Business Plan 2004
HEALTH CARE AGENCY
2004 BUSINESS PLAN
TABLE OF CONTENTS
I. Executive Summary . . . . . . . 1
II . Mission and Goals . . . . .. .
5
Vision. . . . . . . . . . . . . . . . . . . . . 5
Mission. . . . . . . . . . . . . . . . . . . .
5
Values . . . . . . . . . . . . . .. . . . . . . 5
Goals and Business Strategies. . . ..6
Key Outcome Indicators . . . . . . . 8
III. Operational Plan . . . . . . . . 16
Clients. . . . . . . . . . . . . . . . . . . . . 16
Resources . . . . . . . . . . . . . . . . .
.18
Challenges. . . . . . . . . . . . . . . . . . 19
Strategies to Accomplish Goals . . 22
IV. Appendices
A -Health Care Agency 2004 Organizational Chart.
. . .. 26
B -Executive Management and Business Plan Team
. . . .27
C -HCA 2003 Business Plan Accomplishments . .
. . . . .28
D -Caseload/ Client Data . . . . . . . . . . . . . .
. . . . . . . . . .31
E -Labor Management Committee . . . . . . . .. . . .
. . . . .34
F -HCA Collaboratives . . . . . . . . . . . . . . .
. . . . . . . . . 36
March 2004
JULIETTE A. POULSON, RN, MN DIRECTOR
MAILING ADDRESS: 405 W. 5th STREET, ROOM 721
SANTA ANA, CA 92701
TELEPHONE: ( 714) 834-6254 FAX: ( 714) 834-3660
E-MAIL: jpoulson@ochca.com
I am pleased to present to you the Health Care
Agency’s Business Plan for Fiscal Year 2004 - 2005.
This plan is a reflection of our continued
commitment to share with the County and the
community the Agency’s past accomplishments and
future plans. It also discusses opportunities,
challenges and current health service issues.
The Business Plan is an important element of
Orange County’s strategy in serving the public. The
annual process provides us with the opportunity to
reflect on our mission and goals, develop strategies
and new initiatives to achieve those goals, and
measure our performance. It also provides an
important platform for detailed program planning,
and for employee goal setting.
The current fiscal year has been extraordinarily
challenging, requiring service reductions of $24.6
million impacting programs, and staff, across the
Agency. As we prepare strategically for the future,
it is very clear that funding for health care
services locally, regionally and nationally
continues to be extremely vulnerable. With the
support of the Board of Supervisors and the County
Executive Office, and with the commitment of the
Health Care Agency staff, we will
continue to closely examine how we conduct business,
and explore new ways of providing quality services
in the most efficient and effective way possible.
The Health Care Agency also continues to build
strategic partnerships with many community
organizations, working together for a “healthier
tomorrow.”
With warmest regards,
Juliette A. Poulson, RN, MN
Director
I. EXECUTIVE SUMMARY
The Health Care Agency (HCA) is a large and
dynamic public agency, comprised of 2,700 employees
who are responsible for providing a wide-range of
services to the Orange County community.
HCA's core services range from monitoring
communicable disease and water quality, to treating
those with mental illness or substance abuse
problems, to promoting healthy behaviors. The Agency
is highly proactive in building and maintaining
partnerships to ensure the highest quality
of life standards deserved by our residents.
Although the depth of ongoing fiscal difficulties
that face the Agency, the County and the State is
unclear at this time, the staff of the HCA remains
focused on the vision, mission, values, and goals of
the organization that the Agency has established.
HCA staff members remain committed to developing
strategies for the efficient and effective delivery
of core services to the community.
VISION:
Working Together for a Healthier Tomorrow
MISSION: We are dedicated to protecting and
promoting the optimal health of individuals,
families, and our diverse communities through:
Partnerships
Community Leadership
Assessment of Community Needs
Planning and Policy Development
Prevention and Education
Quality Services
VALUES:
Partnering with our clients and the community,
we value:
Excellence in all we do
Integrity in how we do it
Service with respect and dignity
The Agency's Vision and Mission provided the
framework for the development of four Agency Goals,
and two internal Business Strategies.
GOALS
1. Prevent disease and disability, and promote
healthy lifestyles.
2. Assure access to quality health care services.
3. Promote and ensure a healthful environment.
4. Recommend and implement health policy and
services based upon assessment of community health
needs.
BUSINESS STRATEGIES
5. Encourage excellence by ensuring a healthy
work environment that values employees.
6. Support the workforce through the effective use
of technological and other resources.
KEY OUTCOME INDICATORS
Although the Agency uses a multitude of measures
to assess performance, six indicators have been
selected that cross over several goals and directly
reflect our mission. These key performance
indicators include healthcare access for children,
chronic disease, injury, communicable disease, water
quality, and mental/behavioral health.
OPERATIONAL PLAN
This section describes our clients and our
resources, discusses challenges and methods for
overcoming barriers, and identifies the specific
strategies that will be undertaken during Fiscal
Year 2004–05 to further the Agency's vision, mission
and goals.
CLIENTS
While providing direct services to individual
clients or patients, the Health Care Agency's
primary focus is to protect and promote the health
and safety of the community as a whole. Therefore,
our ultimate client is the entire County population
as well as the millions who visit Orange County for
business or pleasure each year.
RESOURCES
The State's fiscal crisis, as well as local cost
pressures, has had major impacts on the Health Care
Agency, resulting in a total of $24.6 million in
program reductions in FY 2003-04. Significant
funding shortfalls continue into 2004-05,
potentially exacerbated by mid-fiscal year actions
such as the recent rollback of the Vehicle License
Fee (VLF) by Governor Schwarzenegger, but certainly
with the beginning of budget deliberations for FY
2004-05. Also, inequities in the statutory
allocation of Health and Mental Health Realignment
funding to counties is an ongoing concern; HCA is
participating in a coalition of under-equity
counties seeking legislative relief to redress this
historical funding disparity.
"Health program leaders estimate that they will
be $23 million short of maintaining current
services, including medical services for the poorest
county residents, mental health care, and programs
affecting children."-Orange County Register 6/25/03
CHALLENGES
We believe that we have crafted strategies for
FY 2004-05 that recognize current and projected
fiscal constraints; however, there are other ongoing
and potential challenges that may inhibit progress.
These challenges can be divided into three
categories: financial, regulatory, and workforce.
This section describes these challenges, and
identifies how the Agency is working to overcome
these barriers.
STRATEGIES TO ACCOMPLISH AGENCY GOALS
The Health Care Agency's 2004 Business Plan
contains 23 strategies that will be addressed during
the Fiscal Year 2004-05. The criteria for
identifying these selected strategies included
consistency with County and Agency strategic goals,
anticipated new funding or service mandates, and a
realistic assessment of available resources.
2003 ACCOMPLISHMENTS
During 2003, a majority of our Business Plan
strategies were accomplished in whole or in part and
significant progress was made on our key performance
indicators. Major accomplishments include:
1. Preventing Disease and Disability, and Promote
Healthy Lifestyles:
Training has occurred to familiarize key HCA
personnel with the Agency Operations Center (AOC)
where coordination of health emergencies or
disasters will occur. The California Health Alert
Network is being implemented providing an effective
means to notify Agency staff and other
health professionals in the community. Testing
procedures for key biological agents are available in
the recently completed bioterrorism containment
laboratory.
