November 3, 2016
Women's City Club
LA County Implementing Priorities to Bring about Real Change
Los Angeles County’s Board of Supervisors has identified four priorities on which to work, according to Sachi Hamai, the Chief Executive Officer charged with bringing the priorities to fruition. It’s a tall order for anyone, considering the size and diversity and the $30 billion budget for the county.
Hamai took time out from her demanding schedule to speak to us at the November 3 League Day. She named the priorities as (1) homelessness, (2) jails, (3) child protection, and (4) merging three health departments to create a more efficient and effective health agency.
Hamai explained some of the actions that have been taken to address these priorities. After she spoke, Dr. Alexander Li, a primary care physician with the county, and now a Deputy Director of the new health agency, explained some of the seventy-two initiatives that the agency is trying to implement in order to deliver more bang for the tax buck and to better serve the 600,000 patients in the county health system.
Regarding the homeless, Hamai said that LA County has more than 48,000 homeless people, and the best solution for that problem is obviously more affordable and, in most cases, more supportive housing. As for the jails, the county is trying to expand diversion programs, which channel offenders with addictions and mental illnesses into treatment programs, rather than perpetuating the current system that cycles these people into jail, back out to the streets, and back into jail. The biggest step the county is taking to improve children’s services is to hire more social workers in order to decrease the caseloads. Currently, that caseload is down from thirty-two children per social worker to eighteen children. They hope to reduce that number even more, to around fifteen.
The county has merged the Public Health, Health Services, and Mental Health departments. Health services integration addresses the four pillars of the Affordable Care Act: (1) insurance reform, (2) coverage expansion, (3) delivery system redesign, and (4) payment reform. Of these, items 3 and 4 are long-term efforts that will take years to achieve. Li noted that among the challenges is the fact that doctor compensation is much higher in the United States than in other countries.
One of the big goals in the health agency is to create centralized treatment teams, which would have doctors, nurses, and other specialists housed in one place, so that poor people would not have to rely on public transportation to long distances to see a primary-care doctor, go to a lab, get a prescription filled, see a specialist, or see a mental health doctor.
Dr. Li showed us pictures of affordable, supportive housing complexes that are sprouting up all over the county. The goal is to house ten thousand homeless people with addiction, mental health, and other health conditions in buildings that contain the various health and social services the residents need. He said that studies show that homeless people die twenty-five years younger than their more fortunate peers, because they are exposed to unhealthy diets and conditions that make taking care of themselves difficult or impossible.
And yet, a chronically homeless person can cost the county $8,000 per person per month, because of lengthy hospital stays, frequent but ineffective doctor visits, time in jail, and cycling through the legal system. The goal of the county is to not spend more money but to spend it wisely, by investing dollars in permanent, supportive housing that will actually treat people with chronic conditions that keep them homeless and ill.
Ms. Hamai and Dr. Li communicated their commitment to improving the lives of everyone in the county and to preventing limited funding from being spent without actually helping and treating the poorest and most vulnerable residents of our county.