Message From The Director
The ACA Survives – For Now
We have been following the ups and downs of the efforts to repeal and replace the Affordable Care Act (ACA), also known as Obamacare. It was a sigh of relief when repeal efforts in the U.S. Senate failed at the end of July. It would have been devastating for so many reasons.
The bill that failed would have not only repealed Medicaid (Medi-Cal in California) expansion for more than 70,000 Contra Costa residents, it would have greatly impacted Contra Costa Health Plan (CCHP), Contra Costa Regional Medical Center and Health Centers, and all of our community health center partners. Medi-Cal expansion brings approximately $90 million in federal revenues to the County. CCHP manages the care of 55,000 of those enrolled and the rest are managed by Blue Cross or fee-for-service Medi-Cal. Needless to say, elimination of Medi-Cal expansion would create a huge deficit in state and county budgets.
Medi-Cal At Risk for Cuts
It was in February of this year that I last wrote about the impact of repealing and replacing ACA. Since that time there have been many attempts, but so far millions of Californians still have health insurance and federal subsidies to help them pay for their coverage. Although the ACA is still at risk of repeal, I’m now more concerned about cuts or changes in reimbursements for the Medi-Cal program.
This last Senate bill that failed would have restructured the relationship of the state and federal government’s 50/50 cost sharing for the entire Medi-Cal program. Changes to this long-term funding source--from which we have depended for many decades--threatens the lifeline for low-income children, elderly and disabled persons. Medi-Cal may also undergo significant cuts through the federal budget process. Any cuts in Medi-Cal will be detrimental to us and those we serve.
Insurance Marketplaces Face Uncertain Future
As we move into the fall, I hope that Congress will engage in bipartisan efforts to shore up the underwriting in the individual marketplace. Insurance companies are due to set their rates for next year in the very near future. Many insurance companies are exiting the market for individuals and the ACA, and premiums are increasing at an alarming rate. Repeal threats, loss of subsidies, and uncertainties are contributing to this growing problem.
We, our legislative delegation, hospital and health plan associations will continue to monitor any efforts by the federal administration to reduce Medi-Cal funding by budgetary or regulatory efforts.
I will update you if any new or significant changes occur. In the meantime, as always I encourage you all to continue to focus on what we do best – care for and improve the health of all people in Contra Costa County with special attention to those who are most vulnerable to health problems.
Going the Extra Mile:
These CCHS Employees are GEMs
Click here to find out how the people named below went the extra mile.
Lai Ping Atalanta Wan
Vandana Kumar, RN
Rosemarie Tibay, RN
Gurbir Kaur, RN
Jennifer Giron, RN
Jane Luna, RN
Leah Wesley, RN
Akjawail Ward, RN
Rabbert Bala, RN
Susan Salazar, RN
All Antioch Health Center Staff
Brentwood Health Center Staff
2017 Ruth Pease Award Winners Named
Health Equity Manager Connie James and Phoebe Oliveira, a nurse with our Choosing Change program, have been named this year's recipients of the Ruth Pease award. This award is given by the medical staff to a non-physician who exemplifies the dedication of Ruth Pease, who was a long-time CCHS employee and registered nurse.
“Phoebe is by far the best nurse I’ve ever had,” said one Choosing Change client. “She goes above and beyond for me and all patients no matter what I need – a last-minute appointment, resolve prescription issues, someone to call or just speak to when I’m struggling emotionally.”
Connie’s nomination submission praised her for working “steadfastly with determined passion for change by questioning or breaking down institutional barriers to care by addressing health disparities and advocating for health equity.”
Phoebe and Connie will be honored at the annual Medical Staff Dinner Dance on Friday, Sept. 22 at the Pleasant Hill Community Center.
Contra Costa County Adopts New Tobacco Protections for Youth
The Board of Supervisors recently approved several new regulations to protect youth from tobacco marketing, including prohibiting the sale of menthol cigarettes, flavored vaping solutions and other flavored tobacco products within 1,000 feet of schools, parks, playgrounds, and libraries in unincorporated parts of the county.
