Alameda County Health Care for the Homeless - Providing Culturally Informed Health Care and Housing Services

1. ACHCH Health Center Overview October 8, 2019 – AHS Co-Applicant Board Alameda County Health Care for the Homeless 1404 Franklin Street, Suite 200 Oakland, CA 94612 www.achch.org

2. Mission Our mission is to improve the health of Alameda County residents experiencing homelessness by ensuring access to culturally informed, whole-person health care and housing services. Vision We envision a just society where all persons have access to quality health care and housing. We believe the problems of homelessness and health inequities can be solved.

3. Alameda County Health Care for the Homeless is a HRSA Funded, 330(h) Homeless Health Center program housed in the Alameda County Health Care Services Agency ACHCH provides directly-provided health care services and coordinates a network of health care providers to provide people experiencing homelessness access to a full range of Health Center required and additional health care services at accessible clinic-based and portable sites throughout Alameda County.

4. History ACHCH Street Health Teams

5. Health Care for the Homeless (HCH) Health Center Started in 1988 and based in Alameda County Health Care Services Agency 113 Full Time Equivalent HCH Health Center Staff 9.987 Patients Served 22 Full Time Equivalent HCH Program Staff 45,035 Visits Numbers rising in 2019

6. ACHCH Health Center Operational Chart GY 2020 HCH COMMISSION ACHCH Health Center Co-Applicant Board Colleen Chawla Director, Alameda County Health Care Services Agency HCH CONSUMER/ COMMUNITY ADVISORY BOARD (HCH CCAB) Co-Applicant Agreement ACHCH directly-provided Services Federal Grant-funded Contracted Care Non-Federal funded Contracted Care AHS Co-Applicant HCH Health Center Governing Board Subrecipient Alameda Health System (AHS) Board of Trustees ACHCH HEALTH CENTER PROGRAM DIRECTOR Lucy Kasdin, LCSW ACHCH MEDICAL DIRECTOR Jeffrey Seal MD Co-Applicant Agreement ACHCH STREET HEALTH SERVICES ACHCH PRIMARY CARE HOMES ACHCH SPECIALTY CARE SERVICES ACHCH SHELTER HEALTH SERVICES ACHCH CONTRACTS & ADMINISTRATION • Alameda Health Systems Primary Care Clinics: • Subrecipient provided primary care homes with comprehensive care services: • Highland Wellness • Same Day Clinic • Eastmont Wellness • Hayward Wellness • Newark Wellness • Same Day Clinic • 65.31. FTE • ACHCH StreetHealth Team: • Directly provided portable street health care: • Psychiatrist • Nurse Manager • Psych.NP • Social Worker • Pharmacist • 2 CHW • W.Oakland • 12 Street Sites • 7 FTE Lifelong Street Health Downtown: Contracted portable street health care Downtown Oakland 8 Street Sites 4FTE • ACHCH DENTAL CARE: • Contracted mobile and clinic-based full service dental care: • Onsite Dental (mobile)* • La Clinica Dental (clinic)* • *ACHCH shelter health staff provide embedded dental case management • ACHCH SHELTER HEALTH TEAM: • Directly-provided portable health care services: • Behavioral Health Supervisor • Behaviorist • Nurse Practitioner • Social Worker • Social Worker • 7 FTE • ACHCH/AHS MOBILE HEALTH SERVICES: • Subrecipient AHS -staffed Portable Mobile Health Care Services: • Mobile Health Manager • Nurse Practitioner • CHW • Medical Assistant • Medical Support Staff • 5 FTE • ACHCH Contracts and Administration Staff • Program Director • Medical Director • Quality Director • Grant Manager • Finance Manager • Contracts Manager • Facilities Manager • Support Staff • 10 FTE Lifelong Street Health E.Oakland: Contracted portable street health care East Oakland 10 Street Sites 4.6FTE • ACHCH OPTOMETRY • Contracted optical and ophthalmology care • Fruitvale Optometry Mobile Clinic-based primary and urgent care at 10 shelter sites in Alameda County Lifelong TRUST Health Center: Contracted/Directly-Provided primary care home comprehensive care for chronically homeless and disabled 25.6 FTE Health Care Services at 11 Shelter locations in Alameda County Tiburcio Vasquez Street Health: Contracted portable street health care Central Alameda County 8 Street Sites 4.6 FTE Tri-City Street Health S.County Contracted portable street health care South-East Alameda County 10 Street Sites 5.3 FTE • Alameda Health Systems Specialty Care Services: • Subrecipient-provided specialty care services at Highland Hospital: • Dental Clinic • 11 Additional Specialty Care Services Total 10,000 patients served in 50,000 visits GY2020 Total 144 FTE Direct, Grant-funded FTE: 26 1,000 patients served in 2,000 visits GY2020 2,000 patients served in 7,000 visits GY2020 8,000 patients served in 38,000 visits GY2020 950 patients served in 3,000 visits GY2020

