manatee county government administrative center commission ... · 8/24/2017 · indigent health...
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August 24, 2017 - Work Session Agenda Item #1
Subject 2017/18 Health Care Programs Briefings Briefing Provided Upon Request Contact and/or Presenter Information Cheri Coryea, Director, Neighborhood Services, ext 3468 Joshua Barnett, Healthcare Services Manager, ext 3030 Action Requested Review annual Healthcare Programs for 2017/18 budget Enabling/Regulating Authority Efficiency in Service Background Discussion Annually, the Board of County Commissioners discusses the interest and amount of financial participation for programs to low income persons and special needs individuals. This group of programing which deals with healthcare and behavioral health care includes service providers from not for profit organizations and for profit organizations. Staff will present recommendations for consideration by the Board based on factual data for healthcare needs in Manatee County. By the Budget adoption hearing on September 28, 2017, recommendations suggested by the board will be included in the annual funding budget for healthcare. Upon budget adoption, staff of the department prepare funding agreements and establish results first performance outcomes that are monitored through the year. County Attorney Review Not Reviewed (No apparent legal issues) Explanation of Other Reviewing Attorney N/A Instructions to Board Records None Cost and Funds Source Account Number and Name
Manatee County Government Administrative CenterCommission Chambers, First Floor
9:00 a.m. - August 24, 2017
TBD Amount and Frequency of Recurring Costs TBD
Manatee County Government Administrative CenterCommission Chambers, First Floor
9:00 a.m. - August 24, 2017
Health Care Services 2017-18 Budget Recommendations August 24, 2017
Joshua T. Barnett, MHS, MA, CPRP, ICCDP-Diplomate Health Care Services Manager Community Services Division Department of Neighborhood Services
WORK SESSION AGENDA • Acknowledgements • Vision • Healthcare Advisory Board Recommendations • Staff Recommendations • BOCC Discussion • October 17th Work Session – Service Details
Barnett, J. HSC BOCC Work Session 8-24-17
Health Care Services Community Involvement
• Behavioral Health Consortium/Acute Care Meeting • Central Florida Behavioral Health Network – Board of Directors & QI • Chamber of Commerce: Healthcare Subcommittee • Community Paramedicine Steering Committee • Department of Health’s CHIP & CHA
– Access to Care – Addiction Crisis Taskforce
• Drug Epidemiologic Network – Manatee • Drug Free Manatee – Board of Directors • Health Care Advisory Board - Liaison • Health Care Alliance • Health Council of West Central Florida • Manatee Community Foundation • Medical Society of Manatee County • and Presentations: Center for Local Government Excellence, Lake Eerie
College of Medicine, Probation & Parole, and Faith Based Alliance
Barnett, J. HSC BOCC Work Session 8-24-17
Health Care Context History & Present • Acute Care Services
– Emergency Department – In-Patient Services
• Medical • Mental Health
• Physician Services – HIE Requirement – Safety Net Hospital
• Homeless Health – Dental, Screenings, Diabetes
• Eligibility Guidelines
Future Vision • Enhance Diversity of Services • More Services & Patients • Improve Health Status • Accountable to Quality
Standards of Care • Coordinated & Collaborative
Treatment • Reduced Cost Per-Capita
Barnett, J. HSC BOCC Work Session 8-24-17
Institute of Health Innovation Triple AIM & Results First
Barnett, J. HSC BOCC Work Session 8-24-17
Population Health Management Patient – Centered Approach
• Engage Residents into Health Care Services
• Facilitate How/When/Where Residents Access Care
• Assess Needs & Manage • Follow-Up • Equitable Resources
Systems-Focused Approach • Community & Clinic Based • Accountable to Quality • Performance & Value-based
Contracting • Collaborative Care
– Between Providers – Integration of Services – FQHC
• Reduces Emergency Department (Acute)
Dependency
Barnett, J. HSC BOCC Work Session 8-24-17
County Health Statistics - WHO Category Manatee County Statistic
Number of Uninsured below 200% FPL ~25,000
Indigent Health Program Enrollees ~2,400
Percent at or below 200% FPL 36.31%
Percent of Population Uninsured 18.03%
Quality of Life 12th Best in FL
Dissatisfaction Greatest Amongst Women, Hispanics, Blacks, Lower Income, and Younger Age Groups
Patient Dissatisfaction in Health Care Lack of Coordination, High Deductibles, Unmet Health Needs, and ED Delays
