Lompoc Valley Community Healthcare Organization

Improving the health of the Community

Development Process

Frank Signorelli,
President, Lompoc
Healthcare District
Board of Trustees

Secretary, LVCHO
Board of Directors

• Managed care had just entered the market.
• Choice was being limited for the first time.
• Patients, providers and employers dissatisfied.
• Attempted to find solutions but they did not include system approach like DRIS.

• Brought together 50 community leaders for education and dialogue.
• Examined the effects of the managed care marketplace on Access, Quality and Cost for health services in the Lompoc Valley.
• Examined the question would an integrated system enhance the community’s ability to directly impact access, quality and cost.

Reviewed extensive data analysis.

Key findings:

ACCESS

• Population < 18 double national average.
• Population below 200% of poverty 35%
• 25% of population over 65 below 200% of poverty
• Large non English speaking population
• Significant primary care physician shortage

COST

• Duplication of many administrative services
• Large uninsured population
• Systems organized by payer not by community need
• Three of five major providers managed by out of community interests

QUALITY

• Insufficient translation services
• No system to assure coordination of care
• No system for referrals out of the area and for return
• Each individual provider has unique quality measures
• No system to measure outcomes of an episode of care

Voted unanimously to form LVCHO in 1998

Mission Statement

To improve the health of the community by assuring local access to a coordinated system of health promotion, disease prevention, and treatment services available to all.

LVCHO became 501 (C) 3 in January 1999.

Goals

• A community health system which is client friendly
• A community health system which maximizes coordination of care
• A community health system which invests in disease prevention and health promotion

Lessons learned

• Community education on health system requires that acronyms and buzzwords be decoded
• Development of new community organization takes more time that we thought
• Community involvement essential

Description and Functions

Jim Raggio, Administrator, Lompoc Healthcare District

Treasurer, LVCHO
Board of Directors

Membership

• Lompoc Healthcare District
• Lompoc Valley Healthcare Council
• Mission Valley IPA
• Santa Barbara County Public Health Department
• Santa Barbara County Mental Health
• Santa Barbara County Alcohol and Drug Services

Feasibility of developing ASO

• Wanted to keep medical management local and plan administration local, keep these dollars in the community

Findings

• Volume of at risk and self insured lives was insufficient to be competitive
• Net premium revenue in contracts for Medicare was insufficient
• Infrastructure needed for the ASO was not locally available
• Staffing needed for the ASO was not available locally

Functions selected by LVCHO

• Single signature contracting
• Community Health Information Network
• Community Health Improvement Program Management
• Medical Management

Future Plans

• Physician Practice Management

Accomplishments to date

• Contract with Federal Bureau of Prisons to manage care for 3,000 prisoners
• Agreement, in principle, with Cigna Healthcare
• Grant for development of case management system for seniors

• Anchor member of County wide telemedicine project

  Goals

  • Development of order entry and results reporting
  • Development of Community Health Information Data repository
  • Development of telemedicine links with Federal Prison and Vandenberg Air Force Base
• Development of Substance Abuse Alliance which has received funding for development of a youth and family center.

Community Healthcare Council Role

Captain Tim Dabney
Lompoc Police Dept.

Chair, Lompoc Valley
Healthcare Council
LVCHO Advisory Committee

Membership

Click here to see the membership

Developmental Role of Council

• Review and understand data on community health system
• Understand 7 characteristics of an integrated system
• Review recommendations for system organization
• Develop consensus on community goals for the health system

Council made a standing committee of the LVCHO

Committee Role

• Assure continued focus on Health Promotion and Disease Prevention Services
• Identify community needs
• Provide direction to LVCHO in meeting community needs

Accomplishments to date

• Unanimous consensus to form CHO
• Identified substance abuse as target issue
• Partnered with SB County Public Health to develop ophthalmology clinic for uninsured and received funding from SB Regional Health Authority
• Provided a Chronic Disease Self-Management Course
• Purchased defibrillator for police

Prevention and Early Intervention Committee

Deborah Marsh,
Health Educator

Chair, LVCHO
Prevention and Early
Intervention Committee

Prevention Committee is standing committee of LVCHO

Chair appointed by SB County Public Health

Mission

To assess needs for prevention and early intervention services in the Lompoc Valley, to educate the LVCHO regarding those needs and to make recommendations to the LVCHO on effective strategies to increase prevention and early intervention services in the Lompoc Valley.

First charge to committee: To assess the current state of the substance abuse issue and make recommendations to the LVCHO regarding strategies to pursue that will assure high levels of coordination, minimize duplication and maximize the community investment in substance abuse prevention, early intervention and treatment.

Performed Assessment of the Substance Abuse Services System in Lompoc Valley

Findings

Data

• There is inadequate data concerning substance abuse for the Lompoc Valley especially as it relates to adults.
• There is no minimal outcome data regarding substance abuse prevention and treatment services in the Lompoc Valley.
• 81% of families with children referred to MISC have a history of substance abuse.

• 5% of EMS runs to Lompoc District Hospital were designated with alcohol as the primary reason for the run.
• 2% of EMS runs to Lompoc District Hospital were designated with other drugs as the primary reason for the run.

• Annual admissions to Santa Barbara County Department of Drug and Alcohol Programs were 416 in 94-95 and declined to 291 in 96-97.

Services

• There are four entities which provide substance abuse prevention services in the Lompoc Valley Service area.
• There are 5 entities that provide substance abuse prevention and treatment services in the Lompoc Valley service area.

• In addition, there are six additional groups of providers who provide health care services in the community and deal with patients with substance abuse problems.

Funding

• The county reports investing $516,375 in prevention and treatment programs in Lompoc Valley in fiscal year 97-98.
• There is no mechanism in place to assess cost effectiveness of the services currently provided.

Coordination

• There is no formal system in place to deal with the substance abuse issue in the Lompoc Valley.
• There is no current system of formal communication between health providers in the community and substance abuse treatment and prevention providers in the community.

• There is no common data set regarding the substance abuse issue in the Lompoc Valley service area.
• There is no consensus on what are the essential elements which need to be measured to monitor effectively the substance abuse issue in the Lompoc Valley service area.

• There are no outcome measures assessing effectiveness of the available programs and services in the Lompoc Valley service area.

With approval of the Healthcare Council, the PEI Committee hired outside consultant for recommendations.

Consultant findings concurred with committee findings.

1. There was a consistent lack of awareness of who the substance abuse providers were and what services were being provided.
2. A number of individuals expressed concerns about the existing service providers.
3. Services were fragmented with limited interaction apparent between agencies and limited coordination of clinical activities.
4. The population currently served is often low income and oftentimes requires bilingual staff to most adequately meet client needs.
5. There are service gaps identified related to youth services as well as detoxification and residential services for adults.

Consultant Recommendations

1. The MediCal funding entity, major referral sources like Probation and the Courts, the community hospital, the United Way and an elected official meet and discuss the current service delivery system for substance abuse and agree to appropriate structural changes in the substance abuse treatment system.
2. Once decisions have been made on the necessary structural changes in the treatment system, work with the preferred providers(s) to generate outcome measures for treatment participants.
3. After stabilizing the treatment services, expand community awareness of resources available including prevention.
4. Once treatment services are stabilized, begin to integrate alcohol and drug services with other behavioral and physical health.
5. Develop a system that tracks community problems with substance abuse over time.

Accomplishments to date

• Formed Substance Abuse Alliance with two preferred providers
• Received grant from County A&D to create Youth and Family Center
• New Center will be coordinating point for prevention, education and treatment services.

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