss, Chairperson Supervisor Ken Yeager, Vice Chair County Government Center - 70 West Hedding Street San Jose, California Phone (408) Fax (408) DATE: March 21, 2011 TIME: 2:30 PM PLACE: Board of Supervisors' Chambers, First Floor, 70 West Hedding Street Notice to the Public - Meeting Procedures -- The recommended actions appearing on the agenda are those recommended by staff The Committee may take other actions relating to the issues as may be determined following consideration of the matter and discussion of the recommended actions -- Persons wishing to address the Committee on any item on the agenda are requested to complete a request to speak form and give it to the Deputy Clerk so the Chairperson can call on you when the item comes up for discussion -- In compliance with the Americans with Disabilities Act, those requiring accommodations in this meeting should notify the Clerk of the Board's Office 24 hours prior to the meeting at (408) , or TDD (408) To obtain a copy of any supporting document that is available, contact the Office of the Clerk of the Board at (408) Any disclosable public records related to an open session item on a regular meeting agenda and distributed by the County to all or a majority of the Board of Supervisors (or any other commission, or board or committee) less than 72 hours prior to that meeting are available for public inspection at the Office of the Clerk of the Board, 70 West Hedding Street, 10th Floor, during normal business hours -- A quorum of the Board of Supervisors may be present to discuss items listed on the agenda COMMUTE ALTERNATIVES: The Board of Supervisors encourages the use of commute alternatives including bicycles, carpooling, and hybrid vehicles 1

2 Committee Agenda Health & Hospital Committee, County of Santa Clara March 21, 2011 Public transit access is available to and from the County Government Center, 70 West Hedding St, San Jose, California by VTA bus lines *61, 62, 66, 181 and Light Rail (*61 Southbound last trip is at 8:55 pm for this location) For trip planning information, contact the VTA Customer Service Department at Monday through Friday between the hours of 6:00 am to 7:00 pm, and on Saturday from 7:30 am to 4:00 pm Schedule information is also available on the web at wwwvtaorg Bicycle parking racks are available in the James McEntee, Sr, Plaza in front of the County Government Center building 1 Welcome and Introductions 2 Public Comment (This portion of the meeting is reserved for persons desiring to address the Health and Hospital Committee on a Committee-related matter not on the agenda Speakers are limited to one minute If you wish to address the Committee, please complete a Request to Speak form and place it in the container at the front of the room The law does not permit Committee action or extended discussion on any items not on the agenda except under special circumstances If Committee action is requested, the matter can be placed on the next agenda All statements that require a response will be referred to staff for a reply in writing) 3 Approve Consent Calendar and changes to the Health and Hospital Committee Agenda (Items listed on the consent calendar may be voted on in one motion at the beginning of the meeting If you wish to discuss any of these items, please request that the item be removed from the consent calendar by completing a Request to Speak form and placing it in the container at the front of the room) * 4 Approve Minutes of February 9, Review Pending Board Items * 6 Approve Policies and Procedures 7 Accept report from Medical Staff Office on Medical Staff a Approve Credentials b Review Patient Care and Medical Staff Issues 8 Review General Fund and Enterprise Fund reports for January Accept report from Santa Clara Valley Medical Center on Security Services (Held from February 9, 2011 Health and Hospital Committee meeting, Item No 14) 2

3 Committee Agenda Health & Hospital Committee, County of Santa Clara March 21, Consider recommendations from Valley Health Plan on the current Santa Clara County Employee Wellness Program (Referral from December 8, 2010 Health and Hospital Committee meeting, Item No 8) 11 Consider recommendations from Valley Health Plan on a Request for Proposals for a Pharmacy Benefit Management Company 12 Accept quarterly report from Alvarez & Marsal on initiatives relating to Santa Clara Valley Health and Hospital System and Santa Clara Valley Medical Center 13 Accept report from Santa Clara Valley Medical Center on Hospital Consumer Assessment of Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS ) 14 Accept report on various clinical trials taking place in association with the Santa Clara Valley Health and Hospital System 15 Accept quarterly report from the Mental Health Department on the status of the Mental Health Services Act (MHSA) * 16 Accept monthly report on healthcare reform * 17 Accept final adult healthcare coverage report from Valley Health Plan on adult health coverage for the uninsured, including the Coverage Initiative (Valley Care), a Federally-subsidized program * 18 Accept semi-annual report from Valley Medical Center on implementation of the Valley Homeless Healthcare Program * 19 Accept report from the Santa Clara Valley Health and Hospital System on the Compliance and Privacy Program * 20 Accept report from Santa Clara Valley Medical Center on pharmacist protocol authorization 21 Accept verbal report from Santa Clara County Public Health Officer 22 Announce next meeting of the Health and Hospital Committee scheduled on Wednesday, April 13, 2011, at 2:30 pm, in the Board of Supervisors' Chambers, First Floor, County Government Center 3

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5 Committee Agenda Date: March 21, 2011 Agenda Item No1 System Generated Transmittal SANTA CLARA COUNTY Board Date : March 21, 2011 Transmittal ID : Agenda Item Details 1 Welcome and Introductions Board of Supervisors: Mike Wasserman, George Shirakawa, Dave Cortese, Ken Yeager, Liz Kniss County Executive: Jeffrey V Smith

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7 Committee Agenda Date: March 21, 2011 Agenda Item No2 System Generated Transmittal SANTA CLARA COUNTY Board Date : March 21, 2011 Transmittal ID : Agenda Item Details 2 Public Comment (This portion of the meeting is reserved for persons desiring to address the Health and Hospital Committee on a Committee-related matter not on the agenda Speakers are limited to one minute If you wish to address the Committee, please complete a Request to Speak form and place it in the container at the front of the room The law does not permit Committee action or extended discussion on any items not on the agenda except under special circumstances If Committee action is requested, the matter can be placed on the next agenda All statements that require a response will be referred to staff for a reply in writing) Board of Supervisors: Mike Wasserman, George Shirakawa, Dave Cortese, Ken Yeager, Liz Kniss County Executive: Jeffrey V Smith

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9 Committee Agenda Date: March 21, 2011 Agenda Item No3 System Generated Transmittal SANTA CLARA COUNTY Board Date : March 21, 2011 Transmittal ID : Agenda Item Details 3 Approve Consent Calendar and changes to the Health and Hospital Committee Agenda (Items listed on the consent calendar may be voted on in one motion at the beginning of the meeting If you wish to discuss any of these items, please request that the item be removed from the consent calendar by completing a Request to Speak form and placing it in the container at the front of the room) Board of Supervisors: Mike Wasserman, George Shirakawa, Dave Cortese, Ken Yeager, Liz Kniss County Executive: Jeffrey V Smith

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11 Committee Agenda Date: March 21, 2011 Agenda Item No4 System Generated Transmittal SANTA CLARA COUNTY Board Date : March 21, 2011 Transmittal ID : Agenda Item Details 4 Approve Minutes of February 9, 2011 Board of Supervisors: Mike Wasserman, George Shirakawa, Dave Cortese, Ken Yeager, Liz Kniss County Executive: Jeffrey V Smith

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13 County of Santa Clara Health & Hospital Committee Supervisor Liz Kniss, Chairperson Supervisor Ken Yeager, Vice Chair County Government Center - 70 West Hedding Street San Jose, California Phone (408) Fax (408) DATE: February 9, 2011 TIME: PLACE: 2:30 PM Board Chambers Meeting Minutes 1 Welcome and Introductions The regular meeting of the Health and Hospital Committee (HHC) convened at 2:36 pm, with Chairperson Liz Kniss and Vice Chairperson Ken Yeager present Chairperson Kniss introduced Linda Smith as Chief Executive Officer, Santa Clara Valley Medical Center (VMC) 2 Public Comment There were no public comments 3 Approved Consent Calendar and changes to the Health and Hospital Committee Agenda, adding Item No 16 to the Consent Calendar at the request of Vice Chairperson Yeager (Items with an asterisk [*] in front of the number were on the Consent Calendar and were voted on in one motion at the beginning of the meeting) The Consent Calendar was approved on Committee consensus 1

14 Health & Hospital Committee Minutes February 9, 2011 * 4 Approved minutes of January 12, Reviewed Pending Board Items Vice Chairperson Yeager highlighted the Pending Board Item relating to the selection of an integrated revenue cycle management technology solution for the Santa Clara Valley Health and Hospital System (SCVHHS) Vice Chairperson Yeager directed Administration to collaborate with the Management Audit Division, Harvey M Rose Associates, LLC, to participate and evaluate the results of the Accretive Health, Inc contract, audit the compensation structure on a regular basis, and provide periodic updates on the findings to both the Board of Supervisors and Administration Pending Board Items were reviewed and accepted on Committee consensus * 6 Approved Policies and Procedures 7 Accepted report from Medical Staff Office on Medical Staff on Committee consensus a Approved Credentials on Committee consensus b Reviewed Patient Care and Medical Staff Issues Alfonso Banuelos, MD, Chief Medical Officer, VMC, described research relating to stem cell treatment for spinal cord injuries and a collaboration between VMC and Berkeley Bionics to assist paraplegic patients 8 Reviewed General Fund and Enterprise Fund reports for December 2010 At the request of Chairperson Kniss, Paul Estess, Acting Director, Ambulatory and Managed Care, SCVMC, indicated that staff will provide information at the March 21, 2011 HHC meeting relating to increasing mental health clinic visits, an update on the electronic medical record project, details relating to expanded evening hours to absorb patient volume in urgent care, and budget goals for Fiscal Year (FY)

15 Health & Hospital Committee Minutes February 9, 2011 In response to an inquiry by Chairperson Kniss, Mr Estess indicated that staff will provide an off-agenda report on date uncertain clarifying data regarding ambulatory access and performance 9 Accepted monthly report from SCVHHS on Health Care Reform Chairperson Kniss recommended that the monthly report on Health Care Reform and the update on Coverage Expansion under the Medicaid 1115 Waiver remain as individual reports, rather than incorporated as proposed by staff, and clarified that issues related to the waiver may be included in Health Care Reform reports Chairperson Kniss advised staff to continue to monitor Public Health Prevention Fund (PHPF) grant opportunities and announced that she will travel to Washington, DC, to attend the National Association of Counties (NACo) Health Steering Committee Fly-In meeting on February 14-16, 2011 The report was accepted on Committee consensus 10 Accepted update from SCVHHS on Coverage Expansion under the Medicaid 1115 Waiver Sylvia Gallegos, Deputy County Executive, Office of the County Executive, and Acting Director, SCVHHS, indicated that the SCVHHS FY 2012 budget plan will be presented to the HHC on March 21, 2011 Ms Gallegos and Mr Estess highlighted infrastructure development and proposals to rebalance the SCVHHS portfolio Nancy Kaatz, Chief Financial Officer, SCVHHS, provided an overview of requirements for the County to receive funding under the new waiver, and Ms Gallegos stated that additional details will be presented to the HHC on March 21, 2011 Chairperson Kniss 3

16 Health & Hospital Committee Minutes February 9, 2011 requested Administration oversight and leadership relating to monitoring waiver system changes and performance measurements The update was accepted on Committee consensus 11 Accepted update regarding Procurement Process Pilot Project at SCVHHS Jenti Vandertuig, Director, Procurement Department, provided an overview of the Procurement Process Pilot Project and in response, Vice Chairperson Yeager spoke of the importance of establishing an atmosphere where employees who manage contracts are comfortable asking questions regarding procurement and contract issues The update was accepted on Committee consensus 12 Accepted report related to contracting processes at VMC Hospital and Clinics Michael Lipman, Acting Director, Planning, Contracting, and Business Development, SCVHHS, provided a PowerPoint presentation relating to streamlining contract processes at VMC The report was accepted on Committee consensus 13 Accepted update from Planning Department on the County General Plan to include Noise, Health and Wellness, and Safety Chairperson Kniss and Vice Chairperson Yeager commented regarding the importance of inclusive development of the County General Plan, including collaboration among the Public Health Department, the Department of Parks and Recreation, the Roads and Airports Department, the Department of Agriculture, and the Department of Environmental Health Vice Chairperson Yeager directed staff to collaborate with key liaisons from outside agencies and General Plan jurisdictions within each city in the County Chairperson Kniss spoke of the importance of applying innovation, such as Geographic Information System 4

17 Health & Hospital Committee Minutes February 9, 2011 (GIS) technologies and mapping scenarios, and requested an inspirational plan that promotes public health and the County as a healthy community The update was accepted on Committee consensus 14 Held to the March 21, 2011 HHC meeting, at the request of Chairperson Kniss: Accept report from Santa Clara Valley Medical Center on Security Services (Referral from August 24, 2010 Board of Supervisors meeting, Item No 17) * 15 Accepted monthly report from Santa Clara Family Health Plan on Healthy Kids Program * 16 Accepted bi-monthly report from Mental Health Department on 24-Hour Care Program Ann Stewart, Service Employees' International Union, Local 521, speaking on behalf of Joseph Tansek, Marriage and Family Therapist, SCVHHS, expressed support for expansion of suicide and crisis services within the Mental Health Department's 24-Hour Care System and spoke of the importance of improving patient care * 17 Accepted report from Valley Health Plan a Accepted Enrollment Report b Accepted Consumer Issues/Advisory Committee Report * 18 Accepted semi-annual update report from Santa Clara Valley Medical Center on VMC Foundation * 19 Accepted semi-annual report from Santa Clara Valley Medical Center on VMC hospital and clinic quality and patient safety 5

18 Health & Hospital Committee Minutes February 9, There was no report from Santa Clara County Public Health Officer 21 Accepted verbal report from Santa Clara Valley Health and Hospital System-Chief Executive Officer Ms Smith expressed appreciation to staff and spoke of the importance of quality and patient satisfaction 22 Announced next meeting of the Health and Hospital Committee scheduled on Monday, March 21, 2011, at 2:30 pm, in the Board of Supervisors' Chambers, First Floor, County Government Center 23 Recessed to Closed Session at 4:21 pm to Consider the Following Items: a Significant Exposure to Litigation (Government Code Section (b)): The Committee met in Closed Session to confer with Legal Counsel regarding three items of significant exposure to litigation 24 Reconvened at 4:41 pm into Open Session for Closed Session Report Orry Korb, Assistant County Counsel, Office of the County Counsel, announced that no reportable actions were taken in Closed Session 25 Adjourned meeting On order of the Chairperson, the meeting was adjourned at 4:42 pm Respectfully submitted, Colin Kutch Deputy Clerk of the Board 6

19 Health & Hospital Committee Minutes February 9,

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21 Committee Agenda Date: March 21, 2011 Agenda Item No5 System Generated Transmittal SANTA CLARA COUNTY Board Date : March 21, 2011 Transmittal ID : Agenda Item Details 5 Review Pending Board Items Board of Supervisors: Mike Wasserman, George Shirakawa, Dave Cortese, Ken Yeager, Liz Kniss County Executive: Jeffrey V Smith

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23 Health and Hospital Committee March 21, 2011 Pending Board Items Department of Public Health 1 HIV/AIDS Approve Request for Appropriation Modification transferring $36,669 within the Public Health Department budget There is no impact on the General Fund In order to maximize the effectiveness of the limited funding and resources for sexually transmitted disease (STD) services, the Public Health Department realigned responsibility for its STD programs from Communicable Disease Prevention and Control to HIV/AIDS Prevention and Control These programs include the STD Community Intervention Program (SCIP), Chlamydia Screening Program (ClaSP) and STD Disease Intervention and Surveillance (DIS) The appropriation modification will realign the County budget to recognize the transfer of SCIP, ClaSP and DIS program services and staff to HIV/AIDS Prevention and Control As the goal of STD programming is to facilitate, develop and enhance local capacity for the prevention, awareness and control of STDs through a process of community and health department collaborations, they often share a common approach and serve a similar high-risk population as the HIV programming This transition in disease prevention and control program responsibilities is consistent with a national trend to co-locate HIV and other STD programming within the same program unit 2 PH Preparedness - Approve Request for Appropriation Modification transferring funds in the Public Health trust fund budgets There is no impact on the General Fund Funds for Public Health Preparedness awards are first deposited into appropriate Public Health Preparedness trust funds, and, as expenditures are approved, they are drawn down into the Public Health Preparedness program for expenditure The recommended appropriation modification will address three issues: (1) increase disbursements needed from the PH Preparedness trust fund for the remainder of FY11 PH Preparedness grant activities; (2) reconcile receipts to the PH Preparedness Trust Fund incorrectly allocated to the wrong funding source; and (3) realign budgeted funds for staff allocated for this grant activity 3 PH Laboratory - Possible action: (a) Approve Agreement with Association of Public Health Laboratories relating to providing Measles IgM Serology Enzyme Immunoassays Comparison Study in an amount not to exceed $40,000 for period April 1, 2011 through June 30, 2011; and (b) Approve Request for Appropriation Modification increasing revenue and expenditures in the Public Health Department budget There is no impact on the General Fund The Public Health Laboratory, in conjunction with the Association of Public Health Laboratories (APHL), will participate in evaluating Measles (Me) IgM EIA kits Although Me IgM testing is not currently a test commonly performed in local (county or city) public health laboratories, with the frequency of international travel and unknown immunity status of individuals (due to increased numbers of unvaccinated children as well as possible vaccine failure), it is becoming increasing important to test a symptomatic person for Me IgM The PH Laboratory will run/test Me IgM EIA kits by six different manufacturers Each kit will be tested using a panel of specimens provided by APHL and the Centers for Disease Control and Prevention for Measles IgM antibody Each specimen will be tested twice to determine the Page 1 of 8

24 Health and Hospital Committee March 21, 2011 Pending Board Items precision of the assay The goal of this study is to be able to provide public health laboratories with information specific to the attributes of each of the six kits being tested Public health laboratories - it is presumed - will be able to better determine which kit will most appropriately meet their specific needs Funding for participation in this study is coming from APHL Approximately $20K will be allocated for the cost of the test kits and related ancillary supplies (microtiter plates, tips, pipettes, etc) and approximately $20K will be allocated for costs related to directing and staffing the study 4 EMS Agency - Adopt Resolution delegating signature authority to Public Health Director, or designee, to negotiate, execute, amend, terminate, and take any and all necessary or advisable actions relating to contracts and contract amendments with fire departments (cities and districts) authorizing operation in the Santa Clara County Exclusive Operating Area for EMS response to 911 calls for period July 1, 2011 through July 1, 2016, following approval by County Counsel as to form and legality, and approval by the Office of the County Executive Delegation of authority shall expire on July 1, 2016 There is no impact on the General Fund Participating fire departments/districts are eligible for up to $5M (total amount available for all departments combined) in First Responder Funding from the County contracted 911 ambulance service provider (Rural/Metro) upon meeting various performance standards determined and monitored by the EMS Agency Excluding the City of Palo Alto and NASA/AMES, all fire departments that operate within the Santa Clara County Exclusive Operating Area are eligible for funding provided by Rural/Metro Section of the Health and Safety Code states that the local EMS agency shall plan, implement, and evaluate an emergency medical services system, in accordance with the provisions of this part, consisting of an organized pattern of readiness and response services based on public and private agreements and operational procedures The written agreement specifies the scope of services to be provided by the fire department provider and County, and authorizes the fire department provider to utilize paramedics to deliver those services as part of an integrated Countywide EMS System Delegation of signature authority to the Director of Public Health is being requested for these agreements due to the complexity of negotiating one set of performance standards and associated penalties (liquidated damages) that are acceptable to both the EMS Agency and all municipal fire Departments and Districts which participate in the First Responder Fund In addition, knowing that each of the various municipal and district fire departments have different time lines and processes for endorsing such agreements, delegation of signature authority provides PHD/EMS Agency with the ability to finalize contracts as they are completed Department of Alcohol & Drug Services 5 Adult Outpatient - Approve Request for Appropriation Modification - $10,938 increasing revenue and expenditures in the Department of Alcohol and Drug Services budget for the adult outpatient agreement with Gardner Family Care Corporation There is no General Fund impact Page 2 of 8

25 Health and Hospital Committee March 21, 2011 Pending Board Items The budget modification is to recognize the increase in Drug Medi-Cal (DMC) revenue and appropriate matching expenditures for the adult outpatient agreement with Gardner Family Care Corporation (GFCC) Drug Medi-Cal reimbursement is being implemented for the contractors that provide adult outpatient treatment services GFCC's Proyecto Primavera program is the second of five DADS contract providers to begin billing for these services 6 California Emergency Management Agency (CalEMA) Grant Possible action: a) Approve Request for Appropriation Modification - $42,041 increasing revenue and expenditures in the Department of Alcohol and Drug Services budget b) Accept spending plan for the California Emergency Management Agency (CalEMA) grant c) Approve agreements with (vendors TBD) to provide residential treatment and transitional housing in an amount not to exceed $504,492 for period June 1, 2011 through May 31, 2012 There is no General Fund impact as a result of this recommended action The Department of Alcohol & Drug Services is the lead agency for the CalEMA-CDCI grant and will be responsible for providing residential treatment services, transitional housing units, tracking expenditures and meeting the grantor s performance measures The grant award for CalEMA-CDCI over the oneyear term, January 1, 2011 December 31, 2011, of the project is $504,492 The appropriation modification recognizes $42,041 in the Department of Alcohol & Drug Services budget for FY 2011 and $462,451 will be budgeted in FY 2012 There are no matching requirements for this grant from CalEMA 7 Provision of Substance Abuse Services - Approve agreements with (vendors will be known by the 5/24/11 BOS meeting) to provide substance abuse treatment services in an amount not to exceed $2,772,496 for period June 1, 2011 through June 30, 2012 There is no impact on the General Fund as a result of this action Funds are budgeted in the FY11 budget and will be budgeted in the FY 12 Department of Alcohol and Drug Services (DADS) budget Alcohol Recovery Homes, Inc (ARH) has indicated they will not continue to provide services beyond June 30, 2011 The DADS has decided to go out to bid for these services and will commence program services starting June 1, 2011 Starting the contract on June 1 will allow the new provider to hire and train staff while ARH is still on contract There are sufficient contract savings in ARH s FY11 contract budget to cover the one-month overlap of services Santa Clara Valley Medical Center 8 Non-emergency Medical Transport - Approve amendment to Agreement with American Medical Response West (AMR) for Non-emergency Medical Transport services to SCVHHS departments, extending the term from April 30, 2011 through December 31, 2011 There is no impact on the General Fund as a result of this action Funds are available in the FY11 budget and will be included in the FY12 proposed budget to cover these services Year to date costs for FY11 are under the budgeted $2,100,000 and estimated costs for FY12 are expected to be within $1,300,000 for the period July through December 2011 Approval of the recommended action will allow for the non-emergency transport services to Page 3 of 8

26 Health and Hospital Committee March 21, 2011 Pending Board Items continue while the Request for Proposal (RFP) process is completed The current agreement with AMR expires on April 30, 2011 Due to the critical nature of the services provided, it is important to ensure that sufficient time is allocated to complete the RPF process and select the appropriate vendor Interruption in or discontinuation of this service will negatively impact the daily operations of many SCVHHS facilities, including SCVMC, Mental Health, Children s Shelter and Custody Health Services, Acute Psychiatry, and Valley Health Plan that depend on this service to transport their patients Given the large number of departments that use these services and possibly other departments that will use these services in future, discussions and meetings have been convened with the various stakeholders to ensure the scope of services in the RFP meets the unique needs of each department Assessments of current and projected volume as well as additional service areas have been completed and the RFP is currently being developed It is expected that the RFP will be released in March 2011 with a final contract to be awarded no later than December 2011 Hence, an extension of the current contract through December 31, 2011 is being requested AMR currently provides transport services to acute psychiatric, Custody, and SCVMC patients Mental Health and Acute Psychiatry departments utilize this service for inter-facility transport Custody Health Services use these services to transport clients to/from the hospital and jail SCVMC needs this service for transport of patients from clinics and other facilities to SCVMC and from SCVMC to other facilities Neonatal Intensive Care Unit (NICU) also uses this service for the specialized transport of newborns and babies Additionally, Valley Health Plan uses these transport services for its members for non-emergency transport It is important to note that this agreement covers non-emergency medical transport services and is therefore different from the 911 contract the County has with Rural/Metro Corporation 9 SCVMC - Approve Business Associate Agreement with American Society of Clinical Oncology, Inc and Outcome Sciences, Inc for the data collection and management of quality improvement data and information There will be no impact on the General Fund as a result of this action There is no cost associated with this agreement The SCVMC Department of Oncology consistently provides high quality care to cancer patients American Society of Clinical Oncology s Quality Oncology Practice Initiative (QOPI) promotes excellence in cancer care by helping oncologists engage in practice-based quality improvement activities through monitoring quality measures in their daily practice The QOPI process involves limited chart data abstraction of patient-related information via a secure internet data collection tool under an agreement compliant with HIPAA data use Following every data collection period, the QOPI system will generate a report to compare the Department s results to the aggregate data of all other hospital participants Practice-specific data will be kept confidential The participation in this data collection process and reporting requires the County to execute a Business Associate Agreement with American Society of Clinical Oncology, Inc and Outcome Sciences, Inc The Business Associate Agreement (BAA) was developed by the American Society of Clinical Oncology (ASCO) As such, ASCO has expressed to the County that they will not make any Page 4 of 8

27 Health and Hospital Committee March 21, 2011 Pending Board Items modifications to their standard BAA ASCO s BAA does not contain language that is consistent with the County s standard contract provisions The provisions not included in the agreement are specific contract terms, indemnification, insurance, and budget contingency Additionally, the agreement requires an online signature on behalf of the County in that by clicking the I agree button at the end of the BAA, it is understood that the County agrees to the terms of the BAA 10 Facilities - Infrastructure Cabling for SCVMC Bed Building I Possible action: a) Accept Contract Documents and Authorization to solicit Bids for the Communications Infrastructure Cabling for SCVMC Bed Building I b) Approve the Project, adopt the plans and specifications, and authorize advertisement of Contract Documents for the Communications Infrastructure Cabling for SCVMC Bed Building I (Project No ) There is no General Fund impact as a result of this project Funds are available in the Seismic Safety Program (SSP) budget within the SCVMC Capital budget The construction estimate is $4,900,000 Approval of the recommended actions will allow for the necessary construction and installation of the communication infrastructure and network cabling (voice, data and fiber) for SCVMC Bed Building I Bed Building I, currently under construction, will be 368,000 square feet It will be ready to receive the telephone/data cabling effort in the Fall of 2011 The contract documents are complete and ready for Bid Bids will be received and opened on May 5, 2011 or on a date stipulated in any further addenda by SCVHHS Facilities The timing of this process is necessary to initiate at this point to avoid unnecessary delays or the added expense of working under more adverse conditions later 11 Facilities - Approve eleventh amendment of the Professional Services Contract with Cuschieri Horton Architects for architectural engineering services for the Seismic Safety Project, increasing the maximum compensation limit by $3,300,000 from $5,610,000 to $8,910,000, following approval by County Counsel as to form and legality, and approval by the Office of the County Executive The end date of the agreement remains at June 30, 2015 Funding for this contract amendment, which covers completion of the Old Main West section of the building, will be supported by Seismic Safety Project (SSP) funds within the SCVMC Capital Budget There is no impact to the General Fund In April 2000, the Board of Supervisors approved a Professional Service Contract with Cuschieri Horton Architects (CHA) for architectural engineering services related to various types of projects, including seismic retrofit of the Ancillary Building The agreement was amended to extend the term of the agreement and increase the maximum compensation The Tenth Amendment was approved by the Board on March 23, 2010 In 2008, SCVHHS Facilities contacted the three architectural engineering services firms already under contract (CHA, SmithGroup and Anshen+Allen), familiar with the campus and the complexity of building systems associated with the Ancillary and Old Main buildings, and able Page 5 of 8

28 Health and Hospital Committee March 21, 2011 Pending Board Items to perform the work and meet the Seismic Safety Project requirements of SB 1953 and SB 1661 in a timely manner Of these, only CHA had the staff available to respond to the Office of Statewide Health Planning and Development (OSHPD) schedule requirements Therefore CHA was selected as the architect of record for the Old Main West/East partial demolition and seismic upgrade project OSHPD required receipt of a Building Permit by the end of December 2010 with plans to be under construction during 2011 in order to qualify to request a two year construction extension (if necessary) for the Old Main Demo and Seismic Upgrade project, and completion of the project by end of year 2014 On December 23, 2010, Cuschieri Horton Architects obtained the necessary Building Permit for the "Demolition of Hazardous Materials from Old Main West" and the extension option will allow continuation of the use of the Old Main and Ancillary facilities for inpatient care functions Cuschieri Horton Architects has also resubmitted response documents to OSHPD comments in two parts to expedite review, Volume 1 (architectural, mechanical, electrical, plumbing) and Volume 2 (structural) which includes support of the Ancillary Building OSHPD review and comments on the sophisticated structural design model developed by the Structural Engineer of Record required more preparation and interaction with OSHPD than anticipated The 11th Amendment will fund additional requests in the final phase of the OSHPD approval process which includes non-linear analysis, pounding analysis, material testing program, retaining wall on the north side of the Rehabilitation Building link, and other OSHPD Deferred Approvals associated projects such as fire sprinklers, elevators, windows, and roof mechanical platform and stairs The Amendment will also fund additional Construction Administration requirements due to the construction extension of a complex phased construction project in the middle of the SCVMC campus existing facilities To provide continuity of design, it is critical to maintain the Architect of Record and key Engineers of Record to complete the work and meet the deadlines 12 Hospital Administration SleepMed of California Approve Agreement with SleepMed of California for adult sleep studies in an amount not to exceed $165,000 for the period July 1, 2010 through June 30, 2011 There will be no impact to the General Fund as a result of this action Funds to support this action are included in the FY 2011 Santa Clara Valley Medical Center (SCVMC) budget SCVMC has contracted for adult sleep study services since November 1995 with Home Sleep Diagnostics (HSD) and later with SleepMed of California (SMC), which acquired HSD in May 2001 The latest agreement with SleepMed of California expired on June 30, 2010 with a contract amount of $165,000 per year Since July 2005, SleepMed of California technologists have conducted an average of 451 studies per year on the SCVMC campus Approximately 200 of these studies are for patients where SCVMC has legal financial responsibility for their care An off-site facility such as Page 6 of 8

