this is a test.
>> good afternoon.
I'm going to call the May 15
budget workshop to order.
please call the roll.
>> supervisor kniss, cortese,
wassermann, vice
President Yeager, President
Shirakawa, you have a quorum.
>> ladies and gentlemen please
stand and join in the
pledge of allegiance.
>> I pledge of allegiance, to
the flag of the united
states of america and to the
republic for which stands, one
nation under God, indivisible,
with liberty and justice for
all.
>> thank you item three is
public comment.
I have two speakers at this
time.
linda kincaid and richard
calhoun come on up please.
Give you a couple minutes to
speak.
Good afternoon.
Hold on a second, is the mic on?
Let's make sure the mic is on.
>> thank you, my name is linda
kincaid.
I'm speaking on behalf of
jazell. Notice of rights and
file states unless the court
has limited or taken the right
of way, the conservative keeps
right to receive personal
mail.
The court has not taken away
her right to visitation.
However, the public guardian
has violated that right
since becoming conservator in
2010.
She was allowed to visit her
son marcus for less than 2
hours in the past two years.
She is not allowed visitors
from the community.
She is not allowed phone calls
and her mail is
intercepted. She lost about a
third of her body weight
under the care of a public
guardian.
She needs new eye glasses.
she is rarely allowed access to
hearing aid.
Her world is dark, silent and
very lonely.
She pray every night that God
take her.
I pray santa clara county will
protect the public
guardian.
>> thank you richard calhoun.
>> good afternoon.
The public guardian spent about
45 minutes on the phone
with me regarding my
mother-in-law elder abuse case
in
southern california.
They assured me that abuse will
not happen here in
santa clara county.
it's happening under his direct
control at that time of
the conversation.
That abuse happening in this
county is worse.
The county despite selling our
house for $350,000
recently -- she has to use
toilet paper.
she has to use toilet paper.
Kleenex is not that expensive.
We walked across the street and
bought three boxes.
There's something wrong.
The pastor of westgate church
should be able to walk
over and visit.
He was denied.
I was denied visits.
Everybody has the right to
visits, even prisoners have
rights to visits.
But yet the guardian is not
letting me visit her.
That takes time in southern
california, we got no
citation approved for months.
then you probably heard about
it, there was conviction
of bribery down there.
We already have four about
dozen investigations under
way.
There's probably about five or
six here in santa clara
county happening under your
public guardian and you guys
need to wake up and pay
attention and find out we
cannot
visit our elders when they're
under the care of guardian.
That is wrong and it's abusive
and it's a human right
the violation and we should not
tolerate it in this county.
Thank you for your time.
>> be richard, we mentioned
before.
We cannot engage on issues on
this agenda.
I don't want to gauge back and
forth.
for the record, our public
guardian office does great
work protecting those most
vulnerable in our community.
I understand there's issues out
there in some of those
homes.
We're on top of it.
>> I will say, we brought this
to your attention two
weeks ago and nobody
communicated in any shape or
form.
I did hear from Mr. Cortese and
therefore it's not
happening. I'm sorry,
vacations doesn't take priority
on
someone personal right.
>> I understand richard, you
will be contacted by
staff.
Thank you.
Next item -- anyone else want
to address the board?
I have cards on other issues.
On this item on the opening
session.
i see none in the room.
Moving on to item four, vivre
view and county executive
fy '13 budget.
>> Mr. President, members of
the board.
I like to give a little
introduction to the proposed
budget that we are starting to
evaluate today.
First slide.
We've been discussing a
maintenance budget for a number
of months now and I would like
to clarify maintenance budget
does not mean status quo.
What we focused on in this
budget as we've developed
it, is trying to not only
maintain the services that we
are
providing but also change the
style and process with which
we provide those in order to
reduce the cost for unit
service.
Then fundamentally rebuild our
foundation which
includes rebuilding both the
physical and financial
infrastructure of the county so
that we can prepare for the
future.
We know that this year's
budget, fiscal year '13, will
give us a bit of a break from
the more than a decade of
reduction that the board has
been asked to take.
However, that brief relief will
not last forever.
We're preparing the
organization for the future.
i like to point out that
concessions from labor had an
enormous part in helping to
balance this budget.
As you remember, last year, we
asked labor for
concessions in the general fund
amounting to $75 million.
They were very difficult
negotiations but successful.
our partners in labor and our
employees take great
credit or should take credit in
great part for this budget.
You'll notice as you go through
the budget, you won't
see a line item that says $75
million.
All of those concessions have
been successful and
they're built into the object
one cost of each department.
As we look forward, we're
looking at a new normal.
There's been a lot of talk
about in the economy lately.
But not a new normal just
because we don't see an
amazing number of jobs
returning to the nation but
because
at a county level, we can no
longer rely upon state and
federal revenue to keep pace
with the need for services.
Also, with healthcare reform
changes, our hospital and
clinic system, santa clara
valley medical system, where we
can no longer rely on lump sum
supplemental payments.
Next slide.
we do have a bit of respite
from deficits because in
2012 this board took the very
thoughtful approach of only
using one time moneys to solve
one time problems and not
putting them into ongoing
deficits.
That has stabilized our budget
to great extent and
we've also noticed some
stabilization of the economy
around
us with some slight up tick in
revenues.
However those revenues are
typically related to public
safety realignment.
we've had relief from
reductions this year.
As a matter of fact, you'll see
in this proposed
budget, we're actually adding
positions.
Total over 300 positions.
I will point out many of those
positions are funded
from other sources than the
general fund we've looked at
each one closelily to make sure
that next year, fiscal year
'14, will not be faced with a
situation of reducing those
positions that we're now adding.
We think they're all justified,
we think they are all
critical.
we have utilized them to try to
rebuild our foundation.
However this brief respite will
give us time to refocus
our attention in the county on
what our core mission and
values are.
The board of supervisors
adopted this mission and value
statement over two years ago.
We have an opportunity now to
make sure that it spreads
throughout the organization and
refocus the organization on
the values that are critical to
our future success.
as I mentioned in the last
decade, we have deferred
many capital projects and much
maintenance in order to
continue provide services.
This year we have the
opportunity as the economy
stabilizes to begin to rebuild
and some of recommended
budget invest in four key
issues.
Number one is the retiree
medical benefits also called
opeb.
Gary will give you more
detailed discussion on this
budget.
We also rebuilding our
inspection technology systems
putting some money into a few
of the capital projects that
have been on hold for a long
time.
We're recommending some
reserves because of the
question marks at the state
level that have only gotten
larger in the last day because
of the May revise.
Briefly, as I mentioned gary
will give you more details
later, but in recent years --
>> President Shirakawa, can I
ask a quick information
question?
Where you listed epic and the
funding sources how they
will be spent, within there
somewhere is an incentive bonus.
Are you going to mention that
at some point?
>> yes, we will mention that.
>> is that another time?
>> we'll get there.
with regard to the retiree
medical benefits, this is a
very significant problem.
A decade ago, this county was
very forward-thinking and
unfunded the light retiree
health.
over the decade of cuts of
funding to that system has
decreased.
At this point we're
recommending in this budget 75%
funding to the normal cost for
retiree health with a
commitment to go up to 100%.
Normal cost is a word used to
describe essentially what
would be equivalent to minimum
payment on your credit card
not really adequate to actually
fund the unfunded liability
in the long run.
But certainly a minimum and we
think you should commit
to that.
We need to develop further
strategies in the future to
deal with that.
Information technology, we are
recommending some
significant investments in
technology and as supervisor
kniss pointed out, with regard
to epic, one of the
advantages that we have is that
we are anticipating money
from meaningful so called
meaningful use which is federal
money that will help defray the
cost of revamping the entire
core health information system.
we have decided to issue debt,
technology bond for
$100 million.
This is not a bond that needs
to go to the voters, this
is a bond we paid for based
commitment from the meaningful
use money.
$70 million of that will go
towards epic.
$20 million will go towards
general fund I.T. Project.
$10 million for the cost of
issuance and contingency
fund.
You can see that the total cost
of epic that's budgeted
at $68 million, most of that
will be from bond proceeds.
There also be will money from
mental health services
act.
These are the list of the
general fund I.T. Projects
that we are recommending that
you fund.
You'll see that all of them are
critical function.
on the left are the ones we
think we can fund with the
bond proceeds.
They are basic enterprise
functions that are required
for us to move forward.
Things like public safety
radios, sheriff's mobile
computers, enterprise system
called clarinet and our
voiceover internet protocol
system which helps with
communications.
We did not add all the I.T.
System in here.
These are just the ones that
are absolutely necessary.
Additional I.T. Projects which
will not be funded
through the bonds include the
assessor system, modifications
to kronus which is our time
sheet keeping mechanism the
cloud system and you can see
also public safety radios.
The next category that we're
recommending for
additional foundational
investment is capital programs.
I won't go through all of these
capital programs.
Again, these are actually small
number of the programs
-- projects that we need to
accomplish.
These are the most critical
ones and totals up to
$13.7 million.
Terms of budgetary reserves, as
always, your reserve
we're keeping at 5% general
fund revenues.
We're recommending a funding
$10 million for economic
uncertainties from the state
and fed.
As I mentioned, the state
proposal particularly the
recent May revise has a lot of
questions associated with it.
At this point, we're doing
analysis to try to decide
exactly effect it will have on
us.
There are cuts recommended to
medi-cal and safety net
hospitals.
Actually, it looks like to the
best of our analysis at
this point, those cuts will not
have an effect upon us this
year but it certainly will have
effect upon us next fiscal
year.
However, don't hold me to that
because there's still
details we need to straighten
out.
As you watch the federal budget
process, you remember
that there automatic trigger
cuts that are built into the
federal process from last year
so we're very concerned if
congress and President Don't
move ahead with effective
budget or spending plan, we
will end up with automatic
reductions.
We're also recommending a small
set aside reserve for
cash.
This is not money we anticipate
spending but this will
actually help us with our cash
flow issues which has been
for the last two years, an
issue.
>> jeff, real quick.
Last year we had extensive
discussion on the
contingency reserve.
It's not all cash.
just take 30 seconds to remind
us again that the
$96 million is not all cash.
>> yes.
>> we don't have to have the
discussion again.
>> the contingency is cash.
It's an unspent allocation or
appropriation.
>> assets though?
>> no, it's a budgeted
allocation.
It is equivalent to cash.
>> what you're talking about is
that we get the revenue
over a period of time.
We've allocated at the
beginning of the year so we
don't have a big lump sum
instantaneously sitting there.
>> how it was described to me --
>> it's like buying on time.
>> right, we also had some
assets included in there.
We had discussions about not
being actual liquidable
cash.
I just want do make it clear
because it's a different
what we had last year.
>> the fund balance is part of
a fund balance.
It's not 100% cash but it's
tied into other assets
which will convert to cash over
a period of time.
>> right.
I guess that was my point.
>> that's it.
>> when you said asset, I was
thinking you were talking
about tangible assets as
opposed to assets like
receivable.
>> the basic bottom line,
there's not a lot of cash
around.
>> we had a long discussion
last week.
>> thank you Mr. President.
May I ask one question page 7.
On page 7, the debt issuance, I
see the $70 million,
the $20 million and $10
million,ed needs for
replacement of
that debt, how is that
happening?
>> technology bond comes from
the meaningful use money
and it's also the general fund
is committed to pay it back
also.
But it will come out of the 921
budget.
>> the $10 million jeff, where
it says cost of
issuance, I understand cost of
issuance and contingency.
What does that mean by
contingency?
>> it means basically that we
have anticipated the cost
of the infrastructure programs
in a very rough way.
We're not 100% sure those
numbers are completely
accurate.
