HomeMy WebLinkAboutRegional Health Authority DocumentsDeschutes County Board of Commissioners
1300 NW Wall St., Suite 200, Bend, OR 97701-1960
(541) 388-6570 - Fax (541) 385-3202 - www.deschutes.org
AGENDA REQUEST & STAFF REPORT
For Board WORK SESSION of September 15, 2010
DATE: September 8, 2010.
FROM: Scott Johnson. Health Services 541-322-7502
TITLE OF AGENDA ITEM:
"Consideration of Board Signature of Central Oregon Regional Health Authority and
Chemical Dependency Organization documents".
PUBLIC HEARING ON THIS DATE? No.
BACKGROUND AND POLICY IMPLICATIONS:
Since the merger of Deschutes County's Mental Health and the Public Health
Departments in 2009, County health staff and Advisory Boards have been working with
the Board of Commissioners and County Administration to better integrate health
planning and services in our County. We have begun this work in collaboration with
other counties and health departments, other health providers and insurers and the State
of Oregon.
Most recently we have focused on HB 2009 (new Oregon law), the work of the Oregon
Health Authority, national research on the topic and changes in Federal law related to
health and health care. This work has resulted in early improvements in community
health services. It has also created a foundation to form a Central Oregon Regional
Health Authority. In its simplest form, we are working collaboratively on what is
referred to as the Triple Aim, enhancing client care, improving health outcomes and
reducing the cost of health care.
On July 20, 2010 Commissioners from Crook, Deschutes and Jefferson counties agreed,
in principle, to move toward the development of a Central Oregon Regional Health
Authority over the next few years. The Boards also agreed in principle to unify the
Oregon Health Plan contracts through Central Oregon Individual Health Solutions, with
Accountable Behavioral Health operating as a behavioral health organization and
contracting with counties for both mental health and alcohol and drug outpatient
services. This will require Deschutes County to not renew its Chemical Dependency
Contract January 1, 2011. It is essential that the Board sign a letter to that effect by
September 15 for that change to occur in January.
Lastly, attachments to this summary include a Concept Paper for the Regional Health
Authority and the three documents that require County Commissioner approval and
signature by a designated Commissioner on behalf of the Board.
FISCAL IMPLICATIONS:
No fiscal implications in FY 11 budget. Formation of the Central Oregon Regional
Health Authority and changes in the Oregon Health Plan contracts (and possibly other
public sector health contracts) may affect funding levels in subsequent operating
budgets.
RECOMMENDATION & ACTION REQUESTED:
Approval for Commissioner Tammy Baney, as Chair of the Regional Health Authority
Transitional Board and Vice Chair of the Accountable Behavioral Health Alliance
Board, to sign the following documents on behalf of the Deschutes County Board of
Commissioners:
a.Letter to the State of Oregon (attached) declining to renew our Chemical Dependency
Contract effective January 1, 2011;
b.Memorandum of Understanding: Central Oregon Health Integration Project (attached);
and
c.Letter of Understanding regarding Medicaid / Children's Health Insurance Program
Managed Care Contract Changes for the Central Oregon Health Integration Project
(attached).
ATTENDANCE: Scott Johnson.
DISTRIBUTION OF DOCUMENTS:
Letter agreeing to not renew CDO contract to the addressees on the letter.
Original signature document for Memorandum of Understanding and Letter of
Understanding to Robin Henderson, St Charles Health System, 2500 NE Neff Road,
Bend Oregon 97701.
Copy of all three signed documents to Kathe Hirschman, Deschutes County Health
Services, 2577 NE Courtney, Bend OR 97701.
Thank you
DESCHUTES COUNTY DOCUMENT SUMMARY
(NOTE: This form is required to be submitted with ALL contracts and other agreements, regardless of whether the document is to be
on a Board agenda or can be signed by the County Administrator or Department Director. If the document is to be on a Board
agenda, the Agenda Request Form is also required. If this form is not included with the document, the document will be returned to
the Department. Please submit documents to the Board Secretary for tracking purposes, and not directly to Legal Counsel, the
County Administrator or the Commissioners. In addition to submitting this form with your documents, please submit this form
electronically to the Board Secretary.)
