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where collaboration creates a healthier community


History of the Jefferson Regional Health Alliance
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A Need for Change Identified

 

As we entered the 21st century, it became increasingly clear that the healthcare system of Southern Oregon had pressing issues to address. Study after study turned up multiple levels of concerns. In 2003, Providence Health System contracted a study for the Southern Oregon Service Area to evaluate unmet community healthcare needs. They found that the most critical areas were access to primary care, prescription assistance, dental care, serving the mentally ill and the unprecedented growth in the number of frail elderly needing services. 

 

The Healthcare Coalition of Southern Oregon, a small non-profit organization that acts as the collaborative backbone for regional community-based federally qualified health care clinics and county public health programs, brought together diverse stakeholders throughout the Jackson County community to address current assets and challenges. The Jackson County Chamber of Commerce held health care related meetings for employers and businesses. All parties were deeply concerned by the rising numbers of uninsured and underinsured residents within the region as well as the notable gaps in services regardless of a person’s insured status.

 

The findings in a report prepared by The Rogue Valley Chapter of the League of Women Voters on The Rogue Valley healthcare system further underscored the immediate need for addressing this complex community issue. A poll of doctors, hospitals, and community clinics determined that there was a “serious problem in Oregon: our healthcare system is not working. The 'symptoms' of the problem are apparent to everyone: rising costs, inconsistent quality, and limited access to care for many Oregonians. There is an urgent need to take action to address these problems.” Representatives from these diverse organizations unanimously agreed that efforts to improve these identified issues would be best addressed by organizations working together within the regional community using a sustained and multi-sector approach.

 


The Formation of the Jefferson Regional Health Alliance

 

To address these rising concerns, in 2003-2004, a small number of interested collaborators and the Gordon Elwood Foundation came together to ultimately convene over 60 key community and health care leaders from insurance companies, hospitals, county health departments, the local state university, corporations, school districts, nurses, and physicians, to talk with Peter Senge, MIT researcher and writer, well known for The Fifth Discipline and creating corporate “Learning Organizations.” The principal outcome from this health care leadership summit was the birth of a “health care think tank” in 2005. The small group named themselves the Jefferson Regional Health Alliance (JRHA) with the purpose to improve the health and healthcare resources for Southern Oregonians.

 

The JRHA Board of Directors contracted for operational leadership and facilitation services that were essential in bringing together multiple and competing interests from the local health care delivery system. Support for JRHA’s start-up came from several local institutions including Asante Health System, Providence Medford Medical Center (PMMC), Ashland Community Hospital (ACH), Jackson County Health and Human Services (JCHHS), and Medford Fabrication. To support JRHA's day-to-day activities, office space and managing support was donated by the Gordon Elwood Foundation and Northwest Health Foundation provided fiscal sponsorship.

 

With this generous and unified support, in the first year of its operation JRHA leaders researched and identified the most critical health care priorities facing these founding institutions. JHRA brought together the CEOS of acute care settings, board presidents, medical directors from community based facilities and the county public health directors for a series of facilitated leadership dialogues about health needs and healthcare system issues in Southern Oregon. The conceptual framework of JRHA as a “learning community of health care leaders” was offered to encourage open dialogue and help build relationships between and among the institutional leadership.

 

The initial topics discussed in JHRA’s focused dialogue included national and state public policy issues and health care delivery concerns such as end-of-life care, chronic disease management in a growing elderly and obese population, mental and behavioral health issues in the emergency room and primary care setting, the importance of alcohol and drug treatment provision to community members, the projected allied health and nursing workforce shortage, and dental health access issues which caused emergency rooms to be flooded by the uninsured presenting with acute pain.

 

In that first formative year the most notable outcome was the initiative that addressed the methamphetamine problem in the local area. Through convening the JRHA leadership, significant progress was made to enhance the employment options available to those in recovery from methamphetamine and alcohol use. These efforts lead to expanded communication among leaders of the hospitals and health & human services and spawned a shared commitment to improve the fragmented system of care available to the severely mentally ill.

 

 

Moving Towards Systems Collaboration

 

Beginning in 2006, Hank Collins, director, for Jackson County Health & Human Services, championed a community based effort using Jefferson Regional Health Alliance (JRHA) to improve service to adults experiencing a mental health crisis. Over a three year period an extensive process ensued that included interviews with clients and their families, mapping existing mental health services from acute to community based, meeting continuously with providers from throughout the system to create transformational recommendations for improving client outcomes and service delivery. The goal was to create an integrated community based crisis and ongoing care site outside the acute hospital setting. Numerous work groups were organized and met to craft the structural and operational details of an integrated crisis response system.


