Radical collaboration


Focused on collaboration and prevention, Alameda County is pushing to expand health care and wellness to as many residents as possible.

The county was the first nationwide to accept a federal challenge: provide healthcare to every child eligible under two federal programs: the Children’s Health Insurance Plan, and Medicaid (or Medi-Cal in California).

More expansively, Alameda county aims to lead the state in progressive reform efforts by 2014, when most provisions of the federal Affordable Care Act take effect.

Over the next year, the board of supervisors is hosting expert discussion on various topics – including prevention, acute care, and insurance options – “with the goal of being one of the leading counties in California as far as implementation and access (under the Act),” says supervisor Wilma Chan, whose health pedigree includes chairing the state Assembly’s Committee on Health as California’s first female Assembly Majority Leader. One of two members of the county board’s Health Committee, she also previously served as a county supervisor from 1994 to 2000.

“We have relatively mature collaborative structures… preparing for a post-reform health economy,” says Alex Briscoe, director of the county’s health care agency.

The county expects over 150,000 more residents – 10 percent of the county’s population – will receive insurance after the Affordable Care Act takes effect, either through low-income government provider Medi-Cal or from private insurance offered by new healthcare “exchanges” that will help cover California’s 7 million uninsured.

The county has already laid the foundation to make this transition a successful one.

It participates in a waiver program for Medi-Cal recipients that Chan calls “the bridge to healthcare reform,” and is exploring ways its nonprofit county health plan can offer insurance through the new exchanges. Also, a study of Accountable Care Organizations due early next year (2012) will explore the benefits of programs that reward providers based on positive health outcomes, rather than simply treating illness.

Still, county officials fear that new competition created under the Act will affect its safety net: community clinics as well as the county’s independently-contracted hospital system.

The Alameda County Health Consortium consists of eight safety net clinics that reach a vast ethnic mix totaling 160,000 of the county’s 1.5 million residents.

Clinics within the consortium realize they will be thrust into a more competitive marketplace, and have to continue providing quality care to survive.

Sherry Hirota, CEO for Asian Health Services, says that her community clinics treat a specialized population not easily served by the private sector.

“It’s quite a specific niche that we fill,” says Hirota, pointing out that 10% of the clinics’ patients have HMO coverage, but choose instead to be treated there. Staff members treat patients who speak 15 different languages.

“We are trusted places in the community,” says Hirota. “We are their advocate, as well as their provider.”

But supervisor Chan says the county’s safety net hospital system – Alameda County Medical Center, or ACMC – is a different story.

“I am more concerned with ACMC, as many of their currently uninsured patients may be attracted to other hospitals when they have more of a choice of provider,” she says. The center consists of six locations that include emergency care, skilled nursing, and specialty clinics.

“If we do nothing we will be out of business,” said Warren Lyons, the medical center’s chief strategy and integration officer, to a Bay Area healthcare conference in November. “That’s surprising when we’re building hospitals at a cost of $1 billion.”

Chan compares today’s climate to the 1990’s “when Sutter took almost all of the paying patients” from ACMC for obstetrics and gynecology after Medi-Cal benefits were expanded to cover pregnant women.

How is the medical center tackling this challenge? By polishing its public image.

Its Highland Hospital is known as the “knife and gun club,” a trauma center that caters heavily to gang violence — a reputation it’s been unable to shake.

Lyons said it was crucial for the medical center to change that image, and instead market its entire suite of services, which range from maternal and child services to mental health, rehabilitation, and geriatric care. Of the center’s six facilities, three focus on wellness.

Alameda county is banking on this success.

It has invested $700 million in ACMC’s future – a state-of-the-art Oakland hospital set to open in 2015 – a year after the Affordable Care Act takes effect.

County officials have long heralded the collaboration between safety net providers as a foundation for reform.

Louella Penserga, policy director for the Alameda Health Consortium, says that the seeds for the county’s collaboration were planted in the 1970s – the heyday of progressive efforts in the East Bay.

The Alameda Safety Net Council – which includes ACMC, the health consortium, the Public Health Department, and others – meets frequently to integrate care countywide for indigent patients. Shared electronic health records are expected to be operational by 2014 to help communication between providers.

“We see the obvious benefits (now) to the patients and the county as we move into healthcare reform,” says Penserga. “The board of supervisors has shown a lot of leadership on this.”

Briscoe proudly rattles off the successes produced by the county’s collaborative culture.

In December, it opened its 24th school-based health center. It has a pilot program to open five new health clinics based in fire stations. It has established two new clinics in local community colleges, with two more in the planning phase. Its Health Pipeline Project helps fast-track youth and young adults into health professions.

The county has also funded a worker-owned food coop. Two of its community clinics prescribe fresh food to pregnant women.

And Briscoe calls Youth UpRising “the coolest teen center you’ve ever seen” with a skate park and attached health clinic with hopes it will be replicated elsewhere.

Finally, the county has created an impressive web directory “for uninsured Alameda County residents seeking free or low-cost health care” that covers over 40 different healthcare categories: teen clinics, chronic disease care, child exams, immunizations, dental health, and nearly 40 other services.

All of these efforts are focused on a single goal.

“The heart of any healthcare system is social justice,” says Briscoe, complimenting his neighboring county across the Bay. “For indigent healthcare consumers you want to live in San Francisco or Alameda county.”

Briscoe says the county looks at health holistically – with vision far beyond traditional definitions of health to include the impact of the foreclosure crisis, low test scores, and other social and environmental factors.

“We have really embraced the concept that you can’t ‘treat away’ healthcare disparities (with medicine alone),” says Briscoe. “You have to address the social determinants of health.”

ACMC’s Lyons says the future of health in Alameda county depends on this philosophy – collaborate or fail.

“Other parts of the country should look to Alameda county for its collaborative efforts,” he says. “We have to give up our clan and tribal attitudes.”

Matt Perry is a correspondent for the California Health Report at www.calhealthreport.org

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