Date:
Please complete all sections above the Official Review line.
September 8, 2010
Contractor/Supplier/Consultant Name:
Contractor Contact:
Department:
Health Services
Contractor Phone #:
Type of Document: a. Regional Health Authority Concept Paper; b. Letter to the
State of Oregon (attached) requiring signature declining to renew our Chemical
Dependency Contract effective January 1, 2011; c. Memorandum of Understanding:
Central Oregon Health Integration Project (attached) requiring signature; d. Letter of
Understanding regarding Medicaid / Children's Health Insurance Program Managed
Care Contract Changes for the Central Oregon Health Integration Project (attached)
requiring signature.
Goods and/or Services: Health services provided by the Behavioral Health Division of
Deschutes County Health Services for the benefit of Oregon Health Plan members.
Background & History: Since the merger of Deschutes County's Mental Health and
the Public Health Departments in 2009, County health staff and Advisory Boards have
been working with the Board of Commissioners and County Administration to better
integrate health planning and services in our County. We have begun this work in
collaboration with other counties and health departments, other health providers and
insurers and the State of Oregon.
Most recently we have focused on HB 2009 (new Oregon law), the work of the Oregon
Health Authority, national research on the topic and changes in Federal law related to
health and health care. This work has resulted in early improvements in community
health services. It has also created a foundation to form a Central Oregon Regional
Health Authority. In its simplest form, we are working collaboratively on what is referred
to as the Triple Aim, enhancing client care, improving health outcomes and reducing the
cost of health care.
On July 20, 2010 Commissioners from Crook, Deschutes and Jefferson counties
agreed, in principle, to move toward the development of a Central Oregon Regional
Health Authority over the next few years. The Boards also agreed in principle to unify
the Oregon Health Plan contracts through Central Oregon Individual Health Solutions,
with Accountable Behavioral Health operating as a behavioral health organization and
contracting with counties for both mental health and alcohol and drug outpatient
services. This will require Deschutes County to not renew its Chemical Dependency
Contract January 1, 2011. It is essential that the Board sign a letter to that effect by
September 15 for that change to occur in January.
9/9/2010
Lastly, attachments to this summary include a Concept Paper for the Regional Health
Authority and the three documents that require County Commissioner approval and
signature by a designated Commissioner on behalf of the Board.
Agreement Starting Date:
January 1, 2011
Annual Value or Total Payment:
None
Ending Date:
7 Insurance Certificate Received (check box)
Insurance Expiration Date:
not applicable
Ongoing
Check all that apply:
❑ RFP, Solicitation or Bid Process
❑ Informal quotes (<$150K)
❑ Exempt from RFP, Solicitation or Bid Process (specify — see DCC §2.37)
Funding Source: (Included in current budget? ® Yes ❑ No
If No, has budget amendment been submitted? ❑ Yes ❑ No
Is this a Grant Agreement providing revenue to the County? ® Yes ❑ No
Special conditions attached to this grant: n/a
Deadlines for reporting to the grantor: n/a
If a new FTE will be hired with grant funds, confirm that Personnel has been notified that
it is a grant -funded position so that this will be noted in the offer letter: ❑ Yes ® No
Contact information for the person responsible for grant cornpliance: Name: Scott
Johnson
Phone #: 541-322-7502
Departmental Contact and Title: Scott Johnson, Director, Deschutes County Health
Services Phone #: 541-322-7502
Department Director Approval:
Signature Date
Distribution of Document: Who gets the original document and/or copies after it has
been signed? Include complete information if the document is to be mailed.
Official Review:
County Signature Required (check one): ❑ BOCC 0 Department Director (if <$25K)
❑ Administrator (if >$25K but <$150K; if >$150K, BOCC Order No.