2. Assuring Access to Quality Healthcare Services:
Four clinicians are available to the community
to access behavioral health crisis response
services. A team has been established to provide
intensive mental health services to those
individuals who have frequent hospitalizations
and/or incarcerations due to behavioral health
problems. A specific program
for seniors with mental illness was established to
provide education regarding their mental illness and
offer interventions, with the goal of restoring
seniors to their highest possible level of
functioning.
3. Promoting and Ensuring a Healthful Environment: The
Agency Operations Center is fully equipped and
training has been provided which will enhance the
County's emergency response capabilities; the public
can access ocean water quality information through a
newly created web page.
4. Recommending and Implementing Health Policy and
Services Based upon Assessment of Community Health
Needs:
The Health Care Agency provided health related
data to the Ninth Annual Conditions of Children
Report and the Second Annual Report for the
Condition of Older Adults.
5. Creating a Working Environment that Encourages
Excellence: The Labor Management Committee has
provided updates to employees and established a
procedure for Team Excellence awards. The Health
Care Agency is in full compliance with the Health
Insurance Portability and Accountability Act (HIPAA)
privacy standards, as mandated by Federal Law. The
HCA has also accomplished all identified projects in
full compliance with the Americans with Disabilities
Act (ADA).
6. Supporting the Workforce through the Effective
Use of Technological and Other Resources:
Information Technology successfully implemented
the initial phases of the Integrated Records
Information System, more commonly referred to as
IRIS.
II. MISSION AND GOALS
The Health Care Agency completed a strategic
planning process in 2001 that led to a new vision,
mission, and goals, as well as a statement of core
values, strategic directions and key outcomes for
the next five years. These statements serve as the
Agency s foundation for setting priorities and
making decisions.
The 2004 Business Plan for the Health Care Agency
again deals with a challenging fiscal environment.
Yet in spite of the financial difficulties facing
the Agency and the County, we find that the Agency's
vision, mission, values, and goals continue to serve
us well in shaping strategies designed for the
efficient and effective delivery of core services to
the community.
Vision
Working Together for a Healthier Tomorrow
Mission
We are dedicated to protecting and promoting the
optimal health of individuals, families, and our
diverse communities through:
Partnerships
Community Leadership
Assessment of Community Needs
Planning and Policy Development
Prevention and Education
Quality Services
Values
Partnering with our clients and the community, we
value:
Excellence in all we do
Integrity in how we do it
Service with respect and dignity
HCA's goals describe how we will achieve our
vision and our mission – the value created, or the
desired improvement in a condition that is of direct
consequence to our clients and the public.
Employees' individual performance measures are, in
turn, based on the Agency's goals and strategic
directions.
Goals
Prevent disease and disability, and promote
healthy lifestyles.
Assure access to quality health care services.
Promote and ensure a healthful environment.
Recommend and implement health policy and services
based upon assessment of
community health needs.
HCA has also identified two internal business
strategies focused on our greatest asset, our
employees.
Business Strategies
Encourage excellence by ensuring a healthy work
environment that values employees.
Support the workforce through the effective use of
technological and other resources.
HCA Services and Community Benefits
The Health Care Agency is a regional provider,
charged with protecting and promoting individual,
family and community health through coordination of
public and private sector resources. HCA's service
environment is complex, with 180 different funding
sources and over 200 State and Federal mandates. The
mandates under which HCA operates require the County
to provide for, or to regulate, certain health
services. Many also carry specific requirements for
staffing, operations, claiming and record-keeping.
Many of HCA's services are preventive in nature and
therefore are not readily apparent to the public.
Some examples of services include food protection,
hazardous waste regulation, protection from
animal-related diseases, water quality monitoring
and pollution prevention, mental health services,
alcohol and drug abuse services, preventive health
services for the aging, healthcare for incarcerated
individuals, communicable disease control, child
health and disability program, immunizations, public
health field nursing and public health clinics.
HCA is composed of the following service areas:
Public Health Services - Monitors
the incidence of disease and injury in the community
and develops preventive strategies to maintain and
improve the health of the public.
Behavioral Health Services — Provides
a culturally-competent and client-centered system of
behavioral health services for all eligible county
residents in need of mental health care and/or
treatment for alcohol and other drug abuse.
Medical and Institutional Health Services
— Coordinates emergency medical care, provides
medical and behavioral health care to adults and
children in institutional settings, and contracts
essential medical services for patients for whom the
County is responsible.
Regulatory Health Services – Ensures
food safety, water quality and protects the public's
health and safety from harmful conditions in the
environment, from animal-related injury, and from
disease and nuisance hazards through the enforcement
of health and safety standards. Animal Care
Services, which provides services to over 19 cities,
is another component of Regulatory Health Services.
Public Administrator/Public Guardian –
The Public Administrator protects the assets and
manages the affairs of deceased residents of the
County who at the time of death left no known heirs,
no will, and no known or legally eligible executor.
The Public Guardian is a conservator for individuals
who are legally determined to be unable to care for
themselves, assuming responsibility for their
overall welfare including placement, medical and/or
mental health treatment, and asset management.
Financial and Administrative Services
– Promotes and provides for the fiscal and
operational integrity of the Agency through sound
management principles and practices, and provides
support services to Agency programs.
The Agency's current organizational chart can be
found in Appendix A. A listing of HCA's Executive
Team can be found in Appendix B.
HCA's Vision and Mission In Action – "Team
Excellence"
As an adjunct to the 2004 Business Plan process, the
HCA Labor Management Committee (LMC) surveyed HCA
employees for examples of "Team Excellence," to
exemplify the principles of LEAD and Enlightened
Leadership in collaborative activities. A total of
eight teams were nominated by members or colleagues.
The team chosen as best representing Team Excellence
will be announced in January, and will be honored at
an Employee Recognition event early next year. Other
nominees will be recognized in the HCA employee
newsletter, "What's Up," early in 2004.
KEY OUTCOME INDICATORS
The Health Care Agency utilizes a variety of
different indicators of performance to meet the
mandates of its funding sources and regulatory
agencies, and to ensure compliance with established
administrative and clinical best practices. The
annual Business Plan is one means by which we can
summarize our progress in reaching our goals. A
summary of how well the Agency did in accomplishing
its goals for 2003 is presented in Appendix C.
During 2001, as part of the Agency-wide strategic
planning process, a framework for performance
measurement was initiated. Although HCA will
continue to use a multitude of indicators to assess
our performance over the next five years, six
indicators have been selected that cross over
several goals and directly address our mission.
These key outcome indicators include indicators of
health care access for children, chronic disease and
injury, communicable disease and ocean water
quality.
It is important to note that the key outcome
indicators selected are reflective of the entire
health system, and not just of HCA's performance.
The following pages describe each indicator, its
importance, and how we are doing. The particular
goal(s) to which each key outcome indicator is
related are noted in the description.
"A person's health is not a deferrable expense,"
said John Davies,
president of the Health Care Council of Orange
County.