Households Below Poverty Level 43%
Satisfaction in Health Care 39%
County Health Ranking 20th Best in FL
Health Outcomes 23rd Best in FL
Barnett, J. HSC BOCC Work Session 8-24-17
County Health Statistics - WHAT Manatee County-specific Health Needs (not ranked) 1. Diabetes Management 2. High Blood Pressure/Cardiovascular 3. Cervical and Breast Cancer Screening 4. Late Entry Prenatal Care 5. Tobacco Cessation 6. Suicide and Drug Overdose 7. Oral Health 8. STI/HIV/Hep C Transmission 9. Birth to Teen Mothers 10. Unintentional Injuries (falls)
Barnett, J. HSC BOCC Work Session 8-24-17
County Health Statistics - WHERE
Zip Codes • 34207 • 34205 • 34208 & 34203 • 34221
Cities • West Samoset • South Bradenton • Samoset • Memphis • Bayshore Gardens • Palmetto
Barnett, J. HSC BOCC Work Session 8-24-17
Resources Asset Limited, Income Constrained, Employed (ALICE) Report – 2017 Update for Florida. United Way. www.uwof.org. Community Health Assessment. Manatee Health Care Alliance. Department of Health in Manatee County. December, 2015. www.manatee.floridahealth.gov Health Needs Assessment Manatee County. Health Council of West Central Florida. March, 2009. www.hcwcfl.org Higgins, S. et al. Medical homes and cost and utilization among high-risk patients. American Journal of Managed Care. 2014, March. 1;20(3):e61-71. Manatee County Health Care Plan for Low-Income Uninsured Adults. Health Management Associates. August, 2016. Simonet, D. Cost Reduction Strategies for Emergency Services: Insurance Role, Practice Changes and Patients Accountability. Health Care Anal (2009) 17:1-19 Xu, T., et al. Variation in Emergency Departments vs Internal Medicine Excess Charges in the United States. Journal of the American Medical Association. 2017. Accessed June 12, 2017.
Barnett, J. HSC BOCC Work Session 8-24-17
Budget Discussion Thank you
Joshua T. Barnett Health Care Services Manager Division of Community Services Department of Neighborhood Services E-Mail: [email protected]
Barnett, J. HSC BOCC Work Session 8-24-17
8/24/2017 www.mymanatee.org/published/August 24, 2017 - Work Session on Thursday, August 24, 2017/6084EEF9-F457 -4561-961 D-02031 D6E9769-0 ...
www.mymanatee.org Manatee County Government Administrative Center Commission
Chambers, First Floor 9:00a.m. -August 24, 2017 August 24, 2017- Work Session
Agenda Item # 1
Sub~ect 201 /18 Health Care Programs
Briefings Briefing Provided Upon Request
Contact and/or Presenter Information Cheri Coryea, Director, Neighborhood Services, ext 3468 Joshua Barnett, Healthcare Services Manager, ext 3030
Action Requested Review annual Healthcare Programs for 2017/18 budget
Enabling/Regulating Authority Efficiency in Service
Background Discussion Annually, the Board of County Commissioners discusses the interest and amount of financial participation for programs to low income persons and special needs individuals.
This group of programing wh ich deals with healthcare and behavioral health care includes service providers from not for profit organizations and for profit organizations.
Staff will present recommendations for consideration by the Board based on factual data for healthcare needs in Manatee County.
By the Budget adoption hearing on September 28, 2017, recommendations suggested by the board will be included in the annual funding budget for healthcare.
Upon budget adoption, staff of the department prepare funding agreements and establish results first performance outcomes that are monitored through the year.
County Attorney Review Not Reviewed (No apparent legal issues)
Explanation of Other
Reviewing Attorney N/A
Instructions to Board Records None
Cost and Funds Source Account Number and Name TBD
Amount and Frequency of Recurring Costs TBD
http://www. mymanatee .org/published/August%2024, %2020 17%20-%20Work%20Session%20on%20Thursday, %20August%2024, %2020 17/6D84EEF... 1/2
Health Care Service.., 2017-18 Budget Recommendation.., \ui.!.U'-1 .!4, 2017
Joshua T. Bamell, M f/S, MA , CPR P, /CCDP-Diplomate Health Care Services Manager Community Services Division Department of Neighborhood Services
WORK SESSION AGENDA
• Acknowledgements
• Vision
• Healthcare Advisory Board Recommendations
• Staff Recommendations
• BOCC Discussion
• October 17'" Work Session- Service Details
Health Care Serviceo., Community Involvement
Behavioral Health Consortium/A cure Care Meeting Central Florida Behavioral Health Network- Board of Director!i & QI Chamber of Commerce: Healtlrcare Subcommittee Community Paramedicine Sreering Commillee Department of Health S CHIP & CHA - Ara ss to Cart' - Addirt ion (ri~·i.f Taskforrf!
