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 September Feds give safety net clinics a $26,000 boost Editor's note: In July, Oregon Health Forum told about a national study of the country's safety net system -- the clinics and other providers that care for the uninsured -- which is endangered due to funding cutbacks and other market pressures. The following article looks at the problems facing safety net clinics in Multnomah, Washington and Clackamas Counties, as well as initiatives to bolster the region's safety net system. Multnomah County has a long-standing, effective system of providing medical care for the uninsured, largely because of a network of county-operated clinics and several specialized, nonprofit clinics that comprise the Coalition of Community Clinics. But these clinics are challenged daily to meet the needs of low-income patients not covered by the Oregon Health Plan. In Multnomah County, about 72,500 people, or 11 percent of the population, are uninsured, according to the Oregon Population Survey. " Most " of the county's primary care clinics and safety net clinics are operating at full capacity and are saturated, " said Michael Sorenson of the Multnomah County Health Department. " People are being turned away.Government funding is becoming more limited. These clinics must rely on grants and donor bases, which come and go. " This is not just Multnomah County's problem. Patients come from communities as far away as Astoria. " We provide services for anyone who comes to the door," Sorenson said. " It's a community problem. " Recently, the picture brightened thanks to two major grants. Multnomah County received $150,000 from the Robert Wood Johnson Foundation to establish a Communities in Charge program (CIC). Tri-county initiative reaches the uninsured Health care providers on the front lines in Multnomah, Washington and Clackamas counties use words like " exciting " and " creative " when they talk about Communities in Charge, the tri-county initiative that seeks to improve access for the uninsured. The emphasis on collaboration appeals to Dr. Bruce Goldberg, CareOregon's medical director who also treats patients at Clackamas Community Health Center. " The safety net clinics, the non-safety net providers, hospitals, all have to do what they can to provide health care for those who don't have it, " he said. The exciting thing about Communities in Action, is " the sense of trying to come together and look at how to best spend a scarce resource in a way that will benefit the most people, " he said. Mid-Columbia aligns with Clackamas County GOBHI, a mental health contractor in 16 counties, lost its bid to keep Mid-Columbia Center for Living, despite a board decision not to allow the succession. The door opened after the county commissioners intervened, asking for an attorney general's opinion, which determined Mid-Columbia could leave when its contract ended. On Oct. 1, Mid-Columbia joins Clackamas County Mental Health. Since mental health services became part of the Oregon Health Plan in 1995, Mid-Columbia has participated in the GOBHI network, which worked fine -- except for the funding issue, said Sharon Guidera, executive director. " We looked at what GOBHI was offering us and what Clackamas County had, and we believed it was more cost-efficient to align with Clackamas. " GOBHI keeps 10 percent of state funds for inpatient treatment, returning excess revenue once a year. Clackamas County will give that money to Mid-Columbia every month, after keeping a small percentage for administrative costs. " We had a fairly low hospitalization rate, and can use that money to prevent hospitalizations, " Guidera said. PacifiCare tightens its drug benefits At first glance, it appears as if pharmaceutical expenditures were reduced during the 2nd quarter. But, after contacting the HMOs, Oregon Health Forum learned the drug trend continues to rise. PacifiCare is attempting to get a handle on escalating costs by switching from a three-tiered drug benefit to a two-tiered, tightly controlled closed formulary which is being purchased for 3,500 federal employees and one large local employer, said Steve Lynch, vice president and general manager. The drug trend for the closed formulary is 12-14 percent compared to a three-tiered plan, which has an 18-20 percent trend. " It's a way of keeping reasonable benefits in place, " Lynch said. Oregon Health Forum obtained data from the Insurance Division for this report and verified all the numbers with the health plans. How the HMOs Fared
* Only PacifiCare, Health Net Health Plan of Oregon, Regence HMO Oregon and Regence Health Maintenance of Oregon reported drug costs. The newsletter contains additional information on HMOs in Oregon, including revenues, medical/hospital expenses, total expenses and more. Singer draws attention to the elderly As the first medical director for the Senior and Disabled Services Division, Dr. Cliff Singer wants to create a stronger sense of identity for those working in the long term care industry. To achieve that goal, he's organized a conference for medical directors on Oct. 20-21 in Sunriver. At that meeting, Singer anticipates two new groups will emerge -- the Oregon Medical Directors Association and the Oregon Geriatric Society. A geriatric psychiatrist, Singer believes more emphasis should be placed on the quality of care patients receive in emergency rooms. However, there's a financial disincentive built into the system that prevents physicians from making nursing home calls. " It's a money losing proposition and very time intensive, " Singer said. Even if the financial incentives were enhanced, there's a severe shortage of geriatric practitioners around the state. " Geriatrics isn't a hot field for medical students and residents because it requires additional training." Schering-Plough brings Boyer to Portland Claritin, one of the country's top selling drugs, has the support of Annette Boyer, PharmD, health care and group benefits consultant for William M. Mercer in Pittsburgh. She reached that conclusion after developing a productivity model for employers that showed Claritin was the most effective antihistamine when compared to other drugs. Boyer is coming to Portland to speak at Oregon Health Forum's breakfast seminar on challenges facing the drug industry. That event takes place Sept. 28 from 7-9 a.m. at the Multnomah Athletic Club. Schering-Plough, which manufacturers Claritin, is paying her travel expenses, but not an honorarium, she said. (Editor's Note: Schering canceled its subscriptions to Oregon Health Forum following articles that discussed the rising cost of pharmaceuticals and the impact of direct to consumer advertising.) This isn't the first time Boyer has made an appearance on behalf of Schering. " I believe Schering pays my way because they like my message," Boyer told Oregon Health Forum. "I've had an opportunity to present these findings on my own, in a number of employer situations. When employers are making decisions on access, I like to use this as a case example. " Consultants take $296,000 As Multnomah County attempts to redesign its mental health system, people are wondering whether too much money is going into consultants' pockets rather than services. At least $296,000 has been spent on consultants, which doesn't include work by Multnomah County staff who frequently attend night meetings. Last fall, Michael McCracken was paid $85,251 to lead a task force that called for a major system overhaul. Since then, a Boston Consulting Group, Technical Assistance Collaboration, has been hired for $162,000 to develop a master plan and determine how many contractors are needed, the role of the crisis triage center and ways to reduce over-utilization of inpatient beds. Finally, Elinor Hall has a $49,000 contract. She's written a values and principles statement that will guide the mental health system. "I've been involved for more than a year, and all I've seen are consultants get paid and consumers not get services," said Sandy Hayden, a mental health consumer. "I don't see why the people who need services aren't getting them. What's being delivered is lip service." Also in this issue...
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