7. CY2019 ACHCH Health Center Finances • $4,289,842: HRSA Grant • $1,954,924: Mental Health Services Act • $1,324,213: County & Other Funding (Net County Cost, MAA, TMSF) Total Funding (CY19): $7.6M • $14.5M: subrecipient & Contractors Self-Reported Costs of Care • AHS Reported Cost of Care: $11.3M ( $22.1M: Total ACHCH Health Center Wide Costs • $4.2M: FQHC Patient Revenue Reported by AHS & Contractors

8. 2019 ACHCH Contractors

9. Current Challenges • 2019 Point in Time Count showed 42% increase in homelessness in Alameda County • Top 10 most expensive rental market in the country • Explosion in unsheltered homeless and homeless encampments • Aging and increasingly complex population • Defining and Coordinating roles of cities, counties and health care providers in homelessness crisis • Large and geographically diverse county with distinct subpopulations of homelessness and varying service needs • Growing homeless health care needs outstripping ACHCH funding

10. Countywide Homeless Action County Homeless Action Plan: https://homelessness.acgov.org AC Housing and Community Development, Measure A1 Health Care Services Agency Alameda County Care Connect (AC3) HCH program Health Care: Alameda Alliance for Health, HealthPAC EveryOne Home (HUD Continuum of Care) Alameda County Homelessness Council Alameda County Behavioral Health Alameda County Social Services Cities and City Staff Community: Advocates, Faith, neighbor groups, residents. Alameda County Public Health Criminal Justice System Alameda County Environmental Health, Public Works Other Districts CalTrans, BART, Schools,

11. Current Initiatives ACHCH StreetHealth Team • Funded by 2017 HRSA AIMS, 2018 SUDS-MH and 2019 IBHS expansions • Adds psychiatry and Medication-Assisted Treatment (MAT) to mobile outreach teams • Psychiatric medications and opioid replacement available on the street • Featured as HRSA Health Center Promising Practices 2019 • 2019 California State Association of Counties Challenge Award - Merit Award Winners

12. Current Initiatives Expanding Street Health Teams Countywide • Expanded from two contracted teams to five and soon to eight • Defined smaller geographic areas based on unsheltered homeless density • Focus on greater depth of care • Enhanced technical assistance and monthly Learning Community to support the development of the program model

13. Current Initiatives TRUST Health Center • Braided HCH/Contractor staffing and oversight model using non-federal MHSA funding. • Serves population of people who are homeless, chronically disabled, and with high rates of trauma • Integrates services and organizations (contractor Lifelong, benefits attorneys, ACHCH behavioral health, housing services) to provide care under one roof • Cutting-edge, low barrier Medication Assisted Treatment for opioid use disorder • Addresses social determinants of health through medical-legal partnerships, supported employment, and housing services

14. Other Current Initiatives • Data sharing • Development of countywide “Community Health Record” and universal release • Increased sharing of Health Care for the Homeless data to improve whole-person health care • Subrecipient AHS transition to new Electronic Health Record (EPIC) • Quality • Implementation of Results-Based Accountability in all contracts to improve quality of services • Ongoing development of HCH and AHS Ambulatory quality committees • Outreach • Leading coordination of county-wide homeless outreach providers • Continued development and implementation of best practices • Emergency Response • Collaboration with Alameda County Public Health Department for Hepatitis A outbreak and extreme weather emergency responses for unsheltered homeless

15. Consumer Input • HCH Consumer/Community Advisory Board (HCH CCAB) established in 2002 • Consumer representation on the HCH Commission, AHS Co-Applicant Board and Quality Committee • Current innovative work in Patient Experience/Patient Satisfaction • Implementation of consumer-developed patient experience survey across HCH health center • Implementation of review process to ensure patient-centered literature and health literacy standards

16. www.achch.org