>> construction project, you
got 10% contingency built
in.
Could end up with those moneys.
Okay thank you.
>> going back to page 11, a
little bit about valley
medical center and you'll hear
a whole lot more later on in
the day.
You'll remember from mid-year,
this year, this fiscal
year, we anticipated about a
$60 million current deficit.
We look like we're on track to
solve that deficit
problem as was mentioned in
health and hospital last week.
We also had to commit $30
million from the general fund
in order to deal with that.
Now, as we've known and
mentioned many times in the
past, the 921 fund, the
enterprise fund is a very
difficult
fund to project because it's
contingent revenue.
Contingent on visits and mix of
patients and lot of
other issue.
We have many billing problems
associated with that.
even though we look like we're
solving this problem, we
do expect some bounces back and
forth over the next couple
of months.
You might see in the financial
things going up and down
but we think that in the end,
we'll end up balancing.
the recommended budget for this
coming year, for 2013,
we looked at very carefully.
You'll notice that it does
include significant
projections of new revenue.
The county execs office and I
know the board has been
concerned about the past about
projecting new revenue.
However, it is a revenue
generating enterprise fund and
that's a critical component of
the -- patient care revenue
is a critical component for the
overall picture.
We had to project something.
we looked very carefully trying
to come up conservative
projections based on experience
in 2012.
We think they are justifiable
and reasonable and we
think they will be obtained.
We also focused on work
process changes, schedule
changes and patient access
changes
in order to increase revenue.
then the final comment, if the
projections end up not
being accurate, we will have a
plan b to you which will
actually decrease expenditures
significantly.
We plan this year on watching
the revenue in the county
execs office on a monthly basis.
We will keep close track of
those revenues and any
projections that look off, we
will address immediately.
Again, to reemphasize the risks
that are associated
with this budget, there are
always risks associated with
any
budget.
The budget is really projected
spending plan and
revenue plan.
The projections are based on
assumptions.
Those assumptions can change.
We need to let you know what
the risks are.
In terms of healthcare reform,
you know that the
supreme court is in the process
of reviewing healthcare
reform act.
It's pretty much anybody's
guess what they'll do if
they were to reverse the act
significantly, that would
definitely cause chaos and make
funding really unpredictable
at the local level.
We also have our own local
problems, which I just went
through at vmc that essentially
boils down to turning the
entire organization into a
competitive organization
compared
to what has been in the past
which relied upon lump sum
revenues.
Other local risks, I mentioned
earlier on, the
$35 million that's built into
this budget for labor
concession.
Remember that this coming year,
2013, is when the
nurses, dsa and the district
attorney investigators
contracts open up and we
programmed into this budget the
expected concessions from those
unions.
If we are not successful in
obtaining those concessions
that will be a problem we would
have to address with more
reductions.
We also are expecting increase
retirement cost this
coming year 2013.
These retirement costs will
come out of our general
fund.
We will not ask the employees
to contribute to any of
that.
We will also have the risk of
the retiree health which
will be discussed in a little
bit.
I think I talked about state
and federal issues enough
so we can move on to the next
page.
>> supervisor kniss had a
question.
>> on this one in particular
jeff, because, ken and i
said on health and hospital.
We spent substantial amount of
time especially with
washington consultants
discussing the supreme court
decision.
You referenced chaos.
I think more than chaos will
ensue.
I'm not sure that we need to do
this right away.
i think we should at least be
very technical term,
noodling what happens.
It's a three part decision
they're making.
The first one would essentially
not require states to
have health insurance.
That begins to alter the entire
thing.
That's one of the thing that we
have been the most
concerned about.
Then as you know, the question
will secondly be, can
they separate different parts
of the law and maintain other
parts.
I think you're right.
It's a toss up at this point.
It's probably up to one,
believe it or not, probably up
to one justice which is quite
significant.
I don't want us to lose the
importance of that and that
decision being made and also
that there is a saying this is
correctly as I can.
There is a group in washington
who very much had it as
their goal to eliminate the new
healthcare law should the
administration change starting
next year.
Again, we can't be aware and
ready for all
contingencies.
but at least, because I know
that folks like gary are
very good of kind of thinking
ahead on this kind of issue.
I hope that we're keeping that
in mind.
That will be a rather dramatic
alteration for where we
have been heading.
It wipes out that meaningful
use and dsrip whatever we
will use for it.
It's considerably alters that
for the future
>> yes, you're right.
We have been noodling on it.
Sort of standard logic in state
of california has been
that whatever the supreme court
does, they won't invalidate
the waiver and the waiver has
been structured as a bridge to
reform.
However, we're seeing with the
governor's proposal this
year in the May revise, there's
actually local effort to
change the waiver.
if the federal law changed,
it's quite possible the
state might change its mind too.
>> as long as we're not caught
off guard.
I know you won't be.
I think it's also important for
us to say that in
public and on the record that
we are very aware of what
those just what you call them
risks and threats are that are
out here.
Cause us all kinds of heartache
as a county.
Of course, the $16 billion
surprise I think it's
sobering for all of us.
Thanks george.
>> okay.
Page 13.
We talked about restoration of
personnel.
There are issues having to do
with bit rebuilding and
financial infrastructure.
You will see there are
additions back to fleet and
facility to deal with our
increasing space.
Additions back to employee
services to deal with many
of our workload issues and
additions back to social
services
to deal with inhome supportive
services and senior
nutrition, which have not been
performing as well as we
would like without those
resources.
This is a summary of our one
time funds.
I won't go into it in detail
but you can see basically
that we're committing again to
the 5% contingency.
We have built in there the
commitment to -- the
repayment of loan from retiree
health that was utilized to
purchase the downtown clinic
site.
We built in here the sale of
the children's shelter and
we're spending that money on
issues related to children.
that will be on your agenda
later on today.
We'll give you much more detail
about public safety
realignment during the entire
process but, I wanted to point
out that santa clara county has
been recognized across the
state developing the most
innovative ab109 plan available.
we've been very successful in
it at this point with
reduced recidivism.
We have not seen a dramatic
increase, even significant
increase in our jail population.
Although there are mixed
population and the population
is changing a bit towards the
more serious offenders.
This budget assumes that our
allocation will
effectively be doubled.
The formula has been in the
works with negotiations
between c sac and the state.
We're seeing preliminary
numbers which suggest that it
will be at least doubled and
we're therefore planning to
spend on probation and public
safety services commensurate
with that.
We're going to have a new
population.
We expect the state will
continue with its commitment
to fund our services to this
new population.
It is true that there is no
guarantee at this point
that this funding will come
through without some more
attached requirements.
I wanted to highlight one part
of the budget that we
have relied upon for the last
two years now.
That is the center for
leadership and transformation.
We've focused on trying to
change the way that we
actually do business and we've
had great success with
empowering our employees to
look at their jobs differently,
to improve performance, to
focus on customers and
transforming the workforce so
that people can lead from the
middle as they say.
So far, there are 39 teens
currently working on
projects which have saved us
well over millions of dollars.
You'll even see in your budget
book, break out of all
of those teams.
these are the milestone dates
for this budget process.
We're currently starting the
budget workshop.
Last day for submission
budgetary items will be the
29th.
We're starting our hearings on
the 7th.
We expect to be done by the 5th
and then our final
meeting after that to approve
the entire process.
I'm open to any questions that
you might have.
>> so, just on this one jeff,
the center for leadership
and transformation is
transformative.
I wonder if we have looked yet
at finding ways.
I know I seen it mentioned
occasionally but finding
ways to let the public know the
kinds of differences we have
made.
some of you know, I was in
pittsburgh at the end of
last week and it was a
conference put on in order to
talk
about transformation.
It happen to concentrate on
pittsburgh where we were.
Pittsburgh as in pennsylvania
and not california.
the transformation that has
taken place there and I
never been there before, they
certainly showed a great demo
of what it used to look like.
Many of you remember in the
past, the three rivers
there will catch on fire for
the incredible amount of
pollution.
Transformation is so powerful
that it really turning
that city around.
I think you can make an
argument for this in this
county and let our employees as
well as those live in the
county know that we have done
this because, if I'm going to
accept all that you say as
gospel and so forth, it would
be
great to see a series in the
murk that talks about what were
the differences that came about.
We made substantial investment
in this.
We involved stanford at a very
high level and I think
it's a wonderful opportunity to
show how we use county money
in different way to save a good
deal of money and also to
motivate and transform some of
our employees.
Just a thought.
>> well, in this year's budget
message, pages 9-18,
we've gone through all of the
current projects that are in
place.
You're right, it hasn't gotten
out as much to the
public as we would like.
We had a couple comments in the
newspaper but and we
put out a number of press
releases that don't typically
get
picked up.
We have this on our website
both our internal website
and our external website.
This year, will give us a
chance to refocus on getting
the message out.
>> a series was highlighted in
some departments.
some person putting a face on
it, can be very
influential.
Whenever I travel, there always
certain counties that
stick out including yours.
Fun to do that.
>> perfect.
>> supervisor cortese.
>> page 11 of the slides, you
went through this, that
page closes talking about a
plan b under development and
possibly revenue materialize as
planned.
Under development, can you
expand on that a little bit
more?
I don't know where is it at and
when will we hear more
about it?
Presumably if we were going to
have a contingency plan,
woe would have it ready before
the project develop and not
after.
I'm just wondering when is that
going to be
forthcoming.
I'm also wondering if any of
the thinking this board
asked to have looked at in
terms of areas where there can
be
a firewall between the general
fund and the enterprise fund.
i know we received some legal
advice as to where we
can't do that but we haven't
seen anything come forward
trying to make suggestions in
the areas where we can do
that.
>> let me try to take those two
questions one at a
time.
Number one, in terms of
developing a plan b, we don't
have that plan to the point
where we would be prepared to
put it out in the public.
The only other approach to
unrealized revenue is to
reduce expenditures.
There are a number of programs
in the health and
hospital system which are not
absolutely mandated.
Certainly not mandated to the
level that we provide
them.
If indeed we were unable to
meet revenues, we'd have to
start looking at those services.
They typically are specialty
type services and other
support services. That will be
in significant reductions.
Obviously, none of us want to
do that.
Therefore, we trying to project
a budget here we think
is very conservative and
rational.
In the midst of healthcare
reform, it is not the time
to be reducing services but as
you well know, the budget has
to balance one way or the other.
We are in contingency planning.
We will bring that forward when
we feel like it's ready
to be public.
in terms of the second answer
or second question about
a firewall, as you know, the
board does have constitutional
obligations under 17,000 to
provide healthcare for
medically
injured in the county.
we provide far more than that.
But, there is no legal
structural way to actually
prevent the expenditure of
money on that program.
It really boils down to setting
up systems -- policy
and commitments in the board
policy area that will restrict
how much money gets moved from
the general fund.
At this point, I know that
county council has been
working on some of those ideas.
we are targeting in this budget
trying to keep the
general fund subsidy below the
10% range of the entire
expenditure.
I think you'll see that we are
successful in that with
some leeway.
When I started 2.5 years ago,s
general fund subsidy was
about $220 million.
This budget envisions it to be
about $85.5 million.
That's a significant reduction
without significant
reduction in services.
I obviously can't take the
credit for that.
The hospital should take the
credit for that.
they done a fabulous job of
improving their efficiency
and effectiveness.
That's a good step forward
indicating that we are
making significant progress.
>> if you measure that by board
presidency, we've all
done well, President Shirakawa
you just have $85 million
more to go.
[Laughter] I want to get this
clear so it doesn't get
-- probably will anyway --
perhaps it doesn't get
misprinted
somewhere by some opinion
maker. I'm not suggesting nor
do
i hear the board suggest that
we do anything other than
guarantee the 17,000
commitments.