"Protecting our most vulnerable residents must be
the top priority for every civilized
society."-Los Angeles Times 6/25/03
Health Care Access for Children
What is the indicator? The number of children
in Orange County with health insurance, as indicated
by results of 2002 OC Health Needs Assessment (OCHNA),
and the number of eligible Orange County children
and youth enrolled in health insurance programs
including Medi-Cal, Healthy Families, California
Kids, Access for Infants and Mothers (AIM), and
Kaiser Permanente Cares for Kids health insurance
programs. These measures relate to HCA Goals 1, 2,
and 4.
Why is it important? Access to health care is
a priority. These programs provide health care
insurance coverage for children and youth in
low-income families. Individuals who are insured are
more likely to receive preventive services and
health care when needed resulting in improved health
outcomes. Monitoring the number of eligible children
and those enrolled in these programs enables us to
plan outreach and utilization strategies.
How are we doing? Progress has been made.
Results of the 2002 OCHNA community survey found a
23% reduction in the number of uninsured children
since 1998. Specifically, the percentage of children
without health insurance has declined from 12.7% in
1998 to 8.6% in 2001 (see table below). This
represents more than 20,000 fewer children without
coverage, leaving an estimated 69,000 children
without insurance. Next year's 2004 OCHNA survey
will hopefully show continued improvement.
OCHNA Survey Results
1998
2001
Percent of OC children with health insurance
87.3%
91.4%
Number of OC children with health insurance
704,566
799,790
The number of children enrolled in insurance
programs such as Medi-Cal, Healthy Families,
California Kids, Access for Infants & Mothers (AIM),
and Kaiser Permanente Cares for Kids continues to
expand. Since January 1999, the total number of
children enrolled in these programs nearly doubled,
from approximately 121,000 to almost 240,000 as of
June 2003.
Chronic Disease
What is the indicator? National Healthy
People 2010 (HP2010) focuses on deaths due to the
three leading causes of death in Orange County –
specifically cancer, heart disease, and
cerebrovascular disease (stroke). This indicator
relates to HCA Goals 1, 2, and 4.
Why is it important? Heart disease, cancer,
and stroke are the three leading causes of death of
Orange County residents, accounting for 63% of all
deaths in 2000, and over $1.5 billion annually in
hospital charges. It has been estimated that
effective preventive measures could reduce early
deaths due to such causes by 70%.
Hospitalization Rates and Charges
Orange County, 2000
Disease
Number of
Hospitalizations
Hospitalization Rate
per 100,000
Total Charges*
All Cancers
9,000
401.6
$ 401,007,040
Heart Disease
24,688
1,077.6
$ 877,507,477
Cerebrovascular Disease
6,890
286.9
$ 223,581,100
Total
40,578
$ 1,502,095,617
Some hospitals are not required to report
charges; hence not all charges are included.
Source: Office of Statewide Health Planning and
Development
How are we doing? Rates have improved. The
table below identifies 2000 and 2001 age-adjusted
death rates for Orange County and California (2000
only), as well as the goals established through the
Healthy People 2010 (HP2010) initiative coordinated
by the U.S. Department of Health and Human Services
(shaded area in table below).
The mortality rates for cancer, heart disease and
cerebrovascular disease have declined between 2000
and 2001 but are still higher than California's.
Over the next seven years continued preventive
efforts will be necessary to accomplish the HP2010
objectives for these diseases.
Health Status Indicator
Orange Co. Age-Adjusted Death Rate
2000
2001
Statewide Age-Adjusted Death Rate (2001)
National HP2010 Objective
All Cancers 179 178.3 173.4 159.9
Heart Disease 250.6 243.6 225.9 166.0
Cerebrovascular Disease 66 62.2 59.4 48.0
Source: State of California, Department of Health
Services, and Death Records.
State of California, Department of Finance,
2000-2001 Population: 1997-2040 Population
Projections, Dec. 1998
Age-adjusted rates are per 100,000 Year 2000
standard populations.
Communicable Disease
What is the indicator? The Healthy People
2010 indicators for tuberculosis (TB) are measured
by the annual incidence of new TB cases and
successful completion of treatment for both active
TB disease and latent TB infection. These indicators
relate to Goals 1, 2, 3, and 4.
Why is it important? Tuberculosis, though
treatable, is a serious public health concern.
Without treatment, as many as one in ten of the
estimated 300,000 persons in Orange County currently
infected with latent TB will eventually develop
active tuberculosis, a condition which may infect
others. Drug-resistant tuberculosis is a major
problem in many parts of the world and has emerged
in the U.S. as well. Failure to complete drug
therapy programs is one of the primary causes of
increased drug-resistant TB.
An important strategy in efforts to eliminate
tuberculosis is the treatment of latent infection,
which substantially reduces the risk of developing
active tuberculosis. Persons who are infected with
tuberculosis have roughly a 10% chance of developing
active tuberculosis disease during their lives. The
TB program annually treats approximately 6,000 of
the estimated 300,000 Orange County residents with
latent TB. Thus, an estimated 600 future cases of
active TB are prevented annually through this
approach.
Tuberculosis in Orange County
230 active TB cases
"Tip of the Iceberg "
300,000 persons with TB infection
Now 3 million people in Orange County
How are we doing? The rate of new cases
continues a downward trend, but the complexity of
cases increases. Orange County reported 230 cases of
tuberculosis in 2002. This was a decrease of 17%
below the 278 cases reported in 2001. Case reports
have declined 23% since 1998 when 298 cases were
reported; there has been an overall trend of
declining cases over the past 10 years, as can be
seen in the accompanying graph. Orange County TB
cases peaked in 1993 with 431 cases reported. Orange
County's 2002 TB case rate of 7.8 per 100,000
population is higher than the U.S. 2002 rate of 5.2,
but lower than the California rate of 9.0. These TB
case rates remain
significantly higher than the Healthy People 2010
objective of 1 case (1.0) per 100,000 population.
Homelessness, substance abuse, and drug-resistant
tuberculosis have resulted in increasing complexity
of cases and more dedicated staff time to provide
appropriate medical and psycho-social case
management.
Orange County TB Cases by Year of Report
1992-2002
Reported
411
431
368
336
273
330
298
246
246
278
230
1992 1993 1994 1995 1996 1997 1998 1999 2000 2001
2002
Trendline
Investigation of all active cases of tuberculosis
in order to prevent transmission of disease is a
high priority of the TB Control Program. More than
900 individuals were identified as contacts to the
179 persons diagnosed and treated for pulmonary TB
in 2002. Of those contacts identified with latent TB
infection and recommended for treatment, 73% were
started on treatment. The treatment completion rate
for contacts started on treatment in calendar year
2001 was 56%.
Communicable Disease
What is the indicator? The incidence of
Acquired Immunodeficiency Syndrome (AIDS), and
successful management of the disease using
anti-retroviral treatment for human immunodeficiency
virus (HIV) infection (the virus that causes AIDS),
as measured by: (a) annual rate of AIDS cases in
Orange County, (b) persons living with AIDS (PLWA),
and (c) the annual death rate due to AIDS. These
indicators relate to Goals 1, 2, 3, and 4.