At about the same time, a national concern for the nursing workforce was catalyzed by a Robert Wood Johnson Foundation’s Partners in Nursing Future initiative. Local health care leaders approached Kathy Bryon, director for Gordon Elwood Foundation, to act as the lead applicant for funding on behalf the region. The foundation, as a member of JRHA, acted as the regional champion for this initiative under JRHA. In partnership with the Rogue Valley Workforce Development Council, The Job Council, and a multitude of education and community partners, JRHA worked toward the following four goals: 

Increasing the number of nurses entering schools of nursing by increasing spaces in the educational institutions locally
Providing sufficient clinical training and mentoring so that graduates are ready for the workforce
Graduating more nurses locally and employing them locally throughout the region
Increasing the number of nurses who are retained in the nursing profession throughout the whole community


National Economy Impacts JRHA

The national economy’s precipitous plunge in the fall of 2008 had a ripple effect in the State of Oregon causing both of these public-private partnerships to come to a halt. The final application for funding through the RWJF Partners in Nursing Future initiative was tabled because a depressed local economy reduced confidence in raising the philanthropic match necessary for the grant. Similarly, the formalized Community Crisis Response project was shelved for lack of investment funds by the State and County governments. In spite of this setback, JHRA’s collective vision for improvement of clinic based social services and mental health had already taken hold and continues to evolve in the community health clinic setting with philanthropic support and stronger working relationships between community providers.

For the next two years, JRHA leadership turned their attention to the national health reform conversation that was influencing Oregon Health Plan reform. Educational dialogues with local legislators and the Oregon Health Fund board and staff were held with Alliance leaders throughout 2009 and 2010. Dr. John McConnell, health economist from Oregon Health Sciences University presented at an April 2010 educational forum for all members of the regional medical community on Accountable Care Organizations.

Concurrently, La Clinica del Valle, a Jackson County based Federally Qualified Health Center lead by JRHA member Brenda Johnson, produced two significant reports on the status of dental health and dental health access in Jackson County and the surrounding region. These reports inspired additional dialogue among the JRHA membership about dental health and access to care as well as the momentum needed to establish a full service dental health clinic under the management of La Clinica del Valle, which opened in the summer of 2012.


Oregon Health Care Plan Reform: JRHA Conversations and Evolving Structure

Over time JRHA has evolved incrementally into a small and flexible community organization aimed at addressing systemic issues from a higher vantage point. JRHA serves as a facilitator and coordinator of related initiatives involving the regional health care system. The leadership meetings function as a vehicle for cultivating relationships among the Alliance members and their organizations which are key to the provision of health care services and necessary for “system re-thinking” in the region. JRHA is also a neutral place where the community can begin to better coordinate and leverage resources to ensure access to care, improved health status, and a more effective health care delivery system in the region. Alliance leadership and sponsors are deeply invested in the health and health care services needed in this primarily rural region of Oregon and Northern California.

Jefferson Resource Health Alliance Desired Regional Outcomes:

Relationships and resources are leveraged to bring attention to health and health care systems in order to improve health for Southern Oregonians.
The organizations and individuals responsible for the health of the community are interconnected, creating a unique and sustainable system of support for all members of the Southern Oregonian region.
Current systems are transformed, reducing economic, cultural and system barriers to improve health and access to health care services while the cost of health care services are reduced.

To become more proactive in the State Health Reform process, JRHA reorganized in 2010 to expand community wide engagement in identified project areas. A set of goals were developed to guide specific project areas. Projected short-term and long-term outcomes were proposed to engage the appropriate participants and supporters of these goals and outcomes. This new dynamic structure required greater coordination among participants to move the conversations and activities forward.


At the legislative, fiscal, and operational levels, JHRA exists to support stakeholders in creating necessary changes through collaborative dialogue and systems development. JRHA facilitates relationships and leverages resources by creating a unique and sustainable system of support and interconnectedness between organizations and individuals. JHRA does this through quarterly meetings of the leadership board which offer opportunities for open dialogue in order to elevate diverse perspectives as well as inspire better networking, brainstorming, rethinking of strategies for health care delivery in general, as well as increasing the understanding and support for specific projects by multiple stakeholders.

 

 

Initiatives and Projects

 

  1. End of Life Care: 


    JRHA serves as the fiscal agent and the administrator for Choosing Options Honoring Options (COHO) a community based initiative for promoting conversations about end of life care. COHO envisions a community which values, respects, and honors conversations about end-of-life care, where each person facing the final stages of life may so with the greatest possible comfort and dignity.