29 Health and Hospital Committee March 21, 2011 Pending Board Items Stanford charges $6,610 per study or $13,200 to conduct two sleep studies per night compared to the $600 fee in the expired contract Furthermore, the current arrangement gives SCVMC more control over scheduling that allows the Sleep Clinic staff to hold open two time slots per week for time sensitive cases Adult sleep studies are medically essential for diagnostic purposes in order to provide optimal care to adult patients with Obstructive Sleep Apnea (OSA) The long term risk of sleep apnea includes hypertension, cardiovascular disease and cerebrovascular disease There are two contracts with SleepMed of California; one for adult Sleep Studies and another for pediatric Sleep Studies Before the contracts consolidation took place at Santa Clara Valley Medical Center, the adult sleep studies contract was managed by Hospital Administration and the pediatric sleep studies was managed by the Ambulatory Care Contracts Unit Due to a miscommunication, the department thought that the contract for adult sleep studies was renewed and continued to use the services It was discovered in late 2010 that invoices were not paid and that Board approval was required to execute agreement to pay for services rendered to date Approval of the recommended action will accomplish two objectives First, it will allow SCVMC to pay for adult sleep studies that have been performed since July 1, 2010 SCVMC has continued to schedule sleep studies under an expired contract to avoid sending patients for which SCVMC is responsible to offsite facilities under less favorable payment terms Staff has notified SleepMed of California of the current situation and the need to have Board action to allow payment Second, extending the term through June 30, 2011 will give SCVMC staff time to complete a formal Request for Proposal process The RFP was released on January 20, 2011 and follows an expedited schedule that calls for a contract award in June Hospital Administration/Ambulatory and Community Health Services Supplemental Provider Services, Inc Approve extension to Agreement with Supplemental Provider Services, Inc to provide supplemental provider staffing services throughout Santa Clara Valley Medical Center (SCVMC) in an amount not to exceed $7,341,477 for the period May 21, 2011 through May 20, 2012 Funds to support this action through June 30, 2011 are included in the FY 2011 SCVMC budget Funds to cover the estimated contract cost from July 1, 2011 through May 20, 2012 will be included in the SCVMC Proposed FY 2012 budget On May 21, 2002, the Board approved a five-year agreement with Supplemental Provider Services, Inc (SPS) for the provision of supplemental provider staffing services with the option to renew the agreement for two consecutive three-year terms at the discretion of the Board of Supervisors In May 2007, the agreement was renewed for a three-year term ending on May 20, 2010 On April 27, 2010, the Board of Supervisors approved a one year extension from May 21, 2010 through May 20, 2011 The department is requesting another one year extension to allow time for Administration to Page 7 of 8

30 Health and Hospital Committee March 21, 2011 Pending Board Items continue exploring alternative options for County coded physicians who work under the SPS agreement Administration has convened several meetings with County Executive s Office, County Counsel and Employee Services Agency to discuss these various options Supplemental Provider Services, Inc provides physician and nursing staff services throughout Santa Clara Valley Medical Center, covering a variety of urgent care shifts for both inpatient and outpatient clinic delivery systems including adult and pediatric Same-Day Access, Neonatal Intensive Care Unit, Acute Psychiatry, and Pediatric and Adult Sexual Abuse Response Teams For inpatient care, the Neonatal Intensive Care Unit (NICU) requires in-house, 24/7 coverage with a physician who is skilled at delivery room resuscitation and the management of patients in a Level 3, CCS-accredited, neonatal intensive care unit The call and coverage schedules are filled with coded staff first The list of unfilled shifts is provided to SPS, and it provides the County with a qualified contract physician For acute psychiatry areas, SPS is used to augment coded physician staffing at Emergency Psychiatric Services (EPS), Barbara Arons Pavilion (BAP), Mental Health Urgent Care (MHUC), and Custody Mental Health Services This enables provision of on-site physician services 24-hours daily at EPS or seven days weekly (at BAP, MHUC and Custody Mental Health Services) At BAP, coded physicians provide needed patient care from Monday through Friday and SPS physicians are used to provide direct patient care on weekends and County holidays For Custody Mental Health Services, coded physicians provide needed patient care on inpatient unit, and on an ambulatory basis to the general population from Monday through Friday SPS physicians are used to provide this care on weekends and holidays, and are also used as needed when the level of physician services required exceeds that which can be provided by coded physician staff For outpatient clinic sites, SPS services are used mainly to cover same day evening clinic, physician vacancies, and during times of high demand Approval of the recommended action will allow SPS to continue providing services while ongoing discussions are taking place regarding the compensation of County coded physicians working under the SPS agreement Page 8 of 8

31 County of Santa Clara Public Health Department Public Health Administration 976 Lenzen Avenue, 2 nd Floor San José, CA March 18, 2011 To: From: Supervisor Liz Kniss, Chairperson Supervisor Ken Yeager, Vice Chair Health and Hospital Committee Dan Peddycord Public Health Director Subject: March 21, 2011 HHC Agenda Additional Pending Board Item We request the following item be added to the list of Pending Board Items: Public Health Administration - Approve an extension of Extra Help hours beyond the 1,040 hour limitation through the end of FY11 for one Office Specialist III (Bertha Millan-Cortes) and one Associate Management Analyst B (Gamaliel Galindo) in the Public Health Department There is no new impact on the General Fund as a result of this action Funds are available in the FY11 Public Health Department budget for the extension of 400 Extra-Help Hours for one Office Specialist III and for an additional 400 hours for one Associate Management Analyst B position The Public Health Department is a pilot site for a new web platform that will potentially be used County-wide PHD has worked extensively with Information Services Department (ISD) to plan, build and launch the new website in Spring 2011 Extra-Help Associate Management Analyst B, Gamaliel Galindo, has been coordinating the work of PHD managers, ISD technical staff and contractors on this project The website transition is critical in that it will be used as one of the main vehicles for several high visibility outreach campaigns for the Community Putting Prevention to Work Tobacco and Obesity prevention American Recovery and Reinvestment Act (ARRA) and Affordability Care Act grants recently awarded to Santa Clara County The Vital Records and Registration (VRR) Program is one of many essential and critical services of the Public Health Department In addition to issuing burial permits to families of the deceased, VRR staff have responsibility for reviewing and registering all birth and death events that occur within Santa Clara County The California Department of Public Health establishes timeline requirements for the registration process of both events (10 days for birth, 8 days for death) When vacancies exist within the VRR Program, Extra-Help staff are employed to keep up with the normal workload required to register records It can take between 3-4 months to fully train new staff in birth registration alone (death registration is much longer) Efforts taken to fill two vacancies that have existed since October 2010 through transfer line postings have been unsuccessful An in-placement for one of the vacancies is anticipated on March 21, 2011 The Department is requesting approval to extend the extra help hours for one current extra help staff that will exhaust the maximum allowable hours (1,040) prior to the end of FY 2011 In order to comply with the California Department of Public Health s time mandates for birth and death registration, the Public Health Department is requesting approval of an additional 400 hours for Bertha Millan-Cortes, Office Specialist III, who is fully trained and able to perform the required duties associated with birth and death registration Board of Supervisors: Donald F Gage, George Shirakawa, Dave Cortese, Ken Yeager, Liz Kniss County Executive: Jeffrey V Smith

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33 Committee Agenda Date: March 21, 2011 Agenda Item No6 System Generated Transmittal SANTA CLARA COUNTY Board Date : March 21, 2011 Transmittal ID : Agenda Item Details 6 Approve Policies and Procedures Board of Supervisors: Mike Wasserman, George Shirakawa, Dave Cortese, Ken Yeager, Liz Kniss County Executive: Jeffrey V Smith

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35 HHC DATE: April 13, 2011 DEPARTMENT(s): Santa Clara Valley Medical Center SANTA CLARA VALLEY MEDICAL CENTER HHC Policy and Procedure Approval Request List Policy # TITLE DATE *A/C/D/R-NC Inpatient Nursing AD-19 Critical Value Reporting 1/11 R-NC GPP-42 CAPD, Continuous Ambulatory Peritoneal Dialysis Adapter 1/11 C Change to Fresenius Stay Safe System GPP-9 Cerumen, Removal by Irrigation 1/11 R-NC ICP-1 Skin Care, Preventive 1/11 C IVP-131 Transfusion Reaction, Suspected 1/11 C IVP-4 IV Rate Controller, Manual 1/11 D PCE-111 EKG, 12 Lead HP Pagewriter 1/11 R-NC PCE-22 Wound Vacuum Assisted Closure Device 1/11 R-NC QI-10 Nursing Committees 1/11 D QI-4 Nursing Research 1/11 C RCP-12 Tracheostomy changes 1/11 C SAF-13 Helicopter Transports- Direct Admissions 1/11 C VL-1 Volunteer Services 1/11 R-NC VL-2 Foster Grandparents Program 1/11 D Emergency Department A Medical Unit Clerk Job Description/Performance Standards 11/09 C A Hospital Services Assistant I Job Description/Performance Standards 1/11 A A Hospital Services Assistant II Job Description/Performance Standards 1/11 C Neonatal Intensive Care Unit SAF Resuscitation 11/10 R-NC SAF Delivery Room Response 11/10 C EQ Phototherapy Biliblanket 11/10 C EQ Phototherapy 11/10 D IVA Arterial Lines 11/10 D IVA Arterial Line Placement- Percutaneous 11/10 C IVA Transfusion 11/10 C GAD Admission Protocol 11/10 R-NC IVA Hyperalimentation 11/10 D Mother Infant Child Center MICCNP-1 Nurse Practitioner Health Care Management Protocols* 10/10 C Approved by Governing Board Supervisor Liz Kniss, Chairperson Health and Hospital Committee *A= Add C=Change D=Delete R-NC=Reviewed No Change Page 1 of 1

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37 Committee Agenda Date: March 21, 2011 Agenda Item No7 System Generated Transmittal SANTA CLARA COUNTY Board Date : March 21, 2011 Transmittal ID : Agenda Item Details 7 Accept report from Medical Staff Office on Medical Staff a b Approve Credentials Review Patient Care and Medical Staff Issues Board of Supervisors: Mike Wasserman, George Shirakawa, Dave Cortese, Ken Yeager, Liz Kniss County Executive: Jeffrey V Smith

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41 Committee Agenda Date: March 21, 2011 Agenda Item No8 System Generated Transmittal SANTA CLARA COUNTY Board Date : March 21, 2011 Transmittal ID : Agenda Item Details 8 Review General Fund and Enterprise Fund reports for January 2011 Board of Supervisors: Mike Wasserman, George Shirakawa, Dave Cortese, Ken Yeager, Liz Kniss County Executive: Jeffrey V Smith

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75 Committee Agenda Date: March 21, 2011 Agenda Item No9 System Generated Transmittal SANTA CLARA COUNTY Board Date : March 21, 2011 Transmittal ID : Agenda Item Details 9 Accept report from Santa Clara Valley Medical Center on Security Services (Held from February 9, 2011 Health and Hospital Committee meeting, Item No 14) Board of Supervisors: Mike Wasserman, George Shirakawa, Dave Cortese, Ken Yeager, Liz Kniss County Executive: Jeffrey V Smith

76 Board of Supervisors: Mike Wasserman, George Shirakawa, Dave Cortese, Ken Yeager, Liz Kniss County Executive: Jeffrey V Smith Committee Agenda Date: March 21, 2011 Agenda Item No9

77 Committee Agenda Date :February 9, 2011 County of Santa Clara Santa Clara Valley Health & Hospital System Valley Medical Center HHC Prepared by: Gilbert Gutierrez Director, Clinical and Support Services DATE: February 9, 2011 Submitted by: Trudy Johnson, RN Interim Executive Director, SCVMC Hospital & Ancillary Services/Chief Nursing Officer TO: SupervisorLizKniss, Chairperson SupervisorKenYeager, Vice Chair Health & Hospital Committee FROM: Sylvia Gallegos Deputy County Executive / Acting Director, SCVHHS SUBJECT: Report from Santa Clara Valley Medical Center Concerning Protective Services RECOMMENDED ACTION Accept report from Santa Clara Valley Medical Center concerning Protective Services FISCAL IMPLICATIONS There is no impact to the County General Fund nor Enterprise Fund associated with acceptance of this report It is an informational item only If a security change is enacted, the financial impacts would be addressed at that time Board of Supervisors: Mike Wasserman, George Shirakawa, Dave Cortese, Ken Yeager, Liz Kniss County Executive: Jeffrey V Smith 1

78 Committee Agenda Date :February 9, 2011 REASONS FOR RECOMMENDATION Since early in 2010, the Administration and Board of Supervisors have considered the Office of the Sheriff's proposal to transition the Santa Clara Valley Medical Center (SCVMC) security function to it Since the original proposal was made public during the FY2011 budget process, various forms of a proposal have been offered for consideration and discussion The Health and Hospital Committee was presented a version of a proposal at its October 19, 2010 meeting At that time, the Committee requested information in order to consider the operational and financial implications to SCVMC, particularly, the question of how SCVMC could control its costs under the Sheriff's proposal The Committee also expressed interest in understanding the training provided to Protective Services Officers and how other public hospitals provide security for their facilities Lastly, we were requested to prepare a Memorandum of Understanding that reflects a security arrangement with the Office of the Sheriff that would satisfy our security and budgetary requirements This report provides the requested information BACKGROUND SCVMC has created an open and inviting medical facility for its patients, staff, and visitors in a campus-like setting In recent years, the County has made a significant investment in facilities and equipment that enables SCVMC to provide medical care comparable to many of the private medical and academic institutions in the area It is frequently recognized that SCVMC is a welcome contrast to the stereotypical image of a county medical facility with its professional and caring staff In preparing this transmittal, SCVMC management reviewed the current role of Protective Services and the training requirements, and reviewed the approach of other medical centers with respect to their security function Current Role of Protective Services The current role of Protective Services is to serve as a resource to allow SCVMC patients, employees, and visitors to conduct their business in an environment designed to minimize injury or loss The Department of Protective Services operates as an ancillary service within a medical environment, focusing on patient care and customer service While there are budget challenges ahead for Protective Services and the Medical Center as a whole, there are no major deficiencies in the security program relative to the protection of lives and assets The current Protective Services staff consists of dedicated security professionals desiring to deliver Board of Supervisors: Mike Wasserman, George Shirakawa, Dave Cortese, Ken Yeager, Liz Kniss County Executive: Jeffrey V Smith 2

79 Committee Agenda Date :February 9, 2011 protection services in a timely and responsive manner The lack of a history of major assaultive crimes and major loss of assets speaks well of Protective Services' work In maintaining this environment, Protective Services primarily focuses on the following functions: 1) To develop and educate staff regarding maintenance of a security program to protect the physical security of the Medical Center including physical assets and other staff and visitors Security serves as a first responder, assisting medical staff with a variety of patient/staff/visitor-related safety issues 2) To identify and respond to emergent threats and participate in disaster preparedness activities 3) To develop programs to ensure staff safety and address security issues (ie, to offer training associated with work place violence programs and receive training related to combative and uncooperative patients) 4) To develop and enhance collaborative relationships with hospital departmental and nursing unit managers 5) To ensure compliance with the hospital security plan through periodic drills and performing on-site assessments as required 6) To develop a security plan based on a model of continuous quality improvement to stay abreast of new regulations or legislative and case law and working with external agencies, law enforcement, regulators, etc, to recognize best business practices and new regulations from underwriters and government agencies Training Courses and Orientation of Protective Services Officers Protective Services Officers receive at least 280 hours of training: 80 classroom hours and 200 hours with a Field Training Officer (FTO) prior to working in the field In addition, ongoing training averages 8-hours a month, including but not limited to refresher courses on Arrest and Control Tactics, Weapons, Situation Diffusion, Penal Code, Use of Restraints, Ethics, and Driving Board of Supervisors: Mike Wasserman, George Shirakawa, Dave Cortese, Ken Yeager, Liz Kniss County Executive: Jeffrey V Smith 3

80 Committee Agenda Date :February 9, 2011 PSOs and Supervisors are HAZMAT trained (provided by SCVHHS) FTOs are sent to Police FTO Training (SJPD) Supervising PSOs are sent to Police Supervisor Training (SJPD) Several PSOs have 832 Power of Arrest training (Local) 50% of PSOs and Supervisors have Crisis Intervention Team Training (CIT) with the goal of 100% (SJPD or SO) All PSOs and Supervisors have received Mental Health training over and above Crisis Intervention Training (Mental Health) PSOs and Supervisors have had crowd control training originally with SJPD, including 20 PSOs who have additional Riot and Crowd training (now completed in house) Some PSOs have completed California Police Standards Accredited, Police Academies Some PSOs have bicycle patrol training (SJPD) and the training is now offered in house Some PSOs are currently police reserve officers All PSOs must have at least two (2) years security/police or military experience prior to taking the County written test The final hiring selection process includes a County organized written test and physical ability test Comparable Medical Center Approaches to Security SCVMC staff contacted five hospitals, four public and one private, to ascertain responsibility for the security function within their respective hospitals Alameda County Medical Center (ACMC) utilizes an outside private contractor, Healthcare Security Services, for hospital security functions In addition, the Alameda County Sheriff operates a Sheriff substation on the ACMC campus, usually with two deputies on-site In San Bernardino County, Arrowhead Regional Medical Center maintains an internal security department with contracted augmentation from the local city police department The County of Riverside has a contract with the Sheriff s Department for provision of security throughout its Riverside County Regional Medical Center, as well as its secured locked down unit housing county and state inmates in need of medical care San Francisco General Hospital has a different model The County Sheriff assigns a sergeant and deputies to hospital duty along with non-sworn security personnel Board of Supervisors: Mike Wasserman, George Shirakawa, Dave Cortese, Ken Yeager, Liz Kniss County Executive: Jeffrey V Smith 4

81 Committee Agenda Date :February 9, 2011 Stanford University Medical Center (SUMC) utilizes an internal security force with some contract staff utilized for parking and traffic control In the event SUMC requires a law enforcement invention, the staff contact the Palo Alto Police Department or the County Sheriff s Office Observations about the Sheriff s Proposal In its proposal (attached for reference), the Sheriff s Office presented a two-phase approach Phase One would include the addition and deletion of management positions and the development of an Memorandum of Understanding (MOU) Phase Two would have the Sheriff's Office presenting the Board of Supervisors with the MOU, a security assessment, and actions needed for the Sheriff to continue management The Sheriff's proposal indicates, The presence of on-site professional, highly-trained law enforcement management will result in better coverage, enhanced capabilities, shorter response times, properly equipped first responders on-site for significant incidents and an overall reduction in the time to resolve calls for service It is unclear to SCVMC management how response times could be improved with fewer staff, which was mentioned in the many conversations held regarding the proposal Information to support this claim has not been provided; thus a response cannot be provided One of the primary concerns of SCVMC management regarding the Sheriff's proposal is how the potential change in management of the Protective Services Department would alter its role from providing for a safe environment and protection of assets to the mission of law enforcement, which is to enforce the law and maintain order Currently, Protective Services is viewed as an organizationally integrated resource for SCVMC as opposed to an external agent Introducing a law enforcement presence would shift the focus from protection of the campus to a law enforcement focus, given the training, orientation, administration, and mission of the Sheriff Such a change in focus would affect the overall culture of the institution Should Protective Services' Officers be converted to members of the Sheriff's staff, there would be a noticeable change from unarmed to armed security This would convey a different presence to the public Estimated Cost of the Sheriff Assuming the Security Function In earlier conversations, the Sheriff's Office proposed adding nine (9) Deputy Sheriffs by eliminating a combination of Supervising PSO and PSO positions If the current staffing numbers were maintained, but the staffing mix altered to add the nine Deputy Sheriffs by eliminating the seven (7) Supervising PSO and two (2) PSO positions, the incremental cost Board of Supervisors: Mike Wasserman, George Shirakawa, Dave Cortese, Ken Yeager, Liz Kniss County Executive: Jeffrey V Smith 5

82 Committee Agenda Date :February 9, 2011 would be $492,804 If all 455 PSO positions were converted to Deputy Sheriffs, the incremental costs grows to $29 million A summary of previous options presented and the associated costs is attached This information is provided as context as these sceanrios have been considered including in another Board committee Either option would be problematic as SCVMC is faced with a $70 million reduction target for FY2012 Our assessment of security indicates that the current configuration of Protective Services staff, supported by a rapid Sheriff s response, has been meeting the needs of SCVMC The Board requested Counsel to review the last ten years for claims filed as a result of Protective Services Counsel advised the Board that in ten years, there were five claims submitted with one payment of less than $400 Last week, SCVMC responded to a Public Records Act request for information about Protective Services In the timeframe requested, there were 17 incident reports, several of which involved the use of restraints These reports were reviewed with Counsel, and, in each case, the restraint was undertaken at the direction of medical staff to protect the patient, staff, or other patients Customer service and quality are an ongoing process and must always be monitored and improvements made, but the current security arrangement satisfies the needs of our organization at a reasonable cost That said, under an appropriate set of terns negotiated between SCVMC and the Sheriff's Office, management of Protective Services by sworn Sheriff personnel could improve its function Consideration of Integrated Model Approach The Sheriff s October proposal calls for SCVMC to assume responsibility for an additional $128,518 in salary and benefit costs associated with hiring a Sheriff Lieutenant and Sheriff Sergeant, and deleting the two PSO management positions SCVMC management does recognize that there may be other approaches and conducted a survey of other county facilities to review alternative strategies The review of comparable county medical centers indicates that all have adopted an integrated model of non-sworn and sworn personnel to provide security The adoption of this integrated approach assumes that the management of the security function will occur through law enforcement in coordination with hospital management SCVMC management concurs with shifting management of the Protective Services Office to the Sheriff's Office SCVMC requests that the action be limited to the management structure, as earlier proposals from the Sheriff s Department were based on changes in the staffing mix to add deputies, but at the expense of a much larger number of PSOs That reduction in staff would noticeably reduce the visible presence of security on campus and negatively impact many of the customer service functions performed currently by Protective Services SCVMC believes the current staffing model makes the most sense Board of Supervisors: Mike Wasserman, George Shirakawa, Dave Cortese, Ken Yeager, Liz Kniss County Executive: Jeffrey V Smith 6

83 Committee Agenda Date :February 9, 2011 SCVMC recommends an amended approach to the Sheriff's two phase approach The MOU should be developed and signed before the transfer of responsibility, and, the personnel changes Under this modified approach, both parties would agree to the full scope of the management changes and responsibilities CONSEQUENCES OF NEGATIVE ACTION The Committee would not receive the requested information ATTACHMENTS DRAFT SCVMC-Sheriff MOU for Security Services Sheriff's Proposal PSO position and cost Board of Supervisors: Mike Wasserman, George Shirakawa, Dave Cortese, Ken Yeager, Liz Kniss County Executive: Jeffrey V Smith 7

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93 Committee Agenda Date :October 19, 2010 County of Santa Clara Office of the Sheriff SO DATE: October 19, 2010 Prepared by: Michelle L Sandoval Senior Management Analyst Reviewed by: Martha Wapenski Director, Administrative Services TO: SupervisorLizKniss, Chairperson SupervisorKenYeager, Vice Chair Health & Hospital Committee FROM: Laurie Smith Sheriff SUBJECT: Utilization of the Sheriff's Office for Valley Medical Center Security Services RECOMMENDED ACTION Consider recommendations relating to the utilization of the Sheriff's Office for Valley Medical Center Security Services Possible action: a Approve the transfer of operational responsibility and management of the Protective Services function and staff of the Valley Medical Center to the Office of the Sheriff b Introduction and preliminary adoption of Salary Ordinance No NS amending Santa Clara County Ordinance No NS-511 relating to the compensation of employees Board of Supervisors: Donald F Gage, George Shirakawa, Dave Cortese, Ken Yeager, Liz Kniss County Executive: Jeffrey V Smith 1

94 Committee Agenda Date :October 19, 2010 adding one Sheriff's Lieutenant and one Sheriff's Sergeant position in the Office of the Sheriff, and deleting one Chief of Protective Services and one Assistant Chief of Protective Services position from the Valley Medical Center (Roll Call Vote to waive reading, Roll Call Vote to adopt) FISCAL IMPLICATIONS There is a fiscal impact as a result of the recommended action The FY 2011 fiscal impact of adding one Sheriff's Lieutenant and one Sheriff's Sergeant position to provide management oversight and operational responsibility for VMC Security is $389,138 The cost savings from deleting the Chief and Assistant Chief of Protective Services is $260,620 The difference in the annual cost is $128,518 At a future date when this matter is agendized for the Board of Supervisors, the FY 2011 partial year (7 month) cost would be a lesser amount of $74,968 This cost will be absorbed in the Santa Clara Valley Medical Center budget CONTRACT HISTORY Not applicable REASONS FOR RECOMMENDATION In the County Executive's FY 2011 Recommended Budget message, one of the initiatives proposed was utilizing the Office of the Sheriff for security services at the Santa Clara Valley Medical Center (SCVMC) In his message, the County Executive stated he wanted to provide the Board with information while the plan is being finalized To that end, a report was submitted to the Board's Health and Hospital Committee (HHC) on May 12, 2010 During the HHC meeting, the Committee requested a report-back on two issues: 1) detailed information on the costs and savings within the plan, and 2) our plan for service delivery after reducing the number of staff On May 18, 2010, the Board accepted a report-back during the FY 2011 Budget Workshops that addressed these two issues and provided information on the proposal On August 24, 2010, in conjunction with the County Executive's Office, the Office of the Sheriff brought this matter to the full Board for consideration The Board referred the transmittal to the Public Safety and Justice Committee (PSJC) for review On September 1, 2010, the PSJC discussed the Office of the Sheriff's transmittal and referred it back to the Board for approval Following public comment at the September 8, 2010 HHC meeting, the HHC requested a report on the plan for security services at VMC at their October 19, 2010 meeting Board of Supervisors: Donald F Gage, George Shirakawa, Dave Cortese, Ken Yeager, Liz Kniss County Executive: Jeffrey V Smith 2

95 Committee Agenda Date :October 19, 2010 Overview Currently, security at VMC and its satellite facilities is provided by the staff of SCVMC's Department of Protective Services An existing Sheriff's Lieutenant has been working with VMC Administration over the last several months to review the operation and conduct a comprehensive assessment of the security at the VMC campus and satellite facilities The concept for utilizing the Office of the Sheriff to manage and operate the SCVMC Protective Services would include budgetary spending authority, ability to develop and set policies and procedures, and appointing authority Appointing authority includes functions such as hiring, disciplining, and making management decisions The Recommended Action requests the addition of one Sheriff's Lieutenant position and one Sheriff's Sergeant position to provide management of staff and operational responsibility for SCVMC security, and the deletion of the Chief and Assistant Chief of Protective Services positions Both positions are currently filled Normal lay-off provisions will apply Phase One Through a collaborative partnership with SCVMC administration, utilization of the Office of the Sheriff for SCVMC Security would occur in two phases In the first phase upon Board approval, the Sheriff's Office would have ongoing spending authority, policy development authority, and appointing authority An assigned Sheriff's Lieutenant and Sergeant and SCVMC Administration would develop a security assessment plan, as well as an operational Memorandum of Understanding (MOU) for the Board's future consideration The MOU would delineate the needs of both agencies, as well as roles, responsibilities, and expectations In addition, upon the establishment of operational responsibility, the Lieutenant and Sergeant would:establish goals and objectives, milestones, and desired results, in collaboration with SCVMC Administration Ensure regulatory compliance and pursue mandated hospital training for Office of the Sheriff staff Become involved in the regular hospital staff meetings appropriate to security functions Review the policies and procedures of the Protective Services Department, and ensure that all staff is in compliance with required training Provide VMC Administration with regular reports on the transition, and quarterly reports on budget, security issues, and staffing Phase Two Board of Supervisors: Donald F Gage, George Shirakawa, Dave Cortese, Ken Yeager, Liz Kniss County Executive: Jeffrey V Smith 3

96 Committee Agenda Date :October 19, 2010 Subsequent to the first phase, the Office of the Sheriff, working in conjunction with the County Executive's Office and Santa Clara Valley Medical Center Administration, would return to the Board with its security assessment, MOU, and possible actions necessary to continue the operational management under the Office of the Sheriff The existing budget and positions would remain with SCVMC, and the Sheriff's Office would have spending authority, policy development authority, and appointing authority Collaborative Partnership The Office of the Sheriff and SCVMC Administration would work in a collaborative partnership with regard to the provision of law enforcement and security services Working in tandem, we would establish goals and objectives, milestones, and desired results that would refine the level of service needed for the facilities Also, because of the unique environment, the two agencies would work together to ensure regulatory compliance and pursue mandated hospital training for the sworn staff Effective communication will be a keystone in this process, so the Sheriff's Lieutenant would be involved in the regular hospital staff meetings Operational and financial reporting will be a critical component of the communication between the Office of the Sheriff and SCVMC Administration In the initial stages, the assigned Office of the Sheriff staff would review the policies and procedures of the Protective Services Department, and ensure that all staff is in compliance with required training On an ongoing basis, the Office of the Sheriff would provide SCVMC Administration with regular reports on the transition, and quarterly reports on budget, security issues, and staffing These reports would be developed in conjunction with SCVMC Administration's needs County's Pharmaceutical Take-Back Program With regard to the County's Pharmaceutical Take-Back Program, the presence of sworn Office of the Sheriff personnel on SCVMC property will allow for the seamless transition of the County's program This program was created by the Board in 2008 to comply with SB 966, which was designed to reduce the amount of pharmaceuticals that are discarded improperly The Office of the Sheriff is involved in the process because pharmacies are prohibited by law from "taking back" controlled substances, and federal law states that only sworn law enforcement personnel can supervise the collection of controlled substances The Pharmaceutical Take-Back Program has been extremely successful, yielding over four tons of pharmaceutical waste since 2009 The sworn staff assigned to SCVMC Protective Services would supervise the collection of discarded pharmaceuticals from receptacles within SCVMC, thus streamlining existing processes Board of Supervisors: Donald F Gage, George Shirakawa, Dave Cortese, Ken Yeager, Liz Kniss County Executive: Jeffrey V Smith 4

97 Committee Agenda Date :October 19, 2010 Conclusion Transferring operational responsibility and management of the Protective Services function and staff to the Office of the Sheriff would balance the need to protect with the need to serve the public, while maintaining an open service-oriented atmosphere that operates efficiently The Office of the Sheriff is the largest law enforcement agency in the county with an established infrastructure for managing and operating security and law enforcement services Incidents such as mass prophylaxis, disasters, and terrorist events necessitate a close partnership between law enforcement and the Health and Hospital System Staffing part of SCVMC Protective Services with sworn peace officers further strengthens safety and security of the staff, clients, and visitors of SCVMC The presence of on-site professional, highly-trained law enforcement management will result in better coverage, enhanced capabilities, shorter response times, properly equipped first responders on-site for significant incidents, and an overall reduction in the time to resolve calls for service CONSEQUENCES OF NEGATIVE ACTION The Sheriff's Office would be unable to add two positions to provide operational responsibility and management oversight for the VMC Security function and Protective Services staff, and two existing Protective Services positions would not be deleted STEPS FOLLOWING APPROVAL The Clerk of the Board is requested to notify Michelle Sandoval, Senior Management Analyst, Office of the Sheriff, once Keyboard processing of this transmittal is completed ATTACHMENTS Salary Ordinance Board of Supervisors: Donald F Gage, George Shirakawa, Dave Cortese, Ken Yeager, Liz Kniss County Executive: Jeffrey V Smith 5

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99 Protective Services Unit Salary & Benefits per FTE Total Salary & Benefits 6802 Security Code FTEs Step Supv Protective Services Officer U9D , ,580 Protective Service Officers U ,172 3,202,122 Subtotal ,894,702 Sheriff's Staffing Option w/combination of PSOs/Deputies VMC Security Code FTEs Step Salary & Benefits Deputy Sheriff U ,192 1,351,728 Protective Service Officers U ,172 3,035,778 Subtotal ,387,506 Total Incremental Budget 492,804 Sheriff's Staffing Option w/all Deputies VMC Security Code FTEs Step Salary & Benefits Deputy Sheriff U ,192 6,833,736 Subtotal ,833,736 Total Incremental Budget 2,939,034 Deputy Sheriff U ,192 Supervising Protective Services Officer U9D 5 98,940 Cost for Conversion per position of Supv PSO to Deputy Sheriff 51,252 Deputy Sheriff U ,192 Protective Service Officers U ,172 Cost for Conversion per position of PSO to Deputy Sheriff 67,020

