REPORT/RECOMMENDATION TO THE BOARD OF SUPERVISORS
OF SAN BERNARDINO COUNTY
AND RECORD OF ACTION
September 10, 2024
FROM
ANDREW GOLDFRACH, ARMC Chief Executive Officer, Arrowhead Regional Medical Center
SUBJECT
Title
Positions for Value Based Program Restructure
End
RECOMMENDATION(S)
Recommendation
Authorize 13 new regular positions under the following classifications:
1. One Assistant Hospital Administrator Exempt Unit, Range 74C ($108,451 - $155,084 annually).
2. One Business Applications Manager, Management Unit, Range 71 ($98,196 - $135,324 annually).
3. Four Programmer Analyst III, Administrative Unit, Range 67C ($90,521 - $124,696 annually).
4. Four Programmer Analyst II, Administrative Unit, Range 63C ($82,097 - $113,110 annually).
5. Two Quality Management Nurse, Nurses Unit, Group 5 ($85,384 - $116,230 annually).
6. One Nurse Educator, Nurses Unit, Group 3 ($89,107 - $120,494 annually).
(Presenter: Andrew Goldfrach, ARMC Chief Executive Officer, 580-6150)
Body
COUNTY AND CHIEF EXECUTIVE OFFICER GOALS & OBJECTIVES
Promote the Countywide Vision.
Improve County Government Operations.
Operate in a Fiscally Responsible and Business-Like Manner
Provide for the Safety, Health and Social Service Needs of County Residents.
FINANCIAL IMPACT
Approval of this item will not result in the use of Discretionary General Funding (Net County Cost).
The salary costs will be funded by the increase in the Quality Incentive Pool (QIP) Supplemental Payment. Adequate appropriation and revenue have been included in the Arrowhead Regional Medical Center (ARMC) 2024-25 budget and will be included in future recommended budgets.
BACKGROUND INFORMATION
QIP is a managed care directed payment program aligning more closely with State and Medi-Cal managed care plan priorities and further integrating incentives to improve health equality. ARMC takes part in the annual QIP audit mandated by the Department of Health Care Services (DHCS) to evaluate patient quality outcomes through data extraction. The audit results determine the hospital's supplemental funding for the next fiscal year.
For the 2022 measurement year, the available funding was $81,818,887, with ARMC receiving 51%. The available funding is based on 20 priority performance measures and 32 elective performance measures. The performance measures include Asthma Medication Ratio, Breast Cancer Screening, Controlling High Blood Pressure, etc. ARMC receives supplemental funding for measures that have met the QIP goals set by DHCS.
In the 2023 measurement year, ARMC expects to receive around 50% of the total available funding, leading to an estimated annual revenue loss exceeding $50,000,000. To maximize this funding opportunity, ARMC is enhancing oversight of its Value-Based Program (VBP). The addition of the new positions is requested outside the Mid-Year cycle to maximize ARMC’s QIP by hiring program analysts to align medical codes to capture the performance measures as set by DHCS. By ensuring the correct medical codes are utilized, the performance measures are captured, which in turn will increase ARMC’s funding. The nursing positions will be used to improve quality and provide education to staff when needed. The new positions are modeled after Riverside University Health System, Alameda Health System, and San Francisco General Health, as well as in collaboration with the California Association of Public Hospitals.
ARMC recommends approval of these new positions as they help with oversight of the VBP, aimed to enhance patient access to care and adherence to preventive health measures, ultimately promoting community health and reducing hospital admissions and emergency room visits. By focusing on specific communities and individuals in need, the VBP team strives to boost supplemental funding from 50% to 100% of the available funds. The VBP team will use ARMC’s electronic healthcare record to track the performance measures over time and this will ensure increased adherence to the allocation of staffing resources. ARMC will conduct quarterly reviews of performance data to determine if the revenue generated offsets the cost of the positions.
PROCUREMENT
Not applicable.
REVIEW BY OTHERS
This item has been reviewed by County Counsel (Ken Brown, Deputy County Counsel, 387-5455) on August 23, 2024; Human Resources (Gina King, Assistant Director, 387-5571) on August 13, 2024; ARMC Finance (Chen Wu, Finance and Budget Officer, 580-3165 ) on August 16, 2024; Finance (Jenny Yang, Administrative Analyst, 387-4884) on August 23, 2024; and County Finance and Administration (Valerie Clay, Deputy Executive Officer, 387-5423) on August 23, 2024.