Legal Review Date
Document Number
9/9/2010
The Central Oregon
Regional Health Authority
CONCEPT PAPER
Draft 12: September 7, 2010
Table of Contents
Page
Vision 1
Executive Summary 1
Background 2
Guiding Principles 3
Proposed Framework 4
Frequently Asked Questions 6
Development Plan 10
Vision
The purpose of the Central Oregon Regional Health Authority (RHA) is to promote the health
of our region's residents, making Central Oregon the healthiest region in the nation. The RHA,
in partnership with the Oregon Health Authority (OHA), seeks to achieve the Triple Aim: to
improve health outcomes, increase satisfaction with our health system and reduce costs. The
goal is to manage resources efficiently and effectively, in collaboration with local and State
governments, our hospital system, local providers, private insurers, health collaborative(s) and,
most importantly, our community and the people we serve.
Executive Summary
The Central Oregon Regional Health Authority (RHA) is a collaborative initiative undertaken
by the OHA and a number of Central Oregon stakeholders. This effort will lead to the
establishment of an RHA in Central Oregon. The RHA will oversee and help guide the
planning, regulation and purchase of health care services in our region. Planning and
negotiations for this RHA have been proceeding through the Transitional Board comprised of
representatives of the Crook, Deschutes and Jefferson Boards of Commissioners, St. Charles
Health System, PacificSource, the OHA and the region's safety -net clinics.
9/9/2010 Draft Page 1
The RHA principles are based in the Triple Aim, which measures the ability of our health system
to improve health outcomes for the population, improve people's satisfaction with the health
system and reduce costs. The RHA, in partnership with the OHA, will define, implement,
measure and lead the regional Health Improvement Plan—a collaborative community plan.
The Plan will be grounded in baseline health and economic data and focused on Triple Aim
metrics to measure outcomes and guide decisions that will best serve the health of the
population of Central Oregon. Our goal is to make Central Oregon the healthiest region in the
nation.
This paper outlines the premise of the RHA, its guiding principles and proposed framework,
and answers questions about how the RHA may function in the future. There is also a proposed
timeline for implementation that would result in the formation of the RHA in 2011 for regional
planning purposes, with implementation of contract authority for the Oregon Health Plan by
2013 and full implementation of Central Oregon Regional Health Authority by 2014.
Background
Extraordinary changes are under way in America as many groups seek to improve the health of
an entire population and the performance of the nation's health care system. Change is being
mandated by new Federal and Oregon laws as well as numerous health issues in our
population, rising and unsustainable health care costs, the increasing number of uninsured
Americans and the impact that health care is having on our economy. When it comes to
effective change at a county, community and local population level, how can that best be
achieved?
The Crook County Court and County Commissioners from Deschutes and Jefferson counties
met at Deschutes County's Expo Center on July 20, 2010. At that meeting, these elected officials
reviewed planned changes on a Federal and State level. They also discussed the essential need
for local government to play a central role in supporting the Triple Aim 1 and improving the
overall health of people living in Central Oregon. These officials agreed, in principle, to take a
leadership role in overseeing this change in our region by forming a Regional Health Authority
or RHA. An effort is now under way to outline the roles and responsibilities of an RHA, likely
leading to its formation in 2011. The purpose of this document is to help interested parties
begin to develop a shared concept for the RHA.
Final 2011 contracting decision by September 15, 2010: In consideration of restructuring current
Oregon Health Plan contracts, these local elected officials provided the State with two letters of
intent on July 22, 2010. These letters and preliminary commitments are conditional and clarify
general agreements about a Central Oregon RHA model. At a minimum, agreement must be
Triple Aim: Oregon's health reform efforts are based on the Triple Aim, a concept advanced by the
Institute for Healthcare Improvement. Essential elements include: a. improving health outcomes for the
population, b. improving people's satisfaction with the health system and c. reducing costs.
9/9/2010 Draft Page 2
reached by the three participating counties, the State of Oregon, PacificSource, Accountable
Behavioral Health Alliance, the Deschutes County Chemical Dependency Organization and St.
Charles Health System. All stakeholders interested in the Central Oregon's service integration
effort and the RHA discussion will be given the opportunity to ask questions and offer
suggestions.