Dmg Epidemiologic: Network- Manatee Drug Free Manatee- Board of Directo rs Heal tit Care Afh•isory Board - Liaison Health Care A /Iiana Health Council of West Cenrral Florida
Medical Society ofJ~1anatee County _.!.> ~1.:.~~~~ Manatee Communi()• Foundation ~
and Presentations: Center for Local Cow!rnment Excellence, t:.a , College of Medicine, Probation & Parole, and Faith Based Alliance
8/24/2017
1
Health Care Context History & Present
Acute Care Services - EmugenC.:)' Departmelll - lfi ·Pmiem Sen ·h:ef
• Mnbnd • Ml'ntafi/Mith
Physician Sen;ices - HI£ Requirement
- Scifety Net Hospital
Homeless Health - D enftll. Screeni11gs. Diabetef
Eligibility Guidelines
Future Vision
• Enhance Diversity of Services
• More Services & Patients
• Improve Health Stallls
• Accountable to Quality Standards of Care
• Coordinated & Collaborative Treatment
• Reduced cost Pe~rta -. t!· nt
Institute of Health Innovation Triple All\tl & Results First
• ['upu l01tiun f!,·.dth
• ' t l'.1lit>n + I ~·r l .1p11.1
1·\j.'l'rit"n.;.· ("os!s
Population Health Management Patient- Centered Approach
• Engage Residents into Health Care Services
• Facilitate How/When/ Where Resident.\· Access Care
• Assess Needs & Manage
• Follow-Up
• Equitable Resources
Systems-Focused Approach
Communiry & Clinic Based
Accountable to Quality Peifonnance & Value-based Contracting
Collaborative Care - Ben\·een Prm•iderJ - lmegrmion of Sen ·ices
- FQHC
Reduces Emergency Department (Acute) Depend en c)~
8/24/2017
2
County Health Statistics- WHO Category Manatee County Statistic
Number of Uninsured below 200% FPL -2s,ooo Indigent Health Program Enrollees ... 2,400
Percent at or below 200, FPL 36.31%
Percent of Population Uninsured 18.03%
Quality of Ufe 12th Best in Fl
Oisutisfiilction Greatest Amongst Women, Hispanics, Blacks, lower Income, and Younger Age Groups
Patient Dissatisfaction in Health Care lack of Coordination, High Deductibles, Unmet Health Needs, and ED Delays
Households Below Poverty level 43%
Satisfaction in Health Care 39%
County Health Ranking 20m Best in Fl
Health Outcomes 23rd Best in Fl --
County Health Statistics - WHAT
Manatee County-specific Health Needs (••'"'"•') I. Diabetes Man agement 2. High Blood Pressure/Cardiovascular 3. Cervical and Breast Cancer Screening 4. u1te Entry Prenatal Care 5. Tobacco Cessation 6. Suicide and Drug Overdose 7. Oral Health 8. STIIHIV/ Hep C Transmission 9. Binh to Teen Mothers 10. Uninten tional Injuries (jails)
County Health Statistics - WHERE
Zip Codes Cities
• 34207 • West Samoset
• 34205 • Sowh Brademon
• 34208 & 34203 • Samoset
• 3422 1 • Memphis
• Bayshore Gardem
• Palmetto
8/24/2017
3
Resources Anrt Llmltl-d . lncom" ConsH11111<--d. Empkly<.'!J (ALICE) Report - 2017llpdah~ for J~>nda. Un1k...l Wa) wwwuwoforg
CommUni!) llcslt h :~<:ssmcnt M:mata: l kallh Care: All1anu: IJcpaltm.:nt of llo:alth Ill ~laMicc COI.Int)' lkumbn. :WI~ - '4 maMkf 0.....-..bhs:allh .:<l>-
llcalth Nc:ab scssmcnt Man:ata:Counly llcallh Cutmcll ofWo:st (_'cnlr.d Flood:t Mar~h 2CMI9
~
U1qms. S L1 aJ ~kJ•u.l h~ and cmt and utth1...Jt)Ofl among h•s h·nsi: paucnu Amcnuan Journal of Mana!edCarc: 201.-. MarLh 1.20(3J,.o(} l -71
Manata: Counly l!o:ahh Can: Pbn fOI' J..o.,. ·IIIC()fM Untn~u r .. -d r\Juks llcahh Manago:mcnl w ualcl ,\u!u~t 2016
s.mon<..1. () Cost llcliULllOn StnalC!M.., for Emcr!!CilC) Scr11L'C$ lnsurunco: Ruk P111LI1\4' Chull_ -~ a .J l':!ollcnu Al.:countabthty Jk.:~hh Car« Ana.! 120091 17 1-19
