Changing the primary care landscape in Jackson County, Oregon

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1 Changing the primary care landscape in Jackson County, Oregon

2 Health system transformation in Oregon Coordinated Care Organizations

3 Coordinated Care Organizations (First 5 years) LOWER COSTS: Federal and State government saved $1.4 billion in Medicaid costs just since 2012 and has avoided billions more since the inception of the Oregon Health Plan over two decades ago. STATE SAVINGS: Oregon's health reforms are projected to save a total of $10.5 billion between 2012 and 2022 by holding down cost growth to not more than 3.4 percent per member per year 2.2% less than national averages. BETTER OUTCOMES & CARE: Hospital readmissions have been cut by one-third. Substance misuse assessment, developmental screening, and prenatal care have all increased. PROVIDING CARE AT THE RIGHT TIME AND PLACE: Avoidable emergency department use decreased by nearly 50 percent over five years.

4 Jackson County, Oregon Service area population: 213,765 Largest minority population: 11.7%, up from 9% in These 25,000 residents include about 8,670 migrant and seasonal farmworkers (MSFW) and their dependents. Homeless: Roughly 7,000 people struggle with homelessness in our in our service area, mostly women with children (25 percent of this group are minors).

5 Economic markers Unemployment rate: 5.7% Poverty rate, overall: 18.1% Poverty rate, households with children: 25.9% Low-income rate, overall: 39% (83,368 residents) Median income: $44,835 ($54,148 in Oregon) Median gross rent: $877 Rental vacancy rate: 1.38% La Clinica target population Poverty and housing costs are rising

6 Uninsured rate for medical: 7.4% (about 15,800 residents). This decreased more than 10 percentage points under the Affordable Care Act. Covered by Medicaid: 29% (about 63,000). This includes traditional and expansion populations. Jackson County, Oregon Total population: 213,765 Covered by Medicare: 23% (about 48,400). About 18,880 of these earn incomes below 200 percent of federal poverty guidelines. In all, 111,252 residents, 52 percent, are covered by Medicaid or Medicare.

7 About La Clinica Launched in 1989 as migrant and community health center and has grown to welcome all in community

8 About La Clinica Serves 26,272 medical, dental, and mental health patients each year, and another 9,600 patients in financial counseling, health education, care coordination, and outreach services This totals 30,186 people, 14% of our community.

9 About La Clinica Staff connect patients to affordable housing, living-wage employment, and higher education and act as the critical link in coordination of care to mental health, addictions, and specialty service providers (e.g., oncologists and cardiologists) and hospitals or skilled nursing facilities.

10 La Clinica growth under the ACA Nearly 19% among all patients About 50% in dental care (under the ACA, Oregon includes oral health services in Medicaid)

11 La Clinica health centers 16 permanent locations ranging from small schoolbased centers to large primary care or dental clinics) and one mobile health center that provides care at several homeless shelters and in coordination with faith-based community services targeting the poor New site each year over last six years to address growing demand for affordable services

12 La Clinica health centers Like our health center peers, we offer services on an income-based fee schedule and help uninsured patients enroll in Medicaid if they re eligible. We also conduct annual fundraising initiatives and large capital campaigns to engage foundations and other donors, making much of our growth possible.

13 New services Dental Added pediatric dentist and offer sedation services to improve care to children Expanded communitybased oral health prevention services by adding expanded-practice hygienists to care teams In the final stages of implementing an enhanced electronic dental health record that will provide integration with our primary care/medical records system

14 New services Medical Added Centers of Excellence program (expanded primary care model in rheumatology and gastroenterology) Added physical therapy and acupuncture to reduce the prescribing of opioids for chronic pain

15 New services Medical (continued) Added non-traditional wellness services (movement classes, nutrition/cooking classes, mindfulness classes, and personal development seminars) Expanded Suboxone services for medically assisted treatment of substance use disorders Added wellness coaches, community health workers

16 New services Behavioral health Embedded health center with county public health and mental health services, adapting primary care model to a primary/behavioral health model Added master s-level mental health clinicians to care teams Introduced substance use screening, intervention, and referral to treatment (12 and older screened annually) Improved coordination to specialty care

17 How we change lives Shannon, center, came to La Clinica near death. Today she s clean and sober, with new hope in her life.

18 . How we change lives Linda avoided the care she needed because she didn t feel connected to her doctors. At La Clinica, the foster home resident says, I feel wanted.

19 How we change lives Jerry lost 60 pounds from his 5-7 frame, started walking daily, and was able to stop medication.

20 Thank you. Questions?

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