Guiding Principles
1. In collaboration with local public health agencies, ensure baseline health and economic
data on the region's residents at the inception of the RHA and on a periodic basis.
2. Emphasize outcome -based decision making regarding priorities, projects and
investments with a particular emphasis on the Triple Aim.
3. Retain the Local Mental Health Authority and Public Health Authority as County roles
for the foreseeable future to assure responsiveness to local citizens and issues,
community ownership and accountability.
4. Employ lean thinking to reduce nonessential administrative requirements that draw
resources and create barriers to clients accessing care.
5. Promote effective client care using a medical home model 2 that proactively assists
clients in accessing the appropriate care in the most cost effective environment.
6. Recognizing the social and economic factors affecting health, pursue a high level of
community engagement with social service systems and coalitions.
7. Adopt value -based purchasing strategies to improve quality, efficiency and outcomes.
8. Create mechanisms to document savings as they occur with a strategy for reinvestment
of such savings in communities and programs consistent with the regional plan.
9. Emphasize public accountability and transparency in processes and activities.
10. Engage the community in health planning and the work of the RHA.
11. Create a new vision for care delivery that will demonstrate a model worth emulating
elsewhere in Oregon.
2 The Medical Home Model will help clients access appropriate care in a most cost effective treatment environment.
9/9/2010 Draft Page 3
Proposed Framework for the
Central Oregon Regional Health Authority
Topic Description
The purpose of the Central Oregon RHA is to promote the health of our
region's residents, making Central Oregon the healthiest region in the nation.
Vision The RHA, in partnership with the OHA, seeks to achieve the Triple Aim: to
improve health outcomes, increase satisfaction with our health system and
reduce costs. The goal is to manage resources efficiently and effectively, in
collaboration with local and State governments, our hospital system, local
providers, private insurers, health collaborative(s) and, most importantly,
our community and the people we serve.
The OHA expects to contract with the RHA. Both entities will share a
Relationship responsibility for Oregon's Triple Aim metrics. Communication and
with OHA collaboration between the groups will be significant and ongoing. OHA and
the RHA will employ lean thinking concepts and limit administrative
burdens including plans and reports.
a. Policy: clear overarching policy interests and expectations for population
health and the region's health care system.
b. Access: Increased access to needed health services.
c. Quality: Systems, services and programs that are of high-quality.
d. Measurable results: tracking system and service benefits and outcomes
Areas of e. Sound long range planning: regional Health Improvement Plan
emphasis f. Targeted projects: based on the Plan and annual priorities
g. Wise investments: use of public and grant funds managed by RHA
h. Efficiency: Operational methods that are cost effective and only require
essential administrative responsibilities.
i. Fiscal stewardship: assurance that regional purchasing meets Triple Aim
objectives.
j. Fiscal sustainability: forecasting and investments will seek to achieve long
range outcomes within a realistic and sustainable financial base.
k. Transparency: RHA Board activities and decisions will be managed in a
way to realize a high degree of community awareness and involvement.
1. Health care integration: Development of systems and models that are
holistic in nature, easy to access and that gain desired health outcomes.
m. Innovation: A continual effort to be creative and learn from new ideas.
n. Public awareness: An emphasis on public health and well being as well as
the health system.
Residents of Crook, Deschutes and Jefferson counties; also residents of
Geographic area adjoining areas relying on publicly funded systems in our area (e.g. OHP
members in north Klamath County zip codes).
9/9/2010 Draft Page 4
Board Within State and Federal requirements, regional public policy and oversight
responsibility of public resources in the region to realize the Triple Aim. The Board may
hire an RHA Director or assign any RHA Director duties.
At time of formation as an intergovernmental entity (ORS 190), the RHA will
operate with a three-member Board composed of a County Commissioner
Board from each participating County. Each participating County Board, as the
membership County's public health and mental health authority, will appoint the
Commissioner as its representative. As an intergovernmental entity, these
three Board members may appoint additional ex officio members (if needed)
for specified terms of office.