.-. Xu. T . d al Vanahon m EmcrJCII..:) Dcpanmo:nu \ 'S lnh:mal ~kd)l.."'n<' Elccu C'halJU tn th · Jourru~J of the Amcm:an McJ.cal ,\sMJo;tJ.hon 2017 . A..ccu .. -d June 12. 2017
Budget Discussion
Thank you
Joshua T Barnett Health Care Services Manager
Divil·ion of Community Sen·ices
Deplmment of Neighborhood Sen•ices
£ -Mail: Joshua.Bamen @mymanatee.org
8/24/2017
4
BRIEF STRATEGY RECOMMENDATIONS
POPULATION HEALTH MANAGEMENT FOR UNINSURED RESIDENTS OF MANATEE COUNTY
PRESENTED BY:
HEALTHCARE ADVISORY BOARD
PRESENTED TO:
BOARD OF COUNTY COMMISSIONERS
MANATEE COUNTY
AUGUST 24, 2017 9:00AM
DRAFT PROVIDED BY:
JOSHUA T. BARNETT, MHS, MA, CPRP, ICCDP-DIPLOMATE
HEALTH CARE SERVICES MANAGER
LIAISON TO THE HEALTHCARE ADVISORY BOARD
DEPARTMENT OF NEIGHBORHOOD SERVICES
MANATEE COUNTY GOVERNMENT
Page 1 of 4
The Healthcare Advisory Board (HCAB) initially met in December of 2015, beginning with
an orientation to the County's health resources and contracted programs. To date, the HCAB
has received various presentations and research, providing the thoughtful discussion for the
management of health needs for Manatee County's uninsured population . Following monthly
meetings and additional subcommittee discussions, the time dedicated has provided the ability
for the HCAB to present the following funding recommendations to the Manatee County Board
of Commissioners.
1. Population Health Management Strategies
Proactive methodologies to engage residents in positive health seeking behavior, actively
directing and managing health care resources at both individual and systems levels. By
managing the access of preventative, primary and specialty health care services, avoiding
unnecessary high cost, acute care treatment services such as emergency departments for
primary care or central receiving facilities for psychiatric care, is reduced. Identify the at
risk populations and individuals who most frequently use acute care services for primary
care and non-emergent health issues. Redirect these groups to the appropriate health
settings, avoiding unnecessary costs and educating on how to access health resources for
preventative, primary, and specialty health needs. Support treatment follow-up and address
causal factors of multi-morbid social and health needs.
a. Establish Presumptive Eligibility Procedures which allow patients access to care but also substantiate their eligibility and enrollment into County funded health program with individualized resource allocation . b. Centralize an Eligibility Unit to conduct eligibility analysis and assessment of needs for those currently enrolled in county funded health program . c. Monitored utilization of health communication systems used to exchange health information amongst providers to enhance quality in care and reduce unnecessary costs.
2. Priority Funding of Community Based Healthcare
A significant proportion of health funding in Manatee County is focused on hospital
based, acute care. Accessible primary, preventative and specialty health resources outside
of emergency departments are more affordable. In order to improve health for the
individual and financial health for both the hospitals and the county, early and affordable
health resources within non-hospital settings are recommended to reduce expensive and
unnecessary emergency department dependence. The county may consider contracting for
various health services that direct the patient to appropriate levels of care, sooner, to
prevent deterioration of health and exacerbation of needs as opposed to seeking care in
emergency room settings for primary and specialty care services.