When you present it to us last
year, what the hospital
system was spending money on,
that piece of it is a less
than 10% of the total hospital
budget.
It seem to me we can guarantee
that piece and still
have awful lot of attitude in
term of where we prohibit
ourselves moving money back and
forth.
I'm only suggesting under this
plan b scenario.
I'm coming into this process
more than willing to
support this plan at this point
of half revenue solution and
half subsidy solutions.
Currently plan b -- we all have
concern to have in
place.
i'm actually thanking you for
that.
>> you're correct on both parts.
We do have more flexibility
without reducing services
to reduce our costs.
We can actually increase
services and reduce our cost.
we're making progress there and
that will be our
directive.
Like you say, if we can't meet
it, we will then have to
start thinking about what we
can do without.
>> to the chair, again, not to
be misunderstood, I was
joking with regard to the
credit with the board President.
i do agree that employees are
the ones who have done
this.
There's no way five supervisors
or senior staff can go
out and manage an operation and
bring numbers into alignment
like that.
That's understood.
thank you.
>> anyone else on this section?
Thank you jeff.
Item five is overview of
funding status of the county
retiree medical benefit program.
>> george I'm taking my share
of time this year.
this is my last year.
I get special privileges.
I'm sitting here thinking that
when I first got here in
2001, the budget was quite
robust.
You remember gary, believe it
or not, they were called
funds supervisors had to offer
to their own district.
The next year that wasn't the
case.
By 2003 it was dismal.
It has been dismal for at least
nine or ten years.
It is amazing to be doing a
budget where we're not
discussing how awful it will
be, how terrible the year will
be, how many test we'll have to
make.
i think you're both to be
commended.
It seemed kind of jerky at
times.
Hard word, kind of a stop and
start.
Think we've gotten to an
unusually good spot given
where many other counties are.
Where much of california
doesn't enjoy the privilege
we're having this year of
looking at a budget that
doesn't
have as many challenges that it
has before.
I just don't -- it would not be
there if we didn't call
that out and say, good job.
i can look back over 11.5 years
at this point.
It's been a lot of those times
very rocky.
I thank you and I'm sure whole
board joins me in that.
>> thank you.
>> you better keep up the good
work.
>> well, we will.
It's only because of fabulous
employees and mary and
leslie and gary and department
heads who and all of their
finance people who do yohman's
job and they're here late
nights and making sure
everything adds up.
Thank you for recognizing that.
>> by the way, we are waiting
until January for
reinstated some of those funds
from the districts.
>> thank you Mr. President.
We wanted to provide you with
an overview of the issue
of the opeb retiree benefit.
First slide.
The second slide -- I'm going
to go through this
quickly because there's a lot of
contextual information.
The important thing about this
slide it outlines the
benefit we provide employees by
no means it's all retiree
medical benefit, the most
generous and no way that's the
case.
We only provide the benefit if
you retire from the
county, if you've met five up
to ten year continue of
service in order to get the
benefit.
also we only pay equal to the
geyser premium.
At the same time, that being
said, this is an expensive
benefit.
Next slide provide you with
some perspectives in terms
of how things have changed.
To give you some perspective,
the county began
prefunding this benefit in 1984.
We wanted very few organizes
that did studies to
determine what we needed to put
into this program in order
to fully fund it.
Since that time, there has been
a variety of changes.
2008, new requirements,
required the reporting of the
unfunded actuarial liability.
It requires dedicated assets to
be placed in
irrevokable trust.
The county did open a trust in
cal pers in indicate
2008.
The board approved those
funding. We ended up
suspended contributions in 2010
when we were really dealing
with our cash flow crisis.
That's the reason why in this
year, we are recommending
to increase our contribution to
this benefit program.
Also it's important to point
out that beginning in
2012, we did negotiate, some of
the employees contributing
directly to the cost of retiree
health.
Next slide provide you with
some definitions that might
be helpful for you in terms of
identifying how retiree
medical benefits are funded and
it gives a little
description, pay as you go.
Really only covers the current
period cost for current
retirees. The normal cost is
pay as you go.
Plus we're funding the cost of
benefits for future
retirees.
This is referred tos a partial
refunding, the arc,
which is the annual required
contribution is a normal cost
plus we're also making payments
on the unfunded liability.
This is substantial amount of
payments that ideally we
can reach but when you see the
figures, you can see what a
challenge that will be.
the next slide is a graphic
representation of the value
of these funding methodologies
and as you can see, the arc
currently is in the range of
around $170 million, which is
way above what we're currently
funding.
To the extent to which we do
not pay for the unfunded
liability, as you can see the
trend will increase over time.
These are annual costs.
The next slide gives you a
summary of where we are in
the funding of this program.
The amount that we have
contributed to the irrevokable
trust is $252 million opinion
we are still retaining in our
county funds $163 million.
These are funds that were
originally anticipated to be
transferred to their
irrevokable trust.
We've hold on to them base on
our concerns around cash
flow.
The retiree health trust fund
is a major source.
i think if you recall, we have
about $250 million worth
of play.
I got amount of 160 is retiree
health trust fund.
During the 2009, '10 time frame
when the economy was in
a chaotic state, we felt it was
very important to maintain
that flexibility in cash as was
discussed with the board.
As time has moved on, we're
feeling little more
comfortable in starting to
transfer funds out of the
retiree
health trust fund and that's
went recommendations we're
making in the current year.
Now the number that's startling
and of concern to us is
in fact our actuarial accrued
liability which is now
exceeding $2 billion.
Believe it or not, in 1999, the
actuarial accrueded
liability was $69 million.
So it increased substantially
based on a variety of
factors that I will touch on.
Again, the next slide gives you
a since of how the
unfunded actuarial accrueded
liability has changed over the
last 12 years.
That growth has been
significant as our
contributions
really have been limited again.
We did that in order to really
protect our services.
It's a decision that was
difficult but one that I think
we stand behind because
clearly, our mission is to
provide
service.
I think looking back, it was
the right thing to do.
The next slide provides you
with some more recent
information about our
contributions.
In 2008 and 2009, we
contributed 100% of our arc.
That was possible because we
utilized the retiree
health trust fund in addition
to what we budgeted to meet
100% of those costs.
As our deficits grew and we had
fewer and fewer
options, we made the decision
to reduce those expenditures
and as you can see, the amount
we contributed declined.
So, at this point in time, one
of the things that we're
recommending is to increase our
contribution in terms of our
ongoing funds from 50% of the
normal cost to 75% and then
make up that difference to get
to 100% gi beginning to
transfer from the retiree
health trust fun to the
irrevokable trust.
We begin drawing down reducing
the amount in the
retiree health trust fund by
relatively small amount.
We obviously will not go too
far too fast because we're
not 100% confident in the
economy.
The next slide provides you
with again, a graphical
representation about the
estimated future unfunded
liability
based on the three funding
mechanisms.
Our goal is to again, reach
that 100% of normal cost
and then as possible, try to
begin paying some of that
unfunded liability depending on
circumstances.
the next slide provides some
information regarding why
the unfunded liability has
grown so quickly. Retiree
health
is very sensitive to rise in
health insurance premiums.
That's a problem we face not
only here but of course in our
regular health premiums.
We see substantial growth and
even though they are not
in the double didn't range as
they had been in prior years,
they are still growing
significantly.
The increase number of
employees in retirees when we
look at this from a actuarial
perspective, has an impact on
that.
the funding strategy as I
mentioned, the more we put
into it, the limits the growth
of unfunded liability and
also the investment return rate.
All of those things have been
challenged by the economy
over the last several years.
the next slide provides some of
the things -- some of
the strategies that we're
thinking about and certainly
it's
important to note that these
are all subject to labor
contract negotiations.
These are not things that we
would implement.
Unilaterally but they will be
part of our contract
negotiations.
things that we can do for
instance would be to cap
county contributions.
We could reduce benefit
coverage levels.
Introduce a health saving
account option.
And on and on.
There are ways in which we can
address this obviously,
mistakes obvious --
this is something we have to
address.
The next step on the last
slide, what we are suggesting
we do is to create an
administrative steering
committee for
the retiree health benefit to
study best practices and to
develop options for
presentation to the board.
Obviously we want to obtain
input from our county and
labor organizations.
So that we can provide
information and get feedback in
terms of what this all means
and how best to proceed.
Our time frame is to study this
in the upcoming fiscal
year 2013 and to discuss with
the board probably through the
finance committee and the full
board as we look at the
budget for fiscal year 2014.
Once again, we're making a very
positive step this year
in terms of getting to 100%
normal cost.
Our goal will be to try to put
together a plan in terms
of how we can address and
approach these funding issues
as
we move forward.
with that, I would be happy to
answer any questions.
>> supervisor cortese and then
wasserman.
>> first of all, thank you very
much for including this
as a major component of the
study session.
It's helpful and it's probably
been on a lot of our
minds wherever we sit here in
the county in terms of roles
given the conversation that's
going on externally over the
years.
I know we were all aware of
abstaining the funding
effort.
one of the questions I have is
probably in the a real
question per se.
In the list of things that
could be negotiated, there
could be ideas.
To what extent can we as a
county given our capacities
connected to the healthcare
system?
at least attempt to bargain to
bring people into our
own health plans in order to
sort of mitigate what I would
call a victimization of local
governments by big insurance
companies that we have no
control over.
i'm wondering if it's worth
discussing?
I'm not trying to bargain from
here.
I need to see it up there as a
bullet point.
I didn't know if that's because
there's not much gained
or because it's a collective
bargaining issue.
>> I would speak -- one thing I
would say is there are
limitations.
i think that this is something
that's been looked at
before.
In fact, was challenged and so
there are limitations in
terms of to what extent we can
do that.
I think that's about all I
would say on it.
>> I would add a little bit.
last year we went forward with
trying to make our
internal system, vhp more
attractive by expanding the
network and making it a more
attractive product for our
employee.
There's still we need to do in
that respect.
Gary is right, we can't really
mandate that employees
take one system or another but
we can make it more
attractive.
We have seen significant
transfer.
I think it's up to 700 or 800
or something like that.
1100.
1100 of people transferred over.
That makes fairly significant
dent.
That helps us a lot because
every dollar that we pay
for health premiums it goes to
vhp.
Stays within the county system
and allows us to have
the flexibility to improve our
health system, delivery
system.
Whereas, every dollar that goes
to kaiser or health net
goes outside of the county and
helps them develop their
system.
>> it seems like that alone
would be in a dialogue, an
incentive or interest beyond
just the product itself.
In other words, if that's an
organization, it helps us
bring down accrued liability
that end up impacting employees
anyway. Trying to want if I
that a little bit more.
we're not asking people to take
a hit for the team so
to speak.
But to the extent that people
are attracted by the idea
that we can reach a certain
critical mass, it saves jobs,
it
freeze up dollars and wages and
other things.
I understand the collective
bargaining session.
i take note and other important
thing is willingness
convene early.
My experience has been in other
places, especially
prior to coming here, that the
lack or unwillingness of
management elected officials
and others to do that, really
help lead to a lot of conflict.
Like anything else, just like
any balanced discussion
with budget, there's a lot of
questions whether accrued
liability numbers are real.
Are those numbers really where
they should be.
I don't dispute them but people
need to understand that
before they make commitments
and secondly, what is the --
how sharp does the trajectory
need to be to get there from
here?
How much can we defer until we
see how the macro
economy changes and how
healthcare reform May change
things.
I think those discussions are
invaluable and maybe it's
during those discussions when a
little more sharing about
how internal -- how vhp and how
mechanisms internally might
be able to help the problem.