Decisions of the Board will require a majority vote and must include support
from Deschutes County which represents two-thirds of the region's
population. Consensus will be sought wherever possible. On issues of
Board decisions potential disagreement, the Administrative Council may be asked to provide
solutions. Under extraordinary situations, a County representing a minority
view, may, with the agreement of that County's Board, ask for a joint
meeting of the region's commissioners to address a health matter of high
importance.
The RHA will appoint members to an Administrative (advisory) Council.
This Council of professionals and advocates will be charged with advising
the RHA Board on strategic and operational matters, developing projects and
Administrative action plans in support of regional policies, the regional Health
Council Improvement Plan and our desired outcomes. The Council will be
representative of stakeholder interests and knowledge including
local and State governments, our hospital system, local providers, private
insurers, health collaborative(s) and, most importantly, our community.
RHA staff Determined by the Board based on need and resources. Likely to include an
Executive Director and support staff at the outset.
Formal policies will be adopted to drive and inform the characteristics and
Policy performance of our health system and our success in improving population
health outcomes.
Adoption and implementation of a regional long range Health Improvement
Plan of at least six years to guide public policy, system improvements,
Planning program development, investments and achievement of health outcomes.
Request: State waiver of current requirements for annual and biennial silo
plans unless required to satisfy Federal requirements and State law.
Financing the Resources will be sought from Federal, State and / or private foundation
start up of the sources to support the RHA's initial operation until the RHA assumes
RHA responsibility for the region's OHP contract and any other contracts. Initial
start up and operating costs prior to contract management are estimated at
$250,000.
9/9/2010 Draft Page 5
Annual
priorities
System design,
development
Resource
development
Investment,
procurement
Purchasing
Workforce
development
State changes to
streamline
operation
Annual adoption and implementation of health priorities consistent with the
regional Health Improvement Plan and any necessary and beneficial
developments at a state, regional, county or community level.
Describe and convey essential system characteristics and components sought
by the RHA; contracting guidelines and investment of resources will be
consistent with this determination.
On behalf of the region, clients and providers, seek federal, state and private
grants to advance the regional plan and its priorities.
Manage assigned public and foundation grants to advance the Triple Aim
and regional health plan; includes region's OHP contract. May include other
public grants previously managed on a County level.
The RHA will support purchasing practices aimed at improving the value of
health care services, where value is a function of both quality and cost.
As part of the regional plan and in cooperation with other health interests,
undertake educational programs and skill development opportunities that
assure availability of the necessary work force.
Requested of the OHA through a State and Regional Lean Process
workgroup.
Frequently Asked Questions:
1. How will Community leaders continue to prepare the region for the formation of the
RHA? A Transitional Board, with representatives of the OHA, county governments, the
hospital system, safety net clinics and insurance interests has been meeting throughout
2010. The Transitional Board will remain in operation until the RHA is formed.
2. On what legal basis will the RHA be formed and operate? The RHA will be formed
under ORS 190. It is a relatively easy vehicle if Central Oregon counties reach
consensus on how and when to move forward with an RHA. As suggested by the OHA,
new legislation may prove helpful in the long term design, functioning and legal
standing of this regional authority. Given uncertainties regarding the 2011 session and a
new law codifying an RHA, the region sees benefit in beginning this change process
through ORS 190.
3. When will the RHA be formed? If the RHA idea continues to garner the needed support
and resources, it will be formed in 2011. The formal start date may be adjusted
depending on the completion of the tasks outlined in the attached Development Plan as
well as other necessary requirements.
9/9/2010 Draft Page 6
4. When will the RHA assume contracting responsibilities? Which contracts? Because
contracting responsibilities will require State or Federal changes, assumption of this role
will require up to six months notice to affected parties. The RHA Board and the OHA,
by mutual agreement, will determine which public contracts the RHA will assume and
when. It is expected that the Oregon Health Plan contract to serve OHP members in
Central Oregon will be managed through the RHA.
