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LA County CEO Report Outlines Opportunities and Risks of Proposed Unified Health Agency

The Los Angeles County CEO’s office just released a report under the Board of Supervisors’ direction to explore the creation of a new unified health agency that would include the three County health departments, including Health Services (DHS), Mental Health (DMH), and Pubic Health (DPH). The report considers benefits, risks, and possible structures of the health agency. While weighing important benefits, risks, and stakeholder comment about the proposal, the document also offers an outline of potential service alignments and improvements. Some of these improvements are very needed in the near future, and others are more ambitious longer-term goals.

One of the primary objectives of the agency would be to align and integrate services. For example, the report suggests that integrating population and personal health missions through a unified vision and coordinated service delivery would be a core goal. Connecting, coordinating, and co-locating providers of physical and behavioral health services through data sharing, information technology, and facility planning improvements would be a major aim of the agency. Moreover, aligning the departments’ data collection and analysis activities would be instrumental to improving studies of population health, efficacy of service delivery, and strategic planning.

The unified health agency would also pay particular attention to improving services for vulnerable populations that need the services of all of the departments, as well as other county agencies. These groups include transition-age and foster youth, people involved in the criminal justice system and reentering communities from incarceration, people experiencing homelessness, and people who experience psychiatric emergencies.

One very interesting possibility that the document raises is the creation of new risk-sharing and contracting arrangements with the State and managed care plans. The report offers the option of pursuing a consolidated County contract with Medi-Cal managed care plans for all of the Medicaid services that the departments provide. The County would pursue “these arrangements within a highly integrated model of care that includes a full-spectrum of mental health (mild to severe), physical health, substance abuse, and select public health services.” The report additionally identifies the need to consult with the California Department of Managed Health Care to determine whether or not the County would need to seek a full Knox-Keene license in this scenario.

The CEO also discusses potential risks involved with pursuing the agency model. The main risks include sacrificing the focus of DMH and DPH on community and population health when attempting to coordinate or integrate the clinical services of all departments. The CEO’s office consulted many stakeholders when developing the report, and some mentioned that when the departments were consolidated or merged in the past (1972-1978), population and public health activities were sacrificed to support the needs of clinical and health services facilities. Moreover, mental health stakeholders expressed concern about being relegated to a secondary position behind physical health, and substance use disorder service stakeholders also expressed concern about being subsumed beneath mental health practitioners who might not appreciate the needs of their clients.

Yet, the CEO report responds specifically to the Board of Supervisors’ direction to explore an agency model that retains a separate director and budget for each department. Under this model, while the agency director and a lean staff would lead in setting policy, strategy, and legislative advocacy for the departments, the Board of Supervisors would retain full control over departments’ budgets, and the departments’ leadership would remain in place. With regard to broader programmatic or structural changes in the future, the report recommends that the agency maintain a continuous and robust stakeholder process, and move slowly toward “long-term opportunities that must be carefully considered and planned for in order to avoid disrupting ongoing operations and services.”

On January 13, 2015,  the Board of Supervisors directed the County Chief Executive Office, County Cousel, and the Department of Human Resources to draft the report. The public comment period for this draft is from April 1 through May 15, and the CEO’s office will submit the final report to the Board of Supervisors no later than June 30.

Access full text of the report: Health agency_public release draft_March 30 2015.

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