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101 Committee Agenda Date :March 21, 2011 County of Santa Clara Santa Clara Valley Health & Hospital System SO CEO DATE: March 21, 2011 TO: SupervisorLizKniss, Chairperson SupervisorKenYeager, Vice Chair Health & Hospital Committee FROM: Sylvia Gallegos Deputy County Executive / Acting Director, SCVHHS Laurie Smith Sheriff SUBJECT: Report from the Santa Clara Valley Health and Hospital System and the Office of the Sheriff Concerning Protective Services RECOMMENDED ACTION Accept report from the Santa Clara Valley Health and Hospital System and the Office of the Sheriff Concerning Protective Services FISCAL IMPLICATIONS There is no fiscal impact to the General Fund nor the Enterprise Fund associated with the acceptance of this informational report If a security change is enacted, the financial impact would be addressed at that time Board of Supervisors: Mike Wasserman, George Shirakawa, Dave Cortese, Ken Yeager, Liz Kniss County Executive: Jeffrey V Smith 1

102 Committee Agenda Date :March 21, 2011 CONTRACT HISTORY Not applicable REASONS FOR RECOMMENDATION Since early in 2010, the Administration and the Board of Supervisors have considered the Sheriff's Office proposal to transition the Santa Clara Valley Medical Center (SCVMC) security function to the Sheriff's Office Since the original proposal was made public at the May 2010 Health and Hospital Committee meeting, various forms of a proposal have been offered for consideration and discussion The Health and Hospital Committee was presented with a version of a proposal at its October 19, 2010 meeting At that time, the Committee requested information in order to consider the operational and financial implication to SCVMC, particularly, the question of how SCVMC could control its costs under the Sheriff's proposal The Committee also expressed interest in understanding the training provided to Protective Services Officers and how other public hospitals provide security for their facilities Lastly, the Committee requested the preparation of a Memorandum of Understanding that reflects a security arrangement with the Office of the Sheriff that would satisfy our security and budgetary requirements This report provides the requested information BACKGROUND SCVMC has created an open and inviting medical facility for its patients, staff, and visitors in a campus-like setting In recent years, the County has made significant investments in facilities and equipment that enable SCVMC to provide medical care comparable to many of the private medical and academic institutions in the area It is frequently recognized that SCVMC is a welcome contrast to the stereotypical image of a county medical facility with its professional and caring staff The Sheriff's Office (SO) is the largest law enforcement agency in Santa Clara County with an established infrastructure for managing and operating security and law enforcement services The Sheriff's Office has multiple contracts with County agencies, such as, Social Services, Department of Child Support Services, Parks and Recreation, and County Counsel Board of Supervisors: Mike Wasserman, George Shirakawa, Dave Cortese, Ken Yeager, Liz Kniss County Executive: Jeffrey V Smith 2

103 Committee Agenda Date :March 21, 2011 As requested by the Committee, SCVHHS reviewed the current role of Protective Services and the training requirements, and reviewed the approach of other medical centers with respect to their security function Current Role of Protective Services The current role of Protective Services is to serve as a resource to allow SCVMC patients, employees, and visitors to conduct their business in an environment designed to minimize injury or loss The Department of Protective Services operates as an ancillary service within a medical environment, focusing on patient care and customer service The current Protective Services staff consist of dedicated security professionals desiring to deliver protection services in a timely and responsive manner In maintaining this environment, Protective Services primarily focuses on the following functions: 1) To develop and educate staff regarding maintenance of a security program to protect the physical security of the Medical Center including physical assets, and other staff and visitors Security serves as a first responder, assisting medical staff with a variety of patient/staff/visitor-related issues 2) To identify and respond to emergent threats and participate in disaster preparedness activities 3) To develop programs to ensure staff safety and address security issues (ie to offer training associated with work-place violence programs and receive training related to combative and uncooperative patients) 4) To develop and enhance collaborative relationships with hospital departmental and nursing unit managers 5) To ensure compliance with the hospital security plan through periodic drills and performing on-site assessments as required 6) To develop a security plan based on a mode of continuous quality improvement to stay abreast of new regulations or legislative and case law Working with external agencies, law enforcement, regulators, etc, to recognize best business practices and new regulations from underwriters and government agencies Board of Supervisors: Mike Wasserman, George Shirakawa, Dave Cortese, Ken Yeager, Liz Kniss County Executive: Jeffrey V Smith 3

104 Committee Agenda Date :March 21, 2011 Training Courses and Orientation of Protective Services Staff Protective Services Officers and Supervising Protective Services Officers receive at least 280 hours of training: 80 classroom hours and 200 hours with a Field Training Officer prior to working in the field Additional ongoing training averages 8 hours per month, including but not limited to refresher courses on Arrest and Control Tactics, Weapons, Situational Diffusion, Penal Code, Use of Restraints, Ethics, and Driving PSOs and Supervisors are HAZMAT trained (provided by SCVHHS) FTOs are sent to Police FTO training FTO training (SJPD) Supervising PSOs are sent to Police Supervisor Training (SJPD) Several PSOs have 832 Power of Arrest training (Local) 50% of PSOs have Crisis Intervention Team Training (CIT) with the goal of 100% (SJPD and SO) All PSOs and Supervisors have received Mental Health training over and above CIT (Mental Health) PSOs and Supervisors have had crowd control training originally with SJPD, including 20 PSOs who have additional Riot and Crowd training (now completed in-house) Some PSOs have completed California Peace Officer Standards Accredited Police Academies Some PSOs have bicycle patrol training (SJPD) and the training is now offered in-house Some PSOs are currently police reserve officers All PSOs must have at least two years security/police or military experience prior to taking the County written test The final hiring selection process includes a County-organized written test and physical ability test Comparable Medical Center Approaches to Security SCVMC staff contacted five hospitals, four public and one private, to ascertain responsibility for the security function within their respective hospitals Alameda County Medical Center (ACMC) utilizes an outside private contractor, Healthcare Security Services, for hospital security functions In addition, the Alameda County Sheriff operates a Sheriff's substation on the ACMC campus, usually with two deputies on-site In San Bernardino County, Arrowhead Regional Medical Center maintains an internal security department with contracted augmentation from the local city police department Board of Supervisors: Mike Wasserman, George Shirakawa, Dave Cortese, Ken Yeager, Liz Kniss County Executive: Jeffrey V Smith 4

105 Committee Agenda Date :March 21, 2011 The County of Riverside has a contract with the Sheriff's Office for provision of security throughout its Riverside County Regional Medical Center, as well as its secured locked-down unit, housing county and state inmates in need of medical care San Francisco General Hospital has a different model The County Sheriff assigns a sergeant and deputy to hospital duty, along with non-sworn security personnel Stanford University Medical Center (SUMC) utilizes an internal security force with some contract staff utilized for parking and traffic control In the event SUMC requires law enforcement intervention, the staff contact Palo Alto Police Department or the County Sheriff's Office Consideration of Integrated Model Approach The Sheriff's Office proposal to HHC in October 2010 calls for SCVMC to assume responsibility for an additional $128,518 in salary and benefit costs associated with adding a Sheriff Lieutenant and Sergeant, and deleting the two PSO management positions SCVMC does recognize that there may be other security approaches and conducted a survey of other county facilities to review alternative strategies The review of comparable county medical centers indicates that all have adopted an integrated model of non-sworn and sworn personnel to provide security The adoption of this integrated approach assumes that the management of the security functions would occur through law enforcement in coordination with hospital management The SO and SCVHHS agree that under an appropriate set of terms negotiated between SCVMC and the Sheriff's Office, management of Protective Services by sworn Sheriff personnel could improve its function SCVHHS Administration concurs with transitioning oversight of the Protective Services function to Sheriff personnel SCVMC requests that the action be limited to the management structure Sheriff's Office management staff, in conjunction with Supervising Protective Services Officer staff, would be responsible for the day-to-day performance, supervision, and discipline of Protective Services Officers and administrative staff To that end, SO and SCVHHS, with assistance from County Counsel, have prepared an MOU that, under an appropriate set of terms negotiated between SCVMC and the SO, would place management of Protective Services under designated Sheriff personnel The proposed MOU developed between the SCVMC and the SO contains the following key components: Board of Supervisors: Mike Wasserman, George Shirakawa, Dave Cortese, Ken Yeager, Liz Kniss County Executive: Jeffrey V Smith 5

106 Committee Agenda Date :March 21, ) SCVHHS would retain budgetary authority over Protective Services; 2) Protective Services employees would continue to be employees of SCVHHS; 3) The Sheriff would have appointing and discipline authority as stated in the MOU; 4) Working within the approved budget, the Sheriff would have the authority to set the number and hours of shifts and configuration of staffing for each shift; and, 5) The MOU specifies the services to be provided to SCVHHS by the SO and sets forth the responsibilities of each party The two parties agreed to collaborate in defining the full scope of management changes and responsibilities A signed MOU is attached for the Committee's review CONSEQUENCES OF NEGATIVE ACTION The Sheriff's Office would be unable to add two positions to provide operational responsibility and management oversight for the VMC Security function and Protective Services staff, and two existing Protective Services positions would not be deleted STEPS FOLLOWING APPROVAL The Clerk of the Board is requested to notify Michelle Sandoval, Senior Management Analyst, Office of the Sheriff, once Keyboard processing of this transmittal is completed ATTACHMENTS Agreement Between The Santa Clara Valley Health and Hospital System and The County of Santa Clara Office of the Sheriff Board of Supervisors: Mike Wasserman, George Shirakawa, Dave Cortese, Ken Yeager, Liz Kniss County Executive: Jeffrey V Smith 6

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119 EXHIBIT BUSINESS ASSOCIATE AGREEMENT WHEREAS, County of Santa Clara ( County or Covered Entity ) is a Covered Entity, as defined below, and wishes to disclose certain Protected Health Information ( PHI ) to [Enter Name of Contractor ] Business Associate pursuant to the terms of the Agreement and this Business Associate Agreement ( BAA ); and WHEREAS, Covered Entity and Business Associate intend to protect the privacy and provide for the security of PHI disclosed to Business Associate pursuant to the Agreement in compliance with the Health Insurance Portability and Accountability Act of 1996, Public Law ( HIPAA ), the Health Information Technology for Economic and Clinical Health Act, Public Law ( the HITECH Act ), and regulations promulgated thereunder by the US Department of Health and Human Services (the HIPAA Regulations ) and other applicable law; and WHEREAS, as part of the HIPAA Regulations, the Privacy Rule and the Security Rule (defined below) require Covered Entity to enter into a contract containing specific requirements with Business Associate prior to the disclosure of PHI, as set forth in, but not limited to, Title 45, Sections (a), (e) and (e) of the Code of Federal Regulations ( CFR ) and contained in this BAA In consideration of the mutual promises below and the exchange of information pursuant to the BAA, the parties agree as follows: I Definitions Terms used, but not otherwise defined, and terms with initial capital letters in the BAA have the same meaning as defined under the Health Insurance Portability and Accountability Act of 1996, 42 USC 1320d et seq ( HIPAA ) and the implementing regulations and with the Health Insurance Portability and Accountability Act of 1996, Public Law ( HIPAA ), the Health Information Technology for Economic and Clinical Health Act, Public Law ( the HITECH Act ), and regulations promulgated thereunder by the US Department of Health and Human Services (the HIPAA Regulations ) and other applicable laws Privacy Breach Any acquisition, access, use or disclosure of Protected Health Information in a manner not permitted or allowed under state or federal privacy laws Business Associate is a person, organization, or agency other than a workforce member that provides specific functions, activities, or services that involve the use, creation, or disclosure of PHI for, or on behalf of, a HIPAA covered health care component Examples of business associate functions are activities such as claims processing or administration, data analysis, utilization review, quality assurance, billing, benefit management, practice management, and repricing; and legal, actuarial, accounting, consulting, data aggregation, management, administrative, accreditation, or financial services [Enter Number] Amendment 1 Exhibit [Enter Name of Contractor ] Standard Business Associate Agreement Language 08/31/10

120 Covered Entity shall have the meaning given to such term under the Privacy Rule and the Security Rule, including, but not limited to, 45 CFR Section Designated Record Set shall have the meaning given to such term under the Privacy Rule, including, but not limited to, 45 CFR Section Electronic Protected Health Information means Protected Health Information that is maintained in or transmitted by electronic media Electronic Health Record shall have the meaning given to such term in the HITECH Act, including, but not limited to, 42 USC Section Health Care Operations shall have the meaning given to such term under the Privacy Rule, including, but not limited to, 45 CFR Section Privacy Rule shall mean the HIPAA Regulation that is codified at 45 CFR Parts 160 and 164, Subparts A and E Protected Health Information or PHI means any information, whether oral or recorded in any form or medium: (i) that relates to the past, present or future physical or mental condition of an individual; the provision of health care to an individual; or the past, present or future payment for the provision of health care to an individual; and (ii) that identifies the individual or with respect to which there is a reasonable basis to believe the information can be used to identify the individual, and shall have the meaning given to such term under the Privacy Rule, including, but not limited to, 45 CFR Section Protected Health Information includes Electronic Protected Health Information [45 CFR Sections ] Protected Information shall mean PHI provided by Covered Entity to Business Associate or created or received by Business Associate on Covered Entity s behalf Security Rule shall mean the HIPAA Regulation that is codified at 45 CFR Parts 160 and 164, Subparts A and C Unsecured PHI shall have the meaning given to such term under the HITECH Act and any guidance issued pursuant to such Act including, but not limited to, 42 USC Section 17932(h) II Duties & Responsibilities of Business Associate a Permitted Uses Business Associate shall not use Protected Information except for the purpose of performing Business Associate s obligations under the Agreement and as permitted under the Agreement and the BAA Further, Business Associate shall not use Protected Information in any manner that would constitute a violation of the Privacy Rule or the HITECH Act if so used by Covered Entity However, Business Associate may use Protected Information (i) for the proper management and administration of Business Associate, (ii) to carry out the legal responsibilities of Business Associate, or (iii) for Data Aggregation purposes for the Health Care Operations of Covered Entity [45 CFR Sections (e)(2)(ii)(A) and (e)(4)(i)] [Enter Number] Amendment 2 Exhibit [Enter Name of Contractor ] Standard Business Associate Agreement Language 08/31/10

121 b Permitted Disclosures Business Associate shall not disclose Protected Information except for the purpose of performing Business Associate s obligations under the Agreement and as permitted under the Agreement and the BAA Business Associate shall not disclose Protected Information in any manner that would constitute a violation of the Privacy Rule or the HITECH Act if so disclosed by Covered Entity However, Business Associate may disclose Protected Information (i) for the proper management and administration of Business Associate; (ii) to carry out the legal responsibilities of Business Associate; (iii) as required by law; or (iv) for Data Aggregation purposes for the Health Care Operations of Covered Entity If Business Associate discloses Protected Information to a third party, Business Associate must obtain, prior to making any such disclosure, (i) reasonable written assurances from such third party that such Protected Information will be held confidential as provided pursuant to this BAA and only disclosed as required by law or for the purposes for which it was disclosed to such third party, and (ii) a written agreement from such third party to immediately notify Business Associate of any breaches of confidentiality of the Protected Information within 10 calendar days of discovery, to the extent it has obtained knowledge of such breach [42 USC Section 17932; 45 CFR Sections (e)(2)(i), (e)(2)(i)(B), (e)(2)(ii)(A) and (e)(4)(ii)] c Prohibited Uses and Disclosures Business Associate shall not use or disclose Protected Information for fundraising or marketing purposes Business Associate shall not disclose Protected Information to a health plan for payment or health care operations purposes if the patient has requested this special restriction, and has paid out of pocket in full for the health care item or service to which the PHI solely relates [42 USC Section 17935(a)] Business Associate shall not directly or indirectly receive remuneration in exchange for Protected Information, except with the prior written consent of Covered Entity and as permitted by the HITECH Act, 42 USC section 17935(d)(2); however, this prohibition shall not affect payment by Covered Entity to Business Associate for services provided pursuant to the Agreement d Appropriate Safeguards Business Associate shall implement appropriate administrative, technological and physical safeguards as are necessary to prevent the use or disclosure of Protected Information otherwise than as permitted by the Agreement and the BAA that reasonably and appropriately protect the confidentiality, integrity and availability of the Protected Information, in accordance with 45 CFR Sections , , and [45 CFR Section (e) (2) (ii) (B); 45 CFR Section (b)] Business Associate shall comply with the policies and procedures and documentation requirements of the HIPAA Security Rule, including, but not limited to, 45 CFR Section [42 USC Section 17931] e Reporting of Improper Access, Use or Disclosure Business Associate shall report to Covered Entity in writing any access, use or disclosure of Protected Information not permitted by the Agreement and BAA, and any Breach of Unsecured PHI of which it becomes aware without unreasonable delay and in no case later than 10 calendar days after discovery [42 USC Section 17921; 45 CFR Section (e) (2) (ii) (C); 45 CFR Section (b)] All reports to Covered Entity pursuant to this section shall be sent to the Covered Entity Compliance Officer by facsimile and US mail using the following contact information: [Enter Number] Amendment 3 Exhibit [Enter Name of Contractor ] Standard Business Associate Agreement Language 08/31/10

122 Compliance & Privacy Officer Santa Clara Valley Health & Hospital System 2325 Enborg Lane, Suite 360 San Jose, CA Facsimile (408) Telephone (408) The breach notice must contain: (1) a brief description of what happened, including the date of the breach and the date of the discovery of the breach, if known, (2) the location of the breached information; (3) a description of the types of PHI that were involved in the breach,(4) Safeguards in place prior to the breach; (5) Actions taken in response to the breach; (6) any steps individuals should take to protect themselves from potential harm resulting from the breach, (7) a brief description of what the business associate is doing to investigate the breach, to mitigate harm to individuals, and to protect against further breaches, and (8) contact procedures for individuals to ask questions or learn additional information, which shall include a toll-free telephone number, an address, website or postal address [45 CFR Section ] Business Associate shall take (i) prompt corrective action to cure any such deficiencies and (ii) any action pertaining to such unauthorized disclosure required by applicable federal and state laws and regulations f Business Associate s Agents Business Associate shall ensure that any agents, including subcontractors, to whom it provides Protected Information, agree in writing to the same restrictions and conditions that apply to Business Associate with respect to such PHI and implement the safeguards required by paragraph c above with respect to Electronic PHI [45 CFR Section (e) (2) (ii) (D); 45 CFR Section (b)] Business Associate shall implement and maintain sanctions against agents and subcontractors that violate such restrictions and conditions and shall mitigate the effects of any such violation (see 45 CFR Sections (f) and (e) (1)) g Access to Protected Information Business Associate shall make Protected Information maintained by Business Associate or its agents or subcontractors in Designated Record Sets available to Covered Entity for inspection and copying within ten (10) days of a request by Covered Entity to enable Covered Entity to fulfill its obligations under the Privacy Rule, including, but not limited to, 45 CFR Section [45 CFR Section (e) (2) (ii) (E)] If Business Associate maintains an Electronic Health Record, Business Associate shall provide such information in electronic format to enable Covered Entity to fulfill its obligations under the HITECH Act, including, but not limited to, 42 USC Section 17935(e) h Electronic PHI If Business Associate receives, creates, transmits or maintains EPHI on behalf of Covered Entity, Business Associate will, in addition, do the following: (1) Develop, implement, maintain and use appropriate administrative, physical, and technical safeguards in compliance with Section 1173(d) of the Social Security Act, Title 42, Section 1320(s) or the United States Code and Title 45, Part 162 and 164 of CFR to preserve the integrity and confidentiality of all electronically maintained or transmitted PHI received from or on behalf of Covered Entity [Enter Number] Amendment 4 Exhibit [Enter Name of Contractor ] Standard Business Associate Agreement Language 08/31/10

123 (2) Document and keep these security measures current and available for inspection by Covered Entity (3) Ensure that any agent, including a subcontractor, to whom the Business Associate provides EPHI, agrees to implement reasonable and appropriate safeguards to protect it (4) Report to the Covered Entity any Security Incident of which it becomes aware For the purposes of this BAA and the Agreement, Security Incident means, as set forth in 45 CFR section , the attempted or successful unauthorized access, use, disclosure, modification, or destruction of information or interference with system operations in an information system i Amendment of PHI Within ten (10) days of receipt of a request from Covered Entity for an amendment of Protected Information or a record about an individual contained in a Designated Record Set, Business Associate or its agents or subcontractors shall make such Protected Information available to the County for amendment and incorporate any such amendment to enable Covered Entity to fulfill its obligations under the Privacy Rule If any individual requests an amendment of Protected Information directly from Business Associate or its agents or subcontractors, Business Associate must notify Covered Entity in writing within five (5) days of the request Any approval or denial of amendment of Protected Information maintained by Business Associate or its agents or subcontractors shall be the responsibility of Covered Entity j Accounting Rights Promptly upon any disclosure of Protected Information for which Covered Entity is required to account to an individual, Business Associate and its agents or subcontractors shall make available to Covered Entity the information required to provide an accounting of disclosures to enable Covered Entity to fulfill its obligations under the Privacy Rule, and the HITECH Act, as determined by Covered Entity Business Associate agrees to implement a process that allows for an accounting to be collected and maintained by Business Associate and its agents or subcontractors for at least six (6) years prior to the request Accounting of disclosures from an Electronic Health Record for treatment, payment or health care operations purposes are required to be collected and maintained for three (3) years prior to the request, and only to the extent Business Associate maintains an electronic health record and is subject to this requirement At a minimum, the information collected and maintained shall include: (i) the date of disclosure; (ii) the name of the entity or person who received Protected Information and, if known, the address of the entity or person; (iii) a brief description of Protected Information disclosed and (iv) a brief statement of purpose of the disclosure that reasonably informs the individual of the basis for the disclosure, or a copy of the individual's authorization, or a copy of the written request for disclosure In the event that the request for an accounting is delivered directly to Business Associate or its agents or subcontractors, Business Associate shall within five (5) days of a request forward it to Covered Entity in writing It shall be Covered Entity s responsibility to prepare and deliver any such accounting requested Business Associate shall not disclose any Protected Information except as set forth in the Agreement, including this BAA k Governmental Access to Records Business Associate shall make its internal practices, books and records relating to the use and disclosure of Protected Information available to Covered [Enter Number] Amendment 5 Exhibit [Enter Name of Contractor ] Standard Business Associate Agreement Language 08/31/10

124 Entity and to the Secretary of the US Department of Health and Human Services (the Secretary ) for purposes of determining Business Associate s compliance with the Privacy Rule Business Associate shall provide to Covered Entity a copy of any Protected Information that Business Associate provides to the Secretary concurrently with providing such Protected Information to the Secretary l Minimum Necessary Business Associate (and its agents or subcontractors) shall request, use and disclose only the minimum amount of Protected Information necessary to accomplish the purpose of the request, use, or disclosure Business Associate understands and agrees that the definition of minimum necessary is in flux and shall keep itself informed of guidance issued by the Secretary with respect to what constitutes minimum necessary m Data Ownership Business Associate acknowledges that Business Associate has no ownership rights with respect to the Protected Information n Audits, Inspection and Enforcement Within ten (10) days of a written request by Covered Entity, Business Associate and its agents or subcontractors shall allow Covered Entity to conduct a reasonable inspection of the facilities, systems, books, records, agreements, policies and procedures relating to the use or disclosure of Protected Information pursuant to this BAA for the purpose of determining whether Business Associate has complied with this BAA; provided, however, that (i) Business Associate and Covered Entity shall mutually agree in advance upon the scope, timing and location of such an inspection, (ii) Covered Entity shall protect the confidentiality of all confidential and proprietary information of Business Associate to which Covered Entity has access during the course of such inspection; and (iii) Covered Entity shall execute a nondisclosure agreement, upon terms mutually agreed upon by the parties, if requested by Business Associate The fact that Covered Entity inspects, or fails to inspect, or has the right to inspect, Business Associate s facilities, systems, books, records, agreements, policies and procedures does not relieve Business Associate of its responsibility to comply with the BAA, nor does Covered Entity s (i) failure to detect or (ii) detection, but failure to notify Business Associate or require Business Associate s remediation of any unsatisfactory practices, constitute acceptance of such practice or a waiver of Covered Entity s enforcement rights under the Agreement or BAA, Business Associate shall notify Covered Entity within ten (10) days of learning that Business Associate has become the subject of an audit, compliance review, or complaint investigation by the Office for Civil Rights III Termination a Material Breach A breach by Business Associate of any provision of this BAA, as determined by Covered Entity, shall constitute a material breach of the Agreement and shall provide grounds for immediate termination of the Agreement, any provision in the Agreement to the contrary notwithstanding [45 CFR Section (e)(2)(iii)] b Judicial or Administrative Proceedings Covered Entity may terminate the Agreement, effective immediately, if (i) Business Associate is named as a defendant in a criminal [Enter Number] Amendment 6 Exhibit [Enter Name of Contractor ] Standard Business Associate Agreement Language 08/31/10

125 proceeding for a violation of HIPAA, the HITECH Act, the HIPAA Regulations or other security or privacy laws or (ii) a finding or stipulation that the Business Associate has violated any standard or requirement of HIPAA, the HITECH Act, the HIPAA Regulations or other security or privacy laws is made in any administrative or civil proceeding in which the Business Associate has been joined c Effect of Termination Upon termination of the Agreement for any reason, Business Associate shall, at the option of Covered Entity, return or destroy all Protected Information that Business Associate or its agents or subcontractors still maintain in any form, and shall retain no copies of such Protected Information If return or destruction is not feasible, as determined by Covered Entity, Business Associate shall continue to extend the protections of Section 2 of the BAA to such information, and limit further use of such PHI to those purposes that make the return or destruction of such PHI infeasible [45 CFR Section (e) (ii) (2(I)] If Covered Entity elects destruction of the PHI, Business Associate shall certify in writing to Covered Entity that such PHI has been destroyed IV General Provisions a Indemnification In addition to the indemnification language in the Agreement, Business Associate agrees to be responsible for, and defend, indemnify and hold harmless the County for any breach of Business Associate s privacy or security obligations under the Agreement, including any fines and assessments that may be made against SCVHHS or the Business Associate for any privacy breaches or late reporting b Disclaimer The County makes no warranty or representation that compliance by Business Associate with this BAA, HIPAA, the HITECH Act, or the HIPAA Regulations will be adequate or satisfactory for Business Associate s own purposes Business Associate is solely responsible for all decisions made by Business Associate regarding the safeguarding of PHI c Amendment to Comply with Law The parties acknowledge that state and federal laws relating to data security and privacy are rapidly evolving and that amendment of the Agreement and/or BAA may be required to provide for procedures to ensure compliance with such developments The parties specifically agree to take such action as is necessary to implement the standards and requirements of HIPAA, the HITECH Act, the Privacy Rule, the Security Rule and other applicable laws relating to the security or confidentiality of PHI The parties understand and agree that the County must receive satisfactory written assurance from Business Associate that Business Associate will adequately safeguard all Protected Information Upon the request of either party, the other party agrees to promptly enter into negotiations concerning the terms of an amendment to the BAA embodying written assurances consistent with the standards and requirements of HIPAA, the HITECH Act, the Privacy Rule, the Security Rule or other applicable laws The County may terminate the Agreement upon thirty (30) days written notice in the event (i) Business Associate does not promptly enter into negotiations to amend the Agreement or BAA when requested by the County pursuant to this Section or (ii) Business Associate does not enter not enter into an amendment to the Agreement or BAA [Enter Number] Amendment 7 Exhibit [Enter Name of Contractor ] Standard Business Associate Agreement Language 08/31/10

126 providing assurances regarding the safeguarding of PHI that Covered Entity, in its sole discretion, deems sufficient to satisfy the standards and requirements of applicable laws d Assistance in Litigation of Administrative Proceedings Business Associate shall make itself, and any subcontractors, employees or agents assisting Business Associate in the performance of its obligations under the Agreement or BAA, available to Covered Entity, at no cost to Covered Entity, to testify as witnesses, or otherwise, in the event of litigation or administrative proceedings being commenced against Covered Entity, its directors, officers or employees based upon a claimed violation of HIPAA, the HITECH Act, the Privacy Rule, the Security Rule, or other laws relating to security and privacy, except where Business Associate or its subcontractor, employee or agent is named adverse party e No Third-Party Beneficiaries Nothing express or implied in the Agreement or BAA is intended to confer, nor shall anything herein confer, upon any person other than Covered Entity, Business Associate and their respective successors or assigns, any rights, remedies, obligations or liabilities whatsoever f Effect on Agreement Except as specifically required to implement the purposes of the BAA, or to the extent inconsistent with this BAA, all other terms of the Agreement shall remain in force and effect g Interpretation The provisions of this BAA shall prevail over any provisions in the Agreement that may conflict or appear inconsistent with any provision in this BAA The BAA and the Agreement shall be interpreted as broadly as necessary to implement and comply with HIPAA, the HITECH Act, the Privacy Rule and the Security Rule The parties agree that any ambiguity in this BAA shall be resolved in favor of a meaning that complies and is consistent with HIPAA, the HITECH Act, the Privacy Rule and the Security Rule h Survivorship The respective rights and responsibilities of Business Associate related to the handling of PHI survive termination of this Agreement [Enter Number] Amendment 8 Exhibit [Enter Name of Contractor ] Standard Business Associate Agreement Language 08/31/10

127 Committee Agenda Date: March 21, 2011 Agenda Item No10 County of Santa Clara Santa Clara Valley Health & Hospital System Valley Health Plan HHC DATE: March 21, 2011 Prepared by: Barbara Laskin ASO III Reviewed by: Greg Price CEO, Valley Health Plan Luke Leung Deputy County Executive TO: SupervisorLizKniss, Chairperson SupervisorKenYeager, Vice Chair Health & Hospital Committee FROM: Greg Price CEO, Valley Health Plan SUBJECT: Report back from Valley Health Plan to the Health & Hospital Committee on the Board Referral on Reinforcing Santa Clara County's current Employee Wellness Program RECOMMENDED ACTION Consider recommendations relating to: a Accept report from Valley Health Plan on Reinforcing Santa Clara County's Current Employee Wellness Program b Forward a positive recommendation to the Board of Supervisors to move the Board of Supervisors: Mike Wasserman, George Shirakawa, Dave Cortese, Ken Yeager, Liz Kniss County Executive: Jeffrey V Smith 1

128 Committee Agenda Date: March 21, 2011 Agenda Item No10 Employee Wellness Program under the leadership of Valley Health Plan and to create an employee wellness coalition, as outlined in the attachment FISCAL IMPLICATIONS There is not net impact to the General Fund as the Employee Wellness Program and its assets are transferred from ESA to VHP VHP will continue to receive reimbursement through the Health Rate for the Employee Wellness Program The current Health rate charge includes a component for the Employee Wellness Program that fully reimburses this program This rate is calculated as a per employee charge to all departments, including the non-general Fund departments The General Fund charge is approximately 55% of the whole amount with the remaining 45% spread out to the various non-general Fund departments In FY 2012 the total Health Rate charged for Employee Wellness is budgeted at $643,922 REASONS FOR RECOMMENDATION On August 24, 2010, the Board of Supervisors submitted a referral requesting that Employee Wellness Program be repositioned under the leadership of Valley Health Plan (VHP) The Board requested that the proposed program changes support the enhancement of employees mental and physical health and should result in improved job satisfaction while increasing employee retention and reducing medical costs for the County without compromising benefit levels As we face a new era of healthcare reform, health delivery costs continue to trend upwards Many of the drivers of healthcare costs are chronic diseases that are both treatable and preventable Research proves that one of the best options to reduce this cost is to invest in worksite wellness A focused investment in employees health and well-being can result in reduced health care premiums, reduced absences/sick leave, and reduced worker s compensation claims, which can result in a more productive workforce While Santa Clara County ranks in the top five for counties with the greatest health behaviors and outcomes, there are still areas that, unless addressed, will continue to contribute to the high cost of health care High levels of cholesterol, blood pressure, and binge drinking contribute to the classic chronic ailments such as heart disease, cancer, stroke, and diabetes that continue to be the major causes of death and disease for our County Both obesity, brought on by inadequate physical activity and poor nutrition, and smoking, contribute to more than 50% of chronic diseases And, it is estimated that employees who smoke contribute Board of Supervisors: Mike Wasserman, George Shirakawa, Dave Cortese, Ken Yeager, Liz Kniss County Executive: Jeffrey V Smith 2