    For more information, navigate to our Projects page and scroll down to End-of-life Care, or view COHO's website by clicking here.


  2. Mental Health and Primary Care Integration: 


    This initiative was identified by JRHA as a critical component to fulfill JRHA’s goal of an interconnected community promoting health in the broadest sense. JRHA serves as the fiscal agent and the administrator for the Oregon Pain Guidance (OPG), a group of 70 healthcare professionals from Jackson and Josephine County focused on engaging healthcare professionals and community partners to understand the nature of the current opioid problem, learning about best practices around the management of chronic non-cancer pain, and helping to bring best practices into standardized, general use in Southern Oregon. The Oregon Pain Guidance of Southern Oregon mission is to improve the quality of life in our community through the understanding, evaluation and application of best practices for the treatment of complex chronic pain. 

     

    To learn more about the Oregon Pain Guidance click here for a link to their website.


    To see, download, or print the Opiod Guidnlines, click here.


    For more information on this initiative, navigate to our Projects page and scroll down to Mental Health and Primary Care Integration.


  3. Jefferson Health Information Exchange (JHIE): 


    The JRHA was requested to provide a neutral forum for convening diverse stakeholder interests to move toward the collaborative goal of a regional health information exchange. The goal of the JHIE is a secure, electronic exchange of health information endorsed by regional health care stakeholders – including private and non-profit health care providers and public health agencies. The JHIE will facilitate timely, effective, and patient-centered care by decreasing the inefficient use of existing patient data, fostering careful collaboration, lowering administrative burden resulting in a significant reduction of costs and a marked improvement in the quality of patient care. The JHIE became its own non-profit in March 2013 and is looking forward to going live and creating their secure patient records in the middle of 2014 after hosting electronic referrals and secure messaging among enrolled providers since February 2014.

     

    Link to the JHIE website: www.jhie.org

     

    For more information, navigate to our Projects page and scroll down to Jefferson Health Information Exchange.

     

  4. Health Care Reform: 


    As the State became clearer on the model of Coordinated Care Organizations for the Oregon Health Plan, JHRA facilitated conversations among the emerging CCO’s and their potential partners, supporting collaboration, innovative thinking and timely action necessary for the transformation of the current delivery model of care for OHP recipients.


    One of the projects under the Health Care Reform Initiative is the Complex Care Project, a focused multidisciplinary, multiagency team with talented outreach care coordinators (Community Health Workers, CHW) to work with, and support the engagement of, a willing group of identified patients with high utilization of emergency rooms and hospitalizations, and their providers, to achieve the triple aim: decreased costs, improved health, and improved outcomes. Initially funded by the JRHA and CareOregon with further support from Jackson Care Connect and AllCare CCOs, the Complex Care project has been fully integrated in La Clinica and the Community Health Center.

     

    Link to Jackson Care Connect CCO


    Link to AllCare CCO


    Link to PrimaryHealth of Josephine County CCO

    For more information, navigate to our Projects page and scroll down to Health Care Reform.

 

 

Supporting JRHA and JRHA Initiatives:


The success and continued evolution of JHRA is due to emerging and ongoing commitments from multiple sectors: Public, business and private not for-profit organizations. In addition to the financial support provided by each of the Alliance Leaders, the executive committee has procured interested financial partners and is grateful for the hundreds of hours of in-kind staff time and services that have been consistently leveraged in order to create positive outcomes for each initiative or project.

 

You can find a list of sponsors and donors by navigating to our Partners in Collaboration page.

 

 

 

 

You have been telling the people that this is the Eleventh Hour. Now you must go back and tell the people that this is The Hour.

 

Here are the things that must be considered:

Where are you living?

What are you doing?

What are your relationships?

Are you in right relation?

Where is your water?

 

Know our garden.

It is time to speak your Truth.

Create your community.

Be good to each other.

And do not look outside yourself for the leader.

 

This could be a good time!

 

There is a river flowing now very fast. It is so great and swift that there are those who will be afraid. They will try to hold on to the shore. They will feel like they are being torn apart, and they will suffer greatly. Know the river has its destination. The elders say we must let go of the shore, push off toward the middle of the river, keep our eyes open, and our heads above the water. See who is there with you and celebrate. At this time in history, we are to take nothing personally, least of all ourselves! For the moment we do, our spiritual growth and journey comes to a halt. The time of the lonely wolf is over. Gather yourselves!

 

Banish the word struggle from your attitude and vocabulary.

 

All that we do now must be done in a sacred manner and in celebration.

 

We are the ones we have been waiting for.

 

The Elders,

Oraibi, Arizona Hopi Nation