Travis County Commssioners Court
November 18, 2003
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Item 24
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Morning Discussion
Afternoon Discussion
24. Consider issues and take appropriate action on strategy to improve the following major interlocal agreements with city of Austin: a. Austin-Travis County central booking; b. Austin-Travis County emergency medical services (ems); c. Austin-Travis County social services contracts; and d. Austin-Travis County heath care services contracts. We talked about [indiscernible] issues two or three weeks ago. And my view the purpose of today's agenda setting is to give us an opportunity to hear about various issues from the committees. No objection, we will just go in the order that they are listed. Austin Travis County central booking.
>> good morning.
>> judge, I laid out some general financial issues, I think the committees think that I will lay those out first and they will refer to them, is that right.
>> that's fine with me.
>> is it? The interlocal agreements often involve governments that have cost structures and [indiscernible] service that could be different from Travis County. And all of the people in Travis County don't have the ability to vote for the government officials in all of these other bodies. So -- so as we are looking at interlocals in our office looked at the administration of those, we are careful to make sure that -- that the -- that the rules regarding money, what the local government code require of counties, and also to the extent that you have expressed yourself throughout your contracts, that we are getting what you all think that you ought to be getting from those. In the fy 2004 budget process, I think that it's obvious with price increases with the interlocal that's we did not have within internal departments. Again it begs the issue that they -- those contracts need to be reviewed and looked at just to make sure that we are getting what you thought you would. We have a clear measure and that we are paying an appropriate amount for those services. The financial issues are really kind of the same for all of them. That is welt that we need to define the appropriate measurement for the services that we receive or provide. We need quantity take it active measure, how many and qualitative, how well, how fast for the services in each interlocal, those should be reflected in a contract so that when we are cutting checks for those services we again are documenting that we got what you thought you would. We believe financially the interlocals need to be analyzed for '01, '03, '02, '04 just to see what they look like, would we have been better off financially to have offered those services ourselves instead of our your interim interlocal. That's the financial feasibility. We need to determine the full cost of services as well as the incremental costs, direct costs and indirect costs. The city of Austin has mentioned starting to bill us for indirect costs, that's another issue that we teed to look at. It would be from a cost accounting philosophy that I would like to put forth is that incremental costs should be what we are looking at and what that basically means is that if you are providing a service, the incremental cost is the additional cost that you have by bringing someone else on board. And so the philosophy being that you would be providing those services anyway, but if you add other people they are incremental costs, that's kind of a quick and dirty definition of incremental costs. We should be determining if there's more cost effective to provide services within an interlocal or to provide them ourselves or to outsource from the private sector. Is cost the driving factor, if not what considerations outweigh costs costs may not be driving factor. We should provide pro forma budgets for at least three years forward, perhaps five, for performing services for ourselves and as well as by interlocals. What those are is simply a measure stick. In other words this is what we thought we were going to get. This is what we thought it was going to cost. Then you have a basis on which saying well it does. Or it did not or these things change and therefore our immediate assumptions were not accurate. That's really the reason for that it's kind of a tool to -- to measure and evaluate. On so that Travis County can obtain the ongoing financial information that we need to make good decisions, we've had some specific areas where that could be strengthened. Determine how the interlocal should be structured to handle future wage negotiations and benefits. Who makes the decision, who pays, that's an issue that comes up when the city has a different pay structure for instance than we have on a different structure for the benefit. So that's just something that need to be embedded in those contracts which is clear to both parties in an interlocal agreement. Program concerns really flow with the financial. I just came up with examples that our office has seen as we have been involved in interlocals and the financial administration of those. Central booking, you are going to hear more about these as each of the groups come up, is to the county's benefit to continue using municipal judges, for instance, for magistration or would using county magistrates provide more comprehensive programmatic efficiencies, we had lost change for that this year. Are there efficiencies that could be gained by video technologies for magistration. We have invested some money in video technologies that might be something that we could do -- do a better job at a less cost. E.m.s. Star flight, how has the annexation of the city of Austin impacted service levels and responsibilities of e.m.s. And star flight. Increased number of ambulances -- what percentage of calls are used for medical transport, law enforcement, other emergency management, who directs the deployment, are our costs being recovered when deployed for law enforcement purposes, other than for the sheriff, if not should they. These are questions not a right or wrong answer there. Health health determine the contract provisions needed to ensure that the Commissioners court receives the performance measures and information needed to evaluate programs. Evaluate if there are services which might be better provided by contract agencies or might be brought in house. Evaluate the structure of programs that fit into the major programmatic areas of juvenile and adult justice which could positively impact Travis County's expenditures for programs in the justice area. Look at potential efficiencies and combining medical costs in clinics, jailts and gardner-betts. These are very general idea that just kind of came across my mind from our perspective as we are looking at these contracts. Who you are talking to today are really managing the operation really much more knowledgeable about the operational -- these are some of the issues that we would bring forward, certainly not an all encompassing list.