Exclusive of significant contract performance issues; transferring any State public
contracts currently managed at a County level must be consistent with the Triple Aim
and must offer operational efficiencies. Additionally, any such change will require the
concurrence of that County's governing board currently managing that grant.
5. What support will the State provide to help the RHA be successful? The State agrees to:
a. Sign the Memorandum of Understanding, thereby providing a clear statement to all
interested parties of the OHA's support for this pilot and its potential link to other
reform efforts in Oregon.
b. Convene a "Lean Process" workgroup to:
i. Develop administrative simplification recommendations and implement
consensus agreement with the RHA. This workgroup will include
representatives of the RHA partners. Extensive review to include but not be
limited to items in the Memorandum of Understanding. The workgroup will
review county reporting requirements under the Public Health Authority
and Local Mental Health Authority and those reporting requirements in the
Medicaid contracts. This workgroup will convene within 60 days from the
date of this concept paper being approved by the Transitional Board and
complete its recommendations no later than six months from inception; and
ii. Review Medicaid procurement processes.
c. Wherever feasible, consolidate and streamline health planning requirements by
OHA Divisions that are not required by the Federal and State governments. Assist
the RHA in discussions with other state agencies regarding alignment of other social
service plans with the Health Improvement Plan schedule. 3 Establish a framework
for a comprehensive regional Health Improvement Plan and biennial progress
reports. The process will include a strong data driven, community assessment
process at the region, county and community levels.
d. Assure continuing access to leadership at the OHA and regional level to advance the
RHA and eliminate barriers to its success.
3 Includes but may not be limited to ORS 417.775 (the Local Coordinated Comprehensive Plan), ORS
417.855 (Local High Risk Juvenile Crime Prevention Plan, ORS 423.560 Local Public Safety Coordinating
Council involvement with the Juvenile Crime Prevention Plan and ORS 417.777 Early Childhood
Development Plan. A comprehensive approach to state required plans is intended to help address the
critical, social determinants of health.
9/9/2010 Draft Page 7
e. Maintain close consultation between the OHA and the RHA (or Transitional Board)
on any legislation that may impact the new RHA and its operation (within OHA's
established timelines).
f. Assist the RHA in identifying non -state funding source(s) during start up (as well as
for ongoing operation) to successfully carry out the required responsibilities,
including potential private or public funders, reviewing federal grant opportunities
and providing letters of support.
g. Use the regional Health Improvement Plan and progress reports to inform decision
making for State budgets, policy decisions and program priorities;
h. Provide technical and knowledge transfer to make the Triple Aim concept
operational.
i. Agree to use stable metrics developed by the OHA and RHA in evaluation of system
changes.
j. Continue efforts, within available resources, to develop robust data systems.
6. What concepts and ideas would the OHA ask RHA stakeholders to consider as part of
RHA development?
a. In order to achieve full accountability for health and health outcomes in the region,
the RHA must aim toward integration of public health and mental health authority
duties and services into the RHA where it improves efficiency, cost-effectiveness and
outcomes.
b. The RHA will incorporate OHA strategies to improve the affordability, quality and
outcomes of health care, including:
• Emphasizing promotion of good health and prevention of health problems;
• Focusing on delivery system redesign that emphasizes patient -centered
primary care homes;
• Incorporating the Oregon Health Policy Board value -based benefit design
and quality metrics;
• Evaluating and piloting reformed payment models that encourage value -
driven health care rather than volume -driven health care;
• Working toward a global budget for health care expenditures;
• Using evidence -based care to ensure that residents receive health care that
works;
• Expanding chronic care management;
• Using health information technology; and
• Increasing data transparency about health care costs and quality.
c. Inclusion of consumer and broader purchaser representation on the RHA Board.
d. Inclusion of regional purchasing for other public programs as well as for employer-
sponsored commercial insurance.
