LA Health Collaborative

Organizer’s Meeting 12 Minutes

LA Health Collaborative

Organizers’ Meeting 12 Minutes

June 16, 2005

L.A. Care Health Plan

I.  Welcome and Introductions

Yolanda Vera, Director of LA Health Action, welcomed everyone, asked them to introduce themselves and reviewed the agenda for the meeting.

II.  Activity and Workgroup Updates

A.  Geographic Focus on Long Beach and San Fernando Valley Chronic Disease Projects

Neelam Gupta, Assistant Director of LA Health Action, reported that staff from The California Endowment and LA Health Action is meeting with community groups in Long Beach and the San Fernando Valley this month. The purpose of the meetings is to discuss potential funding for projects that connect health systems and primary prevention to address adult heart disease, diabetes and obesity. It is anticipated that funding will be awarded by Fall 2005.

B.  Health-e-LA

Karen Elliot, Privacy Information Officer of L.A. Care Health Plan, reported on the progress of Health-e-LA, a coalition established to develop an infrastructure for multi-organizational electronic exchange of clinical health care information throughout the greater Los Angeles region (Attachment A). As the coalition does not have dedicated staffing and resources, it will initiate a planning process to develop a strategic focus. Established in 2004, the coalition launched its web site ( and several committees, including a Leadership Group, Technical, Clinical and Evaluation Workgroup, Funding Opportunities Workgroup and Membership Workgroup. Membership expanded, bringing new partners such as AARP into the group. Security and privacy issues are also being addressed.

C.  Web-based Resource Project

Neelam Gupta, Assistant Director of LA Health Action, reported that a vendor was selected to develop the LA Health Action web site: Center for Governmental Studies. The purpose of the web site is to provide information about emerging health issues and to be a repository for reports, data and information for LA County. The design process will include consideration of accessibility standards, as well as links to data sources such as the State.

To achieve the Data Committee’s long-term vision of creating a comprehensive information source, LA Health Action is considering a second phase to the web site. Meeting participants completed a survey to prioritize health indicators, which was distributed and collected (Attachment B). The results will be used to guide planning efforts for this second step.

D.  King/Drew Medical Center and TCE South LA Community Mobilization Grant

Linda McAuley, Interim COO of Navigant Consulting, reported that the following progress has taken place in the top six priorities identified for King/Drew Medical Center (KDMC):

·  Change Governance Structure: With the goal of making the governance structure a routine part of hospital management, the Hospital Advisory Board (HAB) was established. With ad hoc and formal committees, the HAB has met once and is an active, involved group.

·  Increase Quality of Patient Care: Seen as the top priority, Clinical Assistance Teams were established consisting of physicians and nurses. A dramatic drop in death rates has been achieved.

·  Provide High Performing Staff: Some progress has been achieved, with issues related to residency to be addressed.

·  Improve Staff Orientation and Education Structure: Weekly courses have been offered, and a monthly tracking system has been implemented.

·  Recruit and Retain Qualified Management: This has been a challenging area, especially regarding physicians and residents. They are developing creative incentives.

·  Improve Hospital Physical Plant and Environment. This has been a big hurdle, requiring additional financial support.

Questions were asked, with the following answers given:

·  Regarding whether the drop in mortality is influenced by the closure of the trauma center, mortality is measured as a percentage of admissions. Since the trauma center closed, admissions have increased. A 30 percent drop in mortality has occurred from January-May 2005.

·  Regarding quality improvement indicators being used, a large number are currently in place such as infection rates.

·  Regarding if a web site has updates on which departments are not operating, LA County DHS does have a web site that is not updated.

Sylvia Drew Ivie, Member of the KDMC HAB, reported that Tom Priselac, CEO of Cedars-Sinai Medical Center, joined the Drew University Board of Trustees. The HAB is off to a good start with active participation from the membership. The HAB recently lost Dr. Woody Meyers, as he is a candidate for the dual KDMC and Drew University position. Another member, Dr. Michael Drake, was appointed chancellor of UC Irvine. Kathy Ochoa, Member of the KDMC HAB, mentioned that assistance could be used to create a communication strategy

KDMC’s main issue is that there are not enough patients for residents to perform required procedures, especially in the pediatrics department. CHP has been pulled as a result of the loss of accreditation. It takes time to enter into agreements with other area hospitals, and this is a concern with the ACGME visit approaching. Lark Galloway Gilliam, Executive Director of Community Health Councils, was recently added to the Steering Committee on the Future of KDMC.