Why is it important? HIV/AIDS is a serious
public health concern in Orange County, as it is
throughout the world. Unsafe sexual practices and
the sharing of needles by injection-drug users
continue to be the primary modes of transmission of
HIV in Orange County. Improved treatment regimens
have significantly slowed the progression of the
disease from initial infection to onset of AIDS, and
have dramatically increased the life expectancy (and
productive life) of persons living with AIDS (see
chart, below). Treatment and other service
requirements continue to evolve in response to these
dynamic changes in the population in need.
How are we doing? The rate of new cases of
AIDS continues to decline, as do the number of
deaths. The number of persons living with AIDS
continues to increase. As of December 2002, a total
of 6,216 Orange County resident AIDS cases had been
reported to the CDC. In 2002, 159 new cases were
diagnosed, a decrease of 17% below the 192 cases
diagnosed in 2001.
AIDS in Orange County 1980 – 2002
Deaths, New Cases and Prevalence by Year
' 80 ' 81 ' 82 ' 83 ' 84 ' 85 ' 86 ' 87 ' 88 ' 89
' 90 ' 91 ' 92 ' 93 ' 94 ' 95 ' 96 ' 97 ' 98 ' 99 '
00 ' 01 '02
PLWA
1 2 8 21 36 75 130 237 378 526 647 887 1,102
1,457 1,657 1,831 2,017 2,212 2,408 2,562 2,736
2,851 2,939
Note: New Cases by Diagnosis Year, Deaths by Year of
Occurrence
The year 2002 AIDS case rate was 9.1 per 100,000.
The California and U.S. rates for the same year were
12.4 and 14.8, respectively. These rates remain
significantly above the Healthy People 2010
objective of 1.0 per 100,000. As of December 2002,
an estimated 2,939 Orange County residents were
living with AIDS, more than double the number living
in 1993 (1,463). The number of persons living with
AIDS increased 3% between 2001 and 2002.
HIV infection became a reportable condition in
California as of July 2002, using a non-name code.
As with AIDS case reporting, health care providers
and laboratories are required to report individuals
with HIV infection to the health department within
seven calendar days. It is expected that HIV
reporting will provide better epidemiological data
for persons at all stages of the disease, define the
incidence rate and trends for HIV, and demonstrate
the impact that the epidemic has on
the health care system.
Ocean Water Quality
What is the indicator? The number of
beach-mile-days of closure resulting from sewage
spills or other contamination as indicated by
bacterial testing. This measure relates to HCA Goals
1, 3, and 4.
Why is it important? Improved ocean water
quality is a strategic initiative for the County of
Orange. The overall goal is to reduce and eliminate
environmental threats to community health that are
associated with unsafe ocean and recreational water
quality. HCA's Ocean Water Protection Program posts
warnings at shorelines and bay fronts when bacterial
levels exceed health standards, and closes ocean or
bay waters when an immediate health hazard is
identified. In addition to tracking total numbers of
closures, the program uses an additional measure,
closures in beach-mile-days, which provides a more
meaningful comparison of ocean water availability to
the public from year to year. This measure takes
into account the length of oceanfront closed, and
therefore provides a more refined indicator of the
severity of each closure. Ongoing water quality
efforts include projects to identify the sources of
bacteria and refine laboratory-testing procedures to
provide earlier notice of potential health hazards.
How are we doing? A continued, significant
reduction. Data are only available for the first
three quarters of the most recent year (2003),
therefore only the first three quarters of prior
years are shown. The total number of closures has
decreased by 16% between 2002 and 2003. Also, marked
improvement is shown by the decrease in number of
beach-mile-day closures from 2002 to 2003, down 43%
from a year ago and down nearly 87% from the peak
observed in 1999. This trend represents a
significant reduction in the overall impact of the
closures.
"In Orange County, water quality edged up because of
diversions of contaminated flows from storm drains
and other cleanup efforts." - OC Register 10/15/03
Water Closures
Beach-Mile-Days
120 100 80 60 40 20 0
1st-3rd Q's 1999
111.4
14
1st-3rd Q's 2000
49.6
33
1st-3rd Q's 2001
43.4
38
1st-3rd Q's 2002
24.9
25
1st-3rd Q's 2003
21
14.1
Violence and Unintentional Injury
What is the indicator? Healthy People 2010
(HP2010) tracks deaths due to unintentional
injuries, suicide, and homicide indexes. This
indicator relates to Goals 1, 2, 3 and 4.
Why is it important? Unintentional injuries
(e.g., motor vehicle crashes, firearms, falls,
drowning, suffocation, and fire) are the leading
cause of death for OC residents 1 to 34 years of
age. Motor vehicle crashes are the most common cause
of serious injury and death. While the rate is
relatively low depending on the age group, suicide
is the third or fourth leading cause of death among
persons 15 to 54 years of age in OC. Homicide is the
most reliable indicator of all violent crime and has
tremendous impact on persons and the community.
How are we doing? Ongoing, significant
reduction. The rate of preventable losses due to
unintentional injuries has declined over the past
decade and OC is near the HP2010 objective. OC has
already surpassed the HP2010 target objective for
motor vehicle accident deaths (7.5 vs. 9.2).
Similarly, the rate of suicide deaths has
systematically declined over the past decade and OC
is below rates for both the state, nation, and
approaching the HP2010 target.
Accidental & Suicide Death Rates
Rate (per 100,000 pop.)
40
30
20
10
Year 87 88 89 90 91 92 93 94 95 96 97 98 99 00
01
Unintentional Injuries
Suicides
Note: Since 1999 on, crude rates were calculated
using ICD-10 coding and are not 100% compatible with
previous years that relied on ICD-9 coding.
In 2000, the U.S. murder rate was the lowest in
35 years (5.5 per 100,000). Nevertheless, homicide
is among the top five causes of death for 15 to 54
year old OC residents. Moreover, homicide (in
addition to accidental deaths) is the leading cause
of death for 15 to 19 year olds. The overall
homicide rate for OC is below state and national
levels and remains below the HP2010 objective of 3
per 100,000 age-adjusted population.
Cause of Death Indicator
Orange County Age-Adjusted Death Rate 2000 2001
Statewide Age-Adjusted Death Rate (2001)
National HP2010 Objective
Unintentional injuries 21.7 23.6 27.4 17.5
Suicide 8.9 8.8 9.6 5.0
Homicide 2.2 2.8 6.6 3.0
Behavioral/Mental Health Clinical Status
What is the indicator? Clinical status
measures for both adults and children who receive
HCA Behavioral Health Services. These measures have
undergone modification since the previous Business
Plan – the State has discontinued these traditional
measures and the new guidelines have yet to be fully
implemented. Alternate key performance indicators
are available for a sample of clients, 1,922 adults
and 65 children. These indicators relate to HCA
Goals 1, 2, and 4.
Why is it important? HCA Behavioral Health
Services treats Orange County residents of all ages,
many of whom suffer from serious and debilitating
mental illnesses such as Major Depression, Bipolar
Disorder, Schizophrenia, and other mental health
disorders. Thus, it is imperative that these
populations of clients receive timely and
appropriate treatment.
How are we doing?
