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Multnomah County Health Department Reconfiguration of Clinical Services in Response to Current Financial Conditions in Multnomah County and the State of Oregon Medicaid. Briefing to the Board of County Commissioners April 29, , 2004.

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Multnomah County

Health Department

Reconfiguration of Clinical Services in Response to Current Financial Conditions in Multnomah County and the State of Oregon Medicaid

Briefing to the Board of County Commissioners April 29,, 2004

The Health Department assures, promotes, and protects the health

of the people of Multnomah County

Assure

Assure access to necessary and dignified health care

Protect

Protect the health of all County residents

Promote

Promote the health of all County residents

Board Briefing

Health Department Reconfiguration of Clinical Services April 29, 2004

services to revenue picture
Services to Revenue Picture

Board Briefing

Health Department Reconfiguration of Clinical Services April 29, 2004

reconfiguration of clinical services rocs
Reconfiguration of Clinical Services (ROCS)

To Achieve a Sustainable Business Model

  • Goal: Reconfigured clinical system to close the gap from declining Oregon Health Plan and County General Fund revenue.
  • Proposal(2-weeks), Design Options(1-month), Implementation (now)
  • 90 staff involved in the planning effort
  • Consumer Majority Community Health Council
  • Proposal and Design Teams:

Process Customer (Clients)

Employees Infrastructure

Finance

Board Briefing

Health Department Reconfiguration of Clinical Services April 29, 2004

redesign outcome overview
Redesign Outcome Overview

Primary Care, HIV, and Teen Clinic Model:

  • Close 2 primary care clinic sites—Southeast & LaClinica
  • Implement Advanced Access model
  • Implement new support model for service delivery
  • Reduce # of provider teams
  • Reduce administrative and clinical support
  • Change nursing roles

$4 million cut from system

Board Briefing

Health Department Reconfiguration of Clinical Services April 29, 2004

primary care
Primary Care

Board Briefing

Health Department Reconfiguration of Clinical Services April 29, 2004

impact on clinical services
Impact on Clinical Services
  • Reduce support to provider ratio
  • Leverage full benefit of staff licensure and certification
  • Implement Advanced Access scheduling

Board Briefing

Health Department Reconfiguration of Clinical Services April 29, 2004

advanced access
Advanced Access
  • No distinction made between urgent and non-urgent visits; minimal phone triage
  • Daily schedule is a mix of pre-scheduled and same day appointments
  • Patients get appointments when they want them with a single phone call
  • Designated provider cross coverage
  • Supply matched with demand
  • Do today’s work today

Board Briefing

Health Department Reconfiguration of Clinical Services April 29, 2004

redesign outcome overview1
Redesign Outcome Overview

School Based Health Clinics:

  • 1 of 6 Middle School clinic sites to close
  • Reduced hours at remaining Middle School clinics
  • Reduced hours/days at High School sites
  • Reduce administrative and clinical support

$1 million cut from system

Board Briefing

Health Department Reconfiguration of Clinical Services April 29, 2004

school based health clinics
School Based Health Clinics

Board Briefing

Health Department Reconfiguration of Clinical Services April 29, 2004

impact on clients and community
Impact on Clients and Community

Factors considered

  • Demographics (poverty rate, language, transportation options, age, gender) and number of clients impacted
  • Proximity to County clinics or other community health clinics
  • Average cost per visit
  • Facility considerations, future costs, commercial market, size

Board Briefing

Health Department Reconfiguration of Clinical Services April 29, 2004

health care safety net primary care system
Health Care Safety NetPrimary Care System

Board Briefing

Health Department Reconfiguration of Clinical Services April 29, 2004

benefits of reconfiguration
Benefits of Reconfiguration
  • Maximize percentage of budget spent on direct client services
    • Operating and fixed costs
    • Visits
  • Minimize the need to close more clinical sites
    • Redesigned provider teams
    • Fewer sites

Board Briefing

Health Department Reconfiguration of Clinical Services April 29, 2004

benefits of reconfiguration continued
Benefits of Reconfiguration…continued
  • Improved client experience
    • Advance Access patient scheduling
    • Customer improvements = attracting & keeping OHP clients
  • Improved Revenue
    • Maximize billing for nursing services
    • Maximize billing for social work visits

Board Briefing

Health Department Reconfiguration of Clinical Services April 29, 2004

alternatives to reconfiguration of clinical services
Alternatives to Reconfiguration of Clinical Services
  • Provide less service to fewer clients
  • Close more clinics
  • Lay off more staff

Board Briefing

Health Department Reconfiguration of Clinical Services April 29, 2004

implementation timeline
Implementation Timeline
  • May 30 Reconfiguration planning completed
  • June 1 Reconfiguration implementation underway
          • Lay-off planning process underway
  • July 1 Clinical reconfiguration in effect
          • School-Based changes in effect
  • July 30 Clinic closures and moves complete
  • Aug 1 Advanced Access in effect

Board Briefing

Health Department Reconfiguration of Clinical Services April 29, 2004

questions
Questions

Board Briefing

Health Department Reconfiguration of Clinical Services April 29, 2004

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