Sound like you're doing that?
>> absolutely.
The board action a few weeks
ago to direct this to look
carefully at a unified
healthcare strategy is
important
component of this.
It involves having a strategy
to expand the commercial
capacities of our local health
systems so that we can make a
much more attractive product
for employees and for that
matter, for employees of other
organizations.
>> supervisor wassermann.
>> I wanted to thank staff and
all of employees for
being direct, being
transparent, being
collaborative.
We're all working on this
problem together.
What I wanted to state here
with something I stated in
ledge committee,ly say it again
now, at some point, I think
somebody somewhere organization
some individual needs to
hold the medical industry
accountable.
When cost, supervisor cortese
mentioned cost of
insurance going up and up, they
talk about premiums going up
because the cost of the medical
care is going up and up.
I know I seen premiums.
I seen in medical care.
I'm just hoping somewhere
washington, sacramento,
somewhere somebody says why is
medical costs going up 10
times the cpi when we as
employees are happy here when
our
salaries don't go down.
The comcast go up couple 3%
each year.
The medical cost goes up 10 time
s cip.
it was double digit increases.
When your cost of medical care
or coverage insurance or
whatever is estimating 10 and
20 percent and we're
scrambling to try and find to
be more efficient so we can
set aside for money to pay for
the insurance coverage of
retiring employees, you got to
ask at some point, why these
costs are going this way?
I appreciate the respect and
collaborative efforts and
between the administration and
employees to figure out how
we will pay for these expenses.
sooner or later, we got to say
these expenses are
wrong.
I don't know if we can throw
out for further
discussion.
Gary if we have the right for
justification of
insurance premiums.
I know there's a state
insurance commissioner.
I don't know who regulates the
cost and what they
charge for medical care.
it's hard to be playing catchup
all the time and you
got this run away horse and
somehow pull the reigns back.
No matter what we do no matter
with the epic, no matter
with more efficient methods, we
cannot keep up with
escalating medical cost and
premiums that are double digit
each year.
It's not a question of if or
when.
>> I think jeff and I can maybe
both reflect on this.
There was a time when medicine
was not a business.
it was looked at quite
differently.
It was a -- I don't mean to get
carried away -- it was
a laudable calling.
Most of you know I have a
nursing background.
At that time, when people went
into the hospital, there
was insurance coverage but
medicine was not the business
it
is today.
There are, learning about this
in pittsburgh, there are
whole cities in the south that
are devoted to healthcare.
That's how people make their
living.
There's one city devoted just
to dialysis.
Dialysis is a very lucrative
business.
I hesitate saying things out
loud but the more
developed we have become in the
healthcare field, the more
ways there are to save people,
to maintain them sometimes
long after the quality has
disappeared, the more expensive
it becomes.
That is one of the reasons in
the aca there was a
discussion initially which had
a great dealed feedback about
it about the dreaded word, what
do I call that word instead
of what it is.
Call it options.
Whether or not you discuss with
people what they want
the quality of life to be for
them or for their family.
I realize, I'm opining somewhat
on this.
We have become a very
complicated country as far as
healthcare goes.
As we used to say, still do, no
one every dies in
surgery.
they only die later because
there is no way you can do
that.
Again, I am so sympathetic for
families who lost
someone who had that grief.
There's also grief in families
where someone lives far
longer and as one of the women
said earlier today, somebody
who goes to bed praying,
they'll be dead in the morning
because it is so hard to
maintain your life.
It's a long answer mike but I
really think the
transformation that has taken
place in healthcare and the
time I reserved it is pretty
dramatic.
Probably why the aca did pass
and even though it has
its fault.
I think there are a number of
really good provisions in
it.
Longer answer than you you
wanted but it has troubled
me for years how insurance
company have become such big
business.
their executives are paid
extremely well and from time
to time the system is misused.
I don't know if you want to
comment jeff or not.
We have one nurse and one
doctor on a board throughout
california.
Jeff you maybe the only
physician ceo.
I did carry on didn't I?
>> I guess the question was who
regulates this and
there is some regulatory
capacity that the insurance
commissioner has but not
complete.
There also is regulatory
capacity that the department
of managed healthcare has.
Again, not complete.
I guess the fundamental issue
is as supervisor kniss
pointed out that in a for
profit structure, somebody has
to
win and somebody has to lose.
That's the way it no, our
country today.
>> to be perfectly clear so I'm
not misunderstood or
misquoted, I'm perfectly happy
with each and every
individual and organization
making profitings. I don't
begrudge that and it's the
american dream.
What I'm saying, I'm not just
lobbying for government
here.
How government employees
suppose to keep up with the
cost.
Private sector too.
I was self-employed for 30
years.
Can't keep up with the
escalating cost.
We're in government now.
I'm in government now, we're
all in government, can't
keep up with the cost.
Something got to move more in
parallel.
i hope something somewhere
happens at some point.
Last couple years has been
great.
You brought that $220 million
down to $80 million or
whatever the number is, that's
all great.
But if cost go like this, and
revenues go like this,
like I said, it's a question
when you break.
Z
break
>> thank you supervisors.
Anything else?
Thank you gary and jeff.
Item six is a recommendation
relating to the sale of
real property.
Jeff I have one speaker.
I think it's a question.
Let me have her ask the
question.
Why don't you ask the question
as presentation goes on.
>> good afternoon lynn bradley
from seiu.
It talked about the shelter or
receiving center where
children will go.
We have never been told in
social services agency.
we're curious where it will be
moving one.
>> staff?
>> thank you Mr. President,
members of the board.
With me today, this is a
familiar face, he's the
interim acting director of the
social services agency and
responsible for the operation
of a relocation assessment and
intake assessment center.
david and nancy weiner who is
the founding and director
of the silicone valley children
fund.
In the audience we have sharon
pick assistant business
manager for harker school.
in conforming with the
government code following
direction on January 24th when
you adopt resolution for
offering to sale the former
children's shelter.
We subsequently opening sealed
written bids on
March 1st.
We received four written bids,
three at the minimum
qualifying requirements.
there was a subsequent oral
bidding process at the
closed of which harker school
made the highest remaining bid
of $25,505,000.
Before recommend action to
adopt the resolution accept
highest bid approving purchase
of sale agreement.
It provides for 150 day due
diligence period and a
30-day close escrow period.
Following a successful close of
escrow, the county
would realize one time proceeds
of $10.7 million and in the
proposed budget there'sal a one
time allocation of
$3.5 million toward relocation
of the intake and assessment
center.
But I think that those are the
stark details.
This really is a 20 year
collaboration.
there's been much cash --
cachet.
What we now see is prospect of
beautiful facility
entering new phase devoted to
children.
This partnership started out as
a 50/50 joint venture
between the private sector and
the county and it ended up
with 50% of the proceeds from
the sale with the property
being satisfied. Proceeds are
split 50/50 with silicone
valley children's fund.
This afternoon I was also
informed that city council of
san jose played their part and
took action to provide a
process for lifting the
affordable housing restrictions
that
were placed on the property at
the beginning of the project.
With that, Mr. Mavis.
Anything you like to say on
behalf of the fund?
>> we would like to thank mike
wasserman and his staff
and also bruce for helping us
navigate through this process.
We're looking forward to
wrapping it up.
so thank you.
>> I appreciate the opportunity
to just make a few
comments to all of you.
Some of the familiar faces.
I only want to correct one
thing that bruce said.
I was actually a 39 year
employee of santa clara county
and it was in that capacity
that we formed the fund and
developed this very unique
partnership.
Many of you know it was a model
throughout the state
for its community participation
and for thed the model it set.
I had opportunity to create
this partnership.
This gives me a chance to say a
special thanks to
supervisor diane mckenna who
really did an amazing job
with the cheerleader of this
project.
i think we ought to take a
moment and thank the staff
and our county supervisors and
our county administration for
the tremendous work that was
done at the children shelter
during all of these years.
I am particularly appreciative
of the very thoughtful
process that has gone on at
this point in time.
I greatly appreciate the fact
that bruce has been able
and the county executive has
been able to spearhead this
project to place it in the
good hands of harker who by the
way contributed to this project.
A group of kids from harker.
That's a fun thing to note.
I'm particularly appreciative
that the fund will be
able to use the donations that
were given to this project to
further the work because the
real focus these continue to be
to support and help the abused
and neglected children of our
county.
I am very grateful for that and
I thank all of you for
the work you've done.
I thank bruce for the work that
he's done in carrying
that forward.
Thank you.
>> thank you.
>> Mr. President, I like to
respond to lynn bradley's
comment and question about what
is the future of the center
for social services agency.
Comment that the employees have
not been informed.
I think the new shelter sale,
pending sale is common
knowledge as has been reported
in the paper.
The agencies continue to be
seeking for alternate
location for their scaled down
operation.
They received children for no
more than 24 hours. We
are in the process of looking
for possibilities and we will
definitely confer and consult
our employee organization in
the future of where the
location is.
There are other county partners
whether it's pediatric
center of vmc and mental health
department and other
department of social services
agency that we will be
consulting and conferring for
either temporary location
>> thank you, anything else?
Thank you to all of you.
Let me recognize supervisor
yeager.
>> I know all of this,
appreciate all the work
everybody has done to make this
happen.
For those of us following this
very closely like I was.
There was no guarantee we were
going to be where we are
this afternoon with everybody
saying thank you.
Having an agreement that works
for everybody.
this was very complicated from
the very beginning.
It took a lot of excellently of
-- flexibility.
i was excited that harker was
the top bidder.
It's going to fit very well
with the surrounding
neighborhoods.
If I had to sort of choose
where I would want public
land to be used for school
would certainly be at the top
of
my list.
it was good to hear little bit
about the history.
We did have an obligation to
make sure some of the
proceeds did go to abused and
neglected children.
Nancy appreciate you giving a
little bit of history and
all the people involved in that.
It was a magnificent project.
When it started it look a lot
of collaboration and lot
of support and dollars and
leadership to make it happen.
Times changed and we all need
to change with them.
We did all of that obligation
to the children that
using that property to begin
with.
with thatly make a motion that
we adopt this
resolution.
>> motion by yeager and
seconded by wassermann.
Supervisor yeager thank you for
your work.
Bruce of course you and your
staff.
Anything else on this board?
please vote by light.
That carries unanimously.
Thank you everyone,
congratulations.
I think there's nothing before
us for this item.
We will move on to item seven.
Supervisor cortese we are
starting children family
seniors committee.
As a chair, I want to afford
opportunities, if you want
to say any word before we start
with the child support
services. Did want to say
anything prior?
>> only that we've taken a
preliminary look at the
committee.
The budget items -- still
opportunity for that to
happen.
Looking forward to the
engagement of the full board on
respite process.
>> item seven is review of the
department of child
services.
>> good afternoon.
Adele hunter with the
department of child support
services filling in for ralph
miller who has family
emergency.
i want to give you update of
these department budgets
since the recommended budget
was published. Yesterday on
the conference call from the
state department of the child
support services, it was
announced there will be a
reduction.
At this point, the state is
looking at options for ways
to reduce that funding.
We have no additional
information and what the impact
would be on santa clara county
at this time is unknown.
Once impact is known, and what
our reductions are, we
will be working oba to
determine how to balance our
budget
and during the budget process,
we will have more information
for the board of supervisors.
I'm available for any questions
>> questions from the board?
>> when you talk about the
call, you referring to the
May revise?
There was a conference call
dealing with the may
revise.
I just wanted to understand
whether or not these are
just additional proposals or
something cemented?
>> these are results of the May
revise.
>> so it's still up in the air
at least.
>> all right, thank you.
>> anyone else?
