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Multnomah County Health Department

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

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  1. 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

  2. Services to Revenue Picture Board Briefing Health Department Reconfiguration of Clinical Services April 29, 2004

  3. 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

  4. 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

  5. Primary Care Board Briefing Health Department Reconfiguration of Clinical Services April 29, 2004

  6. 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

  7. 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

  8. 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

  9. School Based Health Clinics Board Briefing Health Department Reconfiguration of Clinical Services April 29, 2004

  10. 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

  11. Health Care Safety NetPrimary Care System Board Briefing Health Department Reconfiguration of Clinical Services April 29, 2004

  12. 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

  13. 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

  14. 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

  15. 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

  16. Questions Board Briefing Health Department Reconfiguration of Clinical Services April 29, 2004

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