Alameda County Every Team Member Counts

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Alameda CountyEvery Team Member Counts

• Collaborative to Recruit and Retain Qualified
  Medical Assistants in the Safety Net Clinics

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Alameda County

• 1.5 million residents
• Median income 61,017
• Adult poverty rate of 10.1
• 173,000 adults lt65 without health insurance

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2005-2006 Safety Net care

• CMSP served over 63,000
• 268,000 outpatient visits
• 73,000 emergency room visits
• 15,300 hospital admissions

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SB 1448 CA Care Coverage
Initiative (CI)

• Californias 2005 Federal Medi-Cal Hospital
  Financing Plan provides 180 million in federal
  funds
• Expands health care coverage to eligible
  low-income, uninsured persons

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SB 1448 Coverage InitiativeOverall Goal and
Funding

• Designed to
• Increase the number of Californians with
  healthcare coverage
• Strengthen and build upon the existing local
  healthcare safety net
• Improve access to high quality healthcare and
  health outcomes for individuals.
• Funded for at least three years, potentially
  ongoing

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Alameda County Excellence (ACE) Partnerships

• Alameda County Medical Center
• Alameda Health Consortium
• Health Care Services Agency
• Alameda County Public Health Department
• Alameda Alliance for Health

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Alameda County Excellence (ACE )

• Emphasizes chronic disease management
• Coordination of current programs and system
  enhancements
• Preventive primary care at a designated medical
  home
• Offers a full range of medically necessary
  services including streamlined chronic disease
  focused specialty care services.

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Alameda County Excellence (ACE ) Delivery System

• Focus on medical home
• Enhanced chronic disease focused specialty care
• Integrated access of behavioral health care

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Complements The Overall Goal

• Improved population management involving
  education and collaboration with community-based
  organizations
• Improved access to specialty care through better
  communication within the provider network and
  enhanced use of data systems
• Improved care capacity through decreased wait
  time and reallocate clinic hours

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NACCHO Project

• 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
• Supportive role to enhance current efforts
• 10,000 grant

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Medical Assistants

• Generalist-administrative and clinical duties
• 1n 2004, 387,000 jobs in the U.S.
• 14 work in private or public hospitals,
  including outpatient facilities
• 35,997 per year average in Alameda Co.
• Medical Assistant employment is expected to grow
  an impressive 35 between 2006 and 2016, US
  Labor Bureau.

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Medical Assistant Training

• Community college
• Private programs/post secondary vocational
  schools
• Administrative/medical
• Responding to emergencies
• Computer application systems and literacy

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Medical Assistants Expanded Role

• Used in more specialized services
• Unlicensed health care workers have seen their
  scope of duties expand
• RNs more expensive
• RN shortage
• Employment for medical assistants to grow much
  faster than other occupations

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Workforce Challenge

• Limited post secondary education
• Not working at the level trained
• Decision making roles
• Licensed personnel to accept expanded role

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Grant Activities

• 2-1/2 day trainings on Train the Trainer with Tom
  Bodenheimer, M.D.
• 3 Chronic Care Model trainings at Alameda County
  Medical Center
• Community-based organization trainings
• Assist with hiring cost

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Expanded Role Trainings

• Panel management
• Review and maintain the disease registry
• Calls-appointments, labs, and preventive care
• Medication reconciliation
• Arranges referrals

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Expanded Role Trainings

• Follow up with primary care provider instructions
• Assist in working on action plans/behavior
  changes
• After care visits
• Targeted outreach for the out of care

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Chronic Care Model
Health System
Community
Resources and Policies
Health Care Organization
DeliverySystem Design
ClinicalInformationSystems
Self-Management Support
Decision Support
Informed, Activated Patient
Prepared, Proactive Practice Team
Productive Interactions
Improved Outcomes
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Chronic Care Model Focus

• System redesign
• Identify chronic disease client population
• Use standardized procedures for care
• Expand staff capabilities to improve care
• Document health outcomes
• Self-management
• Train staff in self-management goals setting and
  follow up
• Use culturally appropriate, standardized
  educational materials
• Identify and utilize community resources

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Challenges

• Retention
• MAs start their careers at CBOs, but after 6-12
  months of training they seek a position with
  higher pay
• Short period to spend the funds
• Include medical assistants in the process of
  improving care

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Successes

• Use of expert speakers-Tom Bodenheimer, M.D.
• Encourage and provide an opportunity for to
  increase knowledge of chronic disease management
  
• Involvement in the changes
• Active recruitment and hiring of MAs throughout
  the safety net clinics

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Improved Recruitment and/or Retention Of
Qualified Workers

• Provide opportunities for current staff to lead
  the changes implemented in team care
• Conduct annual staff satisfaction surveys
• Hire from the community

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Summary

• New titles, positions and responsibilities!
• Opportunity to learn panel management
• Use of the Chronic Care Model for improvement
• Promote client self-management

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Summary

• Share ideas and best practices
• Measurement of health outcomes
• Increase collaboration between Pubic Health and
  Safety Net Providers
• Every team members counts!