Page 2 of 4
a. Community Health Workers/ Advisors: An evidence-based approach to navigating
the healthcare continuum in a patient-centered approach to engage primary care,
preventative care, dental services, specialty care, and follow-up in a cost-effective
way that yields significant health improvement than infrequent or delayed acute
care.
b. Community Care Clinics: In partnership with community health providers, establish
"health homes" for high need, high utilizers of acute care services for their complex
health needs. Establish outcomes-based funding with a cost-effective clinic to
improve patient understanding and treatment of multiple health conditions and
prevent unnecessary use of acute care.
a. Examples: Residency Clinics, Continuity of Care Clinics, and Integrated Care
Clinics
c. Emergency Room Diversion: Engage in partnerships that support Manatee
Memorial Hospital's ability to divert unnecessary emergency room use, promote
reduction of its use through outcome-based reimbursement, and redirects patients
to the correct place of care.
a. Example: The Community Para-Medicine Program currently serves as the
County's most effective emergency diversion service and primary linkage
resource throughout the county. It is recommended for its continuation due
to its efficacy locally and effectiveness as a national model.
3. Patient-Centered & Collaborative Treatment
It is recommended that members of the County's health program be provided equitable resources to address their various health needs whereby members receive individualized support, specific to their needs, and participate within the health planning process :
a. Needs Assessment & Enrollment 1. Referrals Triaged by Community Para-medicine serving as Gatekeeper
b. Individualized Treatment Placement i.e. Community Care Clinics, Community Para-medicine, Community Health
Advisor, Dental Services, Behavioral Health, or Federally Qualified Health Centers
c. Accountability, Active Participation, and Health Incentives 1. Promote health seeking behavior 2. Establish patient buy-in and funding limits 3. Patient Health Incentives/Rewards such as : dental, education, or nutritional 4. Managed Treatment with Utilization Review and Reimbursement Rates
Page 3 of 4
d. Coordinated and Collaborative Care 1. Expected exchange and of shared-patient health information 2. Facilitated and proactive preventative treatment 3. Quality-based and Outcome-based reimbursement 4. Incentives for movement toward integrated substance use and mental health treatment
Although concise, this document refers to a significant change in the methodology for which health care is funded and delivered. Accountability, community-based services, active engagement, and patient health management are concepts adopted nationally for the ir evidence and are recommended for Manatee County.
This concept is informed by various resources including, but not limited to : Institute of Healthcare Improvement's {I HI) Triple Aim of Increased Population Health, Improved Qual ity, and Reduced Per Capita Cost; Health Management Associates {HMA) report in 2016; University of South Florida {USF) Healthcare Findings and Analysis to Manatee Chamber in 2008; Department of Health {DOH) in Manatee Community Health Assessment {CHA) and Community Health Improvement Plan {CHIP); the Health Council of West Central Florida statistics report; and, the Health Information Exchange {HIE) data reports.
These resources shall each inform continued funding under the advisement of this Healthcare Advisory Board and by the management of the County' s Health Care Services Manager as changes to healthcare are ongoing and anticipated, locally and nationally.
