Alameda County“Every Team Member Counts”

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

Alameda County

1.5 million residents

Median income $61,017

Adult poverty rate of 10.1%

173,000 adults <65 without health insurance

2005-2006 Safety Net care

CMSP served over 63,000

268,000 outpatient visits

73,000 emergency room visits

15,300 hospital admissions

SB 1448: CA Care Coverage

Initiative (CI)

California’s 2005 Federal Medi-Cal Hospital Financing Plan provides $180 million in federal funds

Expands health care coverage to eligible low-income, uninsured persons

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

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

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.

Alameda County Excellence (ACE ) Delivery System

Focus on medical home

Enhanced chronic disease focused specialty care

Integrated access of behavioral health care

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

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

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.

Medical Assistant Training

Community college Private programs/post secondary

vocational schools Administrative/medical Responding to emergencies Computer application systems and

literacy

Medical Assistants Expanded Role Used in more specialized services

Unlicensed health care workers have seen their scope of duties expand

RN’s more expensive

RN shortage

Employment for medical assistants to grow much faster than other occupations

Workforce Challenge

Limited post secondary education

Not working at the level trained

Decision making roles

Licensed personnel to accept expanded role

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

Expanded Role Trainings

Panel management

Review and maintain the disease registry Calls-appointments, labs, and preventive

care Medication reconciliation Arranges referrals

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

Informed,ActivatedPatient

ProductiveInteractions

Prepared,ProactivePractice Team

Improved Outcomes

DeliverySystemDesign

DecisionSupport

ClinicalInformation

Systems

Self-Management

Support

Health System

Resources and Policies

Community

Health Care Organization

Chronic Care Model

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

Challenges

Retention MAs start their careers at CBO’s, 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

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 MA’s throughout the safety net clinics

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

Summary

New titles, positions and responsibilities!

Opportunity to learn panel management

Use of the Chronic Care Model for improvement

Promote client self-management

Summary

Share ideas and best practices

Measurement of health outcomes

Increase collaboration between Pubic Health and Safety Net Providers

Every team members counts!