Health Services Agency

After numerous discussions with partners to inform our recommendations, Stanislaus County's Health Services Agency proposes to change its role and refocus its resources. It is proposed to cease operational support of the Paradise Medical Office at 401 Paradise Road in Modesto, and no longer provide high-risk obstetric care, physical rehabilitation services, or specialty services. The Health Services Agency would continue to operate the Family and Pediatric Health Center and the McHenry Medical Office.

As part of the proposal, the County would relinquish its role in operating the Paradise Medical Office as the primary teaching site for the Valley Consortium for Medical Education Family Medicine Physician Residency Program. In its place, Golden Valley Health Centers, a federally qualified health center, would occupy the 401 Paradise Road building and take over that role.

For patients, care disruption would be minimized or possibly avoided altogether. Golden Valley Health Centers has a history of providing quality care to Stanislaus County residents at its many other sites and would additionally begin providing medical services to patients at the Paradise Medical Office location, ensuring continuity for patients. Some of the same providers, including the family medicine resident physicians, will remain at the Paradise Medical Office to care for patients. Golden Valley Health Center's capacity and commitment to the residency program align seamlessly with that transition.

Golden Valley Health Centers has the capacity and readiness to operate the Paradise Medical Office as a teaching site as part of the Valley Consortium for Medical Education Family Medicine Physician Residency program. They have the physician capacity to meet program needs and are committed to strengthening the program.

The Valley Consortium for Medical Education is invested in securing clinic sites that will allow the required continuity clinic experience for residents and has succeeded in securing a second teaching site location with Golden Valley Health Center. They would also look to Golden Valley Health Center to provide teaching opportunities for some specialty care including Obstetrics.Golden Valley Health Center is already a member of the Valley Consortium for Medical Education and financially supports the residency program.

In addition to Golden Valley Health Center operating the Paradise Medical Office as a teaching site for the residency program, they would also assume the patient care responsibility for obstetric care and some specialty services.

Staff play a critical role in providing health care services in our County. The recommendation is contingent upon the County first satisfying all bargaining obligations with its labor partners for Health Services Agency full-time labor-represented employees. Stanislaus County’s Chief Executive Office Human Relations team would work with staff and labor representatives to transition staff to other Health Services Agency sites. In addition, a transition plan would be created that assesses the needs for part-time extra help and contract employees. The Chief Executive Office and Health Services Agency would work together to identify labor impacts and honor its meet and confer obligations under applicable law and the Memorandum of Understanding requirements with labor partners.

The Health Services Agency and the County remain committed to the success of the Physician Residency Program, which is administered and overseen by the Valley Consortium for Medical Education.

The primary reasons for this recommendation include (1) state law changes and other developments that have eliminated the need for and altered the purpose of Health Services Agency clinics that historically provided direct clinical services as part of the County's local safety net health care system, (2) ongoing physician capacity issues and related workforce shortages, (3) new viable alternatives for teaching sites for the Family Medicine residency program, and (4) the changing landscape of healthcare initiatives in the state, which allow the Health Services Agency to optimize other opportunities.

The Health Services Agency has been reassessing its role in community health, examining partnerships, and exploring new opportunities in response to the evolving healthcare environment. The recommendations aim to align the Health Services Agency's services with the changing needs of the community, providing a more effective and responsive model for Stanislaus County. The basis of a future effective community model would be built upon the refocusing and realigning of Federally Qualified Health Care Look-Alike clinics, along with partnerships with Public Health and other collaborators.

The Board of Supervisors Agenda item will be published on Friday, March 22, 2024, providing detailed information on the decision-making process and recommendations. The staff recommendation at the March 26, 2024 meeting will trigger the Beilenson hearing process pursuant to Health and Safety Code Section 1442.5, which requires the County to provide a public hearing to hear feedback on the proposed change before any decision is made. Accordingly, the scheduling of the required public hearing will be requested for April 16, 2024. After the hearing, the Board of Supervisors will decide whether to accept the staff recommendation to move forward with the proposal. The Board will decide whether to actually implement the changes at a later date.

Notably, if the recommendation is approved the County would need to satisfy bargaining obligations and actually withdraw from operating the Paradise Medical Clinic by July 1, 2024, because a later date would not allow the Valley Consortium for Medical Education to make necessary arrangements for medical residents' placement with Golden Valley Health Center at the beginning of the 2024/2025 training year.

Yes. Health and Safety Code Section 1442.5 states any County that contemplates (1) closing, (2) eliminating or reducing the level of medical services provided by, or (3) leasing, selling, or transferring management of, a County health clinic must first post public notice of and hold a public hearing to obtain feedback on the potential action.

A public hearing will be requested for April 16, 2024, adhering to Health and Safety Code Section 1442.5, allowing for public feedback on the proposed changes. After the hearing, the Board of Supervisors will decide whether to accept the staff recommendation to move forward with the proposal. The Board will decide whether to actually implement the changes at a later date.

If the recommendation is approved the County would need to satisfy bargaining obligations and actually withdraw from operating the Paradise Medical Clinic by July 1, 2024, because a later date would not allow the Valley Consortium for Medical Education to make necessary arrangements for medical residents' placement with Golden Valley Health Center at the beginning of the 2024/2025 training year.

If the recommendation is accepted by the Board of Supervisors and implemented after satisfaction of bargaining obligations, the Health Services Agency would concentrate on primary care services at its McHenry Medical Office and the Family and Pediatric Health Center locations. They would focus resources on patient care teams, care management, and electronic medical record enhancements that improve operations, patient experiences, and health outcomes. They would also explore state-related opportunities through recent State of California Medi-Cal reforms, and collaborations with Public Health to address health disparities and improve patient engagement and health outcomes.

Stanislaus County's Health Services Agency remains committed to its mission of providing high-quality healthcare services while adapting to the evolving needs of the community.