Message From The Director
ACA – Repeal, Replace, Repair?
We are inundated daily with media reports on the future of the Affordable Care Act (ACA), also known as Obamacare. During his campaign, President Trump promised repeatedly to "repeal Obamacare." Immediately after taking office, he issued an executive order to federal agencies directing them to slow down or stop any implementation of the ACA. The real effects of this remain to be seen.
Congress is considering a variety of approaches involving Obamacare, including repealing it and replacing it now or in the future. The proposals that are being put forward generally modify or eliminate federal reforms, including the mandates for all to be insured, tax credits and federal funding for health coverage. If these proposals move forward, it will impact Covered California, which offers subsidies to purchase health insurance for low-income Californians. As of June 2016, more than 35,000 Contra Costa County residents were insured through Covered California. Covered California enrollees receive approximately $5 billion annually through federal tax subsidies.
Medi-Cal Expansion - Impact on CCHS
A very important part of the ACA was the expansion of Medicaid (known as Medi-Cal in California) to low-income adults. The Supreme Court made it optional for states to take advantage of this 100% federal funding and 33 states, including California, expanded Medicaid for their residents.
If this expansion is eliminated it will greatly impact Contra Costa Health Plan (CCHP), Contra Costa Regional Medical Center and Health Centers, and all of our community health center partners. In Contra Costa, approximately 72,000 people are enrolled in Medicaid expansion and this brings approximately $90 million in federal revenues to the County. CCHP manages the care of 55,000 of those enrolled and the rest are managed by Blue Cross or fee-for-service Medi-Cal. Needless to say, elimination of Medi-Cal expansion would create a huge deficit in State and County budgets. My hope is that public advocacy will preserve the important parts of the ACA, especially the Medicaid expansion. Governors in those states that have implemented Medicaid expansion are voicing opposition to eliminating it. In addition, a new proposal from U.S. Senators Susan Collins (R-Maine) and Bill Cassidy (R-Louisiana) would allow flexibility and the option for any state to:
- Continue implementation of the ACA
- Take the equivalent federal revenue and create a different insurance program or
- Take no federal revenue and not participate at all
We would obviously support this, since it would leave California's coverage programs intact. It remains to be seen which, if any, of the current proposals will move forward in the legislative process. It is not easy to repeal and then immediately replace a 900-plus-page bill.
State and County Budgets – no short-term reductions
Governor Jerry Brown has proposed a state budget for 2017-18 that does not involve any reduction in federal ACA funding. Our County is taking the same approach in developing our budget and we are not anticipating any reduction in our staff or services in the short-term. However, this has been a most unusual first few weeks for this new presidential administration and legislative session. I will keep you informed of any definite changes in plans.
In the meantime, we all need to concentrate on what we do best: providing compassionate care to those most vulnerable and threatened in our community. Thank you all for your service and commitment.
Going the Extra Mile:
These CCHS Employees are GEMs
Click here to find out how the people named below went the extra mile.
Jeannie De Tomasi
Jamie Pehling, MD
Maria Teresa Hernandez
Milagros Garcia, PHN
Dawn Dailey, PHN
Myhoang Nguyen, MD
All Concord Health Center LVN Panel Coordinators
Mary Jane Kiefer
Access to Social Media and Private Email Sites to be Blocked
To better protect patient health information and our networks from viruses, ransomware, and malware, the department will block access to social media and private email accounts from CCHS-owned systems starting March 1.
Web-based email accounts and social media sites pose a major security threat to patient data on health systems’ computer networks, according to Patrick Wilson, head of IT security for CCHS. Earlier this year, hackers seized control of Hollywood Presbyterian Medical Center’s electronic health record using ransomware sent to an employee’s web-based email, Patrick said. Hollywood Presbyterian eventually paid $17,000 to the hackers to regain control over its network.
When mobile cellular reception is unavailable, authorized staff can access their personal email accounts or social media using the CCHS_Employee wifi network. To get access to the employee wifi network, staff must file a User Access Form (UAF) on iSITE. Once approved by their manager, access will be granted.
Staff who need access to social media as part of their work duties will retain access to Facebook and other social media sites.
Gmail and other Google products, including Google Docs, won’t initially be blocked because the Family Medicine Residency Program relies on those platforms. IT will be working with the Residency to find alternatives in the near future.
For more information, contact Patrick Wilson at Patrick.Wilson@hsd.cccounty.us.
Electronic Health Record
Parents Can Now Submit Requests Online To Manage Their Kids’ myccLink Accounts
Parents with myccLink accounts can now submit requests online to access their children’s health information on the patient portal. Parents simply need to go to the family access settings on myccLink and fill out an online form. The request is reviewed and processed by the Health Information Management (HIM) unit within a few days. Once approved, parents can schedule well-child appointments, message their child’s doctor and print out immunization records for school. The option is available for parents with children ages 11 and under. Previously, parents had to fill out paperwork and submit it in person to HIM to review. This deterred many from signing up for family access privileges. Only about 325 people — less than 2% of all myccLink accounts — had been granted family access over the past two years. During the first week alone of the online signup feature being made available, 127 parents requested permission to manage their children’s online health record.