More than 80 percent of stores licensed to sell tobacco that are located near schools in Contra Costa County carry flavored products such as "watermelon" or "tropical blast" cigarillos or little cigars. Many of these products cost less than $1, making them attractive and affordable for youth. The new regulations also prohibit the sale of flavored "e-liquids" for vaping through electronic smoking devices, which also come in candy and fruit flavors that appeal to new, young smokers.
A recent UC San Francisco study showed that many teens who vape would not have started smoking if only traditional tobacco products were available.Other research shows that teens who vape are four times more likely to begin smoking cigarettes a year later than those who do not.
Other provisions adopted by the Board of Supervisors include no-sales of tobacco products in pharmacies, and a requirement prohibiting the sale of any cigarillos and little cigars in packs smaller than 10.
Most of the new regulations take effect on August 17, 2017. Education and outreach will be conducted with retailers over the next few months, and retailers are expected to be fully compliant with the no-sale of flavored tobacco products provision no later than January 1, 2018.
Contra Costa Health Plan
CCHP Expanding Transportation Benefit for Medi-Cal Members
Contra Costa Health Plan (CCHP) will soon be expanding a benefit that pays for its members to take a taxi, bus, paratransit or special van to and from medical appointments. Starting this summer, all Medi-Cal members with CCHP can take advantage of the free transportation benefit. Currently, only certain qualifying Medi-Cal members were covered by the benefit.
The Health Plan asks that members arrange for rides a few days before their appointments—or call CCHP as soon as possible if it’s an urgent matter. Patients need to call 855-222-1218 for authorization. Many patients miss appointments because they can’t afford transportation, said Patricia Tanquary, CCHP’s chief executive officer. The expanded transportation benefit will help more patients get the care they need in a timely way, Patricia said.
Contra Costa HazMat Helps Write State’s New Refinery Regulations
New regulations to strengthen workplace, community and environmental health and safety at oil refineries across the state will go into effect in October. The regulations were developed by several state agencies in the aftermath of the fire at the Chevron refinery in Richmond in 2012. Randy Sawyer and Cho Nai Cheung from our Hazardous Materials Programs provided technical assistance to the effort and helped write the regulations, most of which were modeled after Contra Costa’s Industrial Safety Ordinance. Click here to learn more about the new refinery-safety regulations.
Report Shows Overall Decline in Contra Costa’s Unsheltered Population
Contra Costa's annual survey to document people experiencing homelessness showed a 7 percent drop overall in 2017 compared to last year, but a substantial rise in Central County, according to a report released by Contra Costa Health Services' Division of Health, Housing and Homeless Services (H3).
H3 and its community partners surveyed county residents living in emergency shelters or outdoors on Jan. 25 and released detailed findings in the 2017 Point in Time Count report, released in July.
The report shows that 1,607 people without housing were counted, including 911 who were living outside. About 1,100 were documented living outside in 2016.
But substantially more people were counted this year in central Contra Costa – 331 living outdoors without shelter – after an atypically low count in 2016.
Since the count, H3 and the Contra Costa Council on Homelessness have launched Coordinated Entry, a new initiative to streamline service delivery and enhance collaboration among the county's network of nonprofit, faith-based and government providers of homeless services.
Visit cchealth.org/h3 to read the 2017 Point-in-Time Count report.
Public Health Issues Safety Reminder After Rabid Bat Found in Clayton
A bat found in a Clayton Park tested positive for rabies in July, prompting the Public Health Division to issue a public safety reminder not to touch bats, which are common carriers of the potentially fatal disease.
The bat was found on a pathway at The Grove Park, 6100 Main Street, on July 16. A community member carefully scooped the bat into a box, and it was taken to Lindsay Wildlife Experience in Walnut Creek, where it died a few days later. Contra Costa Animal Services took the dead bat to the Public Health Laboratory, where it tested positive for rabies on July 27.