Adults -- Psychosocial functioning has improved.
Clients who were evaluated at least twice using the
Addiction Severity Index (ASI) in the past fiscal
year were examined. The clinical status and
functional level of the majority of adults showed
improvement along several psychosocial domains
including increased employment and improved
family/social relationships. Importantly, adult
clients also showed marked decreases in alcohol/drug
usage and improved psychiatric status following
behavioral health treatment.
Percent Improvement in Psychosocial Functioning
% Improvement
80
60
40
20
Medical
Employment
Alcohol Use
Drug Use
Legal
Relationships
Psychiatric
Children -- Psychosocial functioning has
improved. The Children's System of Care (CSOC)
program serves some of the most severely emotionally
and behaviorally disturbed children in the County.
This population is at risk for out of home
placement, which is very expensive to provide.
Children receiving services in the CSOC program
showed improvements in psychosocial functioning,
school attendance, and reduced out of home placement
costs by reuniting children with their families and
keeping them out of psychiatric facilities, group
homes, foster care, and/or jail. On average, this
program saved the County $36,000 per year for each
child served and resulted in improved functioning of
these children.
Percent Reduction in Needed Interventions
Days Hospitalized 74%
Placement Days 37%
Days In Custody 58%
Day Treatment 83%
III.
OPERATIONAL PLAN
CLIENT PROFILE
HCA's broad range of programs impacts the entire
County population, as well as the many tourists and
business travelers who visit Orange County each
year. While providing direct services to individual
clients or patients in need, the Agency's primary
focus is to protect and promote the health and
safety of the community as a whole.
HCA's programs and services can be broadly divided
into three major types: services for the community
at large, prevention services for at-risk
individuals, and intervention or treatment services
to those in need of care. A subcategory of the
latter consists of treatment services to persons
residing in County correctional or other
institutions.
SERVICES FOR THE COMMUNITY
Agency programs such as ocean recreational water
protection, food sanitation, hazardous waste
management and animal care services focus directly
on the prevention of threats to health in the
physical environment through monitoring and
inspection, licensing, and statutory regulation.
Communicable disease programs focus on intervention
in the transmission of tuberculosis and sexually
transmitted diseases, including HIV. The Agency also
monitors acute communicable disease trends and
investigates and intervenes in outbreaks and other
unusual occurrences.
The Agency's emphasis on advocating safe and healthy
lifestyles and practices has increased with the
formation of the Health Promotion Division. While
located in Public Health Services, the Health
Promotion Division serves the entire Agency,
assisting with prevention, disease management and
health education efforts. This Division includes the
Alcohol and Drug Education and Prevention Team
(ADEPT) and the Tobacco Use Prevention Program
(TUPP), focusing on substance use and abuse as major
risk factors for many health problems. Health
Promotion programs also collaborate with a variety
of public and private organizations and community
agencies to prevent injury, chronic disease, and
communicable diseases, and to promote personal and
family health.
PREVENTIVE SERVICES FOR AT-RISK INDIVIDUALS
Behavioral Health Services programs focus on
prevention in the areas of substance abuse and
mental health services for adults and children.
These efforts are often in partnership with
community organizations and contract providers, and
are provided in response to legislative mandates.
Initiatives to increase access to healthcare
services for children and families will make
possible health screenings and early identification
of potential health risks for many more Orange
County residents. Several Agency programs currently
provide services designed to identify and protect
individuals who are at risk of developing health
problems, both acute and chronic.
These services include in-home and senior center
assessments by public health nurses and behavioral
health professionals, neighborhood well-child and
maternal health clinics, immunizations, nutrition
counseling, and food vouchers. In addition, a major
goal of the county's Older Adults initiative will be
to prevent and reduce the debilitating complications
of chronic diseases, such as diabetes.
INTERVENTION/TREATMENT SERVICES FOR INDIVIDUALS
HCA programs also provide services designed to
prevent individuals from progressing to more serious
health problems. Behavioral Health serves children,
adolescents, adults, and older adults with serious
mental, emotional disturbances and/or substance
abuse problems. Behavioral Health operates under its
statutory authority to detain and evaluate
individuals and provide crisis stabilization to
persons with mental disorders. Prevention services
are provided to those who may pose a threat to
themselves or to others in the community.
The Preventive Health Care for the Aging Program (PHCA)
provides Public Health Nursing assessment,
education, chronic disease case management,
referral, and follow-up to Orange County's older
adults at accessible senior/ community centers
throughout the county. The goals of the program are
to promote healthy lifestyles, to increase access to
health care, and to improve the quality of life of
Orange County's over-55 population.
Medical Services for Indigents provides for the care
of eligible medically indigent adults who have no
other source of medical care. There also are
clinical and support services for persons with HIV
or AIDS, and other communicable diseases; medical
and other therapeutic services for disabled children
coordinated through California Children's Services;
and emergency dental services for low-income
persons.
TREATMENT SERVICES IN INSTITUTIONAL SETTINGS
The Health Care Agency is responsible for medical,
dental, pharmaceutical and behavioral health
services to adults in the County's correctional
facilities, and minors in juvenile
institutions/camps, or Orangewood Children's Home.
In fulfilling these responsibilities, the Health
Care Agency supports the Sheriff-Coroner, the
Probation Department, and the Social Services
Agency.
HCA continues to plan for the future in light of our
changing population. For example, as the number of
senior citizens grows, the number of County
residents with chronic diseases that contribute to
death and disability will likely increase as well.
As the size of the teenage population grows, the
number of County residents prone to life
style-related causes of chronic disease (e.g.,
alcohol, tobacco, poor diet and insufficient
exercise) will also grow. The number of at-risk
individuals requiring prevention services, such as
low-income families, the elderly and children, are
likely to increase. Individuals requiring medical
and/or behavioral health intervention and treatment
services will inevitably increase.
Additional information regarding caseload data and
population trends is located in Appendix D.
RESOURCES
The HCA adopted budget for Fiscal Year 2003-04
includes $471 million in net expenditures, with
2,707 positions; revenues include 195 different
funding sources. HCA currently operates under 200
state and federal mandates. State and federal
funding allocations and locally generated fees
comprise 84% of Agency revenue; County general
funding comprises the remaining 16%. Private sector
service contracts make up over one-half of the
Agency budget.
HCA's largest single revenue source is State
Realignment Funds, which account for 39% of Agency
program revenue. Realignment was established in 1991
by the State legislature as an independent funding
source for County health, mental health, and social
services programs. Funds are derived from statewide
sales taxes and vehicle license fees, and are
apportioned by formula to counties.
Other major sources of Agency revenue include: Medi-Cal,
Substance Abuse Block Grant, California Children's Services, Proposition 99 (Tobacco Taxes), Tobacco
Settlement, Proposition 36 (Drug Treatment), and
fees for services.
2003/2004 Budgeted Revenue
Fees 9%
County (including match funds) 16%
Realignment 33%
Federal 7%
State-Other 35%
2003/2004 Budgeted Expenditures
Purchased Goods & Equipment 11%
Employee Costs 36%
Private Sector Services 53%
In light of current and pending fiscal
constraints, the County and the Agency have
instituted a number of measures for the careful
monitoring of both revenues and resources. For
example, every vacancy occurring in the Agency is
carefully scrutinized to ensure that the revenue
source providing its funding is stable, and that
only critical functions are considered for backfill.