>> good morning, here on behalf of the central booking committee. The interlocal committee is made up of different departments, sheriff's office, the auditor's office, planning and budget, representative from the Commissioners court, and the county attorney's office and justice and public safety. And our membership got together as per the direction of the Commissioners court to identify some of the key issue areas. And before I get into them, I do want to say that I appreciate the issues presented by the auditor because I think they provide some key considerations and issues that we are going to be looking at in a general sense for all of the interlocals, but also especially for the central booking interlocals as well. One of the first issue areas is the renewal and expiration time frame for the central booking interlocal. Currently, we are in the second renewal period for the central booking interlocal and it -- the interlocal expires at the end of fiscal year '05. So that -- half that point we have no provisions for continuing any agreements. So we are on that time frame if -- when we are considering any subsequent negotiations and consideration of the interlocal. The interlocal has a -- has a fee structure which has a flat fee per year for central booking services. Provided to the city. Each year they increase by 6%, there is a threshold if that is exceeded there is a per booking fee that is assessed as well. That threshold has not been reached even nearly reached over the -- over fy '01 '02 and '03 the key question is the flat fee structure appropriate for the central booking? And then looking at that thresh hold and that -- for the number of booking handled from the city. Magistration services, different questions regarding magistration services currently as the auditor mentioned. They are provided by city magistrates and the question has arisen whether it might be prudent for us as a county to provide those magistration services and look at our options. The committee will be looking at different alternatives and what are the costs and benefits of each. The impact of city arrestees on central booking. They currently make up the largest proportion of booking encountered at central booking. More information is needed on how they impact the workload. What that means as far as processes, also what that means as far as costs. One of the things that we need to look at as well is our legal obligations for providing booking services as opposed to providing those services strictly for things like class c misdemeanor bookings. Cutting across is trying to get at the costs of services actually provided to the county. We are talking about costs, we are talking about just as it is the auditor mentioned some of the direct, indirect, trying to get also at the incremental costs of providing services to the city. Of course we incur costs to provide booking services based on our legal obligations and to various agency that's bring arrestees to central booking, but we also need to look at what services we provide over and above that if there is that. That area needs more analysis so we can look at the costs and benefit and the impact on the central booking operations. Some other key considerations that are rolled up, things that the auditor mentioned is that part of these issues is to look at the monitoring and performance mechanisms for the interlocal, trying to kind key criteria to better monitor interlocal as we move forward. Looking at the appropriate cost reimbursement mechanism or structure for the interlocal, that falls back to the fee structure that we talked about earlier. Also the legal obligations for the county and providing these services. And also looking at other similar interlocal agreements, in other jurisdictions and seeing the -- kind of taking from best practices if there's anything that we can take to -- as we look at options and for improving our model. Seeing if we can use any of those types of practices as well. Our step from here is to once we identify all of the issues, as we move forward start conducting analysis in those areas for further study. We have a lot of work ahead of us, but we are going to be looking at all of these dave areas, try to find more analysis to come up with concrete options and considerations as Commissioners court moves forward with looking at opportunities for improving the interlocal.
