To: Board of Supervisors
From: Anna Roth, Health Services Director
Report Title: Position Adjustment Resolution No. 26315 to Add Two Community Health Worker Specialist positions, Cancel One vacant Public Health Nurse position in the Health Services Department. (Represented)
☒Recommendation of the County Administrator ☐ Recommendation of Board Committee
RECOMMENDATIONS:
ADOPT Position Adjustment Resolution No. 26315 to:
• Add two (2) Community Health Worker Specialist (VKTA) positions at salary plan and grade TC5-1103 ($5,248 - $6,379)
• Cancel one (1) vacant Public Health Nurse (VVXA) position # 20007 at salary plan and grade LT2-1832 ($13,108 - $16,370) in the Health Services Department.
FISCAL IMPACT:
Upon approval, this request will result in an annual cost savings of approximately $69,614 with pension costs of $10,170 already included. (100% Funded CalAIM revenue for Enhanced Care Management Program).
BACKGROUND:
Enhanced Care Management (ECM) is a statewide Medi-Cal benefit that is a key part in the State’s CalAIM initiatives. ECM sets out to address clinical and non-clinical needs of the highest-need participants through intensive coordination of health and related services. Participants have a single Lead Care Manager that coordinates care and services across the physical, behavioral, dental, developmental, and social services delivery systems, making it easier for them to get the right care at the right time. Each case manager can hold up to 50 cases.
In March 2021, the Enhanced Care Management (ECM) program was launched in the Divisions of Public Health, Behavioral Health, and Contra Costa Health Plan (CCHP) of Contra Costa Health Services (CCHS). Since the launch of ECM, Health Services has better able to identify the specific staffing needs of the program and CalAIM. Since the launch of ECM in Contra Costa Health Services, the intensity of the ECM program has increased, requiring more case management staffing to fully provide enhanced case management services. Community Health Worker Specialist case managers offer the most appropriate support for members who have limited, or stable medical conditions and need support with social needs such as social service program navigation, scheduling Primary Care Physician (PCP) visits, and scheduling transportation.
The department has identified that the organizational staffing structure initially created for EMC services, does not meet the current case management support needs for individuals with stable or limited medical conditions or those in need of support with coordination of care. As a result, the department has reassessed its staffing needs for ECM and requests to eliminate 1 vacant Public Health Nurse position #20007 and replace it with 2 Community Health Worker Specialists. The Community Health Worker Specialist positions are a key role in the Public Health multi-disciplinary approach to Enhanced Care Management. This will increase case management support services to program beneficiaries who have limited or stable medical conditions.
By cancelling the position and adding two Community Health Worker Specialist, the program can provide increased caseload support for ECM participants.
CONSEQUENCE OF NEGATIVE ACTION:
If the positions are not approved, the county would be at risk of not being able to sufficiently staff the Enhanced Care Management Program (ECM). This would offer less support services to ECM participants as each additional case manager can hold up to 50 cases. It would also threaten to maintain current funding levels and opportunities to receive increased funding in the future, as the program would be unable to fully utilize the currently funded amount.