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HomeMy WebLinkAboutAgenda - 06-06-1994 - VIII-C I 1 I ORANGE COUNTY BOARD OF COMMISSIONERS Action Agenda Item No. 1I� ACTION AGENDA ITEM ABSTRACT Meeting Date: June 6, 1994 SUBJECT: Extension of Permanent Time-limited Maternity Care Coordination Position DEPARTMENT: HEALTH PUBLIC HEARING: Yes x_ No ATTACHMENT(S) : INFORMATION CONTACT: HEALTH DIRECTOR'S OFFICE X2411 Analysis of Performance TELEPHONE NUMBER: Hillsborough - 732-8181 Chapel Hill - 968-4501 Mebane - 227-2031 Durham - 688-7331 PURPOSE: To extend an existing, time-limited, Maternity Care Coordination position for one additional year. This position will provide case management services for an average monthly caseload of 36 prenatal patients covered by Medicaid and an average monthly caseload of 20 child service coordination clients in order to reduce poor birth outcomes, which is the second highest priority in the health department's community diagnosis. BACKGROUND: At its May 3, 1993 meeting, the Board approved an extension of this permanent, time-limited, Social Worker II, Maternity Care Coordination position through June 30, 1994. The approval was contingent on Medicaid revenue generated by the position and the caseload demand. The incumbent in this position started work with the Health Department in July 1993 after the position had been vacant for three months. Over the next several months, she was oriented to Maternity Care Coordination (MCC) and Child Service Coordination (CSC) and gradually developed a caseload in each program. The caseload history and revenue production are presented in the attached analysis. Over the last year, there has been a steady demand for the services provided by this position; in fact, we have a waiting list of CSC clients which we are unable to serve with current staffing levels. These services are very valuable to Orange County women, children and families. 2 Evaluation of the MCC program on the state level has shown that women who receive MCC services have better pregnancy outcomes. This has been demonstrated by a lower incidence of low birth weight babies and a lower infant mortality rate for children of women receiving MCC versus those who do not. The CSC program provides special early intervention services to children at risk for developmental delays and disabilities. Both programs are cost effective in that they prevent more serious conditions from developing or becoming worse which would incur higher costs to the County and to society in the long run. Without this position Orange County women and children will not receive the benefits of these valuable services and the County will not benefit from future cost savings. A spinoff benefit of this Maternity Care Coordination position is an increase in Maternal Health Clinic activity which results in an increase in Maternity Health Clinic revenue. The attached analysis shows that Medicaid revenue through April 30, 1994, in the Maternal Health Clinic exceeded the annual budget by $25,882. When combined with the revenue produced by the position itself of $18,321 through March 31, 1994, the salary and fringe benefit expenses of $26,746 were covered. As the position reaches a peak caseload capacity, the position will generate $40,760 to offset the salary and fringe benefit expenditure of $34,040. This position has been extended on a time-limited basis to study the caseload demand and the revenue generated. However, the position has been vacated twice, resulting in periods of low productivity due to training and orientation. On both occasions, the caseload built up and the revenue generated was sufficient to support the position. Therefore, it appears that the position will be self-sufficient if the caseload remains at the current level for the entire year. RECOM ENDATION(S) : The Manager recommends that the Social Worker II, Maternity Care Coordination position be extended on a time-limited basis, for one additional year. 3 SOCIAL WORKER II, MATERNITY CARE COORDINATOR PERMANENT, TIME-LIMITED POSITION CASELOAD HISTORY Maternity Care Coordination Child Service Coordination Contacts Caseload Caseload Jul 1993 4 initial 4 0 Aug 1993 11 initial 15 0 4 subsequent 1 home visit Sep 1993 5 initial 20 0 14 subsequent 0 home visits Oct 1993 4 initial 24 11 19 subsequent 3 home visits Nov 1993 4 initial 24 11 16 subsequent 2 home visits Dec 1993 5 initial 27 14 19 subsequent 3 home visits Jan 1994 7 initials 34 17 22 subsequent 3 home visits Feb 1994 3 initial 36 18 24 subsequent 6 home visits Mar 1994 4 initial 34 20 18 subsequent 5 home visits Apr 1994 unavailable unavailable May 1994 unavailable unavailable Jun 1994 unavailable unavailable 4 REVENUE PRODUCED Maternity Care Coordination $11,041.56 Child Service Coordination 71280.00 Jul 93 - Mar 94 Total $18,321.36 The total amount of revenue is affected by the period of 3 - 6 months of orientation and start up time. Total caseloads did not approach capacity until January 1994 . Also figures are not available for April 1994 at this time. EXPENSES Salary and Fringes Jul 93 - Mar 94 Total $26,745.75 ANALYSIS OF PEAK CASELOAD PERIOD Jan 94 - Mar 94 Revenue $9046.56 Expenses $8915.25 It appears that, when functioning at peak caseload capacity, this position can be self-supporting. SUMMARY OF MATERNAL HEALTH AND MCC REVENUE ACCOUNTS ACCOUNT ACTUAL BUDGET BALANCE NUMBER DESCRIPTION Y-T-D 103410143 TITLE XIX MATERNAL HEALTH 66,342 40,460 25, 882 103410144 TITLE XIX MCC INITIAL 10,383 12,957 2,574 103410145 TITLE XIX MCC SUBSEQUENT 28,821 31,084 2 ,263 TOTAL 105,546 84,501 21, 045 There is sufficient MCC-related Medicaid revenue to off-set the short-fall during the start-up period of the new incumbent.