Important note: The following recommendation was approved by the Board of Supervisors on May 21, 2013:

To:            Honorable Board of Supervisors

From:        John L. Maltbie

Subject:    Measure A Report: Medical Services in Pescadero, La Honda, Loma Mar and San Gregori

RECOMMENDATION:

Direct Staff to appropriate Measure A funding of $551,180 in the FY 2013-14 Recommended Budget and $402,359 in the FY 2014-15 Recommended Budget to provide mobile health care services in Pescadero, La Honda, Loma Mar and San Gregorio.

BACKGROUND:

Pescadero, La Honda, Loma Mar and San Gregorio are small, rural communities with limited access to health care. The low-income, often Spanish speaking residents of these communities are particularly isolated from primary health care services.

DISCUSSION:

This initiative would allocate resources to the San Mateo Medical Center's Coastside Clinic. Funds would be used to purchase a mobile clinic van and host a bilingual provider team that would serve Pescadero, La Honda, Loma Mar and San Gregorio. The half-time team would consist of a Physician, Medical Assistant, Patient Services Assistant and Community Worker/driver.

This initiative was developed in partnership with Puente, a local Community Resource Center serving the San Mateo County South Coast. Puente would provide supplemental community health workers to reach out to the community, engage residents in need of care and bring them into the mobile clinic.

The optimal venue to provide medical care to these communities in the long term is to establish a permanent physical presence if there is sufficient demand. A clinic is a preferable option in particular for patients requiring more frequent lab work or complex care. However, there is currently no available space suitable to operate a clinic in

Pescadero, and the use of a mobile van will still meet the needs of those patients lacking primary care who have uncomplicated medical problems. A future clinic space could be included in other construction projects such as the re-building of the Pescadero fire station. At the time the County moves forward with plans to build the Pescadero fire station, an operating plan and cost benefit analysis of the clinic add-on will be prepared. Given the immediate limitations of space availability, a mobile clinic is the best solution to meet the current medical needs of the community.

The use of a mobile clinic to provide regular primary care to patients is a new concept for the San Mateo County Health. The San Mateo County Health currently utilizes mobile clinics to provide medical services that meet the immediate care needs of patients. This initiative would offer primary care in hard to reach communities in an effort to treat chronic disease and provide preventative medical services. The goal is to provide care to 500 new patients and improve the health of the target population. Ultimately these efforts will reduce morbidity and mortality and may also reduce emergency department utilization and hospitalization.

PERFORMANCE MEASURE(S):

Measure

FY 2012-13 Actual

 FY 2013-14 Projected FY 2014-15 Projected

Number of patients brought into

care at the mobile clinic

 0 200 500

% of mobile clinic patients that

receive mammograms according to screening guidelines

 0% 62% 77%

% of mobile clinic patients that

control LDL cholesterol as a result of LDL screenings received according to screening guidelines

0 43% 62%
Cost per patient* N/A $1006 $805

*Cost per patient includes staff services only; the capital costs of the mobile clinic are not included.

FISCAL IMPACT:

It is recommended that $953,739 in Measure A funds be appropriated in the FY 2013- 14 through FY 2014-15 budgets for this proposal. The funds would be used to purchase a mobile clinic van for $350,000 and provide health care services in Pescadero, La Honda, Loma Mar and San Gregorio. Ongoing costs to staff the mobile clinic are estimated at $201,180 in the first year due to ramp-up time to establish service, and

$402,359 annually thereafter, escalating with medical inflation each year.

Measure A Funds recommended in this Report:

Proposal FY 2013/14 FY 2014/15

Medical Services in Pescadero,  La Honda, Loma Mar and San Gregorio

 $551,180 $402,359

Important note: This is a copy of the official report to the Board -- item 6 on the Board's agenda.