>> let me ask you, let me ask you, on the central booking fee structure, it's interesting that we have a flat rate of 6%. I suppose that was predicated on something, when you get down to talking about the city owes the county an additional fee booking if it's over a certain number but our actual number has been 30% lower, I mean, who is is it -- who is it -- I the city or us with the anticipation that we are going to have booking.
>> actually, that's really good --
>> gerrymandered that number. Did the city say we will pay if we hit this, here's what our numbers are knowing that we are never going to get there. Because I suppose we knew that the numbers were going to increase because we've had a 6% -- 6% increase of our contract which means that I guess that we are taking more people from year to year.
>> on that issue, I mean that's -- that's a good question. I invite any other committee members to chime in on that. [indiscernible] based on what the actual bookings are, I'm not sure what those -- what exactly those numbers were, but I know that's something we were going to look at, that threshold amount that was put in there, what those were based upon.
>> Commissioner, I was at most of those meetings which went on for I mean more than a year. I can tell you this, that both parties were at the table and looked at historical trends and statistics that were available at that time with regard to arrests and bookings and those were projections, I guess that were agreed upon by both parties that were likely to occur. Obviously it didn't turn out that way. They have not continued to increase as they had been increasing in years immediately prior to that time. But -- but there had not been as many.
>> well, then I guess my question would be is our 6% is it -- is it keeping up with the costs that we have to operate central booking?
>> well, I think that's -- that's a key question for us to look at, is to look at the costs, both the flat fee and that additional threshold amount and cost per booking, to take a look at, you know, does this make sense based on our costs incurred and based on what we are anticipating.
>> I guess that is surprising to or interesting to me because very seldom do you ever see that -- that we have anticipated at -- I haven't seen many things over here that it's been in that trend versus the other because everything always seems to be so much greater than has what we thought it was going to be. Obviously we predicated the numbers on something and since we are 30% lower, I am sure everybody is kind of sitting around kind of going boy how did we miss it, by that much. Because I guess we are probably adding I mean haven't we booked more this year than last year or maybe michael you could have a a little report like that that would show what we did in '99 through --
>> yes, I can provide you a spread sheet that I have done on this.
>> okay.
>> that is -- this is exactly some of the different factors that we are going to be looking at as we look through that specifically.
>> my remembrance is that the city is trying to get a capping their exposure and a certainty of costs. And there was going to be kinds of a live range between here and here and have the same number of people down in central booking, even though those numbers may vary great limit it's just going to be the pace of things happening down there, but she's still going to need the same number of people. The thought was it really only exceeded some sense of boundaries that they would indeed have to ratchet up the number of people that they hired. The only other point that I would like to add is that we never were recovering what it was really costing. So the fact that we are ratcheting up what we get in terms of reimbursement, at the same time there are fewer people going through, we might actually be narrowing the gap to what we really ought to be entitled to. It's -- it's way tricky. I'm glad that I'm not on this committee.
>> the other thing that we considered was, jim brought it to our attention, this is a county mandate. And we have to look at that part of it and then of course -- then the legal responsibilities, what do we really have to do. And -- and not those others --
>> at what point. What do we have to do and at what point in the magistration process and the class c's, which are totally separate because they are violating city law, they are not violating state law.
>> so it's very useful to go back and look at our legal responsibilities.
>> interesting.
>> anything else regarding central booking?
>> not unless there are any other questions.
>> thank you,.
>> thanks.
>> thanks, bill, I would like to see that, thank you.
>> thank you.