Further responses to expected challenges are
discussed in the following section.
CHALLENGES
The environment in which the Health Care Agency
operates continues to be quite demanding and
unpredictable. As with the previous fiscal year, the
major challenge anticipated in FY 2004-05 is
financial – specifically, the challenge of
continuing to provide essential services with
declining resources. Other challenges, however, also
remain. A summary of major challenges for FY 2004-05
include:
FINANCIAL
The Health Care Agency, along with all County
agencies and departments, has again had to absorb
significant increases in the basic "cost of doing
business" – unavoidable increases in retirement,
group insurance, and other expenses – in building
the current-year budget. At the same time, program
revenues and available County General Fund revenues
have increased very little, or in some cases
declined.
As of 2000-01, Orange County was $17 million
under equity for Realignment Revenue. Outdated
funding formulas do not adequately reflect the
demand for services in Orange County. The current
level of funding to provide a safety net for health
care services to the residents of Orange County is
just $60 per capita. This has placed Orange County
at 55th out of 58 California counties for per capita
expenditures on health and mental health services.
Orange County health and mental health expenditures
are approximately half that of the statewide median.
HCA is participating in a coalition of under-equity
counties seeking legislative relief to redress this
historical funding disparity.
The State's ongoing fiscal crisis continues to
result in tremendous budgetary uncertainty for the
Agency and the County. Despite the drastic
implications of some proposals early in the FY
2003-04 budget process, the ultimate impact on HCA
of the State budget, as finally adopted, was less
than anticipated. However, major structural
difficulties remain, including those relating to the
amount and timing of the proposed backfill of
Vehicle License Fee (VLF) revenues to local
government.
Even if the VLF is fully backfilled, Realignment
funding, which is HCA's largest single revenue
source, remains a major concern. Realignment funding
is made up of two components – sales taxes and VLF –
both of which tend to increase and decrease with up-
and downturns of the State's economy. Realignment
funds have not kept pace with program costs, and
this discrepancy will likely remain unless and until
the economy is in full recovery.
To implement Proposition 36, which provides for
treatment services for non-violent drug abusers,
Orange County has been and will continue to receive
approximately $7.9 million annually, through
2005-06, for treatment, probation, court monitoring,
vocational training, and other miscellaneous costs.
The number of eligible Orange County participants,
the
severity of addiction, and the extent of their
criminal history have all consistently exceeded
initial expectations; consequently annual funding is
falling short of requirements. In prior years,
reserve funds were used to support the provision of
appropriate, quality services. However, in 2003-04
few reserve funds remained, requiring a reduction of
over $1 million in treatment services. In 2004-05,
over $2 million will be needed in addition to the
expected State and Federal funding, to maintain
services at the 2003-04 reduced level of services.
Significant service reductions are anticipated.
WORKFORCE
The Agency is still experiencing difficulties in
hiring qualified staff, especially for jobs that
require specific certification or expertise.
Examples include nurses, of which there is a
nationwide shortage; physician specialists; and
various behavioral health specialists. As one
recruiting mechanism, HCA promotes participation in
the Management Performance Plan (MPP) and the
Performance Incentive Program (PIP) as a benefit of
employment with the Agency.
Another workforce challenge is the ability to
respond to the changing social and demographic
factors that affect Agency services. The expected
growth in both adolescents and older adults and the
increase in Hispanic and Vietnamese populations
require a long-range plan for working with the local
educational system, recruiting early for
professions, and increasing the number of culturally
competent workers attending and graduating from
college.
The Agency continues to focus on workforce training in collaboration with local colleges and universities. In addition, the Agency has a well-developed Cultural Competency program to provide assistance to staff in the effective delivery of services to all clients. Finally, recent retirements have brought to the forefront the need for succession planning for key positions throughout the Agency; this will be a continuing focus in FY 2004-05 and beyond.
REGULATORY
Compliance with the Federal Health Insurance
Portability and Accountability Act (HIPAA) continues
to be a challenge for HCA and the County financially
and organizationally, and will be so for several
more years. These regulations impose sweeping,
system-wide changes to health care industry
standards for the storage, transmission and
processing of health care information.
Federally-imposed deadlines for compliance with
HIPAA standards began in 2003 and continue through
2005, and will require modifications of policies and
procedures, workforce training, upgrades to the
physical environment, technological upgrades,
systems changes, and perhaps organizational changes.
OVERCOMING CHALLENGES
Meeting the Agency's Net County Cost target for FY
03-04 required that a number of significant
reductions and adjustments be negotiated as part of
the Agency's initial budget submittal. These
included $4 million in offsets resulting from the
use of various trust fund reserves, the deferred
build-out of certain facilities, and deferred
information system and equipment acquisitions. In
addition, $24.6 million in direct service reductions
were incurred, associated with a 51-position
reduction in workforce.
On an ongoing basis, in these difficult times, the
Agency also continues its practices of carefully
monitoring expenditures and revenues and the
deployment of resources, advocating for additional
outside funding, and optimizing efficiency and
effectiveness, as follows:
Advocating for legislation – including equitable
allocations of State funds -- and pursuing grant
opportunities to increase non-County funding for
existing and new programs, in coordination with the
County Executive Office.
Reviewing fees and other revenues on a regularly
scheduled basis to ensure full cost recovery for
Agency programs.
Continuing to work with our many community
partners, through formal and informal mechanisms, to
best meet the needs of the citizens of Orange
County. (Examples of ongoing HCA collaborative
activities can be found in Appendix F.)
Continuing a focus on training and development of staff, succession planning, appropriate contracting for support services, optimal organizational design, and the implementation of new technologies such as IRIS, the enterprise-wide clinical information system and other management information systems, as appropriate, especially in support of revenue generation and compliance objectives (including HIPAA).
STRATEGIES TO ACCOMPLISH AGENCY GOALS -
In addition to the business strategies addressing
unique challenges and supporting all of the Agency's
goals, the Health Care Agency's 2004 Business Plan
contains specific strategies for each goal to be
implemented over the next year. The criteria for
these strategies include:
Consistency with County and Agency strategic goals
and core businesses
Anticipated new funding or service mandates, and
Realistic assessment of the resources available
for individual projects
Following are the four community goals and two
business strategies for the Health Care Agency.
Associated with each goal and business strategy are
new or enhanced strategies that will be undertaken
during 2004. Associated with each of these
strategies are the performance indicators that will
be monitored throughout the year to measure their
success.
GOAL 1: PREVENT DISEASE AND DISABILITY, AND
PROMOTE HEALTHY LIFESTYLES
1.1 HCA staff will aggressively pursue opportunities
that will enable them to empower our diverse
communities to promote healthy lifestyles.
By January 1, 2005, the Health Care Agency, with our
collaborative partners will develop strategies with
local businesses and the community to assist and
enroll families whose children are ineligible for
public programs to reduce the number of uninsured
children in our County, by providing education and
outreach.
