Alameda County "Every Team Member Counts"


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Alameda County "Every Team Member Counts"

  1. 1. Alameda County “Every Team Member Counts” Collaborative to Recruit and Retain Qualified Medical Assistants in the Safety Net Clinics
  2. 2. Alameda County <ul><li>1.5 million residents </li></ul><ul><li>Median income $61,017 </li></ul><ul><li>Adult poverty rate of 10.1% </li></ul><ul><li>173,000 adults <65 without health insurance </li></ul>
  3. 3. 2005-2006 Safety Net care <ul><li>CMSP served over 63,000 </li></ul><ul><li>268,000 outpatient visits </li></ul><ul><li>73,000 emergency room visits </li></ul><ul><li>15,300 hospital admissions </li></ul>
  4. 5. SB 1448: CA Care Coverage Initiative (CI) <ul><li>California’s 2005 Federal Medi-Cal Hospital Financing Plan provides $180 million in federal funds </li></ul><ul><li>Expands health care coverage to eligible low-income, uninsured persons </li></ul>
  5. 6. SB 1448: Coverage Initiative Overall Goal and Funding <ul><li>Designed to : </li></ul><ul><li>Increase the number of Californians with healthcare coverage </li></ul><ul><li>Strengthen and build upon the existing local healthcare safety net </li></ul><ul><li>Improve access to high quality healthcare and health outcomes for individuals. </li></ul><ul><li>Funded for at least three years, potentially ongoing </li></ul>
  6. 7. Alameda County Excellence (ACE ) Partnerships <ul><li>Alameda County Medical Center </li></ul><ul><li>Alameda Health Consortium </li></ul><ul><li>Health Care Services Agency </li></ul><ul><li>Alameda County Public Health Department </li></ul><ul><li>Alameda Alliance for Health </li></ul>
  7. 8. Alameda County Excellence (ACE ) <ul><li>Emphasizes chronic disease management </li></ul><ul><li>Coordination of current programs and system enhancements </li></ul><ul><li>Preventive primary care at a designated medical home </li></ul><ul><li>Offers a full range of medically necessary services including streamlined chronic disease focused specialty care services. </li></ul>
  8. 9. Alameda County Excellence (ACE ) Delivery System <ul><li>Focus on medical home </li></ul><ul><li>Enhanced chronic disease focused specialty care </li></ul><ul><li>Integrated access of behavioral health care </li></ul>
  9. 10. Complements The Overall Goal <ul><li>Improved population management involving education and collaboration with community-based organizations </li></ul><ul><li>Improved access to specialty care through better communication within the provider network and enhanced use of data systems </li></ul><ul><li>Improved care capacity through decreased wait time and reallocate clinic hours </li></ul>
  10. 11. NACCHO Project <ul><li>Recruit, hire and retain culturally competent medical assistants in the community clinics in Alameda County to improve the service delivery for clients with chronic disease </li></ul><ul><li>Supportive role to enhance current efforts </li></ul><ul><li>$10,000 grant </li></ul>
  11. 12. Medical Assistants <ul><li>“ G eneralist”-administrative and clinical duties </li></ul><ul><li>1n 2004, 387,000 jobs in the U.S. </li></ul><ul><li>14% work in private or public hospitals, including outpatient facilities </li></ul><ul><li>$35,997 per year average in Alameda Co. </li></ul><ul><li>Medical Assistant employment is expected to grow an impressive 35% between 2006 and 2016, US Labor Bureau. </li></ul>
  12. 13. Medical Assistant Training <ul><li>Community college </li></ul><ul><li>Private programs/post secondary vocational schools </li></ul><ul><li>Administrative/medical </li></ul><ul><li>Responding to emergencies </li></ul><ul><li>Computer application systems and literacy </li></ul>
  13. 14. Medical Assistants Expanded Role <ul><li>Used in more specialized services </li></ul><ul><li>Unlicensed health care workers have seen their scope of duties expand </li></ul><ul><li>RN’s more expensive </li></ul><ul><li>RN shortage </li></ul><ul><li>Employment for medical assistants to grow much faster than other occupations </li></ul>
  14. 15. Workforce Challenge <ul><li>Limited post secondary education </li></ul><ul><li>Not working at the level trained </li></ul><ul><li>Decision making roles </li></ul><ul><li>Licensed personnel to accept expanded role </li></ul>
  15. 16. Grant Activities <ul><li>2-1/2 day trainings on Train the Trainer with Tom Bodenheimer, M.D. </li></ul><ul><li>3 Chronic Care Model trainings at Alameda County Medical Center </li></ul><ul><li>Community-based organization trainings </li></ul><ul><li>Assist with hiring cost </li></ul>
  16. 17. Expanded Role Trainings <ul><li>Panel management </li></ul><ul><ul><li>Review and maintain the disease registry </li></ul></ul><ul><ul><li>Calls-appointments, labs, and preventive care </li></ul></ul><ul><ul><li>Medication reconciliation </li></ul></ul><ul><ul><li>Arranges referrals </li></ul></ul>
  17. 18. Expanded Role Trainings <ul><li>Follow up with primary care provider instructions </li></ul><ul><li>Assist in working on action plans/behavior changes </li></ul><ul><li>After care visits </li></ul><ul><li>Targeted outreach for the out of care </li></ul>
  18. 19. Informed, Activated Patient Productive Interactions Prepared, Proactive Practice Team Improved Outcomes Delivery System Design Decision Support Clinical Information Systems Self- Management Support Health System Resources and Policies Community Health Care Organization Chronic Care Model
  19. 20. Chronic Care Model Focus <ul><li>System redesign </li></ul><ul><ul><li>Identify chronic disease client population </li></ul></ul><ul><ul><li>Use standardized procedures for care </li></ul></ul><ul><ul><li>Expand staff capabilities to improve care </li></ul></ul><ul><ul><li>Document health outcomes </li></ul></ul><ul><li>Self-management </li></ul><ul><ul><li>Train staff in self-management goals setting and follow up </li></ul></ul><ul><ul><li>Use culturally appropriate, standardized educational materials </li></ul></ul><ul><ul><li>Identify and utilize community resources </li></ul></ul>
  20. 21. Challenges <ul><li>Retention </li></ul><ul><ul><li>MAs start their careers at CBO’s, but after 6-12 months of training they seek a position with higher pay </li></ul></ul><ul><li>Short period to spend the funds </li></ul><ul><li>Include medical assistants in the process of improving care </li></ul>
  21. 22. Successes <ul><li>Use of expert speakers-Tom Bodenheimer, M.D. </li></ul><ul><li>Encourage and provide an opportunity for to increase knowledge of chronic disease management </li></ul><ul><li>Involvement in the changes </li></ul><ul><li>Active recruitment and hiring of MA’s throughout the safety net clinics </li></ul>
  22. 23. Improved Recruitment and/or Retention Of Qualified Workers <ul><li>Provide opportunities for current staff to lead the changes implemented in team care </li></ul><ul><li>Conduct annual staff satisfaction surveys </li></ul><ul><li>Hire from the community </li></ul>
  23. 24. Summary <ul><li>New titles, positions and responsibilities! </li></ul><ul><li>Opportunity to learn panel management </li></ul><ul><li>Use of the Chronic Care Model for improvement </li></ul><ul><li>Promote client self-management </li></ul>
  24. 25. Summary <ul><li>Share ideas and best practices </li></ul><ul><li>Measurement of health outcomes </li></ul><ul><li>Increase collaboration between Pubic Health and Safety Net Providers </li></ul><ul><li>Every team members counts! </li></ul>