129 Committee Agenda Date: March 21, 2011 Agenda Item No10 to an additional $17,500 of lifetime health care costs, much of which is bourne by employers Many companies have seen the opportunity to address the chronic diseases that drive healthcare costs through worksite wellness programs A thorough research of statistics and wellness programs identified four worksite wellness programs as benchmarks: King County, Washington Kaiser Permanente Cisco Systems, San Jose National Institutes of Health (NIH) These four programs were reviewed to understand each company s wellness approach based on their goals and objectives, successes and challenges, investments and their return on investment Underlying the programs implementation were Best Practices and key components In addition, VHP reviewed current wellness activities from various departments to provide insight into potential interdepartmental collaboration between County agencies and departments The current Employee Wellness Program provides a solid foundation of basic wellness activities such as the health fair, employee screenings, fitness classes, and other resources Also, the County has a wealth of untapped internal resources that could provide wellness opportunities An interdepartmental collaboration of these resources would provide the building blocks necessary to improve the existing wellness foundation These other agencies, in addition to Employee Wellness, include: Public Heath Department Parks and Recreation Employee Health Employee Assistance Program Valley Health Plan Lastly, the achievements of the Center for Leadership Transformation (CLT) Employee Wellness Group, Wellness Warriors, were also reviewed and considered In the development of the response to the Referral, VHP reviewed the overall statistics on chronic diseases in Santa Clara County, best practices and benchmarks for a successful program, CLT recommendations, and the status of the current wellness activities in the County for the employees Based on this data, VHP has developed a proposed organizational Board of Supervisors: Mike Wasserman, George Shirakawa, Dave Cortese, Ken Yeager, Liz Kniss County Executive: Jeffrey V Smith 3

130 Committee Agenda Date: March 21, 2011 Agenda Item No10 structure that includes an increase in staffing as well as the creation of a coalition called The WELLiance for Santa Clara County Employees or The WELLiance The purpose of The WELLiance is a coordinated, multi-departmental participation collaboration strategizing sustainable employee wellness priorities and activities The fundamental process for operation of the WELLiance is as follows: Best Practices would be integrated into the Action of the coalition, which are Evaluated, then Assessed to be incorporated back into Best Practices In order to have a structure that upholds the vision of the Board, the direction of CLT, and moves to transform the current program, the following coalition structure is proposed: Advisory Group will provide overall cultural, structural, and political influence to make employee wellness an institutional priority Leadership Group will be responsible for direction, prioritization and cross-coordination of EWP activities amongst the Work Group Work Groups will carry out the priorities of the Leadership Group These groups are the working body of The WELLiance Ad Hoc sub-groups would be added as needed from existing work groups in order to address areas that need more intense involvement and focus Underlying support for the coalition would come from existing EWP staff and the proposed augmentation of a manager and clerical support who will also continue to provide basic core wellness activities Through the suggested strategies and resources to be described, repositioning the Employee Wellness Program to reside under the leadership of Valley Health Plan will reinforce the Boards vision to improve the health status of the county workforce and the County as an employer In addition to the WELLiance structure and function, there are certain objectives that would need to be undertaken prior to, during, and after the initiation of the employee wellness coalition The overview of these phases are: Phase I - Preparation for WELLiance: February - June 2011 Phase II - Implementation of WELLiance: July December 2011 Phase III - Continuance of WELLiance: January - June 2012 Board of Supervisors: Mike Wasserman, George Shirakawa, Dave Cortese, Ken Yeager, Liz Kniss County Executive: Jeffrey V Smith 4

131 Committee Agenda Date: March 21, 2011 Agenda Item No10 Phase IV - Maintenance & Sustainability: July 2012 and on-going These phases and specific objectives are outlined in detail in the attached Response To use a simple but structured model the recommendation is to combine an "intensity model" highlighted by the Public Health Department along with the "7 Indicators of a Successful Wellness Program" by WELCOA, a highly respected national organization committed to employee wellness and include: Senior-Level Support 1 A Cohesive Wellness Team 2 Results-Orientated Data Collection 3 An Annual Systematic Operating Plan 4 Appropriate Interventions 5 A Supportive, Health Promoting Environment 6 Evaluating Outcomes A new and improved Employee Wellness Program must be a robust and dynamic multi-prong approach involving the concerted effort of key stakeholders, partners, and most importantly employees Financially, benefits will encompass a return on investment in the form of reduced health costs, an aggregate decrease in worker's compensation injuries, disability claims, reduced absenteeism, and increased productivity On a personal level, employees will experience improved morale, cross-functional relations, and healthier living County employees are our greatest resource, and all possible means should be explored to maintain and promote their mental and physical health, improve job satisfaction, and retain the best workforce It is time for a cultural shift in the County for the good of its employees and its stakeholders A repositioned Employee Wellness Program will capture the Board's vision in transforming the County of Santa Clara into a hub of wellness and healthy living BACKGROUND As a county agency as well as a health plan choice for medical care for County of Santa Clara employees, IHSS workers, and many other employer groups, Valley Health Plan (VHP) has a vested interest in improving the health of its members and county employees The Employee Wellness Program (EWP) is dedicated to enhancing the health and well-being of Santa Clara County employees by providing services that motivate employees to move toward optimal health Together, VHP and EWP have partnered over the last three years to provide employee communications and wellness class offerings that work towards creating the Board of Supervisor s vision of creating an employee wellness effort that recognizes employees are Board of Supervisors: Mike Wasserman, George Shirakawa, Dave Cortese, Ken Yeager, Liz Kniss County Executive: Jeffrey V Smith 5

132 Committee Agenda Date: March 21, 2011 Agenda Item No10 the County s greatest asset CONSEQUENCES OF NEGATIVE ACTION Failure to approve this action will result in the Employee Wellness Program remaining under the leadership of Employee Services Agency s Risk Management Department ATTACHMENTS Executive Summary Wellness Referral Response Wellness Referral Response Board of Supervisors: Mike Wasserman, George Shirakawa, Dave Cortese, Ken Yeager, Liz Kniss County Executive: Jeffrey V Smith 6

133 Santa Clara County Wellness Program Referral Response Executive Summary March 21, 2011 [Type the author name] [Pick the date]

134 Executive Summary On August 24, 2010, the Board of Supervisors submitted a referral requesting that the Employee Wellness Program be repositioned under the leadership of Valley Health Plan as an organizing body The Board requested that the proposed program changes support the enhancement of employees mental and physical health The results would improve job satisfaction, increase employee retention, and reduce medical costs for the County All the while, without compromising benefit levels As we begin to face a new era of healthcare reform, health delivery costs continue to trend up Many of the drivers of healthcare costs are (both treatable and preventable) chronic diseases Research proves that one of the best options to reduce the costs is to invest in worksite wellness A focused investment in employees health and well-being can result in reduced healthcare premiums, reduced absences/sick leave, a decrease in workers compensation claims, and in a generally more productive workforce While Santa Clara County ranks in the top five for counties with the greatest health behaviors and outcomes, unless addressed, there are still areas that will continue contributing to the high costs of healthcare High levels of cholesterol, blood pressure, and binge drinking contribute to classic chronic ailments such as heart disease, cancer, stroke, and diabetes still the major causes of death and disease for our County today Both obesity, brought on by inadequate physical activity, poor nutrition, and smoking contribute to more than 50% of chronic diseases And, it is estimated that employees who smoke contribute to additional $17,500 in lifetime health costs, much of which are born by the employers Many companies have seen the opportunity to address the chronic diseases that drive healthcare costs through worksite wellness programs Through a thorough research of statistics and wellness programs, there were four worksite wellness programs identified as benchmarks: King County, Washington Kaiser Permanente Cisco Systems, San Jose National Institutes of Health (NIH) These four programs were reviewed to understand each company s wellness approach based on its goals and objectives, successes and challenges, investments and their return on investment (ROI) Underlying the programs implementation were Best Practices and key components Page 2

135 In addition, VHP also reviewed current wellness activities from various departments in order to provide insight into potential interdepartmental collaboration between County agencies and departments The current Employee Wellness Program (EWP) provides a solid foundation of basic wellness activities such as health fairs, employee screenings, fitness classes, and healthier living resources In addition, the County has a wealth of untapped internal resources which could provide wellness opportunities An interdepartmental collaboration within these resources would provide the building blocks necessary to improve the existing wellness foundation The other agencies in addition to Employee Wellness include: Public Heath Department Parks and Recreation Employee Health Employee Assistance Program Valley Health Plan Lastly, the achievements of the Center for Leadership and Transformation s (CLT) Employee Wellness Group (dubbed the Wellness Warriors ) were also reviewed and taken into consideration In the developing a response to the Referral, VHP reviewed the overall statistics on chronic diseases (including those in Santa Clara County), best practices and benchmarks for a successful program, CLT recommendations, and the status of current employee wellness activities in the County Then, given all that information, VHP developed a proposed organizational structure which includes an increase in staffing as well as the creation of a coalition dubbed WELLiance for Santa Clara County employees The purpose of WELLiance is a coordinated, multi-departmental collaboration strategizing sustainable employee wellness priorities and activities The fundamental process for operation WELLiance is as follows: Best practices would be integrated into the action of the coalition, subsequently evaluated, then assessed to be incorporated back into best practices In order to have a structure that upholds the vision of the Board, captures the direction of CLT, and moves to transform the current program, the following coalition structure is proposed: Advisory Group will provide overall cultural, structural, and political influence to make employee wellness an institutional priority Coalition Leadership Group will be responsible for direction, prioritization and cross-coordination of EWP activities amongst the Work Group Page 3

136 Work Groups will carry out the priorities of the Leadership Group These groups are the working body of WELLiance Ad hoc sub-groups would be added as needed from existing work groups in order to address areas that need more intense involvement and focus Underlying support for the coalition and would come from existing EWP staff, as well as proposed augmentation of a manager and clerical support, who will also continue to provide basic core wellness activities Through suggested strategies and resources to be described, repositioning EWP to reside under the leadership of Valley Health Plan as an organizing body will reinforce the Board s vision to improve both the health status of the County workforce, as well as the County as employer In addition to the WELLiance structure and function, there are certain objectives that would need to be undertaken prior to, during, and after initiation of the employee wellness coalition The overview of these phases are: Phase I Preparation for WELLiance: February - June 2011 Phase II Implementation of WELLiance: July December 2011 Phase III Expansion of WELLiance: January - June 2012 Phase IV Management and Evaluation: July 2012 and on-going The phases, as well as specific objectives, are detailed in the Wellness Program Referral Response To use a simple but structured model, the recommendation is to combine an intensity model highlighted by the Public Health Department along with the 7 Indicators of a Successful Wellness Program by WELCOA, a highly respected national organization committed to employee wellness These indicators include: 1 Senior-Level Support 2 A Cohesive Wellness Team 3 Results-Oriented Data Collection 4 An Annual Systematic Operating Plan 5 Appropriate Interventions 6 A Supportive, Health Promoting Environment 7 Evaluating Outcomes Page 4

137 A new and improved Employee Wellness Program must follow a robust and dynamic multi-prong approach, involving the concerted effort of key stakeholders, partners and most importantly, the employees Financially, benefits will encompass: A ROI in the form of reduced health costs; an aggregate decrease in workers compensation injuries, and disability claims; reduced absenteeism; and increased productivity On a personal level, employees will experience improved morale, cross-functional relations, and healthier living County employees are our greatest resource, and all possible means should be explored to maintain and promote their mental and physical health, improve their job satisfaction, and retain the best workforce possible It is time for a cultural shift in the County for the good of its employees and its stakeholders A repositioned Employee Wellness Program will capture the Board s vision in transforming the County of Santa Clara into a hub of wellness and healthy living Page 5

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139 Santa Clara County Wellness Program Referral Response March 21, 2011 Page 1

140 Table of Contents Introduction 3 Background/Research 4 Diseases and Related Costs 4 Wellness Practices 5 Worksite Wellness Programs and Benchmarks 6 County Wellness Activities 12 Employee Wellness Program 12 Center for Leadership and Transformation - Wellness Warriors 13 Santa Clara County Departments 15 Referral Background 20 Program Recommendations 20 Creating an Employee Wellness Coalition 20 Addressing the Board Referral 23 Creating a Wellness Framework 33 Budget 37 Evaluation 38 Conclusion 41 References 42 Appendix 1: Health and Wellness Classes by Provider Type 45 Fiscal Year Fiscal Year Appendix 2: VHP Wellness Wednesdays 51 Appendix 3: County Department Services & Resources 52 Appendix 4: Organizational Framework 74 Page 2

141 Introduction With the rising costs of healthcare, further investment of time and resources into worksite wellness will benefit the County of Santa Clara In FY10, it is projected that Santa Clara County will spend more than $188 million in medical benefit expenses (Board Referral, 2010) This number is expected to grow each year unless other options are explored Research proves that one of the best options to reduce this cost is to invest in worksite wellness A focused investment in employees health and well-being can result in reduced health care premiums, reduced absences/sick leave, reductions in worker s compensation claims, and a more productive workforce The Board has requested that Valley Health Plan reposition the Employee Wellness Program (EWP) to a more comprehensive and up-to-date program based on best practices (Yeager, 2010) Enhancing employees mental and physical health will result in improved job satisfaction, while increasing employee retention and reducing medical costs, for the County without compromising benefit levels Through thorough research of statistics and wellness programs, there were several worksite wellness programs identified as benchmarks These four programs were reviewed to understand each company s wellness approach based on its goals and objectives, successes and challenges, investments and a return on investment (ROI) Underlying the programs implementation were best practices and key components These areas were identified and presented using the 7 Benchmarks of a Successful Wellness Program by WELCOA - The Wellness Council of America - a highly respected national organization committed to employee wellness (Hunnicutt, 2006) An overview of current wellness activities from various departments provides insight into potential interdepartmental collaboration between County agencies and departments Using the August 24, 2010 Board Referral as an outline, various program recommendations are presented Included is the suggested augmentation to the organizational structure to form a countywide Employee Wellness Coalition (EWC) Along with the proposed structure is the framework to be used for an enhanced program Lastly, budget, program objectives, and timelines are presented in order to evaluate the success of these recommendations Through suggested strategies and resources to be described here, repositioning EWP to reside under the leadership of Valley Health Plan as an organizing body will reinforce the Board s vision to improve both the health status of the County workforce, as well as the County as employer Page 3

142 Background/Research Diseases and Related Costs As we begin to face a new era of healthcare reform, health delivery costs continue to trend up Many of the drivers of healthcare costs are (both treatable and preventable) chronic diseases Both obesity, brought on by inadequate physical activity and poor nutrition, and smoking, contributes to more than 50% of chronic diseases (Peddycord, 2010) Obesity is a direct expense to employers, with companies spending about $1,500 Per Employee Per Year (PEPY) in associated medical expenses Hypertension, Type II diabetes, coronary heart disease, and some cancers are additional chronic conditions potentially onset by obesity and excess weight (Alarcon et al, 2010) Employees who smoke contribute to additional $17,500 in lifetime health costs, much of which are born by the employers (Prevention for a Healthier America, 2008) Without current data available Santa Clara County employees, the recommended starting point for the development of the new wellness program will be based on statistics of County residents Thus, it should focus on the identified preventable conditions While Santa Clara County ranks in the top five for counties with the greatest health behaviors and outcomes, unless address, there are still areas that will continue contributing to the high costs of healthcare (Alarcon et al) High levels of cholesterol, blood pressure, and binge drinking show the largest difference between the County of Santa Clara and Healthy People 2010 Targets (Santa Clara County Public Health Department, 2010) These contribute to classic chronic ailments such as heart disease, cancer, stroke, and diabetes, still the major causes of death and disease for our County today In 2009, the percentage of overweight or obese adults in Santa Clara County has increased to 56% (from 52% in the year2000) And in the year 2000, approximately 50,000 adults living in Santa Clara County were reported to have diabetes In 2009, this number rose by nearly 63% to 80,000 (Peddycord) Although our County has the lowest mortality rate from all causes compared to all other counties in the Bay Area, the leading cause of mortality in the County of Santa Clara is cancer, followed closely by heart disease (Peddycord) Page 4

143 Wellness Practices The early 1990s saw the beginning of wellness programs in the workplace These programs for many employers and insurance groups began to pave the way for a lucrative fresh opportunity: to reinvest a portion of member premiums into employee wellness With the health statistics and associated healthcare costs cited above, further investment of time and resources into worksite wellness will benefit the County The level of intensity and investment of resources is something that will reap benefits However, the level of commitment should be determined upfront The level of commitment can expand over time and leverage the upcoming opportunities of incentives and re-investment that comes from the Health Insurance Portability and Accountability Act of 1996 (HIPAA) as well as the Affordable Care Act of 2010 (Peddycord) Many companies have seen the opportunity that lies in worksite wellness, and have started developing such programs Each program varies from the extent and type of interventions Overall, there are certain Best Practices and key components that have been identified to create successful worksite wellness programs These 7 Benchmarks are outlined by WELCOA and include (Hunnicutt): 1 Senior-Level Support A top-down communications strategy that supports the distribution of resources, and role modeling health 2 A Cohesive Wellness Team Cross-functional team members 3 Results-Oriented Data Collection HRA findings, demographics and encountered claims 4 An Annual Systematic Operating Plan - Alignment of the goals and objectives, an itemized budget, evaluation of participation and satisfaction levels, risk factor pervasiveness, and changes in health behavior 5 Appropriate Interventions - Types and intensity of programming, frequencies, targeted audience, and incentives (without which HRAs will yield <15% participation) For instance, smaller employers tend to offer more programming that requires cost sharing with employee users 6 A Supportive, Health Promoting Environment - Supporting employees with a healthy physical working environment, organizational policies that protect and promote good health, increase physical activity and promote better nutrition Page 5

144 7 Evaluating Outcomes - Participation and satisfaction levels, risk factor pervasiveness, productivity (eg absenteeism, turnover), changes in health behavior and/or clinical results, post-hoc organizational indicators, realization of objectives, some Best Practice testimonials, and Return on Investment (ROI) Worksite Wellness Programs and Benchmarks Several worksite wellness programs were reviewed to understand each company s approach along with their goals and objectives, successes and challenges, investments and their return on investment Described below are four organizations which have seen positive results over time from implementing a worksite wellness program yet have taken different approaches Each of these programs demonstrates the incorporation of various aforementioned areas King County, Washington In the state of Washington, King County has formed a worksite wellness program for its 20,000 employees and dependents The initiative, Healthy Incentives Program, SM seeks to foster a work culture around employee health (Thomson Reuters, 2009) Approximately 80% of King County s employees receive medical benefits under the County s self-insured KingCare plan Executives at the County soon discovered that 5% of all workers and spouses in the self-insured plan essentially accounted for 58% of the county s total health costs The majority of such costs were mainly tied to preventable diseases; untreated, they open the floodgates to chronic disease (The Seattle Times, 2009) The Healthy Incentives Program SM empowers the employee while holding the individual accountable The program works on the honor system and money is the prime motivator, as employees incentives are granted as lower health-insurance deductibles Employees report certain healthier living measures by completing an annual wellness survey Since the program s inception in 2005, response rates for the survey have consistently exceeded the 90% mark (King County, 2009) Since the Healthy Incentives Program SM took off in King County, statistical measurements show an improvement in 12 of the organization s 14 risk factors or categories The following behaviors improved between 2005 and 2009, as reported by the employees in their annual survey (King County): Moderating alcohol use Managing depression Preventing injuries Maintaining good mental health Page 6

145 Eating a healthy diet Avoiding excess sun exposure Stopping smoking Managing stress King County spends around $1 million in annual costs to create a healthier workplace culture, and to fund the evaluation of data The worksite wellness initiative has saved the organization $18-million in projected costs during the four-year time span (King County) This County s best practice approach in worksite wellness makes it possible for government-owned organizations to foster a workplace culture mindful of healthier living Of the seven organizational benchmarks, King County s program includes: Results-Orientated Data Collection through their annual wellness survey Annual Systemic Operating Plan Appropriate Intervention through lower deductibles, and Evaluating Outcomes through their annual report of wellness survey results Kaiser Permanente In 2004, Kaiser Permanente reinvented its own workforce when it launched Thrive! a fresh $40-million-dollar ad campaign Efforts to incorporate employee wellness throughout the organization began in 2005 Employee wellness at Kaiser is hierarchically organized topdown as follows: Medical Director, Executive Director, and Physician Ambassadors, all working across the organization s various regions Kaiser s secret of success for keeping employees healthy rests with the company s superior technology and focus on prevention and disease management Prior to the planning and development of Thrive! and employee wellness, the organization made sure to preemptively measure success Kaiser s wellness teams continue to thrive by way of interdepartmental partnerships and the company s systems approach has earned numerous recognitions Among recent ones, three publications deemed Kaiser a Best Place to Work, largely due to its investment and support for innovation, teamwork and employee wellness (Fernandes, 2010) The organizational benchmarks found in Kaiser s Program include: Senior Level Support through effective communications, and Cohesive Wellness Team including participation of medical directors Page 7

146 Cisco Systems A third benchmark for Santa Clara County is Cisco Systems The company launched its worksite wellness program, Health Connections, shortly after it became self-insured in 2005 However, the benefits structure lacked an employee wellness strategy This finding set Cisco Systems in motion and the Health Connections team was formed that same year Before Health Connections took shape, Cisco hired Dr Pamela Hymel, MD, MPH, FACOEM, as their corporate medical director for her expertise in corporate-based population health Health Connections was set-up for a month return on investment (ROI) The program started with including locally grown produce and healthy bites in the cafeteria and adding sports teams, personal training, and aerobics to the fitness center As the program expanded, Cisco began to provide its employees with health coaches and health managers The coaches are licensed or certified in health education, exercise physiology, dietetics, chiropractics, and mental health The health managers have expertise in nutrition, weight management, stress management, physical activity, and smoking cessation matters The coaches help employees prevent disease states and the health managers help to manage those states Beyond the program s initial services, health risk assessments and biometric screenings make up the personal health assessment which is the core of Health Connections Cisco uses a third party vendor to analyze results from the personal health assessments to ensure that employees identities and medical information are kept secure Cisco is personalizing Health Connections through Personal Health Manager and wellness offerings Personal Health Manager is a web-based computer program that allows employees to enter data from their personal health assessment The software then helps the person to identify potential health issues and recommends online resources or web-based classes in addition to health coaching Health Connections is part of total rewards for employees, which includes their compensation and benefits Cisco has linked its participation in the program to actual cash rewards After completing the Personal Health Assessment (PHA), employees and their spouses are rewarded monetarily Each interaction rewards the person with cash that reduces the cost of their health insurance premiums The employees are able to earn enough to cover their entire annual premiums as well as add money to their flexible spending accounts to cover their deductibles and co-payments (Moos, 2007) Page 8

147 Cisco has continued its business strategy of partnering with third party vendors to help develop and manage its Health Connections Much of the content of the program comes from employee-offered health plans (CIGNA & United Healthcare), and external wellness vendors The company strategically promotes friendly competition among its participating vendors and partners to continually drive the high level of quality of the program Ultimately, health and productivity go hand in hand As Health Connections illustrates, what began as a business case with ROI figures has grown into a cultural change of embraced wellness practices Cisco s decision to transform its health fairs into an incentive-driven model wellness program has also produced a healthier workforce proving that good health yields a reduction in health risk Since 2005, inpatient admissions have decreased by 20% and PEPY costs have been reduced by 135% Additionally, absentee costs were reduced by $3-million (Lisa Jing, Cisco, 2010) Cisco s Health Connections incorporates most of the seven organizational benchmarks including: Senior Level Support with participation of medical director Results-Oriented Data Collection through annual HRA, biometric screenings Annual Systemic Operating Plan to report ROI Appropriate Intervention by providing health coaching, onsite fitness classes, web-based PHA which correlate with health insurance premium reduction Cohesive Wellness Team made up of health plan programs and medical director, and Evaluating Outcomes with reporting of ROI from interventions The National Institutes of Health (NIH) The National Institutes of Health (NIH) is the leading biomedical research agency for the country It employs 30,000 people, most of them located in Washington, DC (Gaines, 2010) The NIH s Wellness Program was driven by the federal government s Obama Presidential Initiative The Program debuted in 2008 and is a combination of the public and private Best Practices Housed under NIH s Office of Director, the Program s designated appointees are organized hierarchically, as follows: NIH Director, Deputy Director of Management, Senior Wellness official, Program Director, Program Official, Advisory Council, and Ad Hoc Advisory Group The Wellness Advisory Council includes respective employees serving as representatives from 30 NIH institutes and centers, appointed by their corresponding directors Page 9

148 The Council initiates ideas and sets policies for employee wellness While Program Official Chris Gaines manages the overall Program, each NIH center and institute functions individually The overall Wellness Program budget is $500,000, with marketing comprising 10% of the budget Gaines equally acknowledges that the organization has not yet looked at any ROI numbers With the exception of the Fitness Center, all NIH wellness resources are internally-driven, so there is little overhead or outside contracting costs The NIH Wellness Program oversees food services and the cafeteria A wellness calendar spotlights activities such as fitness, dancing, and parenting classes, as well as lunch-andlearns all free to employees The programs are delivered by in-house health educators Marketing for employee wellness at the NIH is global, all-inclusive, and internally-driven by the Marketing Department Ongoing promotional events include wellness seminars, Take a (5K) Hike Day, and monthly informational streaming videos The Program motivates change through massive communication and visibility, underscoring the free yoga and exercise classes, and wellness seminars There are not incentives offered to employees who participate on the program Employees want to be healthier, says Gaines Thus, wellness seminars are branded as Focus on You, meaning, the worker Currently the Program is not using any health risk assessments (HRAs) to capture data The NIH uses simple statistics to evaluate its worksite wellness efforts, focusing on participation and attendance scores Wellness efforts at the NIH have a 22% response rate for a simple questionnaire, which revealed that employees prefer to be the best method of communication Access to programs and events drive both branding efforts and resulting attendance The Focus on You lecture series is built on topics such as fitness, nutrition, time management, and mind-body wellness Annual events include: Health Expo Wellness stations, free screenings and classes Beach Ready Day Outdoor exercise classes and competitive volleyball Take a Hike Day Almost 3 miles around the NIH campus in Washington, DC Spring into Health - Free exercise classes, wellness seminars and health screenings at various locations throughout NIH campus Many of the interventional activities take on a friendly competitive tone among the 30 institutes and centers A recognized and honorary trophy is awarded to the winning team and rotated throughout the organization Page 10

149 For Chris Gaines and his team, wellness has become a prominent issue and one of the most important starting elements is senior management buy-in and endorsement Just this aspect alone is half your battle, adds Gaines Success with employee wellness at the NIH continues still in part due to the following operating steps: 1 Identifying and developing resources based on what employees want 2 Implementing quick and easy healthy food changes in the cafeteria 3 Using free electronic mass blasts versus an expensive poster campaign 4 Rotating programs and wellness seminars throughout the facilities The organization benchmarks found in NIH Program include: Senior Level Support by being housed in the Office of the Director and promoting strong communications Cohesive Wellness Team which is directed by multi-departmental Advisory Council Annual Systemic Operating Plan which include special events and activities, and Appropriate Intervention such as departmental friendly competitions, lunch and learns, and online seminars Page 11

150 County Wellness Activities The County has a wealth of untapped internal resources which could provide wellness opportunities An interdepartmental collaboration of these resources would provide the building blocks necessary to improve the existing wellness foundation Employee Wellness Program In 1996, the Employee Wellness Program (EWP) was reestablished by the Employee Services Agency EWP is dedicated to promoting the health and well-being of County employees through services that motivate employees to move toward optimal health EWP goals are to: Provide up-to-date worksite health promotion services Make services accessible to as many employees as possible Provide services and activities that increase employees health knowledge Engage employees in activities which motivate them to learn new skills and make positive lifestyle changes EWP s success has been recognized by the Board of Supervisors and has received the Platinum Standard Award from the American Heart Association EWP attributes its success to the number of employees throughout the County that participate in the department activities Currently, the EWP team is staffed with 30 FTE health educators The team develops an annual programmatic theme which is the focus for the year s class offerings and outcomes for employees The EWP team works with the three County-owned health plans as well as community partners and instructors to support and provide classes and services The EWP staff teaches classes, provide one-on-one health coaching for employees, operate a resource lending library, and organize the annual employee wellness fair Additionally, the staff coordinates mini-health fairs, department presentations, and employee health screenings Other wellness campaigns that have been implemented include March into May (which motivates physical activity), and Step It Up (which encourages simple steps for a more active work life) However, with only three employees, the program is limited by what it can produce given the large diverse employee base they serve The approximate annual budget for EWP is $600,000, which includes the 30 FTEs, a small marketing budget, contracts for external vendor services (ie health screening services, event planning), and overhead expenses In addition, EWP currently partners with external massage therapists for onsite massage services and Community Supported Agriculture (CSA) for fresh produce box delivery Page 12

151 The Nutritional and Wellness Resource Group, originally organized by Supervisor Liz Kniss, provides cross-departmental support and resources to EWP This group has helped support the EWP with augmented resources and problem resolution to further the program s mission The group is made up of employees from Public Health, the three contracted health plans, Facilities, EWP staff and aides from the Board of Supervisors In an effort to reach as many employees as possible, the EWP also relies on volunteer wellness liaisons from various County departments and agencies to act as their ambassadors and communicators The participation and support varies by department, agency and the volunteer liaisons workload EWP is currently promoted through a quarterly newsletter, various County intranet sites, the program website and individualized campaign materials Promotional items are purchased to use during larger wellness events and campaigns The marketing portion of budget for EWP averages $10,000 annually Center for Leadership and Transformation s Wellness Warriors During the summer of 2010, the County Executive s Office launched the Center for Leadership and Transformation (CLT) which began a variety of initiatives throughout the County Employee Wellness was identified as a focus area In October 2010, a group of cross-functioning employees began to meet with the vision of creating a worksite culture to support employee wellness Their mission is to enhance employees body, mind, and spirit, occupational and social wellness through motivational programming geared towards optimal health The team, which named itself Wellness Warriors (WW), is made-up of 10 members, representing Employee Wellness, Employee Health, Public Health, Valley Health Plan, Department of Alcohol & Drug Services (DADS), Parks and Recreation, and Nutrition & Food Services departments The Wellness Warriors were tasked with identifying existing resources within the County, then collaboratively integrating them on a transformational and cultural journey for an estimated 15,400 employees The WW s theoretical framework rests on The Fun Theory Fun is the easiest way to change people s behavior for the better (The Fun Theory, 2009) The theory was inspired by a wellness initiative sponsored by auto maker Volkswagen: A subway in Stockholm, Sweden is the pilot for a creative tune-up After researchers found that consumers preferred taking the escalators instead of the stairs, they turned the staircase into an interactive step-sensory piano After the pilot was completed, the same researchers found that 66% more people chose to take the stairs instead (YouTube, 2009) They found that fun modifies behavior for the better and subway goers in Stockholm are now stepping up to a higher note Page 13