Jeff any other comments?
thank you, appreciate it.
Item number ability is inhome
support services.
Luke?
Item eight now, ihss.
>> sorry Mr. President, I was
providing further
explanation to --
>> I know you were working.
>> this is a my ihss support
services.
If you can confer with me, this
is transferring the
function to social services on
the administrative portion?
>> the transfer tax and
responsibility will be
transferred to social services
on an administrative level.
>> this has been historically
been administered under
the county executive office
ever since the public authority
was formed.
>> questions from the board?
>> I'll just point out that the
governors May revise
suggest more cuts when we know
what's going on with that, we
will come back to the board
with modifications.
>> okay.
I'm thinking, it was difference
you spoke of 11 years
ago today and last years today
it's a little different.
I'm sorry I'm shell shocked and
we had more discussions
on some items.
>> [Inaudible]
>> thank you supervisor.
Thank you luke.
We will move on to item number
nine.
item nine is review of custody
health services.
>> I'll just make some very
brief momentos keep with
tradition, I guess.
Thank you Mr. President
shirakawa and honorable
supervisors.
at both Dr. Smith and gary
described, the proposed
budget for our health and
hospital system fiscal year
2013
reflects the direction to stay
with maintenance level.
It reconfirms commitment from
the county mission.
it continues and some cases
accelerates the necessary
changes to respond to the
increasing challenges.
As many of you noted, earlier
discussion related to
healthcare reform as well as
the economic uncertainties.
It's that purpose and with the
county mission as well
as our values in mind our
executive leadership for
adopting
the following five major
strategic priorities.
First and foremost as you know,
since this has been
part of the strategic framework
from the a&m work.
The culture of accountability
is very important for us.
we can happens the monitoring
of our system and also
the manage performance of our
health and particularly
hospital system.
System integration important
for us as well in term of
delivering better quality care
and lowering cost.
Position alignment is better
for provision of care and
strategic and decision-making
process.
Unified managed care in terms
of happening reliability
of safety net in more
competitive marketplace as well
as
deliver the better and still
support the critical functions
of our health system.
we added a tiff which is
transforming communities.
It's a challenge but also even
more important to be
within participations of both
patients as well as community
so we can continuously continue
the health status.
we think combining all of these
five major strategic
priority will position
ourselves in a much better
place in
terms of reform.
As you mentioned, our employees
have done tremendous in
terms of day in and day out,
7/24, 365 days out of year.
Doing what we need to do to
fulfill our mission.
We want to make sure that we
continue to protect and
promote the health of residents
in our communities.
That includes all 1.8 million
residents, that's part of
our public health
responsibility.
Mental health will continue to
treat and care the
seriously mental ill in our
communities on behalf of all of
us.
Custody health will serve
incarcerated adult or youth.
Drug and alcohol services
department, will continue to
serve youth and adults
afflicted by addiction.
Our community health services
will continue to treat
people with illnesses, that are
risk to themselves as well
as others. Certainly our santa
clara valley medical center,
we continue to provide care and
treatment at your hospitals
and clinics.
Each of our department heads
will now present very
briefly the major highlights
offer budget proposals and I
will turn it over to mary yan.
Maryann.
>> let me recognize the chair.
Let the chair say a couple
words.
>> just to say in general,
welcome renee first of all.
It's good to have you.
Secondly, I'm not always sure
that everyone understands
what it takes to upgrade the
health system in this county.
Unless I'm wrong, we're usually
running about
$1.5 billion.
Have we changed any this year?
We upped it to 1.7.
That is a third overall as we
look at our $4 billion
budget. It's very important
service that we provide.
i truly believe and I often say
to people, this county
has universal healthcare
regardless what you might have
in '
county.
We really do have that.
There is absolutely no way that
you could not get
service in this county if you
wish to get it.
You can go to one of our
clinics or partnership clinic.
You can access our urgent care.
You can access -- there are
number of ways that you can
get treatment in this county.
We have had support from that
from the public for a
very long period of time.
Right now, we're under way with
a new building which I
think still is on target for
2013, which is going to be
certainly state of the art.
Having said all of that, we
really have struggled over
the last few years, ken equal
credit and I, to really put
the hospital on a different
track.
because just as mike mentioned
earlier that the rise in
healthcare is phenomenal.
It is also difficult when we
now have so many issues so
many new diagnostic test.
So much is new particularly for
patients not ask for
those.
If you go in with broken leg
now rather than simply
have an x-ray, someone will say
you need an mri and ct scan.
There's a lot of explanation
that must go on between
the provider and the user.
It's become a far more
complicated system that we use
in order to provide healthcare.
one that I think we have to be
explaining to the public
a great deal of time.
Having said that, we still got
great support in '08 for
the bond putting up the new
building. When we have gone
out
for public support particularly
for kids areas, trauma and
so forth, we've gotten that as
well.
i think the public truly does
value this service that
we provide in exemplary way in
this county.
This is not a whole new area
for you but a different
way to deliver healthcare.
I really like to say thanks to
ken because this is --
these are long meetings that we
have.
We've spend a great deal of
time.
I spend a lot of time talking
to jeff and linda
particularly with gays and cfo.
We are working with diligence
to try to keep the cost
down of that most expensive of
our department.
I really want the public as
well as employees know
that, I think we have had a
concentrate effort in order to
understand more completely
exactly how the healthcare
dollar
is spent.
I think we're making some
progress.
I'm going to turn this over to
ken next year and lord
knows he May save a whole lot
more than we've been able to
together.
i really do want to show
everyone that we have worked
hard on this.
It good to see you renee.
You will be over seeing our
umbrella of healthcare
services.
For all the other thing that we
provide, we deliver
kind of a sober message.
if you don't have your
healthcare and you don't have a
way to get healthcare to help
you through the problem to
hopefully get better, there's
no other option.
many other things we can do
without.
When one's health is
threatened, it changes your
whole
life.
We're in a life saving business
and hopefully we're
also in a prevention business,
which has been one of the
areas that both ken and I have
concentrated on through
public health as we look at our
great great grants come in.
A rather long speech but I feel
fairly passionately
about this whole area and it
certainly has been a
challenging but very rewarding
area to work with while I've
been here at the county.
Thanks.
>> thank you very much
supervisor kniss.
You did ask a question in there
that I feel compelled
to answer.
>> I'm trying to think where I
asked the question
[Laughter].
>> you asked whether we're
still on schedule for that
building.
the answer to that is no.
With changes in terms of our
interaction with osh pod
as well as we modify our
strategic planning.
In addition, there's some
issues around the design
build and the relationship with
the contractor.
We are behind schedule and at
this point, I can't give
you an exact number but it's
probably in the year range.
i would not expect to be ready
to open in 2013.
>> heading at least to 2014?
>> with our fingers crossed.
>> one other thing I would say
george, I think we've
become much more realistic in
our prediction of numbers.
you're going to see that in
here.
Ken and I both follow an daily
basis what the consensus
is on the hospital.
Almost no stone has been
unturned if we track this.
As you look at this here, you
have noticed we have
become far more realistic in
our prediction which allow us
to become much more realistic
as we go through our budgeting
session.
That -- we haven't hit our
target.
I think it's more realistic and
i think we have seen a
number of improvements lately
as far as getting toward that
those actual numbers we
allocated last year.
>> thank you supervisor. Jeff
anything else?
Thank you renee and let's go to
the unit form 14 grant.
it was a long way to get to you.
>> I'm happy to wait.
Custody health services. From
the highlights
identified above, just like to
quickly point out two of the
highlights.
The first the second bullet
where we finalized
agreement with the social
security administration.
This is really a critical
piece, success reentry
efforts for inmates back into
our community I'm sure board
members are aware May lose
benefits upon incarceration and
when they are released from the
jail, it takes them three,
six and more months to obtain
benefits. This agreement will
allow us to start the process
three months prior to the
release and the benefits will
be available to them hopefully
on the day of their release.
We will be able to provide
appropriate housing and
other benefits for them.
The last bullet I will point
out 62% of our inmates
receive medicare and equates
about 2200 inmates. 22%
receive mental health services
and approximately a thousand
inmates. As far as our request
for funding, for fiscal
year, the request is six
positions.
These positions are direct
service care providers.
i would be happy to answer any
questions you might have
>> maybe question and comment.
We had discussions with
possibly medical and that whole
model.
i think it was on page 463, the
four positions and it
mentions focus of care will be
on primary prevention and
chronic disease management.
Certainly a good plan that
rotate maybe one out of the
six doctors and ga the
community to do that treatment
possibly and I've always
advocated that the -- can you
talk
about discussions?
>> the plan is that setting and
primary care clinic at
the reentry center.
we want it to be a transition
al center.
We will be providing services
until we can get them
reestablished within the
community with their primary
care
provider.
>> we'll hear that five year
plan.
I'm sure you'll be there too.
other questions from the
committee?
>> on page 460, on the right
hand side three down, it
says unfunded codes.
i understand it cost center and
it list 24 ftes.
Can you explain what those are?
Are they in the body of this
and I didn't see it?
>> the unfunded codes
historically had a number up
funded codes as I believe
valley medical center had
unfunded
codes.
Primary focus of those codes is
they are all clinical
positions. For-instances, we
have clinical nurse position,
nurse practitioner.
They are used on individuals on
a long term leave
>> those are sort of like
temporary health help?
>> they are not temporary help.
>> temporary contracts maybe?
>> they would be.
If we fill the position, it
will be a coded position.
it's a vacant position but it's
unfunded.
Funding will come from the
position that -- let me see
if I can back up.
I can't remember when we last
use them.
We use it on in situations
where we have a critical
position within the
organization to provide
clinical care
and we don't have the capacity
to fill the position because
people are on long term
extended leave and we need to
continue to provide the service.
We would seek permission to use
unfunded code.
Let's say a nurse practitioner,
we will seek
opportunity to use unfunded
code, hire someone under the
code and they will be a coded
employee.
>> what jure saying, these are
sort of your kinds of
provided codes?
You seldom use them but you
need them in a just in case
situation?
>> that it correct.
>> you you're saying you seldom
use them?
>> very seldom.
I have to check with finance.
I know we haven't used them in
many years.
>> employees on long term
leave, we do not need
unfunded codes. Historically,
the unfunded codes in custody
health as well as elsewhere in
the hospital as mentioned are
clinical positions.
They mostly for the patient
census.
We build to the number of
positions that maximumly
going to be used. At times, we
look at those unfunded codes
to see if we continue to
reflect that in the budget.
>> anything else on that?
>> I think you can understand
why I was somewhat
puzzled by those.
I almost call them extremist if
you need to pull on
those.
It's just a lot of codes.
That what seemed unusual.
thanks george.
>> supervisor cortese?
>> this is kind of a general
question about the fte
that will be seen throughout
the budget in terms of ab109
and the add ons.
I'm not really clear.
I didn't catch it in the
overview or anything yet, as
to what the bigger picture is.
Obviously, the reentry program
started in this current
fiscal year.
It started in prior calendar
year.
I don't recall how we factored
in covering the cost of
that.
Obviously reimburses from the
state.
How we factored in terms of fte.
How we getting by.
There must be some strategy
beneath all of this is is
ramping up with the program to
add fte.
I do see the revenue coming in
the documents I don't
know what the methods to to
the madness is.
The way we receive it it's
pieced in unit byunit.
Maybe for the benefit for the
rest of us, you can tell
us how does that ramping
working?
I didn't really want to put
that on one unit here.
>> in the front of the
document, there's a section on
ab109 that 109 attempts.
The department created a plan
to how we approach this.
The key factor is to recognize
the fact since this was
a major change, a change in a
that we recognized there would
be things happening where we
have to adjust.
