Santa Cruz County Health Services Agency: A History of Collaboration

Communities in Charge

Field of Work: Helping community coalitions design and establish sustainable health care delivery systems.

Problem Synopsis: In 1998, 44.5 million people in America did not have health insurance, according to the federal Health Resources and Services Administration (HRSA). In the absence of comprehensive federal efforts to expand health coverage, the burden of caring for uninsured individuals falls on states and local communities. Often, local health care systems are not organized to promote prevention and early intervention, coordinate care and services or monitor access to and quality of care. When people do not receive the care they need, the costs are borne by providers, local governments and, ultimately, local taxpayers.

Synopsis of the Work: In July 1997, the Board of Directors of the Robert Wood Johnson Foundation (RWJF) authorized $16.8 million to support Communities in Charge: Financing and Delivering Health Care to the Uninsured (CIC). CIC was designed to help broad-based community coalitions design and establish sustainable health care delivery systems. The County of Santa Cruz Health Services Agency is the public health department in this California county of 264,000 residents.

The nucleus for health information exchange efforts between the public health department and other community stakeholders was a 2001 Community Access Program grant from the federal Health Resources Services Administration, which allowed Santa Cruz to create the Health Improvement Partnership of Santa Cruz County to tackle the community-wide problem of the uninsured.

Key Results: The health department director appointed a four-member team which:

  • Surveyed nine stakeholders about their perceptions of regional health information exchanges. The respondents agreed on their potential benefits, identified financing and staffing as obstacles to their development and differed in their views about optimal governance structures.
  • Surveyed 13 stakeholders to learn about their information systems, focusing on patient registration practices.
  • Researched the approach to electronic health information exchanges taken in other regions and communities.
  • Interviewed Woodward (Berni) Clum, M.D., chief of the Emergency Medical Group at Watsonville Community Hospital, about the electronic health information needs for emergency department physicians.