History of the Jefferson Regional Health Alliance
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 under-insured 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.
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 bi-monthly 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.