County Takes Action Over Odors at Composting Facility
A Richmond composting facility that has generated persistent odor complaints from surrounding neighborhoods must limit some waste it accepts until it provides a plan for improving its business practices to Environmental Health (CCEH).
West Contra Costa Sanitary Landfill has until March 1 to submit a plan to CCEH detailing how it will abate the community nuisance it causes, including plans to divert drop-off of green waste, food waste and compostable material if necessary.
CCEH issued a cease-and-desist order in January barring drop-off of waste at the landfill’s Organic Materials Processing Facility on Parr Boulevard after numerous inspections showed its waste management practices caused nuisance odors and increased fire danger.
After the initial action, CCEH has agreed to allow limited drop-off at the facility to prevent a public health hazard in the surrounding community, but will require that the mitigation plan include provisions for rerouting all incoming waste to prevent a future public nuisance.
Public agencies including CCEH received more than 400 community complaints about odors from the facility since September 2016, and inspectors have documented seven compost-pile fires there since 2012.
Supervisors Adopt Safe Drug Disposal Ordinance
The Contra Costa Board of Supervisors has adopted an ordinance requiring drug manufacturers to develop and fund a plan for collecting unwanted or unused prescription and non-prescription medicines.
The ordinance, adopted at the Dec. 20 board meeting, promotes product stewardship by requiring drug manufacturers to create safe disposal options for unwanted drugs, such as accessible drop-off sites in each of the five supervisorial districts, mail-back services and periodic drop-off events.
The Public Health Division will consult with affected manufacturers to ensure compliance, work with cities to encourage their participation and report back to the Board by summer.
Creating appropriate options for safe disposal of unwanted drugs is a much-needed prevention strategy to help prevent accidental overdose. Drug overdose is now the leading cause of accidental death for young and middle-aged adults, ahead of automobile accidents.
Removing unwanted drugs from the home is also an important safety measure for young children. About 2,800 of the 6,500 calls to the state Poison Control Center from Contra Costa County involved children younger than 5 who ingested prescription or non-prescription drugs, most commonly ibuprofen, acetaminophen, antihistamines or dextromethorphan, according to Public Health research.
Contra Costa CARES
Health Coverage Program for Uninsured Adult Residents Gets Positive Report
A recent report on Contra Costa CARES shows that of the 3,000 people enrolled in the primary care program for undocumented adults, 96% are Latino, almost all are working-age adults between the ages of 21 to 64, and more than half live in West County. Diabetes was identified as the leading chronic condition among enrollees.
The report, prepared by the Community Clinic Consortium and independent consultant Laura Hogan, said the demand for healthcare is high and Contra Costa CARES reached program capacity in June 16 — only a few months into its inception. The report noted that CARES patients receive significant levels of prevention and screening services that likely lead to increased early intervention and decrease missed work days.
The Board of Supervisors authorized a Contra Costa CARES pilot program in 2015 to cover primary care for uninsured residents who don’t qualify for Medi-Cal or Covered California. The primary care services occur at Lifelong, La Clinica de la Raza and Brighter Beginnings. Contra Costa Health Plan screens applicants to ensure they are not eligible for Medi-Cal, assigns them to a primary care medical home, tracks enrollment, reports monthly participant data, and notifies health centers when there is capacity for them to enroll from their waitlist.
The program has received financial support from the County, Kaiser, John Muir and Sutter Delta. CCHS Director Dr. William Walker recently announced continued financial support of the program to extend coverage for an additional year for up to 3,000 residents provided that private hospitals in the area will match his support. The hope is that the program will continue and grow to include more uninsured residents. Many of the residents enrolled have reported how this program has helped them.
A task force that included a diverse representation of stakeholders convened to identify sustainability strategies for the program and their recommendations will be shared with the Board of Supervisors in the spring. As a result, two workgroups were established to address access to specialty care for this population and to develop strategies to engage the business community in support of Contra Costa CARES.
Brentwood Health Center Expansion Finalized
Brentwood Health Center has expanded to add eight new exam rooms. The health center received licensing last month to provide medical services in the additional space. New providers are expected to begin work at the Brentwood Health Center in March and there are plans to also add more clinic hours, according to Clinic Service Manager Sujeeta Sukhu.
Free Yoga Classes in East County
Free weekly yoga classes for patients are now offered at our Pittsburg Health Center.
The classes, made available through financial support from the Contra Costa Regional Health Foundation, are held in the Cypress Room from 5:30 p.m. to 6:30 p.m. Wednesday nights. Patients can drop in the first Wednesday of each month without a referral from their medical provider. Participants are expected to complete at least 8 sessions.