>>
>> [one moment please for change in captioners]
>>
>> we were in hopes of doing a revision for '03 and '04, however, we realized that there were some major issues that really deserved more time to be looked at, so there's been amendment done to cover '04. And now we're looking in earnest at some of the issues that have arisen. And danny are I are going to go ahead and share those with the court. I believe you should have a backup as well. One of the first ones and most important we believe are performance measures that need to be added to this interlocal. We have focused on emergency services, delivery operations financial, budget collection of revenue, interaction and cooperation with other community resources for delivery of emergency services and built in incentives for meeting measures.
>> we also have increasing costs and programmatic changes. As you know with any interlocal, and especially this one, which is quite large, there are cost and program changes that are going to be evident every year that you do this. And, of course, here we want to look at the decision-making process. Are there improvements that can be made in regards to how decisions are made in increased costs and prommatic changes.
>> we've also mentioned financial accountable factors, which, of course, the auditor spoke to some of these. But we have listed financial accountability, including records, invoicing with supporting documentation, collecting of revenue and inventory controls, reporting of actual expenses, revision of amounts payable based on actual expenses.
>> liability is, of course, touched in the current interlocal, but here we're looking at the apportionment of liability. And as the interlocal itself has so many different aspects to it, we felt like that it's a chance for us to revisit the apportionment of liability. And that has to do with not only just personnel, but has to do with the equipment and operations.
>> number 5 on your list is pro forma budgets. The auditor mentioned this as well, but we feel that it would be a good thing to do a five-year projection of costs as well as update that annually.
>> oversight of the interlocal. This is something I think needs to be looked at on both the county's side as well as the city's. And that is, who exactly is doing what that pertains to the interlocal, both on the operation on the financial side. And we feel like that it's needed as far as -- especially on the county's side as to who currently is managing this interlocal, what's the infrastructure, what's the management structure, let's revisit that and let's also look at the city's side and see exactly what is taking place there.
>> on the next revision of this interlocal, we also need to include the stoplight independent panel recommendations. And the Commissioners court has already approved the inclusion of this into the revision. It just needs to be done and the exact wording figured out.
>> and even though this is number 8 it looks like the last issue here, there are other issues I'm sure that we're going to be touching upon, but we didn't want to be here all day with you as far as going over all the other smaller things. But here is the role of the advisory board. And that's simply looking at what is the current focus, is there a better way of supporting the e.m.s. Service delivery and can this board play a role in that? So it's just looking at their focus and responsibilities.
>> who is on the board?
>> those are primarily folks from the medical community. There are a couple of folks who are at-large members that were named by both the city council and by Travis County, but most of them are representatives from the major hospitals that are --
>> and I guess they were appointed. I had forgotten that this board exists. Is there like a charge or board mission? I guess we may as well see that while we're on the board.
>> creation of the board was invented in the interlocal, and so that was actual a matter of interest discussion at the e.m.s. Advisory board is does -- should it be more than simply it exists and these are the people who are from what communities and who names them, or is there more of a charge, a mission, as you just mentioned judge, that ought to be imbedded in the interlocal or you keep it more of generic related to instructions from the council and Commissioners court and a reporting structure?
>> and this concludes our overview for you. We're here to answer any questions you might have.
>> thank you.
>> I just want to add that we are meeting on Thursday afternoon. We're making that consistent in terms of 1:30 every Thursday.
>> I get an attendance report at the first four meetings?
>> yes, sir. [ laughter ]
>> we probably ought to get the others this afternoon, stephen. This court breaks for lunch at 12 noon.
>> try to.
>> move that we recess until 1:30. My guess is we'll get to you by 1:45. All in favor? That passes by unanimous vote.
>>
>>
Luncheon Recess
>>
>> before lunch we were discussing item 24 and we had covered a and b. C, 24 c is Austin-Travis County social services contracts; and basically we are getting updates on a strategy to improve major interlocal agreements between Travis County and the city of Austin. Yes, sir.
>> good afternoon.
>> stephen.