It's a flexible plan.
Over the course since October
1, we come back to the
board on two different
occasions to make modifications
already to the plan.
we attempting to -- what we
seeing we given forecast.
As we implement the programs we
are adjusting based on
the actual experience.
It's not as if it's a hard and
fast plan because we're
trying to be flexible.
As jeff mentioned in the
introduction, we plan for
basic. Getting a doubling of
our resource and so what's in
front of you in terms of the
recommended budget, reflects
that.
There are an impact in terms of
ftes in each the
area, collection, probation and
custody health.
There's impacts more service
and contract related drug
and alcohol and mental health
type of services. It's a
combination.
What we're trying to reflect is
our actual experience
in the area that is
particularly clear to us as
probation.
We trying to keep a 1 to 30
case load to make sure the
over sight is very intense.
Corrections is a little bit
more difficult because
we're changing the nature of
our collection system.
Previously, we rarely had
people here only a year.
We have to look at how we're
going to manage that
change in the geopopulation.
>> is it fair to say we're
extrapolating growth based
on our immediate past
experience, which only been
about 6
offer 8 months?
In the formula over all seems
to be a doubling of
resources?
sounds like there's nuances in
each unit?
>> their ramping up as we see
more individuals coming
out of state prison, we become
more responsible for in terms
of parole/probation.
We also seeing increase in the
number of individuals
coming into our local jail
system.
these are known the 117hs that
would have gone to
state prison.
You end up with this increase
and then people start to
be released and you end up with
sort of a plateau effect.
We have projections from the
state in terms of the
numbers of people we're getting
out of the state prison
system that would have normally
gone to state parole.
we know the individual that are
being sentenced.
I'm getting more detail here.
There's changes in the way
inmates are sentenced. Some
are sentenced without any
probation and some are split
sentences.
we have to take all of those
factors into account to
determine what's the
appropriate level.
We have the spillover in terms
of custody health as
more people are sicker and
trying to manage all of that in
terms of how we're allocating
our resources.
The other focus is making sure
these people have the
services that they need to avoid
recidivating
>> that's been a helpful
overview.
I heard bits and pieces
depending on who office I was
sitting on.
I understand all that was put
together by the teams
that have been working on this
and you brought it back down
unit by unit.
The board of supervisors
ultimate question is, having
done that, you then match those
unit numbers up with the
revenue.
I don't want to call it new
money.
There's in general fund
encroachment.
I don't what keep asking that
question.
That's what I'm really after
here.
I need it understand the
process, any time we see these
ab109 ft es ramping up, that's
going to come from the unit
of that state.
It's a wash.
>> the dollars allocated for
the ab109 expenses are
100% coming from the state.
we tie them directly.
There's no discretionary
general fund impact.
So far.
>> thank you very much.
That was one of the concerns
that part $15 billion
balancing act might pull the
rug out from under us.
I appreciate the explanation.
I was just worried that these
fte May not have been
unit by unit balance against
the revenue.
If I was in the unit, I would
say this is what I need.
>> we're really managing the
funding allocations from
the county executive's office
working closely with the ccp.
The thing that is really
interesting is that -- one of
the things we will be talking
about is that the preliminary
formula or funding allocation
looks like it's going to
allocate more than we assumed.
Recognizing the concerns that
everyone rightly has with
the state deficit increasing, I
think it's going to give us
an opportunity to reserve
significant portion and hold it
until we have more confidence
that those allocations are
going to be stable.
Of course, one of the issues is
going to be what
happens in November.
There is a funding guarantee
that will be on the ballot
for the ab109, the public
safety realignment.
>> we'll talk more about that
on thursday.
Supervisor wassermann.
>> very quickly, I really
appreciate the point
supervisor cortese brought up.
President Shirakawa you made
about the rug coming out
from under us.
the reason if hasn't happened,
they jumped to three
days ago.
The question I had was on page
four, talking about
custody health services
highlight to fiscal year '12.
it talks about two out of three
inmate receive medical
services daily.
That's an astounding number to
me.
I learn more every single day
while I'm in office.
With the transitions taking
place with those being
transferred from the state to
county, I imagine it's about
the same.
because of the nature of the
individuals that were the
state prison, I understand
there's severity seriousness of
crimes committed are the
make-up the prisoners?
I think it changes over time.
will the medical needs increase
greater still with
those being transferred over?
>> let me make a point of
clarification, the inmate who
within the jail system, the
ab109 inmates, we are familiar
with them because they've been
incarcerated and gone through
trial and they are sentenced.
we believe in providing care to
them.
They now just in a new bucket.
Now they are ab109 inmay notes.
The inmates from the prison
system who being released
from the prison, we do not
provide services to them within
the jail.
>> they're all probationary?
>> yes.
We would establish primary
clinic center. We would
have the doors open to them.
>> thank you for that
clarification.
>> with respect do we
anticipate that the healthcare
needs essentially going to
change this population, we do.
In the past, although many May
stay with us many years
while they going through their
trial, generally, period of
time within the jail maybe 150
average length of stay.
we didn't necessarily need to
provide services.
For instance someone had a
minor hernia, we would not
support having that hernia
repaired while they were in
custody.
It would be taken care when
they were released.
Now that they are going to be
sentenced to the jail, we
need to provide those services
for them.
In fact, we need to provide
preventive healthcare
services because they are going
to be with us year after
year.
We do anticipate there will be
very significant
changes.
>> I like to expand on that a
little bit.
it is also true that the
inmates who classically are in
prison or has been in prison
tend to be less healthy than
what has classically been in
jail.
That has to do with a lot of
factors but when you
figure that the vast majority
of the crimes that are
committed that result in people
being in jail are drug
related and violence related
and people typically also
taking their own drugs.
We are much more able to keep
people alive for longer
periods of time.
lots of people with chronic
heart disease, chronic lung
disease, chronic kidney
disease, diabetes, all kinds of
other issues infection, tb, hiv
and various sort of things.
As maryann brings out, now that
we're going to be
responsible for these people
for a longer period of time,
we're going to be responsible
for things like transplants,
dialysis, lots of very
expensive procedures.
>> you're saying they let
health insurance lapse?
>> we don't --
>> I'm kidding.
>> the question you are getting
at, they're going to
get more extensive and the
answer is question yes, lot
more.
>> I wanted to ask board of
supervisors so extend
services to juvenile hall.
They get visit one day a week.
With 60% of the kids, have
serious dental issues.
It was also noted in the last
juvenile justice report
several grievances were filed
by you because dental payments
were delayed.
We all know how much dental
pain interferes with your
ability to learn and behave.
I know san diego is a much
larger system but they have
two full time dentist.
We need to figure out how to do
this because these kids
-- they have so many issues
with them.
Thank you.
>> any other questions on this
unit?
i see none, thank you.
next unit is 417.
>> good afternoon President And
board members.
I'm bruce copeley.
I'm here to review our
recommended budget.
I would draw your attention to
two elements.
the first is a recommendation
for authorization for
$311,000 for two psychiatric
social workers and a
replacement of dollars lost for
half time psychiatric social
worker.
These are individuals that are
working at the park and
adopted at the clinic to
provide additional medical
services.
They will be providing
screenings, consultation to the
primary care doctors and
treatment.
The second is $401,000 that is
for augmentation and
enrollment of clients into the
valley care.
These are fees previously
collected both from the
county department as well as
from our contract agencies.
With enrollment of valley care
that is eliminated to
continue the capacity necessary
to serve these individuals
and to bring in enrollment in
anticipation medi-cal
qualification.
We're recommending these
dollars be added.
The final good news is,
approximately $2 million of
additional 109 moneys that are
recommended to be brought
into the department to stand
both outpatient services and
residential services.
currently we have a waiting
list from ab109.
It will substantially reduce
that waiting list and
allow us to serve the
individuals that are now coming
for
into ab109 process.
With that I'll take any
questions or clarifications you
would like from me.
>> let me just start by saying
thank you.
Last year we talked about the
gateway program.
We all know people are ready to
make that change and so
appreciate that effort.
You mentioned the $2 million.
Hopefully it will free up this
$2 million more services
for others.
That's a good thing.
Supervisor wassermann?
>> just a quick question, one
way or another, how long
have you been with the county?
>> 24 years in another month.
14 years with dad and 10 years
with mental health.
>> it's probably a good time to
think about, I know
folks have talked previewed
some kind of behavior health
department from a dads merger.
I know others out there talked
about it.
I'm just throwing that out
there as a comment.
>> I know that the issue has
been discussed.
I just met this morning with
bruce.
He's getting up to speed.
We're looking at all of our
options at to point and
pluses and minuses to no matter
what you do and nothing will
be done without stakeholderrer
input.
>> it doesn't hurt to have the
discussion for sure.
That's all I'm saying.
>> I understand.
>> I don't have any other
lights on thank you.
We'll move on to the next
section, unit 418, community
health services.
>> dave wright, directors of
ambulatory care services.
Our community health services
is composed of two
community health clinics.
They also receive the unit and
diversity award by the
board of supervisors.
our tb clinic and refugee
clinic, they have the liest
numbers coming from iran,
burma, iraq and china.
No budget changes are proposed
for fy '13.
>> I don't have any lights on.
You're off the hook.
Good job dave.
Item 12, unit 725.
valley health plan.
>> hello.
Greg price.
Valley health plan has a
commercial plan.
We had a very successful year
this year.
We approach being 15,000
commercial members.
We also manage medi-cal,
healthy kids healthy families
for valley medical center.
We're getting on to about
90,000 new lives and we're
forecasting about 184 million
next year in revenue.
All of our positions for fy '12
were paid for.
We're in the asking for any new
money.
any questions about the budget?
>> I don't have any lights.
No, thank you.
>> always a pleasure.
Thanks.
>> we still --
>> we should mention at health
and hospital committee,
we discussed all of these.
>> as a case with all the
sections and committees
either have or will have
detailed discussions.
Thank you.
Supervisor wassermann.
>> I want to mention that it's
a pleasure spending
hours going over these binders
with staff and discussing and
at the end hearing no new
changes, status quo that kind
of
thing.
Think you're all doing great
work.
>> thank you.
Item 410.
>> we'll start by going through
our highlights for the
year.
Really a huge thanks to our
board of supervisors for
being progressive in adopting a
number of health related
policies. Just a quick
refresher over this list.
We adopted a comprehensive food
and nutritional
policies which a lot of folks
worked on.
Both the city and county passed
a number of outdoor
smoke prevention policy
including tobacco retail
licensing.
We're in the line of to do the
latino health assessment
in the fall of 2012.
The vietnamese community it in
the bay area and become
state and nationally recognized.
as you will recall this time
ast year, we were talking
about a potential new vendor
for our ems system.
I'm pleased metro has been
performing good or better
than prior vendor.
The response time is slightly
better.
All in all slight improvement
in the system and kept
the system affordable.
now budget highlights.
Much like my other colleagues
our budget is essentially
level budget for this next
fiscal year.
No additional county general
fund augmentation request.
I will quickly run you through
where we're moving some
money.
we're moving essentially
$247,000 from federal fund.
I will start with accreditation.
As I mentioned before,
accreditation is a additional
public health effort.
We're going to be moving about
$95,000 into that
particular effort.
The latino health assessment
actually will cost us
around $250,000 to $300,000.
we need to move additional
$75,000 essentially out of
the administration in other
areas and back fill that.
Incidentally, we went out for
bids to do the community
neighborhood assessment for the
latino health assessment.
We got quotes as high as a
million dollars.
The fact that we're actually
able to deliver hopefully,
deliver an assessment during
financial health week, it's
quite an accomplishment for the
amount of money we're
working with.