By January 31, 2005, HCA and partner agencies' staff
will conduct outreach and education to at least
200-400 Asian Pacific Islander community members via
health education presentations, workshops, materials
dissemination, and small and large community health
events.
By June 30, 2005, HCA Family Health will focus on
influencing the eating behavior of low-income
families by providing nutrition counseling and/or
presentations to all Program contacts.
1.2 With an increase in the diabetic community, HCA
Staff will serve as a community resource to families
to prevent disease and disability.
By July 31, 2004, staff members from five-to-seven
Asian/Pacific Islander community based organizations
and HCA will have attended a basic skills and an
in-depth diabetes self-management community health
worker training.
By January 31, 2005, HCA staff will pilot diabetes
self-management training with at least 20-30 persons
with diabetes and their families.
GOAL 2: ASSURE ACCESS TO QUALITY HEALTH CARE
SERVICES
2.1 The HCA will serve as a resource to provide
"user-friendly" medical access to families.
By June 30, 2005, California Children's Services (CCS)
will facilitate access to specialized medical care
by processing 95% of CCS pending cases within five
working days.
By June 30, 2005, CCS will facilitate access to
Medical Therapy Unit (MTU) services by offering
appointments for initial evaluation within two weeks
of date MTU accepts referral on 90% of all
referrals.
By June 30, 2005, CCS will facilitate access to
specialized medical care by offering 100%
orthodontia screening appointments for children
eligible for Healthy Families program within 120
days of receipt of CCS referral.
By June 30, 2005, Behavioral Health Services will
develop and implement a medication only clinic for
adults requiring minimal support to remain in
community. In at least one region, will develop a
medication-only clinic to increase access to
psychotropic medications for those consumers who
have not yet received financial benefits through
physician assistance programs.
Children and Youth Services, in collaboration with
the Social Services Agency, will secure a Community
Treatment Facility for seriously emotionally
disturbed children that will be fully operational by
December 2004.
By June 30, 2005, Family Health will obtain
Foundation funding to expand the Public Health
Children's Dental Clinic to children up to 19 years
of age.
GOAL 3: PROMOTE AND ENSURE A HEALTHFUL
ENVIRONMENT
3.1 HCA will provide information to residents
focusing on a safe and healthy community.
By June 1, 2005, Emergency Medical Services, in
partnership with Quality Management and various
public agencies, will develop a public education
program related to various aspects of emergency
medical services for EMS Week.
By June 30, 2005, Environmental Health will enhance
the availability of information on restaurant
quality via website posting of inspection data and a
new inspection seal. A brochure will be developed to
describe Orange County's Public Notification
Program.
By June 30, 2005, Environmental Health will promote
the protection of recreational ocean waters by
developing and implementing a boating oil exchange
program in Newport Beach.
By June 30, 2005, Environmental Health will identify
and send notice to owners of former landfills that
have no gas control systems in place and which
threaten nearby residences/businesses.
3.2 HCA staff will be prepared to respond in the
event of a major emergency.
Emergency Medical Services will continue to develop
and implement disaster training programs for key
personnel of the Health Care Agency.
GOAL 4: RECOMMEND AND IMPLEMENT HEALTH POLICY AND
SERVICES BASED UPON ASSESSMENT OF COMMUNITY HEALTH
NEEDS
4.1 Continue collaborative efforts that enhance the
use of data in policy development.
Appropriate health-related data will be provided for
inclusion in the 2004 Community Indicators Report by
February 2004, and the Tenth Annual Report on the
Conditions of Children by August 2004, in support of
the Children and Families Commission.
Appropriate health-related data will be provided for
inclusion in the Third Annual Report on the
Condition of Older Adults by March 2004, in
collaboration with the Office on Aging and Social
Services Agency.
HCA will continue to collaborate with Housing and
Community Development in the annual Homelessness
Prevention needs assessment, and in development of
the Homelessness Management Information System.
HCA will continue to play a key role in the
implementation of the Orange County Health Needs
Assessment and provide morbidity, mortality and
hospitalization data for the 2004 report.
BUSINESS STRATEGY 1: ENCOURAGE EXCELLENCE BY
ENSURING A HEALTHY WORK ENVIRONMENT THAT VALUES
EMPLOYEES
5.1 The Health Care Agency is committed to and
dedicated to ensuring that all employees have
opportunities available to them to ensure a healthy
work environment.
Efforts of the HCA Labor Management Committee will
continue to be fully supported.
Performance Incentive and Management Performance
Plans will continue to be fully supported.
Efforts of the HCA Safety Program will continue to
be fully supported.
BUSINESS STRATEGY 2: SUPPORT THE WORKFORCE
THROUGH THE EFFECTIVE USE OF TECHNOLOGICAL AND OTHER
RESOURCES
6.1 Enhance employee performance through increased
access to information technology.
The feasibility of implementing an Electronic
Receiving System for Agency purchases will be
determined by July 2004.
HEALTH CARE AGENCY
2004 BUSINESS PLAN
IV. APPENDICES
APPENDIX A
Organization Chart HCA 2004 Business Plan
APPENDIX B
Health Care Agency Executive Team
Juliette A. Poulson, RN, MN
Director
David L. Riley
Assistant Director
Mark B. Horton, MD, MSPH
Deputy Agency Director/Health Officer
Public Health Services
Mark Refowitz, LCSW
Deputy Agency Director
Behavioral Health Services
Mike Spurgeon
Deputy Agency Director
Regulatory Health Services
Alice Manning
Interim Deputy Agency Director
Financial and Administrative Services
Robert Gates
Project Director
Medical Services for Indigents
Ron LaPorte
Chief
Office of Quality Management
Dennis Masiello
Chief Information Officer
Information Technology
Jeffrey A. Nagel, PhD
Chief Compliance Officer
Office of Compliance
Business Plan Team
Office of Quality Management
Ron LaPorte
Chief
Curtis Condon, Ph.D.
Senior Research Analyst
Steve Ambriz
Planning Manager
David Samarin
Computer Graphics Specialist The content and
preparation of the 2004 HCA Business Plan involved
the Executive Team, Office of Quality Management,
Division Managers, Program Managers, and the Labor
Management Committee and its Project Development
Subcommittee. Feedback and suggestions were also
solicited from all HCA employees and from members of
the various Boards, Committees and Commissions that
advise the Agency.
APPENDIX C
Business Plan 2003 Summary of Accomplishments
The Health Care Agency's Business Plan 2003
contained four goals, two Business Strategies and 26
consolidated projects, of which 80% were completed
in whole or in part. A tally and highlights are
provided below.
1. Prevent Disease and Disability, and Promote
Healthy Lifestyles
This goal had three performance indicators of which
one was accomplished, and two were partially
accomplished. Highlights of the accomplishments that
further this goal include: Training has been
provided to key HCA personnel in connection with the
California Health Alert Network and the Agency
Operations Center. Testing procedures for
biological agents are available, and the new
biohazard containment laboratory is operational.
2. Assure Access to Quality Health Services
This goal had seven performance indicators of which
three were accomplished, three were partially
accomplished, and one was not accomplished due to
cost reductions. Highlights of the accomplishments
that further this goal include:
Four clinicians are available to the community to
provide access to behavioral health crisis response
services. A team has been established to provide
intensive mental health services to those
individuals who have frequent hospitalizations
and/or incarcerations due to behavioral health
problems.