The sessions are led by a yoga therapy instructor from the Niroga Institute. Dr. Michelle Wong, head of integrative medicine at Contra Costa Regional Medical Center & Health Centers, said the yoga classes are being offered as a therapy especially for people with chronic stress and chronic pain. The hope is to improve patients’ stress resilience, pain levels and functionality in daily life, and overall well-being, Dr. Wong said.
For more info, contact Dr. Wong at Michelle.Wong@hsd.cccounty.us.
Housing & Health
Martinez, Pleasant Hill Join New Homeless Outreach Effort
Martinez and Pleasant Hill will soon share an outreach team to connect with homeless residents through the Division of Health, Housing and Homeless Services’ (H3) new initiative to streamline county homeless services.
The cities approved plans in January to split the $110,000 cost of a two-person team to operate full time within their borders through the 2017-18 fiscal year. The team will join three other Coordinated Outreach, Referral and Engagement (CORE) teams managed by H3, which provide the service countywide.
CORE teams visit camps and other locations to connect clients to shelter, medical and mental health care, case managers, substance use disorder treatment and services, benefit counselors, housing and other services.
A 2016 count showed that about 1,100 Contra Costa residents were without shelter on any given night.
The teams are part of H3’s Coordinated Entry plan, funded in part through $1.2 million in grants from the U.S. Department of Housing and Urban Development.
Health, Housing and Homeless Services
H3 Conducts Annual Survey of Contra Costa's Homeless Population
More than 150 community volunteers, county staff and homeless service providers joined the Division of Health, Housing and Homeless Services (H3) on Jan. 26-27 for Contra Costa’s annual effort to document all residents who need housing.
Data from this effort help government agencies, service providers and community advocates develop effective local responses to homelessness, and are also a required part of the county’s requests for federal and state funding for homeless services.
Outreach teams conducted surveys at encampments, shelters, soup kitchens and other service providers.
The 2016 count documented 3,500 county residents as homeless or at imminent risk of losing housing. Contra Costa experienced a 26% decline since 2011 among the “literally homeless” – living on the street or in shelters – but in 2016 there was a 33% increase in in unsheltered residents in East County compared to 2015.
H3 expects to release detailed demographic data for the 2017 count this spring.
New Online Alternative to Calling the Help Desk
Last month our IT department launched a new online support service for CCHS staff that’s accessible through iSITE.
While staff can still call the Help Desk, the new system makes submitting a ticket through iSITE easier. The online alternative is especially handy when the Help Desk is busy or closed, said project manager Holly Osburn. Also, users will find FAQ's that may allow them to resolve the issue without even needing to log a ticket, Holly said.
To access the online IT support service, visit the iSITE home page and click the “IT Service Desk” link near the top of the page.
The new system, built by software vendor HEAT, is much more user friendly than the antiquated LANdesk system it replaced. The HEAT platform will be replacing our current Service Request system and User Access Forms in the coming months.
Recent Changes to Google Search Prevent Websites from Loading
A few months ago, Google began placing ads on the top of search results instead of to the right of them, as it had done in the past. Since CCHS’ website security settings prevent users from going to advertising sites, people who click on ad versions of the links can’t access the websites. To reach websites found using Google search, simply click on the most appropriate link that does not have the ad icon next to it.
Please contact the IT Help Desk at 925-957-7272 if you have technical issues.
Thanks to these employees who have given us long years of service:
Phyllis M. Lee, Francine Tinsley, Jo Elliff
Moung Choy Saeturn
George Julie Anne Parsons, Jennifer I. Tucker, Daniel J. Cremin, Denise M. Bishop, Rommye Qualls, Conrado J. Robles, Jr., Hela
Stephen R. Cohen, Janice Cobaleda-Kegler, Paula J. Williams, Renee Robles, Leslie G. David
Dag H. Richards, John K. Ojewole, Harrison G. Pace, Suzette A. Romero, Ellen V. Ruiz, Julie K. Weigel, Rosulo L. Donida II, Arlyn A. Enriquez, Olga, Esparza-Rojas, Leslie E. Gunsalus, Helen E. Kearns, Jason J. Pingol, Elizabeth (Betsy) O. Orme, Jacquelynne Winfield
Robert A. Freeman, Oscar A. Martinez, Francisca I McGuire, Lovie B. Oliver, Kathleen A. Sullivan, Michael E. Klekar, Marilou Stewart, Danilo F. Aguilar, Veronica I Vega-Curtis, Rocquel D. Levias, Louis J. Jumonville, Dudley R. Lumpkin, Jr., Cindy D. Phillips, Danielle N. Smith, Kathy Randolph, Venita G. Cowlah, Lanisha E. Russ, Monica R. Cam, Sharon M. Eddings, Ringo Patrice
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