No members of the public reported directly touching the bat, so nobody is believed to be at risk of developing rabies from this case. Rabies is spread from animals to humans mainly through bites.
To prevent the spread of rabies, never touch live or dead bats, make sure pets are up to date on their rabies vaccines and avoid handling wildlife. Anyone who has touched a bat or has been bitten by wildlife should contact their health care provider.
Environmental Health Monitors Toxic Algae Blooms in Discovery Bay
The Environmental Health Division (CCEH) led an effort to warn the public after unsafe levels of a toxin created by blue-green algae blooms were detected in several waterways of Discovery Bay this summer.
The toxin was detected in and around the community in June and July, prompting an advisory for people and pets to stay out of the water. Exposure to the toxin can cause rashes, skin and eye irritation, allergic reactions, gastrointestinal upset and other symptoms.
Blue-green algae, also known as cyanobacteria, can look like green, blue-green, white or brown foam or scum floating on top of water, or suspended in the water. Warm water temperatures and nutrients contribute to blooms, which eventually subside under cooler conditions.
CCEH worked with the Central Valley Regional Water Quality Control Board and several homeowners’ groups to get out the word, and continues to collect and test water samples from the community.
No illnesses linked to Discovery Bay algae blooms have been reported in 2017. A child became sick after swimming in Discovery Bay during a similar event in 2016.
CCRMC & Health Centers
Hospital and Health Centers Meet All Goals Under PRIME
Contra Costa Regional Medical Centers & Health Centers has achieved a significant milestone by meeting all 60 of the required metrics for California's hospital quality improvement program this past year.
The five-year program is called Public Hospital Redesign and Incentives in Medi-Cal, or PRIME for short. Seventeen of California's public hospitals and academic medical centers are participating in PRIME. If hospitals meet performance targets through 2020, they could earn a total of $3.26 billion in federal funds.
CCRMC has 10 PRIME projects underway. The projects are improving primary care, specialty care, mental health and prenatal, delivery and newborn services. Some project teams are working on boosting access and quality of services for clinic visits, for instance. Other projects focus on specific services or patient populations. A foster care project is improving medical care for foster youth in the county. A care transitions project is making sure patients have the appointments, medications and information they need when they go home from the hospital. A pain management project is expanding options for patients to better manage their chronic pain. And a cancer-screening project is making preventative screenings more available to all our patients.
All these projects are aligned with our priorities of making sure health services are centered around patients and families, continually improving our care and services and delivering value to our community. PRIME is preparing us for a new era where patients can expect seamless, high-tech and accountable care in a setting they prefer. We look forward to sharing more on our progress in PRIME over the coming years. For an overview of PRIME, please visit this fact page.
Contra Costa Expands Substance Use Disorder Services through Drug Medi-Cal Waiver Project
The Behavioral Health Services Division (BHS) is moving forward with a major expansion of substance use disorder (SUD) treatment options for Medi-Cal beneficiaries in Contra Costa County, authorized through the Medi-Cal 2020 Waiver.
The project was formally approved June 20 when the Board of Supervisors agreed to a contract with the state Department of Health Care Services (DHCS) to implement the Drug Medi-Cal Organized Delivery System (DMC-ODS).
The DMC-ODS Plan expands Medi-Cal coverage for a range of new SUD treatment modalities that align with American Society of Addiction Medicine (ASAM) criteria, including outpatient and intensive outpatient services, residential treatment, withdrawal management, recovery support, case management and medication-assisted treatment.
County mental health clinics and homeless shelters will be certified to provide DMC-ODS services under the plan, and will provide integrated behavioral health services while they are being certified.
Contra Costa will become the fifth California county to offer the pilot program, which will serve as many as 7,000 patients at the end of a gradual buildout.
The county’s contract authorizes approximately $64 million in Medi-Cal funds for the three-year pilot program, with a $2.3 million matching contribution from the county general fund.
BHS is now training, hiring and recruiting providers and staff, and working to ensure program compliance at its clinics and other facilities. Full implementation is expected by the end of 2017.