152 Empowering employees stems from motivating, inspiring, and prompting them to take action for their own betterment Two case studies highlighted by the Wellness Warriors have also incorporated the seven organizational benchmarks identified in the Wellness Practices section of the response These include: In 2000, Johnson & Johnson's (J&J) Health & Wellness Program was able to achieve medical care cuts by more than $38-million over the course of four years This translated into a savings equate of $225 per employee per year J&J s secret to success was integrating federally available tax incentives and grants into employee health and wellness (including disability management, employee assistance, and occupational medicine programs) Today, the company produces an ROI equal to $271 for every dollar spent (Berry, Mirabito, & Baun, 2010) Northeast Utilities offers participants financial incentives for its Well Aware Program The program is open to both employees and their spouses, receiving top level executive support from senior management, and is continuously evaluated The program has shown a $14-million reduction in behavioral health claims and an ROI of six to one (six dollars gained for every one dollar spent) The WWs current transformative timeline was identified as follows: By January 2011, identify Best Practices for worksite wellness By February 2011, develop a County-wide departmental outreach plan By May 2011, develop policy recommendations for worksite wellness By June 2011, present the First Annual Employee Walk-Run Day Best Practices to reduce county-wide costs entail the integration of existing Employee Wellness resources along with other CLT group focus priorities Collaborative leadership efforts identified by WW are focused on improving productivity and absenteeism for the County workforce and employee morale Page 14

153 Santa Clara County Departments Public Health Department The Public Health Department s mission is in partnership with the community to prevent disease and injury and create environments that promote and protect the community's health Within the department resides the Chronic Disease and Injury Prevention (CDIP) Unit The CDIP's mission is to improve health and wellness and prevent chronic diseases among County residents by working with partners to create healthy, safe, and livable communities Their goals are for communities to be smoke-free and that all community members have access to healthy foods and beverages and safe places to be physically active and engage in active transportation Key strategies include culturally appropriate education, organizational and practice changes, policy development, and community engagement (SCCPHD CDIP, 2011) As outlined, CDIP is engaging in numerous grants, projects, objectives and partnerships working on several key areas that would align with proposed County employee wellness activities Specifically, related initiatives include: Health, Climate Change and the Build Environment Community Mapping, Engagement and Mobilization o Access to Healthy Foods and Safe Places to Recreate Sugar Savvy - Rethink Your Drink Healthy Food and Beverage Environments Smoke/Tobacco Free Environments o Tobacco Retail Ordinances County and Cities o Smoke-Free Multi-Unit Housing o Smoke-Free Campus and Parks Healthy Trails Your Path to Fitness, Fun and Adventure Traffic Safe Communities Network o Bike, Walk Safely to School and Work o Senior Driver Safety Program Worksite Environment & Wellness Promotion of Fruits, Vegetables, and Physical Activity at Retail, Community Events, Schools, and Community Youth Organizations o Eat Right When Money is Tight Breastfeeding Promotion Childhood Feeding Collaborative Page 15

154 CDIP was recently awarded two Federal Health Prevention grants known as Communities Putting Prevention to Work (CPPW) Both grants are deliberate in their intention to create healthier environments in which to live work and play The first grant is focused on tobacco prevention The goal is to increase community awareness of the detrimental impact of tobacco utilization by engaging residents, key community partners, and elected leaders in public health efforts to reduce disease, disability, and death related to tobacco use by: Preventing tobacco use by youth and young adults; Eliminating exposure to secondhand smoke; Eliminating disparities related to tobacco use and its effects among specific populations; and Promoting quitting among young people and adults Santa Clara County will address the following intervention strategies: Utilize media and marketing to counter pro tobacco influences; Promote smoke-free workplaces, campuses and residential facilities; Establish local tobacco retail licensing requirements enforcement; Limiting tobacco advertising in proximity to schools; and Build capacity for smoking cessation services group of community organizations providing cessation services (counseling, nicotine replacement therapy, referrals) The second grant focuses on obesity This two-year grant will expand countywide obesity prevention efforts and will focus on high-impact nutrition and physical activity interventions designed to lead to policy, systems, and environmental change as well as to promote health and reduce the burden of chronic diseases for those living throughout Santa Clara County (SCCPHD CPPW, 2011) Goals and strategies include: Active Living and Transportation Initiative: To increase opportunities for active transportation to create inviting and livable communities; Sugar Sweetened Beverage Initiative: To reduce consumption of sugar-loaded or sugar-sweetened beverages through the expansion of the County s Sugar Savvy/Rethink Your Drink campaign; and Healthy Food and Beverage Access Initiative: To increase access to healthy food and beverages Page 16

155 One of the most exciting programs within the obesity CPPW effort is a project called the Let s Move Campaign The project is being promoted by the Local Obesity Prevention Program, the Centers for Disease Control, the Department of Health and Human Services and is being lead by key spokeswoman, First Lady Michelle Obama Established program such as this are key for employee wellness to embrace the principals and initiatives that are part of this campaign Parks and Recreation The Santa Clara County Parks and Recreation Department is comprised of a 46,000-acre park system encompassing a variety of urban and rural recreational amenities The vision is to create a growing and diverse system of regional parks, trails, and open spaces of countywide significance that connects people with the natural environment, offers visitor experiences that renew the human spirit, and balances recreation opportunities with resource protection With this in mind, the Parks Department manages ten reservoirs for recreational use, 312 miles of trails, 41 group picnic sites, five camping parks, two golf courses, and many other amenities of the County s finest natural resources (County of Santa Clara, Director of Parks and Recreation, 2010) Over the last few years, the Parks Department has been involved with joint collaborations They worked with the Santa Clara County Public Health Department and Kaiser Permanente in The Healthy Trails Challenge which encourages residents to explore trails while exercising Collaboration with the Santa Clara County Public Health Department and Valley Health Plan exists in the Festival in the Park, Where Wellness Meets Fun During this event residents can learn about available county-wide health and wellness resources Employee Health The Employee Health Department (EHD) is housed in Santa Clara Valley Medical Center (SCVMC) and provides basic services for SCVMC employees such as employment physicals and immunizations (SCVMC, Infection Prevention Department, 2010) The department objectives are to: Prevent and/or decrease the transmission of infections between employees, patients, and visitors; Emphasize maintenance of sound habits in personal hygiene and individual responsibility for Infection Prevention; Provide guidelines for pre-placement physical examinations for all employees; Monitor and investigate potentially harmful infectious exposures or outbreaks in personnel within the work site; Provide guidelines for care of work-related infections or exposures; Page 17

156 Identify potential infectious disease risks related to employment and institute appropriate preventive measures; and Prevent or reduce vaccine-preventable diseases and resulting absenteeism thereby reducing unnecessary costs Many of these objectives align with the work of the EWP Even though the current definition of employee is limited to SCVMC employees, there has been expressed interested by that department to become involved with overall County employee health initiatives In the last two years while working with the Employee Wellness Program and Valley Health Plan, EHD has been instrumental in providing on site flu shots to all County employees This partnership is just the beginning of possible coordinated services Employee Assistance Program The Employee Assistance Program (EAP) is a labor-management-sponsored, confidential, professional counseling service for employees and their families who want help in solving personal problems EAP helps employees cope with family conflict, alcoholism and drug abuse, relationship problems, depression and other stress-producing problems which can impact work productivity (County of Santa Clara, EAP, 2011) Free and confidential employee services include the following: Up to five sessions of counseling Referral to screened community resources Telephone follow-up after referral to assure that client needs are being met Training and consultation for union and management personnel in early recognition and effective referral of troubled employees Educational seminars that give valuable information to employees on a variety of topics Page 18

157 Valley Health Plan Valley Health Plan is a department of the County of Santa Clara, which was originally created in 1985 to meet the needs of hospital staff for affordable, quality healthcare Its functions range from being a commercial health plan for county employees and other employer groups to functioning as Management Services Organization for SCVMC The Plan is committed and compelled to the promotion of managed care principles such as health education, disease management, preventive care, utilization management, and marketing/outreach Through its Health Education Department, VHP employs 60 FTE health educators and other support staff to both implement and manage classes and services in the areas of fitness & nutrition, childbirth education and chronic care/disease management In addition to internal resources, VHP contracts with area teaching and training hospitals, as well as external health and fitness vendors; many which align and support employee wellness goals VHP is not only devoted to the wellness of its membership but also to the health and wellbeing of County employees For more than 15 years, VHP has consistently provided worksite wellness class offerings and health screenings through EWP In the last few years, VHP has co-coordinated and financed the development of the Wellness Counts employee newsletter As a partner, VHP staff have participated and provided resources for events such as the EWP Wellness Fair, annual employee flu shots, Safety Seminar, Festival in the Park, and mini-health fairs Page 19

158 Referral Background On August 24, 2010, the Board of Supervisors delegated a directive determined to make the Employee Wellness Program (EWP) more robust, dynamic and aligned with their goal of improving the health status of all County residents The referral requested that Valley Health Plan consider the following areas when making recommendations on how to create a more robust organizational culture: Examine current classes (including schedules and locations), resources and programs offered to our employed through the EWP; Inventory current classes and resources aimed at promoting wellness offered by the health plans with which the County currently has contracts; Analyze budget recommendations for resources and staffing for FY2011 and FY2012; Evaluate current communication strategies (eg, EWP website) utilized to promote the EWP and engage County employees in EWP campaigns and programs; Explore current management policies focused on supporting employee participation in wellness activities; and Assess current role of the Nutrition and Wellness Resource Group Program Recommendations Creating an Employee Wellness Coalition Taking the direction of the WWs and other successful multi-agency initiatives, the recommendation is to create a coalition leadership group called The WELLiance for Santa Clara County Employees, or, The WELLiance The purpose of The WELLiance is a coordinated, multi-departmental participation program strategizing sustainable employee wellness priorities and activities Page 20

159 Underlying support for the coalition would come from existing EWP staff and proposed augmentation of a manager and clerical support Staff would facilitate the implementation of the coalition recommendations along with be responsible for such core functions as marketing, communications, meeting logistics, monitoring federal and state employee wellness initiatives along with continuing with basic EWP activities such as website maintenance, class instruction, lending library, annual fitness campaigns and the annual Wellness Fair The fundamental process for operation of the WELLiance is as follows: : Best Practices would be integrated into the action of the coalition, subsequently evaluated, then assessed to be incorporated back into best practices In order to have a structure that upholds the vision of the Board and the direction of CLT, and moves to transform the current program, the following initial structure is proposed: Advisory Group will provide overall cultural, structural, and political influence to make employee wellness an institutional priority Members would be comprised of high level visionaries to include: County Executive, interested Board members, Departmental heads, Union leaders, and an appointed Medical Director or team Coalition Leadership Group will be responsible for direction, prioritization and crosscoordination of EWP activities amongst the Work Group Committee members would be comprised of: Work Group chairs and CLT members Work Groups will carry out the priorities of the Leadership Group These groups are the working body of The WELLiance Members are voluntary County employees such as the Wellness Warriors who have specific expertise or interest in the work group Ad Hoc sub-groups would be added as needed from existing work groups in order to address areas that need more intense involvement and focus Members would include subject or area experts to facilitate the process To start, the following Work Groups are recommended: Data & Assessment Focus on determining and researching necessary data and methods of data collection along with conducting inventories to help drive the basis for employee wellness class offerings and services provided Policy & Practice Focus on examining and developing policies and practice within all departments at all levels that would create a County environment supportive of both physical and emotional wellness Outreach & Education Focus on identifying and creating appropriate communication methods and appealing messages to reach and engage all County employees Page 21

160 Partnerships Focus on identifying and engaging appropriate partners key to the success of developing employee wellness activities, classes and resources Facilities & Transportation Focus on examining County facilities and surroundings to determine any environmental or transportation issues that need to be addressed in order to foster a healthier work location Wellness Ambassadors Focus on ensuring representation and participation from all County departments Each Work Group would have ties back to the overall WELLiance as demonstrated in the following image: Page 22

161 Addressing the Board Referral Valley Health Plan, an organized body committed to the well-being of County residents, was asked to address the following areas in the further development of the Employee Wellness Program through the following Referral Areas: a Create a Santa Clara County employee health profile that identifies our employees underlying health issues and needs A county-wide employee health profile is a crucial tool needed to implement an effective and targeted program Information can be found from existing sources as well as new gatherings such as health risk assessments (HRA) HRAs can gather specific information directly from employees using a research-based survey and could include biometric screenings that check blood pressure, cholesterol, glucose and calculates body mass index The results will be used to establish baseline data of which future HRAs and ROIs will be compared to and to provide the needed feedback There are existing HRA questionnaires to model from as well as third-party vendors who can assist with custom survey development, administration, analysis and reporting The development and administration of an HRA which includes employee interest questions should considered high priority with the roll out of an enhanced employee wellness program In order to gain employee participation, incentives upon completion of the HRA should be considered The biometric health screenings could be introduced as an option but not mandated since this could be perceived as an intrusion of personal health In addition to gathering data from an HRA, utilization management data provided by each contracted health plan can be considered Each health plan can produce membership data with information such as: types of services being used by employees, top medical diagnosis, top reasons for emergency room visits, and leading chronic disease states While this data may not be immediately available, it will be an important piece to consider when planning program activities Workers Compensation data will continue to be used as another piece of the overall County health profile Lastly, County human resources data will be a key source to round out the employee profile Demographics such as age, gender, job code and work location would help to ensure that the program will be accessible by the greatest number of employees Page 23

162 b Offer classes and resources that promote physical and mental health of our employees (eg, chronic disease self-management, stress and safety classes) as well as reinforce the adoption of new County policies focused on health (eg, smoke-free policies) Promoting the physical and mental health of employees through classes and resources is a main focus in creating an enhanced wellness program Currently offered classes and resources through the EWP include Pilates, Yoga, and Tai Chi as well as class topics taught by EWP staff such as smoking cessation, diabetes prevention and stress management (See Appendix 1) The three health plans have expressed willingness to provide classes that are relevant to their member population In addition, the Santa Clara Valley Health & Hospital System has potential to offer classes and seminars that are taught by experts in their fields such as physicians, nurses, physical therapists and mental health providers Other County agencies, for instance, Public Health, Parks and Recreation, and Social Services, also have in-house content experts who could potentially offer classes The employee health profile data will need to be the basis for determining topics for new program class offerings and resources Until the data is collected and analyzed, the current planned program should remain in place An area which needs to be explored is employee encouragement and management support for attending wellness classes Anecdotal evidence has shown that employees are frustrated with the lack of support to take wellness classes during work hours In order to change that perception and practice, specific health-focused policies will need to address the commitment to employee wellness as well as address any barriers to accessing wellness services and classes Any and all health-focused policies considered will need to be embraced by all County departments in order to have the impact and buy in needed to make the program successful The creation of policies must also consider all aspects of the implementation process in order for it to be successful and adopted For instance, the implementation of a smoke-free policy will need to consider not only the desire to have smoke-free environments, but also a way to enforce the policy requirements Without the enforcement, practice will not follow the policy Page 24

163 c Utilize compelling communications (eg health coaches) and incentives that reach all employees through such vehicles as new employee orientations Communication to employees continues to be challenging yet crucial With the implementation of new County-wide distribution groups, information is more easily disseminated to those who are at work stations However, current communication tools such as the Wellness Newsletter, class/event announcements and EWP website are not interactive, which limits the effectiveness of the messages Interactive communication is not only engaging but can feel more personalized for employees Examples of this communication could include personalized s to each employee with wellness and class information based on their interest, blasts with wellness tips, ergonomic reminders, interactive wellness quizzes, and health coaching tips to help motivate wellness habits Valley Health Plan is piloting a weekly department employee wellness news blast known as Wellness Wednesdays (See Appendix 2) These weekly blasts are sent to an established internal distribution list of department employees and have received positive feedback The news blasts have covered topics such as desk stretching, beating the winter blues, self-care over the holiday season and tips on ways to get exercise throughout the day This type of communication could be easily reproduced by EWP staff and sent to the Wellness Ambassadors for distribution Communication to those employees who either do not have a workstation, or who do not have access will pose a challenge Identifying those employees by work location and type of job via their employee profile will be the first step in determining the best method to reach them One way to overcome the barrier would be gaining access and approval to attend department morning briefings or all-staff meetings for information dissemination New employee orientations will be another venue for communication Each County department has an individual orientation in tandem with the County-wide orientation This is a prime time to engage employees from the start of their career with the County It will be necessary to gather and inventory departmental orientations and either attend or provide information to educate new employees about the EWP and related services Lastly, the Employee Wellness website would need to update content and functionality to make information easily accessible and user-friendly The website would need to be maintained and possess interactivity for uses such as online videos, webcasts, a bulletin board, subscriptions to e-newsletters/communications and health tools Page 25

164 An overall recommendation is to build the program s identity and confidence by developing a stronger marketing presence This would include a revamp of the program logo, creation of look and feel brand standards, making EWP materials easily recognizable, and the development of an annual marketing plan As discussed earlier in the Kaiser and NIH programs, marketing and brand recognition is the crux of their success d Develop creative award and incentive programs (eg, health risk appraisals and insurance premium incentives), including special benefits for employees who use active forms of transportation (eg, biking, walking, and use of mass transit) to get to work It is important to be thoughtful about the importance of awards and incentives for County employees People naturally want to be acknowledged for trying to be well and do the right thing There is the understanding that as a public entity there is a need to be cautious in utilizing incentives such as cash for employees due to fiscal responsibility However, as benchmark programs have identified, simple items such as water bottles and t-shirts can incentivize an employee to a healthier path when distributed at an event For example, an employee receiving a t-shirt for participating or completing a wellness event is more impactful than receiving a t-shirt from a raffle Recognition awards with minimal cost can be effective in boosting morale and encouraging behavior Certificates for achieving wellness goals or for trying something new with acknowledgment by their supervisor at a staff meeting or by a Board Member at a Board of Supervisors meeting can be a motivating factor for staff Other possibilities for low cost incentives include milestone buttons or emblem pins for badge holders, a special area on the EWP website, or a mention in a EWP communications the possibilities are endless And as demonstrated in the NIH program, once an employee has initiated and maintained involvement in wellness, simple incentives may not be needed on an ongoing basis The recommendation is to consider the activities of the wellness program and plan accordingly when and if material incentives make sense to include them Consistent, ongoing encouragement and support in the form of health coaching can also be considered an incentive as employees embark on their personal journey Health coaching has been a trend not only in employee wellness programs but also for health plans nationwide The idea behind health coach is that employees have a coach who uses motivational communications such as calls and s to encourage achievement of personal and wellness goals And while health coaching has been successful, the cost for service itself can become significant given the time being spent with each person Instead, health coach training could be offered, possibly in collaboration with the Public Health Department, to create an internal resource within our employee population It would not only engage the employee but also create a sustainable resource within the agency Page 26

165 Long-term incentives to foster a healthier workforce in Santa Clara County would be to consider offering reduced health premiums as a reward incentive for employees committed to and demonstrating healthier living measures And while this has proven to be effective for benchmark programs such as Cisco, implementation of such an incentive at a county level would take time and require involvement from various entities including the Employee Services Agency, the unions, and contracted health plans With this as a longterm option, it is recommended that discussions begin to make this a viable option to implement with the Affordable Care Act becomes effective in 2014 For those employees who use active forms of transportation such as biking, walking, and carpooling, the County created special parking places and installed bike racks By making it easy to continue these practices, the County demonstrates it supports and encourages employees choices to be healthy and green The problem is that not all County facilities have adopted the creation of these perks An inventory of all facilities would help to understand what options are currently available for employees and where potential new locations would be In the meantime, to promote these practices to more employees, a recommendation would be to observe existing programs/events that encourage active forms of transportation Events such as Bike to Work Day, Walk to Work Day, and Dump the Pump Day/Week would be an interactive way to teach employees about options they may have to become active commuters Collaborating with the Public Health Department and Valley Transportation Authority, the planning and support of the observations will create a celebratory feel to the events As with the NIH program, there could be friendly competition between County departments that determine the highest percentage of employees who observed each event The winning department could receive something as simple as a certificate of appreciation from the Board It can also be made into something more competitive, winning a stylish trophy that gets passed around annually which would give the department head bragging rights for a year Any way the events are celebrated, the end result would be more employees exposed to and hopefully more likely to continue with modes of active transportation Page 27

166 e Design innovative and bold approaches to engage employees in wellness activities (eg healthy cooking demonstrat ions, taste tests and County-sponsored fitness programs Consistency and repetition are integral to successful health behavior change One-time offerings are not beneficial to maintaining an ongoing program and overall shift to a healthy lifestyle Taking the Best Practices from the programs previously described, it is important for employees to participate in periodic events and activities to keep wellness in the forefront of their minds Along with the creation of the annual active transportation days, employees could participate in periodic wellness events Existing programs such as March Into May, Step It Up and the Annual Wellness Fair are solid events which could be enhanced with improved marketing and incentives so there is a higher employee participation rate Corresponding incentives would be determined by the level of activity demonstrated, with high movers being acknowledged at a public forum (ie Board meeting, web site) Additional fitness programs modeled after pre-existing successful wellness events could be coordinated with various County departments In fact, engaging internal sponsors similar to the County Combined Giving Campaign could be a way to engage more departments to participate in County employee wellness activities To expose employees to healthier cooking options, one recommendation is to work with Food Services to create healthy recipes and offer taste tests during specific days of the week (ie Tasty Tuesday on the first Tuesday of each month) Subsequently Food Services could offer those recipes as part of their monthly selection as well as provide a copy of the recipe Cooking demonstrations and recipe postings via web-posted video clips could serve as an alternative for those County locations without on-site food services This eventually could turn into on-site cooking demonstrations To encourage peer support, employees may be willing to share healthy recipes of their own A virtual recipe board could be created on the EWP website for employees and Food Services to post and search for healthy recipes In addition to the existing CSA organic vegetable box option, an option of expanding to mini- Farmer s Markets at various locations in the County is being explored This would enable employees to purchase healthy fruits and vegetables and pick up produce boxes while experimenting with a wider variety of foods Another existing resource to help create interest is to use the National Health Observances calendar to promote specialized wellness activities For instance, March is National Nutrition Month and a great opportunity to provide employees with healthy recipes or taste tests June is National Men s Health Month and a great time to have a presentation in person or webinar from a men s health expert Whatever the activity, regular and consistent offerings coordinated with compelling marketing are musts to make it successful Page 28

167 f Organize employee sports leagues, teams and cycling and walking groups Work-coordinated events are a mainstay to any employee wellness programs From annual events that encourage use of more active transportation to ongoing fitness activities, it is important to have options to reach the gamut of employee interest To help encourage not only wellness but also community involvement and team camaraderie, a recommendation would be involve the County in established community health events Events such as the American Red Cross Walk, American Cancer Society Relay for Life, Rock n Roll Marathon, Lupus Walk, Race to the End of Summer and Go Green St Patrick s Day Run would be a perfect opportunity for county departments to organize a team and participate There are events almost monthly with minimal entry or sponsorship fees As with most other activities, strong marketing of the events is essential to successful participation and partnership with the community organizations In addition, expanding existing County organized team activities would feed the interest of those who prefer team sports In 2010, the VMC Foundation started a softball league for interested SCVHHS employees The response was so great that some teams had to be turned away It demonstrated an employee interest in competitive team sports and a way to capitalize on a pre-existing successful program For those who enjoy less complicated activities, lunchtime walking groups, weekend mall walkers, park trail hikers and cyclists could be organized much like carpooling An organized group could form organically started on the wellness website then people interested in organizing or participating in these activities would sign up or meet up at specified place and time g Provide lactation support and accommodation for employees According to the US Department of Health & Human Services Health Resources and Services Administration, a lactation support program is a win-win for employees and employers alike The employee feels supported with her decision to return to work while breastfeeding and the employer benefits from saving money in healthcare and employee expenses such as absenteeism, productivity and job turnover rates The Federal Fair Labor Standards Act and the California Labor Law Chapter 38 were created to make it easier for new mothers to breastfeed their babies when returning to work The intent is respectable however, implementation and practice of the recommendations vary from state to state, county to county, and company to company Page 29

168 The recommendation is minimally to expand the current Public Health Department Breastfeeding Policy to a County-wide policy This Breastfeeding Policy simply stated allows appropriate space for a mother to pump during work hours, not during breaks In addition, create or promote an existing resource list for new mothers to know what is available in the County as well as by their health plan To help encourage pregnant mothers toward breastfeeding as a choice, classes can provide them and their partners with a brief overview and instruction Back to work classes to help mothers returning to work learn about available locations for milk expression, proper storage methods and support resources To make the County more customer and baby friendly, Best Practice recommends that each facility has a place not only for employees but for visitors to breastfeed their babies In order to ensure there is a location for mothers to breastfeed or express milk, it is recommended that all space plans be reviewed to ensure location allocation And in those allocated areas, provide a lockable door, electrical outlet, comfortable chair/recliner, table/surface for placing pump and easy access to a water source for clean-up It may be reasonable to ask departments to subsidize rental of a hospital grade electric pump and refrigerator which remains stationary in the allocated area to make it easier for working mothers to express and store milk And lastly, explore the possibility of getting discounts on pump rental from community breastfeeding organizations and understanding the County contracted health plan benefits around breastfeeding services h Explore possible partnership opportunities with private and public entities to create a more comprehensive program (eg, health clubs, d iscounts for services and activities that promote wellness) There are existing external partners who provide employees with access to discounts for healthy options These benefits include existing health club discounts, CSA organic produce boxes, discounts at healthy restaurants, onsite Weight Watchers at Work Programs and onsite massage therapy A foreseen barrier is that some of these services are not available at all County locations or are not promoted to their full potential There are dozens of potential partners who could possibly provide services to County employees and their families at discounted rates These include wellness services being offered at various municipalities, children s physical activity centers such as Little Gym, adult dance classes, and library health classes An inventory of potential partners will be identified while the employee profile is being gathered Once the direction of the new wellness program becomes established, natural partnerships will develop as a result Page 30

169 In addition to local partnerships, there are natural regional and national partnerships that could be considered Partnering with existing employee wellness events such as National Employee Wellness Month which is sponsored by Virgin Airlines and National Employee Wellness Day which is sponsored by the National Association for Health & Fitness could be a way to gain visibility and credibility as these events are already well established and recognized i Research intra-departmental services or benefits that could be used as incentives for the EWP and benefit County departments (eg, Parks Department Venture Pass) County departments have an abundance of services that are available not only to all residents but in this case all employees A basic inventory of all County websites revealed that dozens of services can be accessed Departments offer classes from learning how to compost and grow your own vegetables to finding an activity to do at a County park, (See Appendix 3), however, the inventory is limited to the information provided on the individual departments web site There is not one central entity compiling and repackaging these offered services in a central, accessible location To produce a more comprehensive list of services, an inventory all departments would need to be developed Each department would be responsible for updating the information periodically via prompt from EWP staff so the information does not become stale and outdated Subsequently, a dynamic searchable database of all available services could be created, creatively repackaged and posted on the EWP web site In EWP communications, a program or service could be highlighted so employees are reminded of the wealth of services they have available to them in their own backyard j Encourage the development of wellness leaders throughout our various County departments Wellness is a subject that requires many methods and messengers With the creation of wellness leaders throughout all County departments, sustainability of the wellness agenda would be upheld Following the lead of the CLT s Employee Wellness Group, the importance of having wellness liaisons, or Wellness Ambassadors, located in each department will strengthen the infrastructure of the wellness program WW would be the main points of contact for disseminating wellness information, encouraging wellness habits, becoming health coaches, and modeling healthy behaviors Their active participation and commitment is essential to the success of a multi-departmental wellness program Page 31

170 In addition to line staff, the active participation and support of executive management, midmanagers and supervisors are critical to a successful wellness program As stated in the NIH model, getting buy-in from management is key to overcoming the participation barrier The next stage of the battle is active participation and wellness modeling from management The best way to support employees is to have a manager who exemplifies wellness and encourages employee participation in wellness k Conduct an annual evaluation of our EWP through employee surveys to assess employee needs, preferences and ideas for improvement to be utilized in future EWP planning Along with the employee health profile, there would be an opportunity in the HRA to include interest and preference questions These questions would be asked yearly in order to identify trends and changes from the initial baseline In addition, it will be important to gather and tabulate evaluations from each wellness class offerings to know its effectiveness and participant satisfaction The information gathered from these class evaluations will determine if the class will be offered again These evaluations can also be used to gather ongoing input from participants with specific questions about the suitability of class logistics l Examine opportunities to increase benefits to our employees as a result of healthcare reform As the County continues to face budget issues, the integration of federal support sources which may be allocated for employee wellness and prevention efforts need to be considered While many small employers are able to apply for grants to improve employee wellness, there are currently no provisions for larger agencies As directed by the Affordable Care Act, a National Prevention Council (NPC) and related Strategy were created to provide an unprecedented opportunity to shift the nation from a focus on sickness and disease to one based on wellness and prevention As reported by the NPC in a July 2010 report, its intent is to generate, align, and focus collaboration among governmental and non-governmental partners in the development and implementation of prevention and wellness initiatives and programs In order to do so, the NPC has drafted ten targeted strategic directives, many of which incorporate worksite wellness into their objectives These ten areas are: 1 Healthy Physical, Social and Economic Environments 2 Eliminate Health Disparities 3 Prevention and Public Health Capacity 4 Quality Clinical Preventive Services Page 32

171 5 Tobacco-Free Living 6 Reduce Alcohol and Drug Abuse 7 Healthy Eating 8 Active Living 9 Injury-Free Living 10 Mental and Emotional Well-Being The NPC will continue to move forward on finalizing and implementing these strategic directives through evidence-based interventions And because the interventions are such broad reaching, it would be mindful of the EWP staff to keep track and monitor the Council s progress as specific mandates or funding may arise as a result As research and Best Practices have demonstrated, there is a variety of activities, incentives and programs to consider From the very basic to the complex, all of which depend on commitment, as well as resource allocation to achieve desired outcomes Creating a Wellness Framework There are many different types of models, theories, and frameworks used by organizations that have employee wellness programs To use a simple but structured model, the recommendation is to combine a model highlighted by the Public Health Department along with the 7 Benchmarks of a Successful Wellness Program by WELCOA (Hunnicutt) The following describes each model and then combines the two for the structure to be used by The WELLiance During the initial kick-off meeting and quarterly leadership group meetings, this structure will be the main tool used to keep The WELLiance on track WELLiance will determine the level of intensity and corresponding activities they would recommend for each identified area with consideration to the initial Board Referral The identified public health model is as follows: Low intensity program includes: HRA (health risk assessment), marketing campaigns and/or printed materials Under $20 per employee per year Average ROI of 375:1 Medium intensity program includes: Low intensity plus any type of intervention About $20 up to $50 per employee per year Average ROI of 6:1 Page 33