Older adults with mental illness have received
education regarding their mental illness and
interventions to reduce symptoms, often including
psychiatric medication intervention to restore to
the highest possible level of functioning.
3. Promote and Ensure a Healthful Environment
This goal had five performance indicators of which
four were accomplished and one was partially
accomplished. Highlights of the accomplishments that
further this goal include:
The Agency Operations Center is fully equipped and
training has been provided which will enhance the
County's emergency response capabilities. The
public can access water quality information through
a newly created website. Shellmaker Water Quality
Lab in Newport Beach is now fully operational.
4. Recommend and Implement Health Policy and
Services Based upon Assessment of
Community Health Needs
This goal had two performance indicators of which
both were accomplished. Highlights of the
accomplishments that further this goal include:
The Health Care Agency provided health related data
to the Ninth Annual Conditions of Children Report
and the 2004 Report on the Condition of Older
Adults.
5. Encourage Excellence by Ensuring a Healthy Work
Environment that Values Employees
This goal had seven business strategies of which
five were accomplished and two were partially
completed. Highlights of the accomplishments that
further this goal include:
The Labor Management Committee has provided updates
to employees and established a "Team Excellence
Award" program. The Health Care Agency is in full
compliance with the HIPAA privacy standards, as
mandated by Federal law. The Health Care Agency is
in full compliance with the Americans with
Disabilities Act.
6. Support the Workforce through the Effective Use
of Technological and Other Resources
This goal had two business strategies of which one
was accomplished and one was partially accomplished.
Highlights of the accomplishments that further this
goal include:
The Information Technology division successfully
implemented the registration and document imaging
modules of the IRIS system, which improved access to
information technology. The Electronic
Requisitioning System was fully implemented by
October 2003.
Projects not accomplished as planned: Only one (1)
of the proposed twenty-six (26) strategies was not
accomplished. As previously indicated, cost
reductions had a significant impact on the proposed
strategy not being accomplished.
Unanticipated Accomplishments: Frequently, projects
develop during the calendar year that were not
anticipated when the Business Plan was prepared.
Major projects that provided unanticipated
accomplishments for the Health Care Agency are
described below:
The first annual celebration of Emergency Medical
Services (EMS) week recognized EMS personnel and
provided EMS related education to the public.
Animal Care Services accepted the responsibility to
provide shelter services for the city of Santa Ana.
Education and smallpox vaccinations were provided to
appropriate Public Health and Behavioral Health
personnel in the event of a bioterrorist event.
Orange County is a recognized leader in HIPAA
implementation with the State from the lead role in
HIPAA transaction and code set implementation. In
collaboration with local sanitation districts,
Environmental Health was able to post historical
water quality sampling data on the web page.
California Children's Services opened a Medical
Treatment Unit in the City of Garden Grove to expand
services for children. Women, Infants and Children
(WIC) opened a facility to serve residents in
Fountain Valley and the surrounding areas. Public
Health initiated rapid HIV testing to provide
results within 20 minutes so patients can receive
immediate counseling following a diagnosis. The
Medical Services for Indigents program conducted
planning efforts to expand the specialty physician
network. APPENDIX D
Caseload/Client Data – Profile of Service
Recipients
The following table provides a brief description of
client groups and caseload information for programs
selected to represent the range of services provided
by the Agency. The data provided are the most recent
available from each program and reflect a 12-month
period, either calendar or fiscal year:
PROGRAM
SERVICE RECIPIENT
TYPE OF SERVICE
FISCAL YEAR
2002-03
1.Animal Care Services
Residents of 19 cities & unincorporated areas
Animal licenses
147,665
2.Animal Care Center
Residents of 22 cities & unincorporated areas
Live animals impounded
35,438 3.Behavioral Health - Adult
Adults with mental illness and/or substance abuse
problems
Persons served in the community
38,524 4.Behavioral Health - Older Adult
Older adults with mental illness and substance abuse
problems; frail elderly at risk of out-of-home
placement
Persons served in the community
4,517 5.Behavioral Health - Children
Seriously emotionally or behaviorally disturbed
children, substance abusing adolescents
Persons served in the community
11,964
Persons served in County institutions (Orangewood,
juvenile justice facilities)
4,508 6.California Children's Services
Children with disabling or potentially disabling
conditions
Case Management Services
13,278
Physical Therapy Units of Service
185,000
Occupational Therapy Units of Service
182,000 7.Maternal, Child and Adolescent Health
Low income children
Child health clinic visits
15,123
Child linkages to Child Health and Disability
Prevention program community providers
201,206
Children and Adults
Immunizations clinic visits
70,987
Vaccines given
401,328
Low income pregnant women
Prenatal care referrals
1,072
Low income pregnant or parenting teenagers and
siblings
Case Management
1,088
Low income women and their partners
Contraception education and methods for women and
partners
11,952 8.Epidemiology and Assessment
All County residents
Communicable disease reports
12,578 9.Emergency Medical Services
All County residents and visitors
Total 9-1-1 EMS responses
195,630
Paramedic transports to designated ER
50,156
Trauma patients served by trauma center
4,080
Emergency Medical Technicians-1's
Certification/re-certification of EMT-1s
477
Paramedics
County licensure of EMT-1s
1,430
Ambulance companies and fire depts.
Local accreditation of paramedics
35
Inspection and licensure of public and private
ambulance vehicles
300
EMT-I and Paramedic Training Programs
Review and approval of EMT-I and Paramedic training
programs
10
Trauma Centers
Designation of Trauma Centers serving Orange County
3 10.Dental Health
Low Income Residents
Emergency Dental Care
3,834
Low Income Children
Dental Treatment and Prevention Services
1,222
Persons with HIV or AIDS without resources
Dental Treatment and Prevention Services
1,905 11.Employee Health
County employees
Initial/routine/return-to-work examinations and/or
follow-up
12,301 12.Environmental Health
All County residents
Retail food facility inspections
30,538 13.Environmental Health
All County residents
Hazardous waste inspections
5,183 14.Health Promotion
All County residents
Public Education
688,671
Target Group Education/Technical Assistance
(includes former separately reported Staff Educ. &
Training Tech Asst.)
80,659
Patient Education/Screening /Referrals
27,327
Policies Instituted
53 15.HIV Test Sites
Persons at risk of HIV infection
HIV testing and counseling
12,525 16.HIV Clinic
Persons with HIV infection or AIDS w/o resources for
medical care
Medical care and case management visits
13,622 17.Institutional Health
Incarcerated adults
Medical screening assessments
62,200
Sick-call visits (medical/dental)
159,842
Behavioral health assessments
9,211 18.Institutional Health
Detained juveniles
Comprehensive intake assessments
10,950
Sick-call visits (medical/dental)
37,729 19.Medical Services for Indigents
Low income adults
Paid hospital inpatient days
24,386
Hospital emergency department visits
12,483
Unduplicated number of patients
13,260
Total Physician Visits
188,501 20.Nutrition Services
Low income pregnant, postpartum, and breastfeeding
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