TRI-COUNTY COMMUNITIES in CHARGE MULTNOMAH COUNTY HEALTH DEPARTMENT
Portland, OR  

§        Objectives

The goal and objective for Phase Two has been developed with input provided by community leaders involved in the Phase One planning process.  These goals and objectives are intended to address the themes (i.e., improving the efficient use of existing resources, and expanding resources) established by consensus at the conclusion of the Phase One process.

The Goal of Phase Two is to:  "Implement Phase Two of a collaborative process designed to establish and implement a new system for delivering and financing high quality, affordable, culturally competent healthcare for the medically uninsured and underserved population of Multnomah, Washington, and Clackamas Counties."

Objectives:

• Within 12 months of receiving Phase Two funding, make recommendations for establishing a "safety net authority" as a new mechanism to ensure the availability of healthcare for the medically uninsured and underserved residents.  This work will be carried out by a Blue Ribbon Panel commissioned by the county boards of the Tri-County metropolitan region.

• Within 12 months of receiving Phase Two funding, evaluate and recommend changes to the community benefits policies of local non-profit hospitals to enhance access to healthcare among uninsured and underserved residents.

• Within 12 months, access, develop, and implement outreach, education and enrollment mechanisms to improve access to health insurance and care for the uninsured and underserved residents.

• Within 24 months, develop and implement a safety net health information system in conjunction with the Oregon Community Health Information Network.

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§        Program Design

The Tri-County Communities in Charge Initiative is designed as a collaborative process to evaluate the needs of the uninsure and vulnerable populations and the resources currently used to meet them; identify and evaluate existing healthcare financing and delivery models that could be adopted to better serve the needs of the uninsured; and to conduct initial steps needed to implement a new healthcare financing and delivery system.

From the data and community input of Phase One, it is clear there is a critical need to address the issues of healthcare access for the uninsured.  It is also clear the improvements in access cannot come from one portion of the community, it must be a shared responsibility with shared risk, shared benefits, and shared commitment.  In addition, the community consensus of Phase One generated themes to guide effective system-oriented approaches to providing financing healthcare to the uninsured:

• Refine and restructure the safety net system to better capture existing resources through improved efficiency and economies of scale; and

• Develop increased resources to improve access for defined populations through implementing service delivery and financing strategies based on rigorous assessment and business planning methods.

Financing & Outreach Strategies

In Clackamas, Multnomah, and Washington County, Oregon Region (Tri-County) there are no dedicated long-term revenue sources to ensure that healthcare services for the uninsured are available from year to year, and safety net providers have experienced threats to their financial stability in recent years.  To address the challenges faced by the local safety net providers, and to avoid healthcare crisis among the uninsured population the goal of Multnomah County, Tri-County Communities in Charge Initiative is...To implement a collaborative process designed to establish and implement a new system for delivering and financing high quality, affordable, culturally competent healthcare for medically uninsured and underserved populations of Multnomah, Washington, and Clackamas Counties.

Financing Strategy

With the creation of the Healthcare Safety Net Authority, we will have the capacity to fund care and care support services through creative use o the federal qualified health center status, improved federal financial participation strategies, potential for new Medicaid waivers and dedicated local general funds.  Further, we anticipate increased community participation in the funding of care and the potential for recouping funds through integration of duplicative services cross-organizationally.  

Outreach Strategy

Outreach strategies to community partners and beyond the Healthcare Safety Net are in the testing and implementation process.  Collaborations with community action agencies, school districts and other social support and minority agencies are being initiated.  This work is currently targeting those eligible for state sponsored programs and providing information about accessing care within the safety net.  As the system integration continues among the Healthcare Safety Net providers and funding is stabilized and increased, more outreach for these services will commence.

Delivery System

The delivery system consists of count and non-profit clinics and providers who offer full service primary and preventive care or some subset of it.  Currently the Healthcare Safety Net is loosely connected through partnership and shared mission.  The Tri-County Communities in Charge project will design and implement a regional framework to coordinate the provision of health services to uninsured and low-income residents.  The intended outcome is increased access achieved through improved funding, better matching of resources with need, shared services, economy of scale and reduced duplication.

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§        Accomplishments to Date

• Completed a high level Blue Ribbon Process to create a Healthcare Safety Net Authority whose purpose is to build and maintain access to basic health services for those under 200% of the federal poverty level.

• Completed a Hospital Charity Care access and application process that is now consistent across the region's 10 health systems and hospitals.

• Implemented several new outreach and education programs targeting minority populations.

• The Tri-County region's three largest community health centers have all gone "live" on the OCHIN system.

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§       Challenges

The Tri-County Region has a healthcare safety net that consists of clinics operated by Health Departments, nonprofit organizations and private providers.  These systems have a history of mission support and riche services but have never been interdependent in the ways described.  Approaching each entity and allowing them to continue to do what they do best with minor changes and additions will be difficult.  Finally, making sure that the Healthcare Safety Net Authority is developed with the power to act regionally and to assure funding, by whatever means, will also challenge this project.

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§        Contact Us

Tom Fronk
Director 
Tri-County Health Care Safety Net Enterprise
110 SW Yamhill, Suite 300
Portland, OR 97204
Phone: (503) 241-3087
E-mail:  tom@tcsne.org                                                            
Website: http://www.mchealth.org/cic

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