For more information, contact AODS Program Chief Fatima Matal Sol at Fatima.MatalSol@hsd.cccounty.us
Medical Reserve Corps
Medical Reserve Corps Teams Up With Students for Competition
With the help of our Medical Reserve Corps (MRC), students from Dozier Libbey Medical High School in Antioch have recently placed in the top 10 in an international leadership competition.
The Dozier Libby students, who are part of the local chapter of Health Occupation Students of America, were one of 36 teams competing at the HOSA International Leadership Conference. The students had to present to a panel on the activities they completed throughout the year with the MRC. These activities were arranged in a portfolio, which they had to submit and then speak for five minutes and answer questions.
The Dozier Libby students earned the right to be part of the international competition after winning a previous state competition. Contra Costa MRC has held a partnership with Dozier Libbey Medical High School since 2013. Our local MRC has worked with the students to build unit capability for points-of-dispensing operations, flu season vaccinations, and sheltering response.
Congrats to the winning students and thanks to all MRC members who contributed.
Change Agent Fellowship
Change Agent Fellows: Leading The Way To Transformational Change
Family, friends, colleagues, senior staff and individual executive sponsors of the fifth cohort of the Change Agent Fellowship gathered at the lobby of Contra Costa Regional Medical Center on June 7, 2017. For nine individuals, this gathering was a celebration of the completion of their 15-month journey to become transformational Change Agents.
The fellows were Brea Bondi-Boyd, Vienna Burchfield, Karen Schlein, Kristina Serrano, Linda Thomas, Patrick Wilson, Stevani Verducci, Marlina Wagoner and Angela Womble. Each fellow presented a synopsis of their projects which ranged from food security to alternative healthcare career observation program. Afterwards, each fellow received their certificate of completion from CCRMC & Health Centers CEO Anna Roth and heard congratulatory comments from CCHS Director Dr. William Walker and members of the senior staff. A well-attended reception was held to complete the event.
A Change Agent is an individual who is a vital part of leading the organization in the continuous transformation to meet its mission: to care for and improve the health of all people, especially those who are most vulnerable in Contra Costa County. The Change Agent Fellowship provides emerging leaders with an environment to develop and hone their knowledge and skills in leadership and transformational change. We congratulate and welcome these nine fellows who are now proud to be known in the organization as a Change Agent Alumni.
Thanks to these employees who have given us long years of service:
Ogo S. Mbanugo, Mila P. Leynes, Vern L. Wallace
Dawn M. Wadle
Leslie A. Palomino, Grace S. Ma, Wilfredo Perez, Vidya Raman, Martha A. Martinez, Lupe M. Gasca, Tambra Gutierrez, Tamara Stanton
Erika H. Jenssen, James R. Deaton, Patricia H. Valdepena, Brad L. Foster, Lance D. Gold, Sunthara Hay, Ryan J. Carson, Margaret L. Turner, Linda M. Wise, Maria C. Sanchez, Etagegn Belew, Souchacksa S. Sheehan, Lucy A. Rosa, Anthony K. Bonhomme, Christine L. Conner, Elenor M. Guarin, Glenda M. Coccimiglio, Rose R. Tapia, Clarence Moody, Severa S. Zamora, Audrey M. McLemore, Mark A. Gonzales
Christine F. Houser, Tony N.M.I. Lopez, Amber I. Owens, Laiss Shirgul, Williams F. Bowers II, Rachel E. Kale, Jodie A. Shields, Twana J. Clemons, Elizabeth A. Fitzgerald, Ravinder K. Johal, Kati M. Johnson, Stefani J. Macagba, Elizabeth Masterson-Barrows, Adolfo Romero-Duran, Stevani N. Verducci, Kimberly J. Valdez, Geraldine A. Bolanos, Maicuong T. McGuire-Tran, Lisa Broughton, Robbie A. White, Denise A. Chmiel, Jon A. Garcia, Susan M. Kulovsky, Olga D. Kelly, Maria T. Morales, Eric C. Sanders, Yoshiko H. Duhow
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