San Francisco Department of Public Health SFHN TRANSITIONS DIVISION Title Presented by: Kelly Hiramoto, LCSW, Director of SFHN Transitions June 20, 2017 Subtitle 1
Department of Public Health Organizational Chart Health Commission Director of Health Finance Policy & Planning Human Resources Information Technology Coordination of Division Initiatives Security Communications Compliance & Privacy Affairs Managed Care & Patient Finance Ambulatory Care Environmental Health Community Health Equity & Promotion Zuckerberg San Francisco General Primary Care Disease Prevention & Control Public Health Emergency Preparedness & Response Laguna Honda Hospital Behavioral Health Emergency Medical Services Office of Equity & Quality Transitions Jail Health Office of Ops, Finance & Grants Mgmt. Center for Learning & Innovation Maternal, Child & Adolescent Health Applied Research, Community Health Epidemiology & Surveillance Center for Public Health Research Bridge HIV 2
Who We Are Business Office *Shared with Behavioral Health DIRECTOR Kelly Hiramoto, LCSW Psychiatric/Medical Consultation Dr. Deborah Borne Dr. David Kan (Part time) (vacant Psychiatrist part time) DEPUTY DIRECTOR (vacant) Administrative Support Frances Yee, Eligibility Marilou Panganiban, Billing PLACEMENT CARE COORDINATION STREET MEDICINE SF BEHAVIORAL HEALTH CENTER Linda Sims, RN Administrator MHRC RCFE ARF Hummingbird Psychiatric Respite [Staff Roster Available Upon Request] Transitions Org Chart-Staff ver 17-06 Elayne Hada, RN, Director Perrie Ancheta, MFTi Jennifer Esteen, RN Daniel Ip, LCSW Jessie James, HW3 Susanna Kiely, RN Susan Noble, RN Annette Quiett, LCSW Annie Shui, MFT Sharon Singletary, MFT Joseph Steward, RN Cindy Sung, ACSW Adam Udlis, RN Dierdre Veals, Clerk OPERATIONS David Sickles, RN Valerie Lai, Sr. Analyst Gary Scherer, MFT Harriet Lem, Health Educator Luis Calderon, Director Jamilla Anderson, HW2 Maria Cumiskey, RN Khoi Dang, LCSW Danna Falla, PHN Emily Ho, MSW Stacey Johnson, RN Roberta McGowan, RN Patricia Rodriguez, SW Alice Yue, PHN vacant, SW Barry Zevin, MD,Medical Director Jason Blantz, NP Gina Limon, RN Leah Warner, NP Linette Martinez, MD (PartTime) Shelter Health* Kate Shuton, PHN, Supervisor Kristin Matteson, RN Virginia Bryant, RN Angella David, HW2 Clara Lusardi HW2 (Part Time) *partnered with TWUH 3
Service What we do The goal of the Transitions division is to ensure clients are stabilized in the most appropriate, least restrictive setting in the most cost effective manner. The Team provides Utilization Management for length of stay, Care Coordination and Case Management to support flow. Whom we serve Severely Mentally Ill SFHN members with Multiple Complex characteristics Mental health Substance use issues Medically compromised Cognitive impairments High inappropriate users of SFHN care systems We consult on those in need of subsidized placement to leave the hospital or support for the wraparound care plan 4
Levels of Care Treatment Shelter Hotel aka SRO (single room occupancy), Stabilization Room Support Service Hotels Co-operative Housing Direct Access to Housing and Shelter + Care Residential Care aka Board & Care - RCF/ARF: 18 y.o. 59 y.o. - RCFE: 60 y.o. and older Mental Health Rehabilitation Center/Institute for Mental Disease/Locked SubAcute Treatment Neuro-Behavioral Skilled Nursing Facility (SNF) - Chronic Inebriate Program Medical SNF State Hospital 5
Where We Do It Acute Psychiatric and Medical Units at SFGH and Community Hospitals Acute Diversion Units, Residential Treatment (Mental Health, Substance Use and Dual Diagnoses), Transitional Residential Residential Care Facilities (Board & Care) Locked settings: IMD/MHRC/Neurobehavioral SNF Laguna Honda Hospital and Rehabilitation Center Community Settings Jail Emergency Departments: Psychiatric & Medical State Hospitals 6
Community Placement Average Bed Census Location FY15-16 Average Bed Census State Hospital 46 MHRC/IMD 93 Neurobehavioral SNF 148 Adult Residential Care 381 Older Adult Residential Care 341 Stabilization Hotel Rooms 25* Mental Health Full Service Partnership Stabilization Hotel Rooms * Current FY average of 20 hotel beds predominantly at 16 th Street Hotel 14 Level of Care Clients Served Cost IMD (out of county only) 78 $4,766,389 Neurobehavioral SNF 182 $6,628,895 Adult/Older Adult Residential Care 898 $9,698,321 7
MHRC/IMD Average Length of Stay Facility <1 Yr 1-3 Yrs 3-5 Yrs 5-10 Yrs >10 Yrs Canyon Manor 4 1 6 1 3 Crestwood Angwin 0 1 0 2 0 Crestwood Vallejo 14 19 3 1 2 8
Residential Care Facilities 9
Care Coordination: HUMS High Users of Multiple Systems* (HUMS) Outcomes for FY 14-15 3,711 people tracked 136 people had at least 100 urgent or emergent services costing SFHN $18.1M 11 are tracked as High Users of Single System (medically frail) costing SFHN $1.8M 65 placements 33 placed in Community Placement beds 25 housed in DAH units 7 returned home out of SF often accompanied by Transitions RN Only includes systems that are able to share data with SFHN: EMS, ZSFGH, PES, Shelter, Jail, Medical Respite, SFHOT 10
Phillip s Journey In FY14-15, Phillip had 136 urgent and emergent encounters at a total cost of $158,335. SFHN Transitions Care Coordination facilitated his discharge to a stabilization room with wrap around services. Phillip went from 40 ED visits in FY14-15 to 1 in FY15-16. He went from top 1% HUMS in FY14-15 to not showing in the HUMS list in subsequent years. 11
David s Journey In FY14-15 David had 194 urgent and emergent encounters, at a total trackable cost of $194,020 A chronic inebriate, David was contemplative towards treatment when we started engaging with him at ZSFGH but it was impossible to find a treatment facility in San Francisco because he is a registered sex offender. David remained contemplative after being placed in a temporary hotel room. After arranging detox at the Sobering Center, we placed him in a Sober Living Environment in Oroville. He remains in the program with no new urgent or emergent costs to SF. 12
Challenges Dementia Resources: few to no custodial care dementia facilities Shrinking availability to step down: Other counties increasing purchase of Locked Psychiatric beds for their MIST clients, Board & Care closures, increasing Board & Care costs, GGRC and other entities are buying Board & Care beds, decrease in available Stabilization Rooms Shelter Bed access: no dedicated beds for hospitals or high users so dependent on collaboration with SFHOT Substance Use Disorder management: treatment resistance Forensic Clients: Dramatic increase in 1370 MIST Misdemeanor Incompetent to Stand Trial and State Hospital Returns 13
Looking Forward FY 2017-18 budget includes 116+ new behavioral health beds: 15 beds at Hummingbird Place at the Behavioral Health Center on the ZSFG campus 34 new medical respite beds (funded in 2015, opened in 2017) 30 + Mental Health Rehabilitation expansion beds in San Francisco 32 residential substance use disorder treatment beds 5 detox beds Whole Person Care Partnerships Collaborative Courts Drug Medi-Cal Assisted Living Waiver Dementia care resources in collaboration with DAAS 14
Thank you! QUESTIONS ANSWERS