172 High intensity program includes Medium intensity plus cultural or environmental change About $ per employee per year Average ROI of 775:1 As described previously, the 7 Benchmarks, identifies the key areas that any successful program should have in launching worksite wellness program These include: 1 Senior-Level Support: Top-down communication strategy; distribution of resources; a volunteer wellness committee, and an executive wellness team of managers; role-modeling health 2 A Cohesive Wellness Team: Cross-functional members who encompass qualities such as historicity, diversity, leadership presence, competency, and dependability 3 Results-Oriented Data Collection: Encountered claims and demographics (absenteeism, disability), HRA findings, and facility intake 4 An Annual Systematic Operating Plan: Alignment of the credo, goals and objectives, timelines, respective roles and responsibilities, an itemized budget; appropriate marketing strategies, and evaluation steps (regarding participation and satisfaction levels, risk factor pervasiveness, changes in health behavior and/or clinical results, post-hoc organizational indicators, realization of objectives, or some Best Practice testimonials) 5 Appropriate Interventions: Types and intensity of programming, frequencies, targeted audience, and incentives (without HRAs will yield <15% participation) For instance, smaller employers tend to offer more programming that requires cost sharing with employee users 6 A Supportive, Health Promoting Environment: Reduce tobacco, promote better nutrition and stress management behavior, examine and evaluate benefits package, leverage all internal resources and limit outside costs, offer lactation accommodations, oversee Food Services and the Cafeteria, and motivate change through creative communication modalities 7 Evaluating Outcomes: Through participation and satisfaction levels, risk factor pervasiveness, productivity (eg absenteeism, turnover), changes in health behavior and/or clinical results, post-hoc organizational indicators, realization of objectives, some Best Practice testimonials, and ROI Page 34

173 By combining these two frameworks, there is a way to create a tool that will help The WELLiance members determine and understand the resources needed to implement levels of involvement A sample of a possible County program at each intensity level can be found in Appendix 4 In addition to the WELLiance structure and function are the end goals of creating a culturally integrated employee wellness program As such, there are certain objectives that would need to be undertaken prior to, during and after the initiation of the employee wellness coalition These objectives include but are not limited to the following: Phase I Preparation Timeline: February June 2011 Assess current Employee Wellness Program (EWP) and existing wellness committee to identify key components Develop transition plan for EWP to reside in Valley Health Plan Develop structure and identify members for The WELLiance Research possible areas and methods for creation of employee profile Identify other CLT efforts that would lend their initiatives to the employee wellness initiative Identify other potential partners with vested interested in employee wellness Begin in depth inventory of: o County facilities and surrounding environment o Existing County program activities Identify existing VHP resources that could augment employee wellness activities Meet with the three contracted County health plans to educate about EWP changes Develop 2012 budget Page 35

174 Phase II Implementation July December 2011 Launch the WELLiance and begin work group meetings Develop coalition and Work Group priorities while integrating the 7 Benchmarks Review and update response to Employee Wellness Referral to gather input for Work Group focus Finalize data collection method for employee profile Evaluate allocated staffing/resources Establish a recognizable marketing and communication plan Identify areas and methods to increase health plan involvement and offerings Continue conducting key components of EWP while coalition builds Phase III Expansion January June 2012 Continue regular Work Group and coalition meetings Evaluate process and structure to ensure efficiency and effectiveness Implement strong marketing and communications to employees Partner with external organizations Incorporate relevant internal professional presence (ie physician experts, nutrition experts, exercise trainers) in wellness programming Develop 2013 budget Phase IV Management & Evaluation July 2012 ongoing Evaluate process and structure to ensure efficiency and effectiveness Research and integrate new Best Practice, benchmark programs and partnerships Generate reports on health behavior change, employee perception, costs and ROI Update identified inventories Evaluate allocated staffing and resources Continue to increase program/coalition visibility and employee participation from creative marketing and communications Expand access and convenience of worksite wellness into web-based programming (ie webcast of health experts) Page 36

175 Budget As eluded to in the previous discussions, the budget of the program would depend on the level of intensity decided by The WELLiance and ultimately supported by the Advisory Group As the program stands today, there are 30 FTE Health Education Specialists dedicated to the program with additional funds allocated to program services and overhead costs Total budget is approximately $600,000 The transition of existing resources is being conducted in coordination with this programmatic response In addition to transitioning current staffing and expenditures, the recommendation is to expand staffing in FY12 The expansion to include 10 FTE Employee Wellness Program Manager or equivalent to provide general oversight (plans, directs, coordinates & evaluates) of County Employee Wellness Program; manage and maintain employee wellness coalition structure and groups; provide day to day supervision of employee wellness staff; research & implement employee wellness Best Practices; collect & analyze relevant data from County departments and coordinate marketing and communications functions Clerical support would also need to be provided in FY12 by a 10 FTE Member Services Representative (MSR) The MSR will support the program and coalition by answering general inquiries from employees via phone, , fax; processing requests; sending out literature & materials; scheduling presentations; performing basic data entry; assembling materials and packets; ordering supplies and promotional items and assisting department staff as needed during health fairs and events VHP would be fiscally responsible for these added staff According to research, the gold standard for hiring or placing staff members is one fulltime position for every employees (Hunnicutt & Chapman, 2006) If this gold standard were implemented, the employee wellness program would need approximately 20 staff By residing in Valley Health Plan s Health Education Department and by the recruitment of Wellness Ambassadors/Liaisons, the program would have a solid foundation to start As the coalition grows and objectives change or increase, staffing needs would have to be evaluated In addition to staffing, the Object 2 budget needs to be considered This would include any funds necessary such vendors as marketing services, survey development & administration, incentives or promotional items purchased, printing costs, further website development & maintenance, educational materials, A/V equipment, work station & phone set up and maintenance And as with the staffing, depending on the level of intensity decided by The WELLiance, this would also need to be adjusted As with additional staffing, Valley Health Plan will provide funding for these identified needs As The WELLiance decides on priorities and direction, staffing may need to be adjusted accordingly during annual budget and mid-year budget negotiations of FY2012 Page 37

176 Evaluation In order to measure the success of The WELLiance valid evaluation steps must be taken in four respective phases: Preparation (Phase I) is the baseline work that needs to be conducted before the program & coalition is launched This would include preliminary inventorying, current program assessments and identification of partners Implementation (Phase II) will include a kick-off of the coalition, beginning meetings of the workgroups, redirection of wellness activities, and initial data collection Expansion (Phase III) will consist of the continuing the efforts of the Work Groups, reprioritizing areas and performing key program activities Management & Evaluation (Phase IV) signifies The WELLiance ongoing activities using the fundamental operational process of Best Practice, Action, Evaluate, Assess Phase I Preparation Timeline: February June 2011 What Assess current EWP activities and functions Transition EWP to VHP Develop coalition structure Research employee profile methods Identify relevant CLT efforts and recommendations Identify internal partnerships Inventory existing activities and facilities Identify existing VHP resources Develop 2012 budget Examples of How SWOT (Strength, Weakness, Opportunities, Threats) analysis; Employee interviews; class evaluations Inventory budget, staffing, transfer of assets, space plan Create advisory, leadership & work groups Conduct literature and Best Practices review; determine existing data sources; health plan meetings Establish interface with CLT office Invite County-wide departments & employees to join the coalition Conduct survey of existing activities and usage of facilities; connect with CLT office to identify other initiatives working on same issue Identify opportunities to leverage with EWP surveys Determine staffing, structure & external resources needs Page 38

177 Phase II - Implementation July December 2011 What Kick-off EWC & establish Work Group meetings Identify coalition priorities using WELCOA s 7 Benchmarks Evaluate referral transmittal response Determine data collection methods Evaluate EWP & coalition resources Establish marketing & communications plan Identify areas of health plan involvement Manage EWP while coalition develops Examples of How Majority County departments represented; meetings held; regular schedule established Consult with Advisory & Steering Groups Consult/Approval from Advisory & Steering Groups Data sources identified; Recommend final assessment roll out; Identify data collection tool Budgetary analysis, surveys, & staff reviews; examine employee workload New branding standards; Collateral & Web development Identified resources to be provided to EWP Annual operating plan based on core functions Phase III Expansion January June 2012 What Ongoing regular coalition/group meetings Evaluate coalition structure & processes Implement marketing & communication plan Seek external partnerships Develop wellness subject matter experts programming Develop 2013 budget Examples of How Meeting minutes; deliverables created; timeline established Action Plan/Objectives met; deliverables completed Strategic plan developed; Implemented branding standards; regular publications; employee recognition Re-engage existing partners (eg American Heart Association); Contact others Schedule of classes & activities provided by internal subject matter experts Determine staffing, structure, & external resources needed; examine employee workload Consequently, The WELLiance structure and processes, along with accompanying activities, will need to be evaluated in order to ensure programmatic efficiency and effectiveness Specific evaluation areas and objectives will be determined as The WELLiance work groups continue meeting over time Page 39

178 Phase IV Management July ongoing What Maintain The WELLiance Structure & Processes Research & Integrate New Practices Generate Demographic Profiles Update Inventories Evaluate Allocated Resources Increase Marketing & Communication Visibility Expand EWP Into Web-Based Programming Examples of How Action Plan/Objectives met; deliverables completed WELCOA membership; Attendance to wellness seminar/presentations; Ongoing Best Practices identification Reports generated and incorporated into coalition meetings on health behavior change, employees perceptions, costs, and ROI Report on survey of existing participation and satisfaction; examine usage of facilities Budgetary analysis, surveys, & staff reviews; examine employee workload Employee recognition & participation; Program branding & recognition by internal and external agencies; web hits; # materials disseminated Scheduled webinars, available RSS Feeds, interactive media; increase web hits Page 40

179 Conclusion As demonstrated and discussed, a conducive workplace environment not only supports but also enhances the health of the workforce and the workplace A new and improved Employee Wellness Program must be a robust and dynamic multi-prong approach involving the concerted effort of key stakeholders, partners and most importantly employees Strategic worksite wellness can advance the County from disease management to prevention aligning with national prevention efforts Financially, benefits will encompass a return on investment in the form of reduced health care costs; an aggregate decrease in worker s compensation injuries, utilization, and disability claims; reduced absenteeism and presenteeism; and increased productivity On a personal level, employees will experience improved morale, cross-functional relations, and healthier living that is priceless County employees are our greatest resource, and all possible means should be explored to maintain and promote their mental and physical health, improve job satisfaction, and retain the best workforce It is time for a cultural shift in the County for the good of its employees and its stakeholders A repositioned Employee Wellness Program will capture the Board s vision in transforming the County of Santa Clara into a hub of wellness and healthy living Page 41

180 References Alarcon, A, Auerhahn, L, Brownstein, B, Chavez, C, Darrow, B, & Ray J 2010 Life in the Valley Economy: 2010 Silicon Valley Progress Report Retrieved on November 16, 2010 from Berry, L L, Mirabito, A M, & Baun, W B (2010) What s the Hard Return on Employee Wellness Programs? Harvard Business Review, 15 pages Retrieved on December 9, 2010 from County of Santa Clara (2010) Director of Parks and Recreation brochure Retrieved on January 18, 2011 from attachments%2fexecutive%20management%2fdir%20parks%20and%20rec% pdf County of Santa Clara (2011) Employee Assistance Program Retrieved on January 14, 2011 from &prior_transaction_id=40239&iq_action=5&answer_id= &highlight_info= ,131,134&turl=http%3A%2F%2Fwww%2Esccgovatwork%2Fportal%2Fsi te%2feportal%2fchlevel3%3fpath%3d%252fv7%252fscc%2520employee%25 20Portal%252FBenefits%252FYour%2520Benefits%252FEmployee%2520Assista nce%2520program# highlight Fernandes, L (2010) Kaiser Permanente recognized by three publications as a Best Place to Work kporg National New Center Retrieved on December 23, 2010 from tml Gaines, C L 2010 National Institutes of Health (NIH) Focus on You: NIH Wellness Website Retrieved on December 14, 2010 from Hunnicutt, D (2008) WELCOA s 7 Benchmarks: An Executive Summary Retrieved on January 18, 2011 from Hunnicutt, D (2006) WELCOA s 7 Benchmarks of Success Absolute Advantage, 6(1), 1-38 Hunnicutt, D, and Chapman, L S (2006) Fundamentals of Worksite Wellness: Planning, Design, and Implementation Absolute Advantage, 5(4), 1-88 Jewett, C (2010) Health Facilities that See $300 million per Month Get IOUs This Week California Watch Retrieved on October 25, 2010 from Page 42

181 Jing, L Cisco s Global Health Engagement Senior Program Manager 2010 Conference call regarding Cisco s Health Connections Program) King County (2009) Health Reform Initiative Healthy Incentives ProgramSM Results 2009 Retrieved on October 26, 2010 from /HealthMatters/HealthyIncentives/~/media/employees/HealthMatters/HealthyIn centives/docs/hipresults2ashx) Moos, Terry TT (2007) National Business Group on Health Honors Best Employers for Healthy Lifestyles Cisco Newsroom Retrieved on November 9, 2010 from National Prevention, Health Promotion and Public Health Council (2010) 2010 Annual Status Report, 1-15 Retrieved on January 13, 2010 from Peddycord, D (2010) Organizational Wellness: A PowerPoint Presentation Santa Clara County Public Health Department Prevention for a Healthier America (2008) Investments in Disease Prevention Yield Significant Savings, Stronger Communities, Trust for America s Health Santa Clara County Public Health Department (2011) Chronic Disease and Injury Prevention (CDIP) Department Retrieved on January 18, 2011 from ealth%20department%20%28dep%29%2fchronic%20disease%20and%20injury %20Prevention%20Programs Santa Clara County Public Health Department 2010 Health Profile Report: Executive Summary Retrieved on November 5, 2010 from wwwsccphdorg Santa Clara County Tobacco Prevention Program (2011) Retrieved on January 18, 2011 from 0Department%20(DEP)%2FChronic%20Disease%20and%20Injury%20Prevention%20P rograms%2ftobacco%20prevention%20programs Santa Clara Valley Medical Center (2010) Employee Health (EH) Infection Prevention Department, 1-13 Retrieved on January 18, 2011 from ol%2fattachments%2finfectioncontrolpolicy_300pdf Page 43

182 The Fun Theory (2009) An Initiative of Volkswagen Retrieved on December 27, 2010 from The National Prevention Strategy (2010) An Unprecedented Opportunity to Improve the Nation s Health through Prevention, 1-2 Retrieved on January 13, 2011 from The Seattle Times (2009) King County's "Healthy Incentives" Program Relies on the Power of Preventive Care Retrieved on October 25, 2010 from sprogramreliesonthepowerofpreventivecareseattletimes3-1-09pdf) Thomson Reuters (2009) King County (Washington State) Case Study Retrieved on October 25, 2010 from KingCountyWashingtonState Wikipedia (2010) Kaiser Permanente Retrieved on November 23, 2010 from Yeager, K (2010) Reinforcing Santa Clara County s Current Employee Wellness Program (EWP) Board of Supervisors Referral YouTube (2009) Piano Stairs Retrieved on December 15, 2010 from Page 44

183 Appendix 1: Health and Wellness Classes by Provider Type Fiscal Year Category Topic/Type Department Date Provider Class Tai Chi DEH- Vector Control 7/1/09-9/30/09 VHP Class Pilates SSA-MCSC 7/2/09-9/24/09 VHP Class Pilates SSA-South County 7/7/09-12/29/09 VHP Class Stretch & Relaxation Charcot 7/29/09-8/19/09 EWP Class Stretch & Relaxation DCSS 7/30/09-8/20/09 EWP Class Stretch & Relaxation Hedding 8/3/2009-8/24/09 EWP Class Back Care Charcot 09/15/09 Kaiser Class Fitting in Fitness Hedding 09/17/09 EWP Class Pilates East Valley Clinic 10/1/09-12/31/09 VHP Class Healthy Eating for the Holidays Charcot 10/06/09 Kaiser Class Tai Chi Charcot 10/7/09-12/30/09 VHP Class Fitting in Fitness Charcot 10/27/09 EWP Class Stretch & Relaxation Hedding 11/9/09-11/30/09 EWP Class Preventing Diabetes Charcot 11/19/09 EWP Class Success Over Stress Charcot 11/19/09 EWP Class Stretch & Relaxation HHS-VMC Oncology 12/01/09 EWP Class Pilates HHS- Timpany Center 1/4/10-6/28/10 VHP Class Pilates SSA-South County 1/5/10-6/29/10 VHP Class Pilates DCSS 1/7/10-3/25/10 VHP Class Tai Chi Clerk Recorder 1/13/10-4/15/10 VHP Page 45

184 Category Topic/Type Department Date Provider Class Diabetes Basics Part 1 Charcot 02/09/10 Kaiser Class Weight Matters Charcot 2/23/10-3/30/10 EWP Class Fit for Life Charcot 02/25/10 HealthNet Class A Woman's World SSA-South County 03/25/10 EWP Class Be Smoke Free Hedding 3/1/10-4/5/10 EWP Class Stretch & Relaxation Berger 3/1/10-3/22/10 EWP Class Stretch & Relaxation SSA-Julian 3/5/10-3/26/10 EWP Class Diabetes Basics Part 2 Charcot 03/16/10 Kaiser Class Pilates Charcot 4/1/10-6/24/10 VHP Class Know Your Numbers Charcot 04/13/10 HealthNet Class A Healthy Heart That's the Ticket! Charcot 04/20/10 Kaiser Class Tai Chi SSA-BSC 4/21/10-6/30/10 VHP Class Nutrition for All Charcot 05/04/10 Kaiser Class Be Food Savvy Charcot 05/26/10 EWP Class Stress Management Charcot 06/22/10 HealthNet Presentation Stress Reduction Activities Clerk of the Board 07/01/09 EWP Presentation TOPs- Wellness/Stress Mgmt Charcot 08/20/09 EWP Presentation ESA-Benefits Hedding 08/26/09 EWP Presentation Exercise for Ergonomic Injury Prevention HHS-Public Health TB Clinic 09/02/09 EWP Presentation Stretching Roads & Airports 09/09/09 EWP Presentation Fitness Walk Roads & Airports 09/09/09 EWP Presentation NEO-Wellness Overview ESA- Employee Development 09/10/09 EWP Presentation Safety Seminar- Safe to Quit ESA- Risk Mgmt OSEC 09/24/09 EWP Presentation Back Injury Prevention Parks and Rec 09/26/09 EWP Presentation Back Injury Prevention Stretches Parks and Rec 10/05/09 EWP Page 46

185 Category Topic/Type Department Date Provider Presentation Back Injury Prevention Parks and Rec 10/19/09 EWP Presentation Stress Mgmt Roads & Airports 10/20/09 EWP Presentation Stress Mgmt Roads & Airports 10/21/09 EWP Presentation Stress Mgmt Roads & Airports 10/22/09 EWP Presentation Nutrition Dos & Don ts Assessor 10/23/09 EWP Presentation Healthy Eating Habits DCSS 11/05/09 EWP Presentation NEO-Wellness Overview ESA-Employee Development 11/12/09 EWP Presentation Stress Mgmt- Recharge from Stress Finance Agency - Tax Collector 11/17/09 EWP Presentation County Specifics-Wellness ESA-Employee Development 12/01/09 EWP Presentation Nutrition-Cooking Tips for Healthier Eating DCSS 12/10/09 EWP Presentation NEO-Wellness Overview ESA-Employee Development 01/14/10 EWP Presentation Managing Emotions Under Stress Public Defender - Clerical 02/12/10 EWP Presentation TOPs- Wellness/Stress Mgmt Charcot 02/18/10 EWP Presentation NEO-Wellness Overview ESA-Employee Development 03/11/10 EWP Presentation Stretch & Relaxation DOC- Fiscal 04/06/10 EWP Presentation NEO-Wellness Overview ESA-Employee Development 05/13/10 EWP Presentation County Specifics-Wellness ESA-Employee Development 05/25/10 EWP Presentation Stretching Library 05/21/10 EWP Presentation Fall Prevention Exercises Roads & Airports 06/01/10 EWP Presentation Fall Prevention Exercises Roads & Airports 06/02/10 EWP Presentation Fall Prevention Exercises Roads & Airports 06/03/10 EWP Presentation Be Food Savvy Public Defender- Investigation Unit 06/03/10 EWP Presentation Stretch & Relaxation Public Defender- Investigation Unit 06/03/10 EWP Page 47

186 Fiscal Year Category Topic/Type Department Date Provider Class Tai Chi Charcot 7/7/10-9/29/10 VHP Class Pilates SSA-South County 7/6/10-12/28/10 VHP Class Pilates DCSS 7/8/10-9/30/10 VHP Class Pilates HHS-Timpany Center 7/12/10-9/27/10 VHP Class Be Smoke Free SSA 7/16/10-8/20/10 EWP Class Diabetes Basics Part 1 Charcot 8/3/2010 Kaiser Class Diabetes Basics Part 2 Charcot 8/17/2010 Kaiser Class Weight Loss Part 1 Charcot 9/7/2010 Kaiser Class Managing High Blood Pressure Charcot 9/14/2010 Health Net Class Weight Loss Part 2 Charcot 9/21/2010 Kaiser Class Pilates HHS-Timpany Center 10/4/10-12/27/10 VHP Class Tai Chi DCSS 10/6/10-12/29/10 VHP Class Pilates Public Health/DADs- Lenzen 10/7/10-12/30/10 VHP Class Nutrition: Surviving the Holidays Charcot 10/19/2010 Kaiser Class Understanding Your Cholesterol Charcot 11/9/2010 Health Net Class Stress Reduction Charcot 11/16/2010 Kaiser Class Stress Reduction SSA-BSC 12/7/2010 Kaiser Class Back Health Session 1 HHS-VMC 12/2/2010 EWP Class Back Health Session 2 HHS-VMC 12/2/2010 EWP Class Weight Loss Part 1 Charcot 01/18/11 Kaiser Class Be Smoke Free Charcot 1/21/11-2/25/11 EWP Class Weight Loss Part 2 Charcot 01/25/11 Kaiser Class Stress Management HHS-Enborg 1/26/2011 EWP Class Stress Management Charcot 1/27/2011 Health Net Page 48

187 Category Topic/Type Department Date Provider Class Cholesterol and Your Heart Part 1 Charcot 02/01/11 Kaiser Class Cholesterol and Your Heart Part 2 Charcot 02/08/11 Kaiser Class The 3 P's of Healthy Eating Charcot 2/16/2011 EWP Class Know Your Numbers Charcot 2/22/2011 Health Net Class Back Care Sheriff 02/24/11 Kaiser Class Healthy Eating for Healthy Living Charcot 3/15/2011 Health Net Class Diabetes Basics Part 1 Charcot 03/22/11 Kaiser Class Tools for Weight Management Charcot 3/23/2011 EWP Class Working Well SSA-Julian 3/24/2011 EWP Class Diabetes Basics Part 2 Charcot 03/29/11 Kaiser Class Stretch & Relaxation HHS-Enborg 3/29/11-4/19/11 EWP Class Healthier Choices: Fat and Fast Food Charcot 4/19/2011 Health Net Class Menopause: Women's Health in Mid-Life Charcot 4/26/2011 EWP Class Fight Fatigue Charcot 5/3/2011 EWP Class Healthy Pregnancy and Beyond Hedding 5/19/2011 EWP Class Diabetes Self Management Charcot 6/23/2011 EWP Class Health and Well-Being Part 2 Hedding 6/29/2011 EWP Presentation NEO-Wellness Overview ESA- ED 7/8/2010 EWP Presentation Wellness at Work ESA ED- TOP 8/19/2010 EWP Presentation NEO-Wellness Overview ESA ED 9/9/2010 EWP Presentation Activating the Body to Reduce Stress Public Health- CDIP 9/14/2010 EWP Presentation Walking Roads & Airports 9/15/2010 EWP Presentation Stretching Roads & Airports 9/15/2010 EWP Presentation Stress Management & Relaxation Techniques Mental Health 9/24/2010 EWP Presentation Stress Management & Relaxation Techniques DADS 9/24/2010 EWP Page 49

188 Category Topic/Type Department Date Provider Presentation Stress Management for Accident & Injury Prevention ESA-OSEC 9/30/2010 EWP Presentation Stretching and Cool-down SSA 10/14/2010 EWP Presentation Preventing High Blood Pressure Roads & Airports- South Yard 11/16/2010 EWP Presentation Preventing High Blood Pressure Roads & Airports- East Yard 11/17/2010 EWP Presentation Preventing High Blood Pressure Roads & Airports- West Yard 11/18/2010 EWP Presentation NEO-Wellness Overview ESA ED 11/18/2010 EWP Presentation Healthy Eating for the Holidays DCSS 11/23/10 EWP Page 50

189 Appendix 2: VHP Wellness Wednesdays Page 51

190 Appendix 3: County Department Services & Resources Department Services Target Audience Dates Office of Affordable Housing A First Time Homebuyer Program B Down Payment Assistance Program C Mortgage Tax Credit Program D Housing Rehabilitation Program County Residents and Employees First time home buyer program effective August 16 Down Payment Assistance program available October 8 Division of Agriculture A Farmer's Market locations B How to be a certified seller at a Farmer's Market County Residents and Employees Services do not have a start finish date C Pesticide information/training/ education/container recycling D Weed abatement E Insect and pest ID information Page 52

191 Department Services Target Audience Dates Department of Alcohol and Drug Services A 3 Principles Services Program 1 Classes teaching psychological principles of mind, thought and consciousness, and how to create a better life experience through the use of these principles County Residents and Employees Classes started in August, class times and dates available on the website 2 Classes range from parenting to workplace enjoyment B Learning Institute - Offers continuing education (CE) classes units for a variety of professions All classes are approved by their governing bodies C Vocational Services - List of resources for job-related support services, ESL, computer training, literacy training, and all available services in the County Page 53

192 Department Services Target Audience Dates Division of Animal Care and Control A Accepts lost, stray or owner surrendered animals B Maintains lost and found records C Rescues and cares for injured stray dogs, cats and other domestic animals County Residents and Employees Services do not have a start finish date D Pet Adoption Program E Public education on pet ownership, safety and licensing requirements F Provides referrals for low cost spay/neuter, testing and vaccinations for stray or feral cats G Field Services which include: Pick up confined, stray domestic animals; patrol for stray, roaming domestic animals; pick up owner surrendered domestic animals within County jurisdiction for a fee; investigate animal bites; investigate animal abuse and neglect, including domestic animals and livestock; investigate dangerous dog complaints; pick up injured stray domestic animals; investigate domestic animal nuisance complaints; pick up dead animals within County jurisdiction, including expressways Page 54

193 Department Services Target Audience Dates Department of Child Support Services A Opening cases B Locating non-custodial parents C Establishing paternity County Residents and Employees Services do not have a start finish date D Establishing Child Support Orders E Modifying Child Support Orders F Enforcing Child Support Orders County Clerk Recorder A Obtaining a birth/death/marriage certificate B Obtaining a marriage license County Residents and Employees Services do not have a start finish date C Purchasing official records copies D Official Document Recording E Fictitious business name filing F Passport applications G County data archives Page 55

194 Department Services Target Audience Dates Office of Development Services A Ensures buildings are safe and code compliant through professional plan checking, building inspection and investigation of substandard structures County Residents and Employees Services do not have a start finish date B Building permits C Building inspections D Office of Land Development Engineering - Inspects newly paved roads for code compliance and quality of work E Office of County Surveyor - ensures professional mapping and surveying services to safeguard property and public welfare F Clean Water Program (water pollution prevention) Page 56

195 Department Services Target Audience Dates Dispute Resolution Program Services A Mediation services & dispute resolution services - assist in the resolution of disputes There is no single type of dispute, which cannot conceivably be assisted with and/or resolved B Child Welfare Ombudsman services - A County Residents and Employees B Ombudsman serves all those individuals with cases or concerns within Santa Clara County, including birth parents, relative care providers, foster parents, children, social workers, and members of the community Services do not have a start finish date Page 57

196 Department Services Target Audience Dates Office of Emergency Services A Getting Immediate Help - List of all hospitals and clinics, Suicide and crisis services B Emergency Preparedness & Response Information and tips County Residents and Employees Services do not have a start finish date C Fire Prevention & Safety Information and tips to safeguard property and defend against wildfires D People with Special Needs - Emergency preparedness for people with special needs such as the elderly, people with disabilities, and medically fragile people E Disaster Planning for Animals F Combating Terrorism - Advice on combating all kinds of terrorism from chemical to cyber terrorism G Tips and advice for Living in Earthquake Country H Other Emergencies and Disasters tips and advice (power outages, storms, floods chemical emergencies, etc) I Disaster Preparedness and planning at Schools & Daycare Centers J Business Disaster Planning K Disaster Recovery and Relief advice on repairing damages (federal assistance information - disaster declaration process) L Coping with Disaster - Helping Children Cope With Disaster Page 58 M Volunteering and Training Opportunities

197 Department Services Target Audience Dates Employee Assistance Program - EAP A Labor-management sponsored confidential, professional counseling service for employees and their families who want help in solving personal problems County Employees and their families only Services do not have a start finish date Office of the District Attorney A Crime Victims Resource Guide - Every crime victim in the State of California who suffers a loss as a result of the criminal activity of a defendant is entitled to a restitution order This is an order by the court granting the victim a money judgment against the defendant for the victim s losses County Residents and Employees Services do not have a start finish date Employee Development Employee Services Agency A Offers many training courses, programs, and resources that can assist in professional development skills 1 Tuition Reimbursement 2 Employee Development certificates 3 Retirement Planning 4 Class - Training for office professionals 5 Accelerated BA and MA degree programs County employees receive 40% discount 6 Training Liaisons 7 Critical Incident Stress Debriefings for Employees Help to Survivors of County Employees Individual Employee Services A Provides data on promotional opportunities, transfer opportunities, MOU and MOA, Salary Ordinance Information, and employee benefits information County Employees County Employees Classes are available at various days and times check schedule for available classes, dates and times N/A Page 59

198 Department Services Target Audience Dates Energy Upgrade Santa Clara County A A regional and statewide effort to create an energy program that supports homeowners, landlords and renters to make their dwellings more energy efficient through energy audits and retrofits County Residents and Employees The program is still under development and has not launched yet More information will be posted on the website as it gets closer to the unknown launch date Page 60

199 Department Services Target Audience Dates Department of Environmental Health A Consumer Protection Division - monitors and protects a variety of basic human needs - including safe food, water, and sewage disposal - needs that affect the health and safety of consumers each day Programs and services include: 1 Disaster Preparedness & Response 2 Food Safety Program 3 Temporary Events 4 Drinking Water Program - Small Water Systems 5 Land Use 6 Environmental Lead Contamination 7 Plan Check and Equipment Installation Requirements for Food Facilities 8 Public Pools and Spas Recreational Programs 9 Non-Point Source Pollution Control Program 10 Noise Pollution 11 Indoor Air Quality/Radon 12 Detention Facilities 13 Homeless Shelters 14 Psittacosis & Animal Complaints 15 Vending Machines 16 Public Swimming Pools and Spas Recreational Health Program 17 Smoking Ordinance 18 Temporary Events 19 Tobacco Retailer Permit 20 Translated materials in foreign languages County Residents and Employees Services do not have a start finish date Page 61