7. How can public health agencies best participate in the RHA? County public health
entities are included in the work of the Regional Health Authority by:
9/9/2010 Draft Page 8
a. Tracking and publishing health metrics at the County and regional level on a
schedule of greatest benefit to RHA planning and decision making;
b. Jointly sharing local responsibility for promoting and implementing Oregon's
Health Improvement Plan;
c. Developing and advocating for health policies and initiatives that 1) positively affect
the social determinants of health (poverty, transportation, economy, special
population considerations) 2) improve population health;
d. Fostering a collaborative and complementary approach, with public and private
agencies, to chronic disease prevention;
e. Implementing a collaborative communications plan that educates the residents of
Central Oregon; and
f. Undertaking collaborative regional public health initiatives to increase our efficiency
and benefit to the region. 4
8. Where will the RHA reside? The RHA Board will determine whether to operate as an
independent entity or to be administered through a local governmental entity or private
organization. It may be desirable to align with a local governmental entity for efficiency
and access necessary support services (e.g. legal, contractual, personnel processes). The
RHA Board will also determine an administrative office location within the region.
9. How will the regional Board ensure an open process in its work? Regularly posted
Board meetings will be held throughout the region. All Board meetings requiring action
will occur within the region and be subject to Oregon open meeting laws. In addition,
stakeholders will be encouraged to participate at a committee and task force level. This
may include currently required Advisory Boards or oversight entities 5.
10. When will the RHA be formed and begin its work? When will it manage resources?
Preliminary Plan:
2012 Form RHA as a 190; staff hired; Development Plan executed (see attached);
Oregon legislature convenes: Central Oregon representatives participate in
health reform discussions; if legislation signed into law; rules drawn;
adjustments are made where needed. Resource and capacity development.
2013 RHA develops and adopts a regional Health Improvement Plan; comprehensive
Oregon Health Plan contract is finalized in the fall of 2012. Resource and
capacity development.
4 For example, historical H1N1 efforts, promotion of Living Well workshops, planning for a new home
visiting model for preschool age children; collaboration with local safety net clinics and school health
clinics
5 For example, Local Alcohol & Drug Planning Councils, Mental Health Advisory Boards, Public Health Advisory
Boards at a county or regional level.
9/9/2010 Draft Page 9
2014 In January, the RHA contracts for OHP services and other health related
services and activities. May also include further participation in the legislative
process as needs and circumstances dictate. Note: other fiscal year contracting
may occur July 2013 or later; grant writing / resource development continues.
2015 Actions in support of the expansion of the Medicaid population in the region
and the development of Health Insurance Exchanges.
Central Oregon Regional Health Authority
Development Plan
This plan describes work that must be completed to support the formation of the Central
Oregon Regional Health Authority.
Responsible
Task party Deliverable
Lead Cmsr in Named individual to assist the Transition
Transitional Project each County or Board and eventual RHA Board in
Management desginee accomplishing the Development Plan.
Incorporation papers County Formal certification as a legal entity by the
counsel(s) State of Oregon no later than October 1 2011.
RHA administrative budget Board adoption Adoption of annual budget and financial plan
for the first two years of operation.
Public health With State public health, provide health and
Baseline metrics agencies, economic data to support tracking health and
Admin. Council economic changes from date of RHA
inception.
Transitional Should legislation be advanced that impacts
Legislation Board, PDC 6 the RHA, active participation in the legislative
and OHA process as allowed by employers and statute.
Work with the OHA Director's office to reduce
Administrative lean administrative burdens and streamline RHA
thinking with State To be assigned and County operations. Document benefits of
RHA option to local and statewide interests.
Questions and suggestions: A work group is in the process of drafting this document to
incorporate the suggestions of key parties. Please send suggestions and questions to: Scott
Johnson: scott johnson@co.deschutes.or.us or Mike Bonetto: mjbonetto@stcharleshealthcare.org.
6 The Program Development Committee or PDC (and other key parties) includes representatives of each
participating county health and behavioral health interest, HealthMatters of Central Oregon, Mosaic
Medical, St. Charles Health System, PacificSource and Accountable Behavioral Health Alliance.