We like to propose to move about
$30,000 into help
promotion media.
we were fortunate to have a
full time position.
We don't have a single dollar
behind her code this is
to recognize a small amount of
money for that type of work.
Public health preparedded, is
an interesting idea.
We never had any dedicated
staff.
This amount money coming from
internal resources which
fund a half time code.
We'd initially hope to work
with oes and faf to fund a
full time position and we could
have contributed half of
that.
We were not able to do this in
this budget cycle.
we have roughly $4 million in
inventory in the
warehouse.
By the time full lease payment
will be made, the county
well invested well over $10
million.
This particular code and the
reason I'm talking a
little bit more about this one,
is that this would be the
one and only individual
dedicated to nation sure that
warehouse is on a ready-go
status at all time.
It's able to both receive and
deploy goods in rain out
of the warehouse in a disaster
situation.
The next item is interesting
one immunization clinic
staffing.
We have 1.5 vacant codes in
that particular code and we
will be adding 1.5 1.5 vacant
code.
We're going to be deleting a
vacant office specialist
and a vacant clinical nurse and
adding a full time office
specialist specializing in data
entry.
Then the childhood led poison
program, we are losing a
state grant of just under
$94,000.
Therefore we're going to let
go of a vacant position.
This is cleanup from last
budget year.
We had lost grant last budget
cycle.
This is actually a cleanup that
is to say that the
services have not been provided
for the full fiscal year.
The child, health and
disability prevention, we're
going to be deleting a vacant
public health nurse three
code.
That's due to the fact we're
losing $110,000 state
grant.
That particular line item
allows us to move $22,000 to
general fund.
we ask pharmacy to be very
aggressive on object two
cost.
Really bringing down the cost
of pharmaceuticals, we're
able to move about $2000 of
what's county general fund.
Any questions?
>> supervisor kniss?
>> just some comments and a
couple questions.
One of the thing I like to call
out is that with all of
our employees, we happen to
work particularly closely with
dan peddycord.
We came to me the other night
with comprehensive plan.
it was a challenging meeting.
He handled it well.
I want to call out that also on
a national level, we
have nose who play a major role
and dan you're one of those.
That would lead me into talking
about the prevention
fund which is part of the aca.
One that naco and c-sac worked
hard to protect.
I had the health steering
committee for naco.
that is one of our top
priorities.
The reason that's so important
that is where we have
applied some time grants do
come from other places. That
is
place where we can get grants.
That is where some money can
come in for just the kind
of thing we talk about, led
poisoning and so forth.
There are issues that are
looking for thousands of
dollars and not for millions.
They make a big difference in
counties.
It is a fund that is constantly
in jeopardy that
congress looks at it like it's
a flush fund.
Prevention doesn't have any
great payback as far as
they are concerned.
It's a lot easier also if we
put money into acute care
and than it is to put into
expression.
It's one of areas public health
keeps working hard.
Marty is part of the national
group as well.
I just want to say out loud
both marty and for dan, i
so appreciate your service
because we do get heard around
the country.
We are recognized being a
county that really does do
excellent work in the
healthcare field.
>> thank you very much
supervisor kniss.
By 2014 that fund is suppose to
be about $2 billion on
a national level.
It represents the first time
the federal government put
some real financial backbone
into prevention.
We were the fortunate
recipients through the
community
prevention work money for
obesity that is reflected this
that fund.
Those funds seeming to come to
an end here in our
county.
>> thank you having said that,
we have a couple
questions.
We just talked about emergency
warehouse position.
Do we have any other department
in the county that has
any role in that warehouse?
i only visited it once.
>> we have a small presence
there.
The sheriff's office has a
small presence there.
We try to work with those
partners to fill out the
other half of the fte that full
time code was justified for
the amount of assets in that
warehouse.
they were not able to fund that
particular request.
Our proposal was to go forward
at least with the half
time code.
>> thank you, I appreciate that.
The other one regards the
ongoing money for the phd
accreditation, prep and
application.
Does it need to be ongoing
situation?
is that one to be a downside to
one time money?
>> we're looking at that level
of commitment on ongoing
basis.
Once we reached point of
applying, we will need to send
in about $55,000 check. This
that's good for five years.
However, most department of our
size are looking a the
staffing 1-3 fte full time
dedicated accreditation.
What accreditation is
instilling high level of
quality
insurance performance
improvement across an entire
organization.
That takes small investment of
human resources.
>> so, I guess my question
would be, because once we've
gotten into ongoing, we tend to
not look at it again as you
know.
You feel that's justified and
something that we should
include over the next several
years?
>> yes, I would very much
supervisor kniss.
We are moving other fte within
the department to back
our resource need.
Rather than coming to you and
asking for a financial
augmentation for fte, we felt
$95,000 if it stays relatively
level should afford reasonable
level of resource to sustain
journey to accreditation.
>> okay, thanks.
>> besides supervisor the
president announced on the
state of the county.
>> you know, george, you said
it.
It's got to be true.
>> dan, just a couple things.
When it comes to trauma and
violence and injury and all
of those issues, you guys are
the experts I'm not.
I can tell you, you come from a
community of me -- I
don't need to study, I don't
need experts tell us the impact
it has.
we all know the impact of those
-- obviously smoking
thing.
Interinterrelated.
I want to thank you for your
work and I know the
committee will continue to have
discussions.
I think it was a one man
discussion last time.
I appreciate your efforts for
sure and you can expect
memo from supervisor kniss and
I here shortly.
Certainly finding someone to
help coordinate some of
those efforts.
I just want to say that and
thank you at this time and
of course, some of the staff
offline will ask you a few
things to bring back in the
future.
Anything else on this item
before the board?
See none, thank you again.
we're down to our last, before
we recess, last unit,
412, mental health department.
i see Dr. Pena making a way up.
>> good afternoon.
President Shirakawa and board
of supervisors, nancy
pena, mental health director.
I am going to briefly talk
about our highlights from
this past year.
We've been extremely busy.
Thanks to really the support of
the full board, mental
health has been extremely busy
and a very happy with our
activities.
School link services
initiative, we are getting for
the
launch in fiscal year '13.
Our older adult summit is also
creating some
implementation planning that we
will also bring forward as
we go into the next year.
Certainly our partnership with
ab109 and the ccp and
all of the county departments
that are participating in that
has been extremely rewarding
and we really look forward to
the next year as we go forward.
then as we do continue our work
with the mental health
services act and our interface
with various innovations
projects as well as
partnership, we're extremely
busy right
now.
One of the things I did want to
note that isn't on the
slides, it relates to the
mental health services acts.
This is an item that will be
coming forward to the
board.
Probably in August once you
return from the break.
That's just because the timing
for the mental health
services act annual report and
30 day posting that to the
public and then the hearing
that we have to have through
our
mental health board won't
happen until July probably.
That means that we now have to
come forward to you with
our full plan for the mental
health services act in August.
There will be some items on
there that we will be
requesting in terms of ftes or
funding for programs that
you will see at that time.
I just wanted to make sure that
are aware of that.
We are expecting with mental
health services act to
have about a 20% increase for
fiscal year '13.
That will pretty much pay for
most of the items that we
have funded with one time funds.
we'll be bringing that forward
and our budget for the
mental health services act next
year will be approximately
$53 million.
So it's a significant amount in
the mental health
department.
Going on to the items that we
have.
The first item should be in the
emerging issues.
We are exploring the
possibility of operating our
emergency site services as a
separate distinct stabilization
program.
You can operate these programs,
these emergency psychs
in two different ways.
one is attached to a hospitals
a an psych er the other
one is a free standing crisis
stabilization service.
Both of them would be locked
and contained and pretty
much in compliance with title 9.
We are really in the
exploratory phases.
we determine whether or not we
will be feasible.
If it is feasible, we will come
back to you later in
the fall with a proposal.
I wanted to make sure people
are seeing that we are
operating off the vmc license.
That is in the next fiscal
year, we'll be coming
forward with some plan about
that or at least some reports
on it.
The second item relates to
changes in the lives relates
to special education.
As aware the responsibility
that the mental health
department had and the counties
had has changed this fiscal
year.
This fiscal year '12 to fiscal
year '13 when the
schools will be solely
responsible for providing iep
related
service.
We will continue to be involved
as medi-cal
beneficiaries are served
through the health system he
will
no longer be the administrator
of the program.
Basically what this item, we're
downsizing somewhat the
budget that we have dedicated
to that in general fund.
Actually what we gend to do is
redirect equivalent
amount of two schooling
services to help support our
new
schooling services effort.
The next item really relates,
we talked to you about
this a little bit in this
fiscal year, programs were
transferred from dads to mental
health.
for the calworks treatment
services. This basically
moving the three administrative
staff who are connected to
those services from dads into
the mental health department.
The next item really is a no
cost item but it does
relate to priority of the board
and certainly the county
exec that we take a look at the
high users in our county
across departmentally.
Particularly those who are
homeless and chronically
homeless as well as those who
are involved in the criminal
justice system and the health
system.
Those we consider most frequent
users.
And really looking at
assessment of that population
to
see what we can do improve the
services that we offer as a
safety net for these
populations.
We also had some grant
terminations ending of grants.
we are picking those up in our
medi-cal program or
lihp, low income program.
We do have 4.5ftes that we
requested through the ab
ab109 program.
We also have a proposal here
that really is done in
collaboration with dads
regarding the low income health
plan
and our continuing to move
towards an expanded medi-cal
program and benefits beginning
in 2014.
In will add some qi staff and
health services
representative staff to mental
health that will be dedicated
to dads.
for the development more of a
managed care
infrastructure, getting ready
for the future when there will
be more individuals with
medi-cal benefit who will be
entitled to substance abuse
treatment as well as mental
health benefits.
Finally, the last item is three
contract staff.
These would all be be paid
through funding.
We came to you earlier through
the mental health
hospital for these positions.
These positions are desperately
needed a we move into
really processing close to 500
either contract, rfps,
mous we expect many for coming
with school link services
as we enter into agreements and
our provides across the
county to articulate services
that we'll be delivering.
These three staff are basic in
our contract units to
support the contracting process.
With that, I will welcome any
questions.
>> any questions.
I have one speaker.
sparky, good afternoon.
>> good afternoon.
I wasn't sure if this belonged
to you but it has to do
with my concern with rap
services.
the reduction of services that
emq and rebecca would
have.
If you've going to change
providers, that's fine with
me but I'm really concerned as
you're putting this stuff out
to bid, how you're going to
transfer clients over?
I know when I lost a grant that
we had for 25 years
with iop independent living
program, the kids were suppose
to transfer over and they did
not.
Because it was so tied to
provider, they really did not
want to transfer over to a new
provider.
Even though we tried really
hard to do that.
So my concern is that you
really look at how those
clients are going to transfer
over sense they are most
serious mentally ill clients
and look attrition fund to give
them time to transition out of
emq.
Another thought I have is
something I know county
department, how about
encouraging new providers to
hire
those people that will be laid
off.
I can tell you right now what's
happening.
there's a lot of movement in
nonprofit sector with
everybody is changing jobs.
We're all getting new contracts.
We're all hiring each other
staff.
>> any questions from the board
before we recess to
6:30?
Jeff?
Members of the boards, we will
recess until 6:30
exactly.
>> we have our hands full at
this time we do not have the
financial expertise to handle
these tasks at this time.
Nor do we feel that the cross
training is sustainable in the
long run.
And this will also relate to
policies and procedures for the
tasks.
Thank you for your time, only
financial experts can provide
financial expertise.
>> thank you.
>> I am brett russell, and an
am state administrator, and I
have been worked in the office
for 25 years and came in as an
entry level position.