200 Department Services Target Audience Dates Equal Opportunity A Equal Opportunity Policies 1 Policy against Discrimination, Harassment and Retaliation 2 Board of Supervisors Policy on Sexual Harassment 3 County of Santa Clara Policy on Sexual Harassment 4 Policy on Diversity County Employees Services do not have a start finish date B Guidelines to filing a complaint C Reasonable Accommodation policy and procedures for qualified applicants and Employees with disabilities D Sexual Harassment and Discrimination Prevention Training for Managers, Supervisors and Leads E Equal Opportunity Staff, Assignments, and Agency Liaisons information Facilities and Fleet Department A The Facilities Department is responsible for the design, construction, maintenance, purchase/sale, and leases of County buildings and property County Residents and Employees Services do not have a start finish date Santa Clara County Fire Department A Information on Employment Opportunities, Administration, Operations (Fire Suppression, Fire Investigation, EMS, Rescue, Special Operations, etc), Fire Prevention, Public Education, Hazmat, Support Services, Training, Volunteers, Toys Donation Programs, Honor Guard, Financial Reports and other Published Documents County Residents and Employees Services do not have a start finish date B Winter Preparing and Holiday Safety tips Page 62

201 Department Services Target Audience Dates Office of the Fire Marshall A Jurisdiction Information - determines which agency has the authority for Fire Code enforcement and which local codes they enforce County Residents and Employees Services do not have a start finish date B Land Development - OFM reviews plans submitted to the County Planning Office for site approval or use permit for the purpose of setting conditions for development or use, also reviews final building plans to ensure compliance with conditions C Construction and hazardous materials permits D Information on permits needed for special events E Burn permits F Information on Wild land Urban Interface (WUI) - a two-pronged approach providing defensible space and constructing a more ignition-resistant structure for fire defense G Documents and Forms, Fees, Frequently Asked Questions, and Report a Fire Hazard options Hate is the Enemy Program A Informational website on Hate Incidents and crimes B Includes information on how to get help if you are a victim County Residents and Employees Services do not have a start finish date Page 63

202 Department Services Target Audience Dates Office of Human Relations A Immigrant Relations and Integration Services (IRIS) 1 Free Citizenship Days: Annual free citizenship days in 16 languages to help county residents become citizens 2 Educational Forums: forums highlighting various issues impacting immigrant communities 3 Immigrantinfoorg: An interactive website that includes a data base that lists over 700 ESL & Citizenship Classes in Santa Clara County and links to local, state and a national resources for immigrants 4 Immigrant Survivors of Domestic Violence Committee: formed to address the unmet needs of battered immigrants County Residents Services do not have a start finish date Page 64

203 Department Services Target Audience Dates Integrated Waste Management A Information on Bay/Environmentally friendly gardening B Home Composting workshops County Residents and Employees Services do not have a start finish date C Business Recycling and waste reduction information D Green Business Program a partnership of environmental agencies and utilities that assists, recognizes and promotes businesses and government agencies that volunteer to operate in a more environmentally responsible way E Residential - Tips on reducing waste, landfills and transfer station information and fees F Resources for Educators G Recycling hotline - Provides info on recycling locations and tips on how to reuse stuff Page 65

204 Department Services Target Audience Dates Santa Clara County Library A Book checkout B Homework Help: Students in grades 3-12 can submit a question in an online classroom and receive live, oneon-one assistance from a tutor Subjects include English/Language Arts, Math, Science, Social Studies and Writing County Residents and Employees N/A C Test Center: Online assessment library to take practice standardized tests (SAT, ACT) D Adult Learning Center: Adults can receive live online help in areas such as US Citizenship testing, GED testing, resume and cover letter writing, business letter writing, term paper writing, and core subject education (English/Language Arts, Math, Science, Social Studies and Writing) E Microsoft Office Center designed to help adults learn how to better use Microsoft Word, Excel, and Power Point Livestock Advisory Program A Information and classes for equestrians on proper maintenance of horses County Residents and Employees Classes are offered in April and May for $2000 Page 66

205 Department Services Target Audience Dates Medical Examiner Coroners Office A Frequently Asked Questions B Reports - autopsy, death certificates, and toxicology reports C Organ Donation Program County Residents and Employees Services do not have a start finish date D Organ Retention E Death Statistics F Private Autopsy information G Burial Donations received for unidentified infant or adult remains H Unidentified Body information Mental Health Services A Mental Health Services B Suicide and Crisis Services County Residents and Employees N/A C Transitional Aged Youth (TAY) program to help youth aged transitioning from teenage years to young adult hood Mothers Milk Bank A Provides breast milk to needy mothers who have a Dr's Prescription and take donations of breast milk County Residents and Employees N/A Page 67

206 Department Services Target Audience Dates Department of Parks and Recreation A Provides information on Park and Recreation locations such as: "The Fantasy of Lights" show, Biking trails, Hiking trails, Campground locations, Picnicing locations, Dog Park locations, Fishing locations and information, boating information, and county park information and locations County Residents and Employees N/A Office of Planning A Permits and Development resources B Plans and Programs County Residents and Employees N/A 1 Green Building Ordinance certification requirements for most new single-family residences 2 Habitat conservation plans 3 Solar Power Info 4 Facts and Figures provides demographic, housing, economic, and other data related to planning and development in Santa Clara County Public Defenders Office A Provides legal representation for indigent county residents and Employees County Employees and their families only N/A Page 68

207 Department Services Target Audience Dates Public Health Department A Informational Website on Health Related issues, statistics, chronic disease and injury prevention programs County Employees and their families only N/A B Birth and Death Certificate information C Communicable Disease and Sexual Health Programs D Immunization travel clinic E Seasonal Flu information Registrar of Voters A Election Date information B Register to vote online County Residents and Employees Dates subject to voting dates C Vote by Mail information D Voter education Roads and Airports Department A Public Notices B Road information, road service requests, road news C Current project updates and information County Residents and Employees Services do not have a start finish date Santa Clara County Works - SCCWorks A Provides Income for low-income families B Help unemployed individuals address barriers to employment, develop soft skills, gain work experience and progress toward self-sufficiency County Residents Program Expired September 30, 2010 Page 69

208 Department Services Target Audience Dates Santa Clara County Medical Center - SCVMC A Ability to Pay Program (APD) for county residents who do cannot afford services and do not have health care B Inpatient and outpatient financial services for insolvent patients County Residents and Employees N/A C Legal Counseling for Pediatric patients D Community Learning Center (Health Information Library) Office of the Sheriff A Info and facts about the Sheriff's Office B Info on the Sheriff's Academy - Career Opportunities County Residents and Employees N/A C Civil Processes Services and Fees D Community Education - Neighborhood Watch, Sheriff's after school youth program E School resource officer F Enforcement operations G Leave a crime tip H Memorials for Officers I Press Releases on recent events J Records - the repository for Sheriff s Records and is the official Custodian of Records for Santa Clara County K Special Operations and units L County Crime Targets (most wanted) Page 70

209 Department Services Target Audience Dates Social Services Agency A Department of Aging and Adult Services 1 Adult Protective Services 2 In-Home Supportive Services 3 Public Administrator 4 Public Guardian 5 Senior Nutrition Program County Residents and Employees N/A B Department of Employment & Benefit Services 1 Health Coverage Assistance (Medi-Cal & more) 2 Food Assistance (Food Stamps & more) 3 Financial Assistance (CalWORKs, General Assistance & more) C Department of Family & Children Services 1 Child Abuse Reporting and Investigation 2 Foster Parent Recruitment 3 Adoption Services for Foster Youth Page 71

210 Department Services Target Audience Dates Office of Veterans Services A Information, training and assistance to organizations helping Veterans B Outreach to hard to contact elements of the veterans community County Residents and Employees N/A C Benefits Claim Assistance D Telephone Claims Assistance E Notary Public Services F Survivors Assistance G Website also lists complete list of Veteran Benefits Wellness Program A Activity Programs (walking groups) B Chair Massage County Employees N/A C Wellness classes D Presentations E Consultations F Resource Center G Screenings H Special Events (Health Fairs) Page 72

211 Department Services Target Audience Dates Whistleblower Program A A county program for the public and county employees Any person who believes that a County employee or officer has engaged in improper governmental activity - such as, but not limited to, violating local campaign finance laws, conflict of interest laws, or governmental ethics; misusing County resources; or using a County position to advance a private interest - should report improper financial activity to the Office of the County Counsel County Residents and Employees Program established on April 22, 2010 Office of Women's Policy A Domestic Violence Services and Council B Employee Rights Advocacy and Services C Publications and Newsletters County Residents and Employees N/A Page 73

212 Appendix 4: Organizational Framework Senior- Level Support ID Senior Leaders CLT Team WW N & W Resource Group/ Committee Members The 7 Benchmarks of Success Low Level Intensity A Cohesive Wellness Team 30 FTE HES (existing) EWP Manager or equivalent (to be added) MSR (to be added) Data Collection Existing Baseline Indicators Existing Data Sets (Human Resources, health plans, worker s compensation) A Systematic Annual Operating Plan Existing Work Plan Existing Marketing Appropriate Interventions Fitness Classes Targeted Wellness Fairs Low-Level Incentives Stationary Library Individual Health Coaching Targeted Trainings A Supportive Environment Endorsement by Sr Mgmt Existing Policies Around EW Union Acknowledgment Evaluating Outcomes Individual EW Class Evaluations Page 74

213 The 7 Benchmarks of Success Medium Level Intensity Senior- Level Support A Cohesive Wellness Team Data Collection A Systematic Annual Operating Plan Appropriate Interventions A Supportive Environmen t Evaluating Outcomes ID Senior Leaders 30 FTE HES (existing) Baseline Indicators Developmen t of Strategic Plan Fitness Classes New Policy Development ID ROI Figures CLT Team WW N&W Resource Group/ Committe e Members EW Medical Director EWP Manager or Equivalen t (to be added) MSR (to be added) Analyst (to be added) Countywide HRA Questionnair e Collected Aggregately, by Class Alignment of Plan with Mission & Vision New Marketing Strategy Targeted Wellness Fairs Low-Level Incentives Stationary Library Union Involvement & Endorsement Group-Based EW Classes HRA Questionnair e Individual Health Coaching Targeted Trainings Wellness Fairs Mind-Body Wellness Classes Interdisciplinar y Collaboration Page 75

214 The 7 Benchmarks of Success High Level Intensity Senior- Level Support ID Senior Leaders CLT Team WW N&W Resource Group/ Committee Members EW Medical Director A Cohesive Wellness Team 30 FTE HES (existing) EWP Manager or Equivalent (to be added) MSR (to be added) Analyst (to be added) Data Collection Baseline Indicators Countywide HRA Questionnaire Collected Aggregately, by Class Assessment of Facilities/Environ ment A Systematic Annual Operating Plan 5-Year Strategic Plan Quarterly Review and Updates Appropriate Interventions (Department) Specific Interventions + Incentives Transdisciplinary Collaboration Chronic Conditions Classes A Supportive Environment Sr Mgmt Endorsements Incentivized Participation Emphasis on EW Participation to Lower Premiums Individual Maintenance & Follow-Up Evaluating Outcomes Calculate Actual ROI Designated Sr Leaders by Agency Graphic Designer (to be added) Web Master (to be added) Dedicated Marketing Team/ Firm Dedicated Survey Consulting Company Facility Demographics by Department Health assessment: Office Visits Workers Comp Hospitalization HRA Questionnaire Departmental Policy Adoption Page 76

215 Committee Agenda Date: March 21, 2011 Agenda Item No11 County of Santa Clara Santa Clara Valley Health & Hospital System Valley Health Plan HHC DATE: March 21, 2011 Prepared by: Denise Carr Business Analyst TO: SupervisorLizKniss, Chairperson SupervisorKenYeager, Vice Chair Health & Hospital Committee FROM: Greg Price CEO, Valley Health Plan SUBJECT: Report on Valley Health Plan s Recommendation to Contract for Pharmacy Benefit Management Services to meet its Commercial HMO business needs effective November 2011 RECOMMENDED ACTION Consider approval of Valley Health Plan's (VHP) recommendation to pursue an RFP for a Pharmacy Benefit Management company (PBM), proceed with contract negotiations with the selected company and return to the Board of Supervisors for approval of the contract documents in August 2011 FISCAL IMPLICATIONS There is no impact to the County General Fund associated with the recommended actions There are sufficient funds within Valley Health Plan s budget (BU 725) to cover the costs Board of Supervisors: Mike Wasserman, George Shirakawa, Dave Cortese, Ken Yeager, Liz Kniss County Executive: Jeffrey V Smith 1

216 Committee Agenda Date: March 21, 2011 Agenda Item No11 associated with the PBM CONTRACT HISTORY VHP s current network of pharmacies for its Commercial HMO members are the seven Santa Clara Valley Health & Hospital Systems (SCVHHS) pharmacies which are located in each of the Valley Health Center Outpatient Clinics VHP has contracted with the SCVHHS Pharmacies to provide prescriptions and mail order services for its commercial members since the Health Plan s inception in 1985 As VHP has grown and expanded its provider network over time, these limited pharmacy locations and limited hours have become problematic for VHP s Commercial HMO members And as VHP continues to improve and become a more attractive option for CountyEmployees, it recognizes the need to expand pharmacy services past the seven SCVHHS Pharmacies In order to pursue this repositioning strategy, VHP has engaged the services of Evergreen Rx a Pharmacy Benefit Consulting organization to assist in the development of an RFP, the selection of a PBM and partnering with the County s Procurement Department on contract negotiations The SCVHHS Pharmacies will remain part of the network of providers for VHP s members The selected PBM will work with the SCVHHS Pharmacies to continue to leverage the 340B pricing as well as continue with the mail order services VHP will look to the selected PBM to leverage rebates and price discounts from the retail pharmacy network REASONS FOR RECOMMENDATION During the strategic planning process for 2011, VHP identified the need to enhance it s pharmacy services for the Commercial HMO members and use this to further the Plan s repositioning strategy to attract new members during this year s open enrollment The new PBM services will offer VHP an expanded network of pharmacies, better clinical data and better clinical management of members VHP recognizes the need to reposition the health plan and become competitive with the other commercial health plans currently offered to CountyEmployees In order to be an attractive option to employees, VHP s strategy is to expand its network of providers to match the network of the other commercial health plans The PBM will bring and Board of Supervisors: Mike Wasserman, George Shirakawa, Dave Cortese, Ken Yeager, Liz Kniss County Executive: Jeffrey V Smith 2

217 Committee Agenda Date: March 21, 2011 Agenda Item No11 expanded retail pharmacy network which is needed to match VHP s growing provider network of community based physicians This increased network of providers both physicians and pharmacies will help increase member satisfaction and retention Pharmacy issues are currently the third largest number of complaints filed with VHP It is very inconvenient for members to be seen by a physician in the community and then have to come back to one of the SCVHHS Pharmacies to fill their prescription instead of being able to go to a retail pharmacy near their home or provider Also if a member becomes ill or injured when traveling and needs a prescription, they must pay out of pocket at a full retail price and then be reimbursed once they submit their documentation to the plan Under this scenario, VHP must reimburse the member the full retail price and is unable to leverage any type of discount The PBM will give VHP the access to clinical data for its members on the pharmaceutical usage This will continue to help improve the clinical management of the members through drug utilization review and disease management These will also assist VHP in identifying issues such as drug to drug interactions, drug to disease interactions, appropriate dosage and excessive utilization with members who might be taking medications that are redundant or medications that might react to one another The drug utilization review will also assist VHP in managing the members with chronic diseases who are under-utilizing or over-utilizing medications VHP is will also benefit from the cost containment strategies that a PBM brings as part of the agreement This included an established network of pharmacies and due to their size of business have deeply discounted pricing and the ability to leverage drug rebates through the manufacturers The selected PBM will also work with VHP the refine and fine tune of the health plan s formulary which can further add to the cost containment BACKGROUND Valley Health Plan is an agency of the County of Santa Clara originally created to meet the needs of hospital staff for affordable, quality healthcare Initially established in 1985, Valley Health Plan commercial plan has grown from a membership of 4,500 in 1995 to over 13,500 at present Membership is comprised of employees of Santa ClaraCounty, Council on Aging, In-Home Support Service, Valley Transit Authority, VMC Foundation and South Bascom Pediatrics VHP is comprised of essential departments to ensure regulations required by the Board of Supervisors: Mike Wasserman, George Shirakawa, Dave Cortese, Ken Yeager, Liz Kniss County Executive: Jeffrey V Smith 3

218 Committee Agenda Date: March 21, 2011 Agenda Item No11 Department of Managed Health Care are upheld so the plan can maintain its Knox-Keene license In 1996, Santa ClaraCounty created the Health Authority (Santa Clara Family Health Plan) to respond to the State s Two Plan Model legislation In response, VHP was assigned to assist Santa Clara Valley Medical Center (SCVMC) with managing member delegation of Medi-Cal, Healthy Families and Healthy Kids patients from SCFHP for SCVMC and the community clinics Currently VHP is responsible for 60,000 delegated members and has created an extensive provider network throughout Santa ClaraCounty In 2009, VHP added Valley Care to its managed services responsibilities Valley Care was created to provide health coverage for county residents at the 200% Federal Poverty Level The coverage is funded by the county and government grants and regulated by the Office of the Inspector General (OIG) Adding all these members together, VHP currently manages over 85,000 enrollees with a network of five hospitals and over 700 providers VHP is a County Agency that manages an enterprise that is funded totally by plan revenue with no General Fund subsidy from the County VHP does absorb allocated costs from the County, including facilities support, personnel, legal services, information services, and financial services The health plan is committed to promoting managed care principals such as paneled physician practices, health education, disease management, preventive care, utilization management, and outreach CONSEQUENCES OF NEGATIVE ACTION Failure to approve this action may impact Valley Health Plan s ability to provide the needed pharmacy network for its members and be competitive with other health plans offered within Santa ClaraCounty Board of Supervisors: Mike Wasserman, George Shirakawa, Dave Cortese, Ken Yeager, Liz Kniss County Executive: Jeffrey V Smith 4

219 Committee Agenda Date: March 21, 2011 Agenda Item No12 County of Santa Clara Santa Clara Valley Health & Hospital System Agency Administration HHC DATE: March 21, 2011 Prepared by: Amy Carta Assistant Director, SCVHHS TO: SupervisorLizKniss, Chairperson SupervisorKenYeager, Vice Chair Health & Hospital Committee FROM: Sylvia Gallegos Deputy County Executive / Acting Director, SCVHHS SUBJECT: Quarterly Report from Alvarez & Marsal, Period of November 1, 2010 through March 1, 2011 RECOMMENDED ACTION Accept second quarterly status report from Alvarez & Marsal on initiatives related to Santa Clara Valley Health and Hospital System and Santa Clara Valley Medical Center FISCAL IMPLICATIONS There is no impact to the County General Fund nor the Enterprise Fund associated with acceptance of this report; it is an informational item only CONTRACT HISTORY On March 8, 2010, the Office of the County Executive entered into a $100,000 professional Board of Supervisors: Mike Wasserman, George Shirakawa, Dave Cortese, Ken Yeager, Liz Kniss County Executive: Jeffrey V Smith 1

220 Committee Agenda Date: March 21, 2011 Agenda Item No12 services agreement with the consulting firm, Alvarez & Marsal Healthcare Industry Group (A&M), to conduct a financial analysis of SCVMC A&M's findings were presented to the Board of Supervisors at its meeting on April 27, 2010 On May 25, 2010, the Board of Supervisors delegated authority to the County Executive to take all necessary actions on an agreement for services with A&M, not to exceed $15 million, for the period July 1, 2010 through December 31, 2011 The agreement was executed and work commenced The Board of Supervisors approved a delegation of authority to amend the compensation limit to an amount not to exceed $5 million during its September 28, 2010 meeting REASONS FOR RECOMMENDATION When the Board of Supervisors approved the Alvarez & Marsal contract on May 25, 2010, quarterly status reports were requested The attached report provides the requested information for the period November 1, 2010 through March 1, 2011 CONSEQUENCES OF NEGATIVE ACTION The Committee would not receive the requested information ATTACHMENTS A&M report Presentation Board of Supervisors: Mike Wasserman, George Shirakawa, Dave Cortese, Ken Yeager, Liz Kniss County Executive: Jeffrey V Smith 2

221 DATE: March, 2011 TO: FROM: SUBJECT: Health & Hospital Committee Sylvia Gallegos Deputy County Executive/Acting Director, SCVHHS A&M Current Project Report Updates as of 3/1/2011 I Panel Management/Patient Access Monthly physician panels have been produced since September with ongoing process refinement 60 doctors receive updated information by the 15 th of each month Approximately 45,000 residents are members of the primary care panels Recent activity has shifted to improving overall clinic patient throughput While exact data will be included in the FY12 budget, the increase in patient access and clinic throughput in the clinics will lead to tens of thousands of additional patient visits when compared with FY11 II One-Day Stays Nuclear medicine and certain radiology functions have reconfigured access schedules to allow for non-inpatients to receive testing and avoid inpatient hospitalization Expansion of one day efforts for pediatric patients is beginning with analysis of data with Dr Schroeder One-day stays in Medicine are down by more than 30% since the project started, which is approximately 1,000 avoided admissions per year at an estimated cost of $2,000 to $5,000 each III SCVHHS Strategic Plan Beginning in September 2010, A&M established two councils of executive leaders to recommend a course of action The councils and A&M committed to completing this task within days Work that took place over the course of the planning consisted of : A review of all previous health agendas and strategic business A report on the implications of the state and federal health policy developments and local changes Consideration of the current and future financial circumstances confronting the County of Santa Clara government Development of a unified managed care strategy for Valley Health Plan (VHP) and Santa Clara Family Health Plan (SCFHP) that aligns with the goals and framework of the overall SCVHHS strategic plan Page 1

222 Development of a final report for submission to the County Executive Officer, the Deputy County Executive, Health and Hospital Committee, and the full BOS for review and approval On January 12, 2011, Mark Finucane presented the report to the Health and Hospital Committee on behalf of both councils To date, the following presentations on the strategic framework have occurred: January 12, 2011 Discussion with Supervisor Kniss (Finucane) January 12, 2011 Presentation to the Health & Hospital Committee (Finucane) January 13, 2011 Discussion with Jeff Smith (Finucane and Pillari) January 21, 2011 Presentation to the Health Care Advisory Group (Finucane) January 25, 2011 Presentation to the Board of Supervisors (Kniss) January 27, 2011 Presentation to the Santa Clara Family Health Plan Board (Finucane) IV Labor & Delivery (L&D) V ELMR This project is complete The punch-list of outstanding major improvements and bug fixes has been winnowed down to a few items, most of which are contingent on forthcoming system upgrades for completion Workflow issues and system speed have now arisen as deterrents in allowing physicians to improve their productivity levels VI Performance Reporting Bi-weekly labor reports are in production and used by management throughout VMC Physician productivity and panel acuity reports are in limited circulation as they continue to be refined High level budgetary models to study the impact of reimbursement changes on county subsidy are under development in conjunction with Finance A&M assisted with the December budget reduction of $30 million and is doing the same for the FY12 targeted reduction of $70 million VII FQHC An initiative is underway to maximize patient flow into regional urgent care facilities to take advantage of improved FQHC reimbursement This initiative is linked to the patient access project described above VIII Core IT System Page 2

223 Regular meetings are underway and options are being explored, Linda Smith has taken over as the lead on this initiative IX Valley Health Plan In the process of assisting with the evaluation of claims system upgrade A&M is working with Greg Price and Gary Graves to minimize overall County dollar exposure to any claims system upgrade contract Current efforts have reduced such exposure by $10 to $15 million X Contracts and Grant Administration An outside vendor (MediTract) specializing in web-based solutions for hospital-based contract administration needs was identified and validated in terms of its capabilities with a tentative scope of services This project was put on hold by County with the request to see if the Contract Management capabilities within the SAP system would meet SCVMC s needs No discussions with external vendors specific to contract administration have resumed Discussions continue with respect to a broader revenue cycle solution with an external vendor which does include a specific solution for VMC s managed care contracts, financial modeling and payment compliance This same technology also has an applicable functionality for VHP s external provider contracts XI Charge Capture/Coding Pilot programs within the Medicine and Surgery departments are underway to improve the inpatient physician charge capture process and efficiently utilize staff to increase professional fee charge capture Improvement of the outpatient charge entry process has been targeted for February/March The Clinical Documentation Improvement (CDI) plan was launched in January Clinical Documentation education was provided for Hospitalists, Attending Physicians and Residents with excellent attendance Care Management staff, HIM staff and Physician Specialists education sessions were held in February A newly hired Clinical Documentation Specialist is now utilized on unit floors to monitor chart documentation and educate physicians The CDI program will contribute to more appropriate coding of medical records, which we estimate will increase Medicare reimbursement by $1M-$2M annually In addition, an existing contract with a Medicare chart auditor can be eliminated or greatly reduced resulting in a cost savings of at least $100K per year Significant progress has been made in the Health Information Management (HIM) Department with the Reduction of Discharged Not Final Billed (DNFB) from $80M to $30M, which equates to a cash acceleration of approximately $12 million to VMC As a result of the elimination of the coding backlog, PBS has decreased the bill hold from 7 to 5 days which is more in line with industry standards A decrease in HIM overtime and extra help expenses is expected and will be quantified Page 3

224 XII Denials-Admin & Clinical A large majority of payers are now billed electronically, which enable tracking of remittance advice and denial data A significant number of denials are due to the Medi-Cal Treatment Authorization Requests (TAR), therefore a focus on the TAR process and implementation for improvement is in progress The Short stay team is in place to monitor and reduce unnecessary admits which would lead to clinical denials Unnecessary admits from the ED have decreased by approximately 100 per month, resulting in an estimated annual cost savings of $20 to $50 million A thorough assessment of the Care Management Department was concluded in December, and final recommendations and plan for implementation were presented in January The plan provides for strategies for aligning duties within the department to ensure appropriate discharge planning and reductions in unnecessary lengths of stay and clinical denials XIII Rehab Completion of a strategic planning process with Rehabilitation Leadership Team (RLT) inclusive of management and clinical team leaders Drafting the initial Rehab strategic business plan Met in February 2011 with CareMeridan (a neuro-rehab specialty services company) and Kindred Healthcare (a LTAC and post-acute care specialty company) to discuss potential strategic relationships to create an integrated care continuum business model to co-promote to payer community Scheduling of meetings with Kaiser Northern CA Case Managers, in March 2011, to present Rehab care capabilities, clinical pathways and suggested transfer policies from other non-kaiser hospitals with Kaiser patients Page 4

225 I AMBULATORY CARE PATIENT PANELS Project Description Panel management is a critically important strategy for monitoring and improving patient care A panel consists of a group of patients that are managed by a physician It can be particularly useful for SCVHHS if the health system participates in current or future pay-for-performance incentive programs or is considering National Committee for Quality Assurance (NCQA) recognition as a Patient Centered Medical Home Additionally, as SCVHHS prepares for healthcare reform, ambulatory care and by extension, SCVMC panel management becomes even more important to the system s overall mission and bottom line An effective panel management strategy allows the system to broaden its strategic focus beyond traditional inpatient services and deliver increasingly complex ambulatory services in a cost-effective, patient-friendly environment which enhances SCVHHS s competitive advantage as the market adapts to the demands of healthcare reform measures With California intending to move Medicaid reimbursement for public safety net hospitals to full global capitation by January 1, 2014, effective panel management is a critical success factor under a global payment methodology SCVMC panels have been closed to new patients, thereby limiting patient access to ambulatory care services, stressing other health system access points and jeopardizing the health system s future ability to meet the community s access and patient care needs To address the above in concert with improving the overall panel management process at SCVHHS, A&M is working with a SCVHHS project team to focus on the design and implementation of an Office of Panel Management that will work closely with physician and business leadership to accomplish the following: Analyze and update all patient data related to physician panels in the Ambulatory clinics Produce detailed monthly reporting for each physician that is responsible for a panel of patients Develop methods to add/delete patients from panels and to maintain open panel capacity Create staffing and space plans for projected increases in patient panels over the next several years On a longer-term basis, reposition SCVHHS/SCVMC with a robust, accessible, and well-coordinated ambulatory services strategy which will be able to achieve much stronger margins and explore multiple opportunities for aligning with SCVHHS physicians and community based physicians Staff A&M: George Pillari, Brian Buchanan, Steve Kraus, Erica Lister SCVHHS: Dr Dennis Low, Dr Marcie Levine, Dr Larry Kwan, Jerry Wallerstein, Margo Maida, David Wright, Selene Ho, Cheri Silviera and Caroline Yip Immediate Goals Open SCVMC panels and revise capacity calculations with physician input Improve the overall In-take process at each patient care site Refine panel reporting to primary care physicians as well as assess each facilities space/capacity staffing relative to patient and panel demand Organize and implement the Office of Panel Management Page 5

226 II ONE-DAY STAY Project Description Emergency department crowding and delays have become major issues for safety net hospitals such as SCVMC It is not uncommon for safety net hospital emergency departments with significant patient flow and crowding issues to admit patients who require services beyond the first hours in the emergency department to either an observation unit or as a one-day stay admission Other factors also may contribute to the situation such as patients without access to medical specialists may view the emergency department as the quickest route to specialized services while in other circumstances physicians may be more likely to refer patients to the emergency department for care, viewing the emergency department as a comprehensive diagnostic center with access to the necessary resources for the patient As concern mounts over health care costs, one-day patient admissions are being scrutinized for the medical necessity of the condition and whether or not the one-day stay admission should have been managed on an outpatient basis As federal and state governments expand Recovery Audit Contractor (RAC) roles as of December 2010 and beyond, there will be an increased focus on one-day admissions to assess if these admissions are based on evidence based admission criterion and verifying supporting medical documentation SCVMC has a very high percentage of one-day stay admissions relative to total admissions which warrants an investigation of the medical necessity and appropriateness of these admissions, the processes used that result in a one-day admission and the financial impact on SCVMC To address the above, A&M is working with a SCVHHS project team to assess the reasons for the high level of acute one day stays at SCVMC and develop solutions to minimize potentially medically unnecessary admissions in the future In the course of this project, the project team is currently: Evaluating the financial impact of one-day stay admissions on the organization Evaluating the practice patterns, physical constraints and other root causes that lead to one day stay admissions Working with SCVMC clinicians and administration to determine the course of action to reduce one day stays Support SCVMC staff in implementing the action plan Staff A&M: George Pillari, Jim McLarty, Milen Hayriyan and Chris Kalkhof SCVHHS: Trudy Johnson, Dr Dolly Goel, Dionette Kelton, Dr Alfonso Banuelos, Dr Cliff Wang, and Dr Jeff Arnold Immediate Goals Assist SCVHHS team in creating action plan to prepare to segregate OP s in one location Shadow Utilization Management staff to better understand role Assist the SCVMC team in creating action plan (including cost of equipment and staffing) to expand ED beds to available space Begin daily analysis of one day stays with case management director to look for trends and long term solutions Page 6

227 Obtain trend data of Transitional Care Unit (LOS, patient diagnoses, admission source, etc) for trends and meet with unit medical director to seek his assistance and develop plan Start to trend and analyze daily observation patients beyond MSSU for appropriateness and the need for further OP space in the near future Utilize existing (or develop additional mechanisms if needed) to track results as changes are implemented Page 7

