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Approve a contract with Solano Coalition for Better Health for $100,000, funded with 1991 Realignment, to provide case management services for homeless clients discharged from hospitals through the Transitional Care Program (TCP) for the period beginning July 1, 2017 through June 30, 2018; and Authorize the County Administrator to execute the contract and, with concurrence from County Counsel, any subsequent amendments that are within budgeted appropriations up to 20% of the total contract amount, not to exceed $50,000
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Published Notice Required? Yes _____ No __X__
Public Hearing Required? Yes _____ No __X__
DEPARTMENTAL RECOMMENDATION:
The Department of Health & Social Services (H&SS) recommends that the Board approve a contract with Solano Coalition for Better Health (SCBH) for $100,000, funded with 1991 Realignment, to provide case management services for homeless clients discharged from hospitals through the Transitional Care Program (TCP) for the period July 1, 2017 to June 30, 2018; and Authorize the County Administrator to execute the contract and, with concurrence from County Counsel, any subsequent amendments that are within budgeted appropriations up to 20% of the total contract amount, not to exceed $50,000
SUMMARY:
Solano Coalition for Better Health (SCBH), formed in 1988 to facilitate discussions between public and non-profit providers of health care services is focused on the development of community programs to address health issues among the medically underserved, uninsured, and vulnerable individuals in Solano County. SCBH’s Transitional Care Program (TCP) provides respite housing and case management services to clients who are referred from hospitals and emergency rooms throughout Solano County. This item recommends approval of a contract with SCBH to provide case management services to clients referred who meet the criteria of being homeless or near homeless, have a chronic or acute medical condition and a frequent user of emergency room services, and who may have a mental health and/or substance use illness. The goal of the program is to reduce unnecessary emergency room visits and prevent hospitalizations for avoidable conditions while improving health outcomes for clients and will serve as a parallel program to support the County’s Whole Person Care Program which will ultimately target the highest 250 medical utilizers in the County who experience complex, comorbid conditions such as substance abuse disorders, mental illness, and other disabilities. SCBH is also responsible for data collection and program evaluation.
FINANCIAL IMPACT:
Appropriation is included in the Department’s FY2017/18 Recommended Budget funded with 1991 Realignment. There is no additional financial impact to the County General Fund.
DISCUSSION:
Medi-Cal 2020 is California’s five year Section 1115 Medicaid Waiver. Among the programs covered under the new Waiver is the Whole Person Care Program. Whole Person Care focuses on changing a fragmented and expensive health care system to a more comprehensive health care delivery model looking at the whole person from a more integrated care management approach. On November 25, 2016, the Board approved acceptance of Solano County’s Whole Person Grant award.
During the life of the grant, which effectively extends from January, 2017 through 2021 due to the delayed application cycle, rather than a five full years, 250 Medi-Cal enrolled individuals will be enrolled in a Health Home (if not already), receive high intensity outreach and engagement services, housing supports, multi-disciplinary treatment, and active, daily or weekly care management of the kind that has been found to be effective with such individuals. ‘Project 25’ in San Diego and other projects like it have demonstrated that intensive intervention that addresses behavioral conditions along with high cost medical conditions are more successful at producing positive care outcomes and reducing continued high cost medical utilization.
Homeless individuals who are chronically ill, and/or who lack access to routine healthcare tend to use the emergency room frequently and experience higher rates of hospitalizations for preventable conditions. The problem is compounded by a lack of housing to facilitate recuperation, often leading to readmissions and poor health outcomes. The Solano County Transitional Care Program (TCP) was developed to provide suitable placement for homeless or nearly homeless clients to recuperate after being discharged from the hospital. The program is intended to help break the cycle of repeated unnecessary use of the emergency rooms by enrolling the clients in Medi-Cal or other health coverage. Clients are linked to a primary care physician, provided access to public assistance such as Social Security benefits, and assisted in finding permanent housing; the program also provides health education to clients so they can better manage their own healthcare.
In conjunction with the County’s Whole Person Care grant funded program which SCBH also manages, the focus is on changing a fragmented and expensive health care system to a more comprehensive health care delivery model and integrated care management approach. TCP combines complex care management with Housing First concepts while also engaging community partners including the hospital systems.
ALTERNATIVES:
The Board could choose not to approve this contract. This is not recommended because SCBH plays an important role in grant funded Whole Person Care program and in coordinating the hospitals and community based organizations in providing patient care, and the TCP program supported by this recommended contract approval has demonstrated success in reducing avoidable hospital care while improving services to clients.
OTHER AGENCY INVOLVEMENT:
H&SS, SCBH, Kaiser Permanente, Sutter Health and NorthBay Healthcare have worked collaboratively on the development, monitoring and funding of TCP. County Counsel has reviewed the contract for legal sufficiency.
CAO RECOMMENDATION:
APPROVE DEPARTMENTAL RECOMMENDATION