>> [indiscernible] [papers shuffling - audio interference]
>> really are looking at health and human services interlocal issues. Our group that convened once and the focus of that first meeting actually had more to do with -- with an orientation of our relationship with the city of Austin as it relates to the provision of services as well as the interlocals. The issues that you see outlined in the backup are -- are a result of the brainstorming that occurred within the group. One thing that I think we are all agreeing on, are in agreement on, are our expectations. We believe that we should clearly define what we want. We certainly, as echoed in the previous committee reports, want to clearly determine what our measures are. We want to agree on what measures of performance we are looking at. As it relates to performance in this area, there are twofold with certain subcategories. From an operational standpoint, we want to look at the quality of the service delivery as well as outputs. But also -- also outcomes, which really relates to whether or not we are getting results that we -- that we expect from the provision of certain services. The issues, as you see resulting from brainstorming starts with thoroughly assessing the value of purchased services versus directly providing the services ourselves from both a county versus city perspective as well as a public versus private perspective. We believe that we should also assess the viability or desirability of what we term granting -- grants versus purchasing services. I think there are -- it has been an ongoing discussion within the court for several years of the fact that we view ourselves as purchasing services from the social service agencies. But we -- we wonder whether or not, in some cases, it would be more advantageous for us to assume a perspective of the grantor. The issue -- a major issue, I think, with the whole issue regarding social services and provision of those services through our current agreement has to do with the delegation of accountability that we are giving to the city of Austin via the current structure we have. We believe that we should -- we should address the -- the lack of clarity about certain roles and current relationship. We also should -- should ensure that our investment is commensurate with the expectations and vice versa. Meaning that if we have a certain level of expectations that were -- that we are actually paying to get those outcomes or if we are not, if our expectations are lower, certainly we could then lower our investments. And as I said earlier, to clearly define those expectations. I think the next category is also important, that is we want to although at the -- we want to look at the fact that we lack a common understanding and agreement on certain roles. An example given mere is our monitoring expectations. We want to make sure that in our relationship in the interlocal is that we are clearing defining the roles and expectations not only of the city of Austin, but of the interests within Travis County, also. You mentioned the next item and we also believe that it's important to ensure that we are -- that there are common understandings and communications from the county to the vendor to communicate with vendors regarding Travis County expectations and requirements and we talked about both doing that and a prebid -- in a prebid setting as well as in a preaward setting to make sure that we are answering any questions and that there is a clear understanding of expectations from the vendor. On -- the [indiscernible] issue has to do with the dedication of direction for future procurement of health and human services. That sounds a little vague, but here are the examples of it. Right now, over time you've talked about the number of contracts and you wonder at least a couple of you wonder why we have x number of contracts. I think we are about 54 now. We had about I think 64, whatever. But we have a variety of contractual relationships with various community based organizations. An example would be a [indiscernible] service organization or what we have been terming as an mso for, through substance abuse services. What that entails is our having a contract or an interlocal with mhmr and they actually are responsible for managing the provider net work to ensure that our clients have access to services. We have a very similar arrangement with mhmr as it pertains to our access for service to the children's partnership as well as for the assessment center. So we need to really explore the feasibility of really moving in that direction as appropriate in certain service categories. Another strategy that we probably need to look at is to see whether or not it is more feasible to -- to really look at the provision of services similar to how we look at the -- at the provision of health care services. And that instance we have a defined population and we have a -- we have a defined benefit package that we actually qualify an eligible population for. And certain instances -- in certain instances that might be more feasible and efficient as it pertains to the procurement of services, ensuring that people, that you as a Commissioner court want to -- to have access to certain service categories. We also want to -- so other groups in a different way, the value for investment to ensure appropriate quality and quantity of services. Basically you want to ensure that we are getting our money's worth and certainly getting what we are paying for. The last issue that we mention understand that category is communication amongst policy makers, in this case we are talking about you the Commissioners court and the city council to ensure that there is some consistency as appropriate as it relates to contracting. For instance, the last issue that actually came up, was a difference in the direction that I think we were pursuing on the county side as it relates to the social service agencies versus where the city council was coming from as it related to the social service agencies. Their opinion was that we should directly contract with the same agencies with just a reduction of 5% in those contracts whereas I think your expectation was that we were actually going to go out on -- on an rfs for social services. You have attached a draft of a -- of processes that we engage in as it relates to social services, including the community assessment and planning that occurs within the broader community with our partner being a major supporter of that effort through the community action network. Also the contract development process and what we have termed as payment on contracts and the monitoring process as well as the evaluation process. This is actually a work in progress. We just develop this so that it will be a starting point in our group so that we can discuss the appropriate steps, roles, responsibilities -- the appropriate process, the steps within those processes, as well as the -- the assigned accountability for each one of the steps. But -- in our first meeting we didn't get much past the orientation and outlined some expectations of the group.