Respectfully submitted,
Steve Hall, CEBS, CHRP, CSFS Healthcare Advisory Board, Chair
Page 4 of 4
DRAFT- 08/ 11/2017
Expenses:
Hospital Payments - Indigent
Doctor Payments - Indigent
FOHC Clinics - Indigent
Homeless Health/Clinic-General Health
Administrative/Third Party Billings
Community Paramedicine
Strategic Initiatives
Emergent Health Fund
Total
Revenues:
Healthcare Corpus
General Fund
Recurring
Additional Recurring Funding in FY18
Additional Recurring Funding in FY19
Additional Recurring Funding in FY20
Non-Recurring
Total
HEALTH CARE BUDGET SUMMARY
4,700,000 4,150,000 4,150,000 3,021 ,586
540,000 1,250,000 1,250,000 1,250,000
270,000 270,000 430,500
1,220,000 208,500 400,000
253,000 150,000 78,740
357,119 357,119
924,979 765,860 925,000
22,950 27,566
7,005,950 6,953,479 6,953,479 6,060,011
7,005,950 679,859
2,908,632 2,908,632
1,000,000
6,273,620 4,044,847 2,151 ,379
7,005,950 6,953,479 6,953,479 6,060,011
Strategic Initiatives: Clinic-based Outpatient Surgery Center(s) Community Health Advocates Opioid Peer Coach Project LECOM Dental for Adults Claims Utilization Management
3,021 ,586 3,021 ,586
1,250,000 1,250,000
400,000 400,000
80,920 80,920
357,119 357,119
925,000 925,000
25,386 25,386
6,060,011 6,060,011
2,908,632 2,908,632
1,000,000 1,000,000
1,000,000 1,000,000
1,151 ,379
1,151 ,379
6,060,011 6,060,011
HEALTH CARE SERVICES- MANDATED SERVICES Agency Program FY13/14 FY14/15 FYlS/16 FY16/17 FY17/18
Armor Correctional Health Jail Medical FS 901.35 & 951.032 s 5,152,367.00 s 4,735,103 .00 s 5,327,477.00 s 5,694,484.00 s 6,119,503.00
Centerstone of Florida Mental Health Transport s 93,970.00 s 93,970.00 s 93,970.00 s 93,970.00 s 93,970.00
Health Care Responsibil ity Act HCRA FS 154.301 s 118,670.00 s 47,915 .00 s - s 2,834.00 s 150,000.00
Medicaid Match Medicaid Match FS 409.915 s 4,769, 773.00 $4,778,212.00 s 4, 796,486.00 s 4,911,908.00 s 4,349,527.06
Department of Health in Manatee Services s 929,962.00 s 929,962 .00 s 929,962.00 s 929,962 .00 s 929,962.00
Department of Health in Manatee Facil ity s 143,960.00 s 146,155.00 s 132,334.00 s 121,256.00 s 152,499.00
Department of Health in Manatee Minority Aids Social Service s 7,172.00 s - s - s - s -
TOTALS $ 11,215,874.00 $ 10,731,317.00 $ 11,280,229 .00 $ 11,754,414.00 $ 11,795,461.06
HEALTH CARE SERVICES- COUNTY ADMINISTERED PROGRAMS FOR LOW INCOME PERSONS
Agency Program FY13/14 FY14/15 FYlS/16 FY16/17 FY17/18
Prescriptions 0.00 s 103,663.00 $220,763.00 s (52,170.00} s 200,000.00 s 200,000.00
General Fund Cost Allocation 0.00 s 100,000.00 s 100,000.00 s 100,000.00 s - s -
HIE Heplth Information Exchange Health Information Exchange $- $- $- s 3,750.00 s 4,750.00
Hospital Audits Hospital Audit Services $660.00 $- $75,750.00 s - s 105,039.00
IHS Indigent Health Solutions Billing Software $43,415 .00 $23,648 .00 $31,924.00 s 59,235 .00 s 73,666.00
TOTALS $247,738.00 $344,411 .00 $ 155,504.00 $ 262,985.00 $383,455 .00
HEALTH CARE SERVICES- FOR PROFIT FUNDING
Agency Program FY13/14 FY14/15 FYlS/16 FY16/17 FY17/18
Blake Medical Center Indigent Health Care $ 1,121,488.00 $ 1,225,262 .00 $ 523,155.00 $ - PENDING LIP
Clinics Indigent Health Care $ 839,645 .00 $ 724,850.00 $ 564,476.00 $ - PENDING LIP Low Income Pool (LIP) AHCA $ - $- $ - $ 505,000.00 $ 3,021,586.00
Manatee Memorial Hospital Indigent Health Care $ 5,996,520.00 $5,406,707 .00 $ 3,526,586.00 $ 3,021,586.00 PENDING LIP
Physician Payments Indigent Health Care $ 1,000,000.00 $538,238.00 $ 657,266.00 $ 1,250,000.00 $ 1,250,000.00
Speciality Care Indigent Health Care $ 58,286.00 $54,186.00 $ 56,975.00 $ 56,975 .00 PENDING LIP TOTALS $ 9,015,939.00 $ 7,949,243.00 $ 5,328,458.00 $4,833,561.00 $ 4,271,586.00
Pending decision of LIP fund in ool
MMH request in 17/18 the same amount as received in FY 15/16
Consideration for new programs
HEALTH CARE SERVICES • NOT FOR PROFIT
Baker Act Adult
Pharmaceutical Program
Pilot - Community Health Home
Case Mgmnt