I have worked myself up to the
state administrator position.
I was hired shortly after the
grand injury admin strargz that
held for the model was
insufficient to protect our
clients and the county
incompetence and waste.
>> good evening.
So first highlights from fiscal
year 12.
We have increased hours of
service at valley health center.
we have reduced our diversion
hours by 60%.
Meaning that we are open to
more ambulances arriving
serving our community.
We achieved our disrepresent
milestones for the year, and
collecting all revenue we could.
And we have begun installation
of the electronic record and
scheduled to go live on that.
We have formed a partnership
for fciu to help in health care
reform.
We have seen increase in
satisfaction over the last
three quarters.
And finally credited by the
american college surgeons for
burn care.
Those are the highlights of our
current fiscal year.
We have 15 budget proposals for
next fiscal year.
We started with a deficit of 84
million, once we based our
revenue and the experience of
the current fiscal year.
The item that genders the most
conversation is the clinic care
volume.
Some comments about where we
are with that in this year.
The projection for next fiscal
year is a 15% -- 14% drop from
the kurpt -- current year.
we believe this is an
achievable number.
This is a sustainable number.
We reduced our unused
appointment slots.
We have in our current clinic
scheduling system the capacity
to achieve this number.
and it's managed to fill every
appointment slot.
Which we have many strategies
to do.
The inpatient volume increase
is a result of down stream
revenue from increased primary
care volume.
And increase enrollment in our
low-income health plan that is
a later budget proposal.
It's simply a calculation.
Revenue cycle redesign.
We have four strategies to
bring in that additional $21
million.
And as the board is aware that
we brought in revenue
collection.
we are renegotiating some of
our surance -- insurance
contracts and working on
collections of lab and dialysis
centers.
Reduction of vacant positions,
these are positions that are
not currently filled.
that we don't intend to fill,
for which we are not use are
over time or extra help to get
the work done and believe we
can do without those 33
positions.
icpp-10 was delayed by cms by
one year.
But for the preparation of
implementation, we will have
some costs in the next fiscal
year, approximately 2.8 million.
Our core project for the
medical record, we figure
that's about 68 million, and I
believe that jeff covered that
earlier in the budget.
Covered by technology.
Is that correct?
Okay.
The cms incentive program.
As I mentioned earlier, one of
our highlights this fiscal year
is that we achieved all of
those revenues and goals as
required in that program.
We went back and looked at the
possibility for next year.
And we believe there is an
additional $5 million we can go
after and achieve.
our managed care contract this
is a renegotiation between
santa clara health care.
We have a different way of
calculating valley health plan
with transferring risk over to
them that dmc has had in the
past.
But had no control of that risk.
So this is more of an
accounting transaction to move
the revenue and expense to the
appropriate place in valley
health plan.
Cap conversion.
In the health plan, we started
the year with 8,000 enrollies.
And have a goal of 12,000
enrollies by the end of the
fiscal year, we are rapidly
approaching 10,000.
we believe this is achievable
to bump that enrollment up.
And our managed care contract
featured service.
A renegotiation of our future
service, santa clara health
plan contract.
and thal bring -- that will
bring an additional 7 million.
we are currently in
negotiations and we May be
reforced to reduce our
enicologists by 3.5 ftes.
The contract position budget,
in the past we used an outside
firm care and we brought our
physicians in and putting ftes
back in the budget and this is
cost neutral.
We have assistance in opening
the downtown location.
they did not get guarantee this
amount.
We are bringing this next area
in the custody health
discussion.
so questions?
>> with information about
gardener, I know at the hcc
meeting I asked questions and
didn't quite get clarification.
I knew we had given the 550,000
that we thought would cover the
expense.
but because they didn't get the
additional dollars.
Therefore we are covering it
and it wasn't covered by the
550,000?
>> I see that gary is reaching
for the microphone phone.
>> gardener's projection is
that in the first year of
operation, they require a
550,000 subsidy.
The second year of the
contract, they require a
$300,000 subsidy.
What happened here, we are
being a little conservative.
Because the original plan was
for gardener to open earlier.
So really what is happening,
right now we are hoping that
the downtown clinic will open
on June 1.
If we look at this on a
calendar basis.
Basically we are allocating
330,000 that is the amount for
2013 to 2014.
The timing is a little skewed.
But at this point in time the
expectation is that what we
were funding is a two-year
program effect.
And so the 550 is the first
year and 300 for the second
year.
over two years it's a title of
850,000 subdiddys are --
subsidy because they weren't
able to acquire the federal
funds.
>> but we anticipated that they
would and added that extra.
>> adding the 850,000, our hope
is that the amount they needed
to open -- operate on a
break-even basis.
And with the clients and
expenses results in a need for
a 550,000 requirement in the
first year.
And because of a ramping up and
seeing more clients, that
requirement will decline to
300,000.
Again this is based on forecast
and we will be working with
closely with them to see what
their needs are.
That at this point is what is
funded.
by allocating this 300,000, we
will have funded them for two
years.
>> and we are anticipating
gardener not receiving other
grants that they were expecting
and we would have to cover?
>> at this point this is the
maximum we expect to have to
fund.
>> okay, and also at our
meeting, I had asked a couple
of questions about the unused
appointment rate.
And maybe get a little more
understanding about that.
I know that the no-shows and
the unused appointment rate.
And maybe if you can talk a
little about both of those.
Where we have, I know we are
trying to increase the number
of patients that the dollars
-- doctors see.
And I assume that's the unused
appointment rate, trying to get
more patients in.
And making sure, in a way you
overbook, just in case you have
the no-show.
And can you talk about that.
and as we look at that and
reduce that, is that savings or
additional revenue and how that
will help the overall budget?
>> sure.
The unused appointment rate
that we used in the budget is
6.25%.
That's [Inaudible] Class is
zero.
There are physician practices
out there that fill every
appointment everyday.
And we get an unused
appointment rate daily.
and since we have studied
that, reduced our appointments.
And appointments go unused for
a variety of reasons.
we don't include the no-snow
-- no-show rate in the report.
That's a different piece of it.
An unused appointment is an
appointment where the patient
canceled in less than 24
hours and we weren't able to
fill that.
Or it's a case where the
patient demand wasn't there.
Or the appointments we had
availability for patient demand
didn't match the type that the
patient needed.
Maybe we had three return
appointment slots available.
And this was a new patient.
and we didn't have an
appointment slot for them that
day.
So there is a tremendous
science between managing of the
appointment schedule system so
every slot is filled.
What I can tell about the
budget, as compared to prior
years, this year's clinic
volume is based on what is in
the scheduling system.
We have a means electronically
and by schedule to achieve it.
And now it's as much about
massaging the types of
appointments.
And you know making sure that
there are very few unused
appointment slots on a daily
basis.
>> yeah, I know this is a one
part of a big puzzle we are
trying to work with, trying to
coordinate so many things in
the hospital that we haven't
been doing in the past.
And my congratulations to focus
in on that.
And because so much revenue May
be earned in addition, I am
glad that everyone is focusing
on that.
And trying to tweak that
schedule as ach -- as much as
they can.
>> thank you for the report.
on your first page of
highlights, I enjoyed seeing
that.
Second bullet from the end
talked about patients
increasing what would recommend
the facility to friends and
family.
A couple of weeks ago I saw
several graphs that recommend
them to noise at night and
cleanliness.
And not thrilled where it
showed that.
But I am thrilled improvement
of something, and when months
go by and when you have
measurements.
i would appreciate receiving a
copy of that.
And where we are with our peers.
I did this last year and I will
continue it this year, thank
you for taking a look at that
funded vacant positions, and
how necessary to keep them on
the books.
You eliminated 33 pots --
spots and that equated to 43
million.
Thank you for looking at that.
I don't know what the numbers
are, still in the 700 range of
funded vacant positions
throughout the county.
For a variety of reasons, some
are brand-new and summon --
someone leaves and retires.
But when a department head
takes a hot -- shot at this
and it's instant savings to the
country.
>> probably the fluctuating
to the department and this is
an hour by hour science that
goes on at the hospitals and
clinics.
>> siappreciate -- I
appreciate that and every bit
helpss and that's a big thing,
thank you for that.
>> thank you.
Supervisor kniss.
>> so I thought perhaps I would
get a lot less grandular, even
those are the things that made
enormous difference.
And I agree with ken asking
about the clinics and unfunded
positions.
Those are what make the
differences over the long run.
But jeff, because I talked
about this a little this
afternoon.
I thought maybe this time you
could restate this.
But I think in three years,
while we haven't solved the
problem, we have at least
identified it.
We have worked pretty
successfully I think with the
anm group that came in.
And so I want to talk a little
about what I think are some
really good strides we made.
And one might be far less
subsidy than we have done in
the past.
And another might be far more
attention to the numbers.
As I mentioned before, I get
the daily flash, I know what
the numbers are all over the
place.
Which really helps.
And you know, I think maybe you
could toot your horn for a
minute.
It wouldn't be all bad.
>> not my horn.
>> it's been a tough two years
to come in and make major
changes in the health care
system.
>> it's not my horn.
>> you can do gabrielle it is
or anyonacy, just a horn.
>> just like any other health
system in the nation, vmc was
faced with a total
transformation in a short
period of time.
Going from a system that relied
on med cal funding, that is one
way of funding a system, to a
system in the future that will
rely on performance payment.
and that's an enormous change
in infrastructure and cultural
approach.
It means a lot of changes.
And the team has done a
fabulous job in the last years.
Working towards that change.
It's very difficult
particularly at the same time
that they are preparing for
health care reform.
and dealing with lip and
medical expansion, everyone has
a lot on their plate at vmc and
health and hospital.
And it's true, that in the
past, we've removed little too
much from the administratorive
support.
people are running around from
one crisis to another at same
time they are planning a
long-term strategy.
It makes it difficult to do and
they have done an excellent job.
The clinicians and nurses and
doctors and technicians and
everyone continue to do very
high-quality work.
And they are very proud of the
work they do.
And our job and the systems job
is to get patients connected
with the clinicians.
In the riept time, in the right
place and the right level of
service and the right type of
care.
And we have proven that can be
done and we are doing a good
job of it.
That all being sides.
>> you still have a way to go.
>> we have a ways to go.
You don't change an
organization of this size in a
rapid period of time.
particularly when the risk of
rapid change is life and
welfare of patients.
You know, at any time it's
certainly the highest priority
to make sure that the patients
are safe and cared for
appropriately.
and so change is not super
rapid.
But it's happening.
And I am very proud of the team.
And they are doing a great job.
And individuals and the
employees in the health and
hospital system and the
hospital system are truly
committed to make sure they
provide the best care possible.
And they are all struggling
with change.
But they are doing a good job
of it.
>> I appreciate saying that.
Because I think going from one
system to another, as you said,
from the dish and the system
where money was really given to
us.
Without any measurable outcomes
required.
And that's a huge difference
now.
As measurable outcomes are
required.
And without them you will not
get your money.
And we will not get our money.
We will not be able to continue
to provide those services.
And the one thing you didn't
mention, jeff, the substantial
decrease in the amount of
essentially subsidy or general
fund money we are using.
It's down depending on how you
look at it.
Certainly 50% or more.
And that's making a big
difference as well.
I think it's important, you
know, we usually are saying far
more inquisittive types of
things, but it's good to hear
that we are making good
progress.
And that we are not only doing
that but paying great attention
to how that progress can be
made and reach those
measurements.
So far, so good.
Thanks.
>> thank you.
Any other supervisors?
I see none.
>> thank you, Mr. President.
>>> jeff, anything?
Okay.
Board we will recess until
tomorrow afternoon at 1:30.