>> stephen, just on the side, did we get our payment issues worked out with the social service agencies? Are those checks still on hold or are they flowing through the process?
>> we are processing the checks.
>> I was asked, stephen, when I went to do one of the site visits last week, the caritas, that apparently last year that the county and the city had given an additional $500,000 and that the city reupped -- which was supposedly for a one-year fine and that the county or that the city signed off on it again and they were asking me, I mean, is that something that -- that we are to expect? I said, well, I didn't see it in our budget. But they -- they didn't have the word on that. And so they were --
>> well, at the time of the --
>> does that make sense what I'm asking.
>> yes, I understand what you are asking. The city did renew their 500 -- the additional $500,000 investment.
>> they cut it by 5%, but they did.
>> they cut the contracts overall by -- they cut certain contracts by 5%.
>> okay.
>> in addition to that, they did reup the $500,000. Now, we did not -- we, you, the court, did not add in the additional $500,000 from outside agencies, but you added $500,000 for the emergency assistance program, at least $500,000.
>> okay.
>> I think the thing that's been really interesting on the tour to date, which is family elder care, any baby can, people's community clinic and just did lifeworks yesterday, legal aid is Monday, followed by caritas and the capital area food bank which will get us through christmas. Is that I'm already impressed by -- I know we are starting with many of the larger agencies.
>> yes you are.
>> but there are lessons to be learned that we hope that we can pass on to the smaller ones. Lifeworks was already a collapsing down of four separate agencies into a new collaboration.
>> yes.
>> that impressed me greatly. We just found out that -- of course the big one that was first one was Austin rape crisis and battered women's collapsed into safe place. The newest one is candlelighters, which has to do with children and cancer, is now coming under the umbrella of any baby can. And what was cool about that is they were going to see an immediate savings on the candlelighters side because they no longer had to have a facility and an executive director. They were coming under this wonderful umbrella and getting a place. They brought with them to strengthen any baby can a unit, four people, Gerald, was that what it was? A billing unit related to medicaid. So you wound up having an immediate strengthening and a cutting of administrative costs that can only improve the amount of dollars available to go into services. I think I'm also learning from visiting with lifeworks yesterday, they have a lot of collaborations going on with other of these agencies in terms of any baby can and people's, they will all working together. What I'm hopeful is that all of this we can take to some of these smaller agencies perhaps the opportunity to come under somebody else's umbrella because we see a good fit. Or a collapsing down of some of these agencies, which means better contracts. But if nothing else, to encourage the collaboration because we might see standing from the edge as opposed to being right there, of where certain agencies could come together in terms of being able to provide something that we choose to purchase. But I think you are right, stephen, it may -- the complexity it may be best to come under an mso as opposed to five checks to five agencies doing one task force to think in terms of more of the managed service organizations, but anyway enjoying it, learning a lot.
>> any questions? Thank you stephen.
>> thank you, stephen. Judge is there an expectation -- are we going to periodically report back to the court in terms of progress? Do you have a sense so that we can carry back that to our groups in terms of the task ahead.
>> I think after the first of the year we ought to --
>> okay.
>> provide an opportunity for a status report.
>> that works.
Last Modified: Wednesday, November 19, 2003 9:11 AM