Tamara Moore, Program Associate of The California Endowment, reported the South LA Community Building grant to build lay community health leadership was awarded to Community Health Councils, in collaboration with Strategic Concepts in Organizing and Policy Education (SCOPE) and the Community Coalition for Substance Abuse Prevention and Treatment. Agencies invited to apply and more information is available in Attachment B.

III. Access to LA County ED and Trauma Care Services

Charlie Cosovich, Principal of Kurt Salmon Associates, and Shelley Oberlin, Consultant of Kurt Salmon Associates, presented on a California Health Care Foundation funded study on access to ED and trauma services in LA County (Attachments C and D).

Questions were asked, with the following answers given:

·  A question was asked regarding the exact problem this study was addressing and if any other analyses had been conducted regarding these issues. This study raises many interesting questions that require further research. Several communities in the eastern US have started freestanding ERs in suburbs hoping to attract a good patient mix. They are both ambulatory and walk-in. Efforts are underway to get legislation in California for freestanding ERs.

·  Regarding the reasoning behind not including Antelope Valley in the study, the problems with access in a rural area are different compared to an urban environment.

·  Regarding other successful regional planning efforts for ED systems, Dallas was not successful in their attempts. San Diego has started a safety net planning process.

·  The data sources will be shared with the group. Attachment E has the final report.

·  The designation of areas used in the study, along boundaries such as freeways, is useful for planning purposes, especially with respect to the area surrounding KDMC.

An article about the health system co-authored by Mr. Cosovich is provided as Attachment F. Courtesy of the National Immigration Law Center, CMS’s final guidance on reimbursement for emergency services provided to uninsured immigrants is provided as Attachment G.

IV.  Ambulatory Care: Lessons Learned from Public Private Partnership Program

Mandy Johnson, CEO of Community Clinic Association of Los Angeles County, shared information from a recently released policy paper regarding the Public Private Partnership (PPP) program (Attachments H and I).

A question was asked regarding the PPPs and care for depression. While chronic diseases and depression have become focus areas, there are challenges faced. Similar trends are appearing in other counties. In Alameda County, they have no racial and ethnic health disparities. The Bureau of Primary Health Care has data that shows community clinics are performing better than the private sector.

V.  Financing and Delivery: Medi-Cal Reform and Hospital Financing Restructuring

Gary Wells, Director of Finance of LA County DHS, and Andy Schneider, Principal of Medicaid Policy LLC, provided an update regarding Medi-Cal reform and the hospital refinancing waiver. The following attachments are included:

·  Attachment K, a letter which describing hospital financing restructuring concerns from the California Hospital Association, California Association of Public Hospitals and Health Systems, California Children’s Hospital Association, Private Essential Access to Community Hospitals and University of California;

·  Attachment L, a draft letter describing hospital financing restructuring concerns to Governor Schwarzenegger and Kim Belshé;

·  Attachment M, various handouts from Mr. Wells on hospital financing restructuring; and

·  Attachment N, a policy brief authored by Mr. Schneider for the California Budget Project regarding proposed Medicaid spending cuts.

Yolanda Vera mentioned that a small workgroup has been working on principles regarding the distribution of funds. If authorized by the State Legislature, LA County will be among the first counties to undergo conversion of the aged, blind and disabled population to managed care in January 2007. Regarding what may be done at this time, Mr. Schneider suggested examining the Massachusetts state waiver to learn how Certified Public Expenditures are generated.

III.  Adjournment

Ms. Vera announced that the next Select Committee Hearing on the LA County Health Crisis originally scheduled for this month is taking place July 15, 2005, place and time to be determined. The meeting was adjourned at approximately 4:00 p.m.