228 III SCVHHS Strategic Plan Project Description The Affordable Care Act (ACA) will result in industry wide transformative changes to healthcare delivery and financing Reform laws include provisions that pressure Health plan historical pricing and assumptions about managing provider costs Provider net revenue with the assumption of more risk Provider and health plan margins Much of the ACA is designed to provide health insurance coverage for approximately 32 million currently uninsured individuals To finance the increased costs associated with this major expansion, a rebalancing or rebasing of core healthcare financing mechanisms will be required The model will most likely require a transition from the current fee-for-service volume driven system to a value-driven/outcomes-based system which also: Holds providers accountable for their performance in terms of patient quality, safety and outcomes as well as the cost and setting of care delivery Emphasizes population and disease care management across a care continuum Creates significant financial incentives for physicians, hospitals, health insurance plans and other healthcare providers; to better align and coordinate care delivery The above has already been articulated through the State of California s Section 1115 Comprehensive Demonstration Project Waiver A Bridge to Reform: Vision for 2014 The articulated goals of the waiver seek to transition the current Medi-Cal fee-for-service reimbursement system to a global capitation based payment system for public safety net hospitals A&M is working with a SCVHHS strategic planning team to develop a recommended course of action for SCVHHS to respond to current and future national and state-level reform initiatives through a strategic planning process which is dynamic and adaptive to change A&M s role has been to: Facilitate policy discussions, briefings, and provide other general advisory services on state and federal reform initiatives Provide assistance to position SCVHHS to attain optimal benefits through the renewal of the State 1115 Waiver, which expired in August 2010 Assist in the coordination of Agency efforts necessary to accommodate the program, regulatory reporting and compliance insures related to Federal Health Reform legislation Staff A&M: Mark Finucane, Jim McLarty, Erica Lister and Barb Masters SCVHHS: Sylvia Gallegos, Trudy Johnson, Nancy Kaatz, Dr Dolly Goel, Dr Alfonso Banuelos, Nancy Pena, Dan Peddycord, Bob Garner, Paul Estess, Robin Roche, Greg Price, Dr Larry Bonham, Pat Cox, Elizabeth Darrow, Amy Carta and Michael Lipman Page 8

229 Immediate Goals Work with staff at SCVHHS as well as among other County agencies to assess and evaluate the synergistic aspects of each business units strategic plans relative to changes in the marketplace under healthcare reform, understanding that for this planning process, past precedent is of less predictive future value due to the transformational nature of the market changes underway under healthcare reform Develop health agenda for SCVHHS and strategic business plans currently being prepared and updated for distribution to the Santa Clara Board of Supervisors, the County Executive Officer, and the Agency Director/Deputy County Executive Conduct a one-day visioning retreat to discuss the developed fact base with SCVMC physicians relative to developed core and alternate strategies Physician alignment, integration and acceptance of the SCVHHS strategy will be a key determinant of the success or failure of all developed strategies Develop a final strategy report to be submitted to the County Executive Officer, the Deputy County Executive, Health and Hospital Committee, and the full Board of Supervisors for review and approval The Unified Plan is to incorporate the current operational plans and restructuring being implemented at SCVMC, including the development of a unified managed care strategy The coordination and integration of the restructuring of the Medical Center, its finances, and performance must proceed unencumbered by this or any other process Page 9

230 IV LABOR AND DELIVERY Project Description The labor cost component of healthcare services represents the single largest expense associated with the provision of healthcare services to patients Patient demand and volume of services required to support patient demand relative to service capacity determines the necessary staffing levels to provide high quality, effective and patient safe services At any given hospital, over time, demand for specific clinical services either decreases or increases, and staffing should be adjusted to accommodate patient demand At SCVHHS, with respect to the Labor and Delivery and Maternal Child Health Units, over the last three years there has been a decline in births and overall patient volume Earlier this year a staffing adjustment was made to adjust for the reduced volume A&M was asked to review the appropriateness of the staffing adjustment To address the above situation, A&M worked with a SCVMC L&D team to determine demand/volumeappropriate staffing levels for the L&D/MCH patient care units The scope of this initiative entailed: Analysis of the staffing and volumes of the labor and delivery at SCVMC in comparison with other SCVMC patient care units Meeting with the clinical staff to discuss patient input/throughput/output processes Observing the on-floor operations and work flow processes Reviewing internal, publicly available and specially requested benchmark data as well as historical in-house data trends, and California mandated staffing ratios Producing an analysis of staffing levels, including comparisons to benchmarks and regulatory standards Preparing and presenting findings to the Health & Hospitals Committee of the Board of Supervisors Staff A&M: Brian Buchanan, Jim McLarty and Milen Hayriyan SCVHHS: Trudy Johnson, Pam Stanley and Sue Riordan Immediate Goals This project is complete Page 10

231 V ELMR Project Description Electronic health record systems have been the focus of recent attention from policymakers The American Recovery and Reinvestment Act of 2009 (ARRA) authorized incentive payments to eligible hospitals and physicians that are meaningful users of EHRs Per ARRA and CMS requirements, if SCVHHS does not have an electronic health records solution which meets meaningful use requirements by 2015, there is an associated financial for SCVHHS As a result of the incentives and other funding opportunities, SCVHHS initiated a strategy for providing the health system with a technology solution that provides Electronic Health Records or ELMR, as a platform for integrating clinical and operational information In order to identify the most effective systems strategies for SCVHHS, it is important to have an understanding of the processes involved with: Existing ELMR Implementation Current Systems Outreach Initiatives (Orders / Results Integration, Portal Strategies, etc) Participation in Health Information Exchange Affiliated Physician Support Existing Information Systems Strategy The implementation process associated with the ELMR rollout ran into a number of obstacles in terms of useable functionality and rather than continue to rollout the ELMR solution across each clinic, a decision was made to temporarily halt the process to ensure full implementation of the ELMR solution at existing clinic sites before beginning the implementation process at other sites To address the above, A&M is working with a SCVHHS project team to assist in the revising of the ELMR implementation plan and refocusing on the best approaches to use for ELMR implementation Staff A&M: Brian Buchanan and Milen Hayriyan SCVHHS: Dr Tom Bush, Andrea Goldsmith, Dennis Kotecki, Dr Alfonso Banuelos, Immediate Goals A punch-list of enhancements and functionality improvements has been developed and is being implemented VI PERFORMANCE REPORTING Project Description SCVMC like any complex healthcare enterprise depends on well-defined metrics and strong reporting Staff and physician productivity, corporate structure, governance and management, revenue cycle management and information technology, are all highly interdependent work processes for which defined metrics and reporting serve as a valuable communication tool for managing the business enterprise aspects of SCVHHS Effective Page 11

232 metrics and reporting also serves as a means for governing boards and committees, physician leadership, management, practicing physicians and hospital support staff to measure and monitor what SCVMC views as vital to organizational success To ensure identified metrics for reporting are meaningful to key SCVMC stakeholders, they should be developed with input from employed physicians, physician leaders and health system executives This is vital to ensuring that reports provide actionable information as opposed to simply large quantities of data The number of metrics reported should be limited in number, actionable toward a pre-determined objective, and informing to governance, physician leadership and management To develop appropriate metrics and reporting at SCVMC, A&M is working with a project team to design and implement an actionable and timely flow of information to management and executive leadership Thisincludes: Development of a daily flash of operational data for the Board of Supervisors and executive leadership Creation of bi-weekly manager level staffing and productivity reporting Refine and improve the delivery timeframe of physician dashboard reporting Develop and/or standardize monthly reporting of key operational aspects such as billing, scheduling, staffing, etc Staff A&M: Brian Buchanan, Steven Kraus and Raul Smith SCVHHS: Nancy Kaatz, David Claude, Mary Fisher and Matt Harrington Immediate Goals Produce Daily Flash Reports Both Ambulatory and Inpatient flashes are in-circulation and being enhanced Need to add budget data for census and visits Need to remove BAP from report Bi-Weekly Labor/Productivity Report Data has been sourced and Excel version of report has been created based on actual data from a recent pay-period Awaiting finalization of budget so that MH can provide appropriate budget numbers Need to establish report production and circulation process Page 12

233 VII FEDERALLY QUALIFIED HEALTH CENTER (FQHC) Project Description Federally qualified health centers (FQHCs) include all organizations receiving grants under section 330 of the Public Health Service Act FQHCs qualify for enhanced reimbursement from Medicare and Medicaid, as well as other benefits FQHCs must serve an underserved area or population, offer a sliding fee scale, provide comprehensive services, have an ongoing quality assurance program, and have a governing board of directors FQHCs are in the forefront of healthcare reform and plays a pivotal role in healthcare reform and are integral to the future change and that federal ACA legislation will drive SCVHHS however, is not positioned to benefit from coming changes under healthcare reform with respect to FQHCs because the system s current FQHCs only reach a small percentage of SCVMC ambulatory care patients The SCVMC reach of the FQHC will also take on added importance under Medicare Accountable Care Organization guidelines which bases primary care physician assignment on historical ambulatory care usage patterns, potentially excluding SCVHHS PCPs from being ACO participants and thereby having potential Medicare patients rechanneled to competing healthcare organizations To address the above, the A&M is working with a SCVMC project team to assess the fiscal impact of the current FQHC designation and provide recommendations for ways in which to capitalize on the current market as well as adjust to upcoming changes in reimbursement Staff A&M: Brian Buchanan, Steve Kraus, and Erica Lister SCVHHS: Nancy Kaatz and Michael Lipman Immediate Goals Develop an understanding of the SCVHHS ambulatory operation Develop and test structural options for the SCVHHS ambulatory enterprise Page 13

234 VIII CORE INFORMATION TECHNOLOGY (IT) Project Description Workflow clinical, operational and financial technology has expanded substantially over the last several years for hospitals and health systems Many hospitals are embracing this technology as a means to improve overall operational efficiency, achieve patient safety goals and positively influence the quality of care To address the above potential short-term and long-term Core IT strategy for SCVMC requires: Identifying the most effective systems strategies requires a full understanding of the context of existing technology Implementations and the organization s Information Systems Strategy Understanding healthcare reform and financial risk shifted to providers favors a clinical integration strategy (eg, Protocols-EBM, EMRs, Clinical Data Sharing, etc); all which will drive the systems infrastructure required to support a clinical integration plan A process needs to be developed and deployed to evaluate potential business and clinical care model strategies to arrive at the most effective short and long term IT strategy for SCVHHS At present at SCVHHS, the IT strategy is tied to a 5 year strategic technology plan which may not apply to expected requirements under the Affordable Care Act or which will support performance improvement initiatives to change highly manual and work around-based business processes To help ensure that SCVHHS s core IT strategy is aligned with the transformative changes occurring in the marketplace, A&M is working with the SCVHHS team to identify the most effective system strategies for the health system under federal and state healthcare reform as well as with anticipated changes from other industry trends which includes an increasing focus on ambulatory vs inpatient care services Staff A&M: George Pillari, Brian Buchanan, and Milen Hayriyan SCVHHS: Dennis Kotecki and Albert Sanchez Immediate Goals To assist in evaluating alternatives and providing a business case and recommendations for potential ARRA incentive funds and vendor selection Page 14

235 IX VALLEY HEALTH PLAN Project Description Valley Health Plan coupled with Santa Clara Family Health Plan, if combined, are the dominant health plans in Santa Clara County with respect to the Managed Medicaid population Valley Health Plan anticipates a number of opportunities in the market for business growth which will benefit both Valley Health Plan and SCVHHS and also anticipates various operational changes that will be required under federal and state healthcare reform To assist Valley Health Plan pursue business growth opportunities while also addressing its operational requirements, some driven by regulatory compliance issues, A&M is working with a Valley Health Plan project team to prioritize which change processes to pursue first As such, this project has several business goals, all related to expanding/enhancing the current working relationship between Santa Clara Valley Medical Center and Valley Health Plan with tangible economic benefit to both organizations Some of the key desired outcomes are summarized as follows: Minimize VHP-SCVMC capitated member/patient out-of-network migration to non-scvmc providers Develop a shared resource model for contract administration and decision support Work with parties from both organizations to establish necessary encounter reporting to improve clinical care management, improve Medi-Cal and Medicare reimbursement to VHP and to ensure compliance requirements are met Assist VHP with the Pharmacy Benefit Manager evaluation process to better manage financial risk and patient care Position VHP and SCVMC for membership and patient volume growth (respectively) from anticipated changes under federal healthcare reform (ie, Affordable Care Act) and from potential Medi-Cal program revisions Assist VHP and SCVMC to develop action plans and implement performance improvement opportunities which improve access and throughput of VHP members at SCVMC while also reducing inefficiencies Assist VHP to enhance its operational support capabilities Staff A&M: George Pillari, Brian Buchanan and Chris Kalkhof SCVHHS: Greg Price, Dr Larry Bonham, Mike Lipman (others as needed for specific work streams) Immediate Goals Revise and renew Santa Clara Family Health Plan Contract with Valley Health Plan Encounter data reporting/compliance for Valley Health Plan, Santa Clara Family Health Plan and Santa Clara Valley Medical Center Due diligence preparation for select non-vmc provider contracts and contracting process Page 15

236 X SCVHHS CONTRACT AND GRANT ADMINISTRATION Project Description Virtually all of SCVHHS s transactions are governed by some type of agreement between parties Each of these agreements creates rights and imposes obligations with implications that reach throughout the health system The SCVHHS enters into agreements for goods and services related to: Patient care, professional and consulting services and information technology aimed at improving efficiency and enhancing the patient experience at Santa Clara Valley Medical Center Third party payers for reimbursement and referral contracts to non-vmc providers Grants administration Non-VMC providers and multiple vendors to provide the necessary operational support for Valley Health Plan To address overall contract management improvement needs at SCVHHS, three areas are being addressed relative to the overall Contract and Grants Administration process Establishment of an Overall Centralized Contract & Grants Administration Functionality At present, many of SCVMC s contracts are in paper form or scanned into one or more shared service drives as a PDF document, however there is no central repository for all SCVHHS contracts or a system wide capability to monitor and manage these contracts Each of these contracts can be either assets or liabilities for SCVMC, depending on how well the organization manages them Poor contract management practices can lead to missed milestones, incurred contractual penalties, the continuation of unfavorable contracts, corporate compliance challenges, lost institutional knowledge, poor record retention and added, unnecessary expenses Centralizing the contracting activities within the SCVMC to include Ambulatory and Managed Care, Hospital Administration, Nursing Administration agreements and grants, would address the Board s concerns regarding the SCVMC contracting processes Furthermore, the establishment of centralized source for contract information dedicated to contract questions and identification of subject matter experts will assist the department in retrieving and disseminating consistent contracts information to managers, directors and contract monitors The centralized unit would also be responsible for drafting and reviewing Board transmittals and responses as it pertains to grants and agreements The Board believes that the advantages of centralizing contracts would be: Contracts approval process is followed consistently throughout SCVHHS Accountability is visible and maintained throughout SCVHHS organizational structure Consistent contracts information is used by those involved in creating and drafting contracts and elimination of duplicate resources Greater responsiveness to Board inquiries regarding contracts with the central database for contract reporting Transparency between subgroups within the centralized contracts unit and throughout SCVHHS The above functionality and capabilities would be incorporated into a new business unit called Contracts and Grants Administration, within the Planning and Business Development Division Payer Contracting Cycle Management and Decision Support Page 16

237 In addition to general contracts administration process across all SCVMC agreements, specific to the Managed Care functionality within Planning and Business Development; there is a defined need to reorganize the department s functionalities relative to the managed care contracting process as well as its abilities with respect to decision support, pricing, modeling, payer denials and payment compliance and related The latter becomes increasingly important under healthcare reform and alternate payment methodologies as well as with respect to Medi-Cal s movement towards mandatory enrollment in managed care health plans At present, the Managed Care department has limited technical/decision support capabilities and has no ability to price SCVMC hospital and/or physician services under alternate payment methodologies such as bundled payments Over the next few years, Planning and Business Development anticipates that contracted payer agreements may increase to sixty percent of all net patient revenues Absent the proposed capabilities enhancements, the SCVHHS will have very significant and largely unmanageable financial risk exposure As part of the overall reorganization process to establish a Contracts Administration business unit, Planning and Business Development is also proposing to leverage its expanded contracts administration and decision support capabilities with Valley Health Plan in a shared services type of business model, to avoid duplication of services while at the same time providing ongoing operational support capabilities that both SCVMC and Valley Health Plan need New and Existing Payer Contracts There is a need to improve SCVHHS s day-to-day working relationship with its key managed care payers to address both existing issues such as payment rates, denials and payment compliance as well as to strategically position SCVHHS to increase SCVHHS s market share with the contracted third party payers Both will be beneficial to SCVHHS To address the above, A&M is assisting the Planning and Business Development division to: Reorganize its business processes and decision support capabilities to establish both a high performing Contracts and Grants Administration business unit as well as enhance Managed Care s payer specific decision support capabilities Assist in third party payer relationship building and the payer contracting process, as directed by the Director of Planning and Business Development All of the above would be designed to achieve an integrated shared services enterprise wide solution for SCVHHS; thereby avoiding duplication of services while improving efficiencies and revenues while also reducing operating expenses Staff A&M: George Pillari, Brian Buchanan and Chris Kalkhof SCVHHS: Mike Lipman, Selene Ho, Leslie Oberhelman, Greg Price, Dr Larry Bonham and James Parker Immediate Goals Design an integrated Contracts and Grants Administration business unit Assess technology tools to support the above divisional reorganization business plans and assist in the preparation of RFPs to solicit competitive bids from identified vendors, as appropriate Page 17

238 XI PHYSICIAN CHARGE CAPTURE, CODING, CLINICAL DOCUMENTATION & BILLING Project Description Effective revenue management processes can accelerate cash, increase net revenue, enhance the patient experience and decrease costs A key revenue management business process which impacts SCVMC cash flow, net revenues and costs is physician charge capture, coding and clinical documentation coupled with the corresponding charge entry process at each SCVMC patient care site (inpatient, outpatient and ambulatory) Physician and other SCVMC practitioner clinical documentation of services provided/ordered impacts billable/collectible patient revenues at both the facility and professional fee level Initial project scope would focus on assessing current physician and mid-level practitioner (ie, nurse practitioners and physician assistant) charge capture, coding and clinical documentation practices which support the charge entry process at each SCVMC patient care setting to create baseline measurements The baseline measurements assist in determining which areas need to be improved by specific practitioner and/or department This process of measurement and reporting also serves as a component of a future physician education program Staff A&M: George Pillari, Brian Buchanan, Tami Aloi, Chris Kalkhof, and Milen Hayriyan SCVHHS: Dr Matt Kanzler, Dr Rami Keisari, Dr Rajesh Shinghal, Michael Lipman, James Parker, Olga Moya, Monica Spahr, Marchelle Hammond and Mary Fisher Immediate Goals Define root causation variables at the practitioner and administrative operational levels with an initial focus on specialty clinics and inpatient services Develop actionable reporting to help identify the sources of coding errors and billing delays Provide recommendations to improve manual charge capture process at the physician level Page 18

239 XII DENIALS MANAGEMENT Project Description When SCVMC files a claim with a payer, payment for the claim is made to SCVMC or payment is denied Denials fall into administrative and clinical denial categories Administrative denials are largely linked to SCVMC compliance to the varied payment rules of different third party payers (eg, Medi-Cal, Medicare and negotiated Payer Agreements), authorizations obtained/not obtained, patients eligible/not eligible, and services covered/not covered, timely filing, duplicate claims, etc Clinical denials are largely related to the lack of clinical documentation of medical necessity/appropriateness of services, intensity of service, as well as services covered relative to services provided Denial management and denial prevention business processes are not optimized at SCVMC for a variety of reasons The ability to measure and quantify total administrative and clinical denials and link the associated economic value of these denials to specific reasons, across all third party payers, at present, does not exist To address the latter, we are assisting the Patient Billing Services, Care Management, Patient Access and Planning and Business Development Departments to create and put into production an actionable denials report, which in turn will assist SCVHHS management to reduce and prevent claim denials as well as improve coordination of business processes between these different departments Staff A&M: George Pillari, Brian Buchanan, Tami Aloi, Chris Kalkhof and Milen Hayriyan SCVHHS: James Parker, Olga Moya, Dionette Kelton, Darlene Testaguzza, Monica Spahr, Jody Yusim, Melissa Rubalcava, Martin Muratore and Mary Fisher Immediate Goals Initial goal is to develop a basic denials report which tracks and quantifies administrative and clinical denials by major payer class, for hospital and physician services After the initial goal is accomplished the longer term goals are: To put a denials report into production with drill down capabilities at the hospital/payer and individual physician level Establish an action plan with the denial management team to encompass clinical documentation, coding and process improvements Page 19

240 XIII Rehab Project Description SCVMC Rehab-Trauma-Burn services are the highest reimbursed services among all SCVMC medical services, yet its current operational structure represents a hospital-centric care model which is not well positioned to compete for additional commercial business in which the customer is looking to buy a care continuum As a result, occupancy has been in decline for years Even with occupancy decline, Rehab generated slightly over $50M in net inpatient revenue in FY 2010 with a profit of $46M across all payer classes and over $127M from its commercial contracts (50% of the Rehab payer mix) With the advent of healthcare reform and the CA 1115 waiver, these legislative changes create unique high value growth opportunities for SCVMC within the health plan customer community attracting patients from the entire Bay Area and contiguous Western States, if SCVMC Rehab evolves into a more competitive business model Staff A&M: George Pillari, Brian Buchanan and Chris Kalkhof SCVHHS: Nari Singh, Mike Lipman, Ann Perkins, Dr Jeffrey Englander, Dr Akshat Shah, Dr Thao Duong, Dr Stephen McKenna, Pamela Stanley and Janet Jabri Immediate Goals To integrate SCVMC Rehab, Trauma and the Burn Center into an integrated Trauma, Burn-Rehab Center of Distinction for moderate to complex rehabilitative and restorative care To create a Rehabilitation and Restorative Service Line through the above integration of services and expand capabilities to provide a full continuum on on-campus inpatient, outpatient and ambulatory care rehabilitative services for both adult and pediatric populations To seek and enter into select strategic alliance relationship(s) with external provider organizations whom can complete the multi-level of care services continuum (facility based and within community based settings) to position SCVMC Rehab and its strategic alliance partners to offer a complete continuum of rehabilitative care services to third party payers and other hospitals in the Bay Area, with the combined ability to manage patient care to the highest level of patient functionality in the most appropriate and lowest cost care setting This type of continuum of care delivery model positions SCVMC Rehab to grow and thrive under both healthcare reform and the CA 1115 Waiver Page 20

241 1-Day Stays Trend 150% 1-Day Stays, Medicine, As Pct of All Stays* 145% 140% 135% 130% 125% 120% 115% 110% 105% * 90-Day Trailing Averages 2010 Santa Clara Valley Medical Center Santa Clara Valley Medical Center is owned & operated by the County of Santa Clara DRAFT 3/9/2011 Page 1

242 TCNU 1-Day Stays Trend A decline of 25% from FY 10 to FY 11 for the five month period Stays Admits TCNU 1-Day October November December January February FY'10 FY' Santa Clara Valley Medical Center Santa Clara Valley Medical Center is owned & operated by the County of Santa Clara DRAFT 3/9/2011 Page 2

243 DNFB Tracking DNFB Tracking $85,000,000 $75,000,000 $65,000,000 Decrease in DNFB of ~$500 mm results in cash acceleration of ~$118 mm within 3 months $55,000,000 $45,000,000 $35,000,000 $25,000,000 11/3 11/17 12/1 12/15 12/29 1/12 1/26 2/9 2/ Santa Clara Valley Medical Center Santa Clara Valley Medical Center is owned & operated by the County of Santa Clara DRAFT 3/9/2011 Page 3

244 SCVMC Cost Accounting Model Over the course of four weeks, A&M personnel, under the direction of the CFO, created a framework for a new cost accounting model for SCVMC Implementation of the cost accounting model is one of the DSRIP initiatives, with associated potential payments of $62 million in 2012 and $127 million over 5 years The completed model will enable allocation of costs to individual charge items in sufficient detail to allow analysis at the service line level With the framework in place, development of appropriate allocation bases will proceed 2010 Santa Clara Valley Medical Center Santa Clara Valley Medical Center is owned & operated by the County of Santa Clara DRAFT 3/9/2011 Page 4

245 Committee Agenda Date: March 21, 2011 Agenda Item No13 County of Santa Clara Santa Clara Valley Health & Hospital System Valley Medical Center Hospital Administration HHC DATE: March 21, 2011 Prepared by: Carolyn Brown Director, Quality and Safety Reviewed by: Trudy Johnson, RN Chief Nursing Officer TO: SupervisorLizKniss, Chairperson SupervisorKenYeager, Vice Chair Health & Hospital Committee FROM: Linda M Smith SCVMC Chief Executive Officer SUBJECT: Santa Clara Valley Medical Center Report on Measurement of Patient Experience - Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS ) RECOMMENDED ACTION Accept report from Santa Clara Valley Medical Center on Hospital Consumer Assessment of HCAHPS FISCAL IMPLICATIONS There is no impact to the General Fund or the Enterprise Fund This is an informational item only Board of Supervisors: Mike Wasserman, George Shirakawa, Dave Cortese, Ken Yeager, Liz Kniss County Executive: Jeffrey V Smith 1

246 Committee Agenda Date: March 21, 2011 Agenda Item No13 REASONS FOR RECOMMENDATION Supervisor Kniss requested a report on HCAHPS be provided to the Health and Hospital Committee The HCAHPS survey is the first national, standardized, publicly reported survey of patients' perspectives of hospital care HCAHPS (pronounced "H-caps"), also known as the CAHPS Hospital Survey, consists of a survey instrument and methodology for data collection that measures patients' perceptions of their hospital experience Results are publicly reported and accessible electronically, thereby allowing valid comparisons to be made across hospitals locally, regionally, and nationally Santa Clara Valley Medical Center (SCVMC) has participated in the HCAHPS survey since its inception This report provides the requested information including a summary of results and the integration of findings with quality and performance improvement BACKGROUND HCAHPS was developed by the Centers for Medicare & Medicaid Services (CMS) to assure the use of a credible, useful, and practical method with a focus on three broad goals: The survey is designed to collect data about patients' perspectives of care that allow objective and meaningful comparisons of hospitals on topics that are important to consumers Public reporting of survey results creates new incentives for hospitals to improve quality of care Public reporting enhances accountability in health care by increasing transparency of the quality of hospital care provided in return for the public investment The HCAHPS survey asks patients recently discharged from the hospital setting 27 questions about their stay The survey contains 18 core questions about critical aspects of patients' hospital experiences (communication with nurses and doctors, the responsiveness of hospital staff, the cleanliness and quietness of the hospital environment, pain management, communication about medicines, discharge information, overall rating of hospital, and likelihood of recommending the hospital to others) The survey also includes four items to direct patients to relevant questions, three items to adjust for the mix of patients across hospitals, and two items that support Congressionally-mandated reports Patients may be surveyed by phone or mail or both Board of Supervisors: Mike Wasserman, George Shirakawa, Dave Cortese, Ken Yeager, Liz Kniss County Executive: Jeffrey V Smith 2

247 Committee Agenda Date: March 21, 2011 Agenda Item No13 At SCVMC, the survey is administered by Professional Research Consultants, Inc (PRC), an independent firm approved by CMS that also conducts SCVMC s patient satisfaction surveys The survey is administered on a continuous basis throughout the year to a random sample of recently discharged adult patients via telephone interviews The survey is not restricted to Medicare beneficiaries Surveys are conducted in English, Spanish, and Vietnamese CMS implemented the HCAHPS survey in October 2006, and the first public reporting of HCAHPS results occurred in March 2008 The Patient Protection and Affordable Care Act of 2010 (PL ) includes HCAHPS among the measures to be used to calculate value-based incentive payments in the Hospital Value-Based Purchasing program, beginning with discharges in October 2012; the value of this will be defined in future CMS rules The 18 core questions are consolidated into 10 categories for reporting purposes CMS publishes participating hospitals' HCAHPS results on the Hospital Compare website (wwwhospitalcomparehhsgov) four times a year, reported as a rolling four quarters of data To ensure that publicly reported HCAHPS scores allow fair and accurate comparisons across facilities, adjustments are made for factors that are not directly related to hospital performance but which affect how patients answer HCAHPS survey items Results are available to SCVMC on PRC's secure website on a continual basis Typically, CMS posts three quarters behind the current quarter Since the report is by rolling quarter, improvements take time to be seen in the most currently posted data on the federally sponsored website Analysis and reports are available internally on the PRC website that provide more real time data on trends on demand and data can be viewed in aggregate or sorted by hospital patient care departments Data is trended and can be queried to provide detailed information SCVMC's Customer Service Department reports results regularly to the Quality Steering Committee and the Nursing Department has integrated HCAHPS data and analysis into departmental improvement efforts Results are discussed in meetings throughout the facility RESULTS The average California state score is lower than the national average SCVMC scores are below the national and the California average in all categories A review of National, California, and a comparison of two county facilities and three non-profit facilities in California are included as Attachment: Hospital Consumer Assessment of Healthcare Board of Supervisors: Mike Wasserman, George Shirakawa, Dave Cortese, Ken Yeager, Liz Kniss County Executive: Jeffrey V Smith 3

248 Committee Agenda Date: March 21, 2011 Agenda Item No13 Providers and Systems HCAHPS AND PERFORMANCE IMPROVEMENT Since the HCAHPS scores for SCVMC are below the California and National average, it is clear that SCVMC needs to improve the customer experience To that end, SCVMC formed an interdisciplinary team including clinicians, administrative, labor representatives, and support staff to define the goals and objectives In order for patients and families to recommend us to others, an overall strategy for improvement was needed The Customer Experience Committee identified four objectives: engage leadership for cultural change, identify and implement recognition strategies, encourage communication and participation, and assess effects of operational integration The team developed framework for service excellence with the tag line "SCVMC CARES"; with CARES standing for Compassionate, Accountable, Respectful, Excellent, Safe as important attributes for staff to behave and demonstrate commitment to our patients The first strategy for improvement is First Contact, which is how customers first interact with staff whether at a registration desk or being greeted as a visitor, or by a clinician Other teams include the Quiet Team and Way Finding To date the Quiet Team has implemented a device on several inpatient units that measures the noise level and displays a red, yellow, green indicator to visually display if it is too noisy (red) or satisfactory (green); reduced noise level of overhead paging and spread out the frequency of routine fire drills to reduce noise in the hospital Since the main campus of SCVMC is very large and has one address with many functions and departments, the Way Finding Team has developed new color coded campus maps to help identify the different buildings and the services on each floor of the buildings The team has also developed instructions for the front desk and is planning change in the appointment phone system and maps on the website for ease in patient access As part of the County s Center for Leadership and Transformation (CLT) initiative, a project titled "Transforming the Customer Experience" is supporting the work of the teams and is led by three members of the Committee who are providing leadership in promoting and accelerating change CONSEQUENCES OF NEGATIVE ACTION The Health and Hospital Committee will not receive the requested information ATTACHMENTS Board of Supervisors: Mike Wasserman, George Shirakawa, Dave Cortese, Ken Yeager, Liz Kniss County Executive: Jeffrey V Smith 4

249 Committee Agenda Date: March 21, 2011 Agenda Item No13 HCAPHS PPT Board of Supervisors: Mike Wasserman, George Shirakawa, Dave Cortese, Ken Yeager, Liz Kniss County Executive: Jeffrey V Smith 5

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251 Hospital Consumer Assessment of Healthcare Providers and Systems HCAHPS Health and Hospital Committee March 21, 2011 Trudy Johnson, RN Chief Nursing Officer Carolyn Brown, RN Director Quality and Safety