9/9/2010 Draft Page 10
Memorandum of Understanding
Central Oregon Health Integration Project
Parties: St Charles Health System, Inc., Crook County, Deschutes County, Jefferson
County, Accountable Behavioral Health Alliance ("ABHA"), Central Oregon Individual
Health Solutions, Inc. ("COIHS"), (collectively "Central Oregon Parties"), and the State
of Oregon, by and through the Oregon Health Authority ("State)"
PURPOSE
The purpose of this Memorandum of Understanding (MOU) is to clarify the roles and
responsibilities of the collective agencies that will be providing services to Oregon
Health Plan (OHP) members in Crook, Jefferson, and Deschutes' counties in Central
Oregon. The process will be organized initially through COIHS, which will serve as the
single point of accountability for physical health, mental health, and chemical
dependency services until the development of the Central Oregon Regional Health
Authority (RHA) is achieved. This integration of physical health, mental health and
chemical dependency services will be termed the Health Integration Project (HIP).
Mental health and chemical dependency together will be referred to as Behavioral
Health. The Parties intend to cooperate toward establishing a RHA to serve as this
single point of accountability. This MOU is a step towards achieving that end.
This MOU will be effective when signed by all Parties. This MOU is not a binding
contract, and the transactions described in this MOU will not be binding until contracts
and agreements governing them are entered into.
The Central Oregon Parties, in collaboration with the State., intend to:
1. Coordinate efforts to provide seamless and effective health services to OHP
members.
2. Make the following changes to the current service delivery system during the first
year of the HIP commencing January 1, 2011:
• The Parties will prepare standard client screening instruments to be used by
all participating providers in Crook, Deschutes and Jefferson counties to
identify health conditions (including physical health and behavioral health
conditions).
• Persons who are screened or assessed to be at risk for physical health or
behavioral health conditions will be clinically engaged regarding these
problems at the time and location of the screening or assessment. As
clinically appropriate, there will be a timely, "warm handoff' to a specialty
As of January 1, 2010, Deschutes County members include OHP members from four adjacent zip codes in Klamath
County.
provider (e.g., from a physical health provider to a behavioral health
provider or from a behavioral health provider to a physical health
provider.)
3. Streamline contracting, administrative and oversight processes to eliminate
duplicative oversight, cost and reporting requirements.
4. Share information at both the client and system levels to facilitate a holistic,
efficient, and effective healthcare delivery process. It is understood that there will
be many details to work out for this to be operationalized. The Central Oregon
Parties commit to working through these details.
5. Modify existing COINS and ABHA governance structures as needed to provide
oversight of health services to OHP members in Central Oregon. These structures
will interface with the organizational structures which govern the HIP, (i.e., the
Transitional Board and Stakeholders Committee).
6. Prepare and execute Agreements (see Funding and Contracting section) to begin
no later than January 1, 2011 and, following annual renewals, expire no earlier
than December 31, 2016 which accomplish HIP objectives. In addition:
• At least six months prior to the termination date of the Agreements referred
to in this paragraph 6, the Parties will negotiate to extend them.
• The Agreements may be modified with mutual consent, to improve service
delivery and system efficiency.
• The Agreements will have provisions that allow for termination when
specified conditions are met. OHA will recommend -contract language to
the Central Oregon Parties.
Funding and Contracting Effective January 1, 2011:
In order to accomplish the objectives in this MOU, the following contract terminations
and initiations will take place:
Deschutes County will not renew its contract with the State as a Chemical Dependency
Organization in Deschutes County. ABHA will not renew its Mental Health
Organization contract with the State for services in Crook, Deschutes and Jefferson
Counties. The State will contract with COIHS for physical health, mental health , and
chemical dependency services in Crook, Deschutes and Jefferson Counties. COIHS will
in turn subcontract with ABHA for both mental health and chemical dependency
services in Crook, Deschutes and Jefferson Counties. ABHA will subcontract with
Crook, Deschutes, and Jefferson Counties and their respective health departments, and
other necessary panel providers for outpatient mental health and chemical dependency
services. These contracts and subcontracts, including any annual renewals, are
collectively referred to as the "Agreements". The Agreements are intended to remain in
place until such time as the RHA is able to assume operational responsibility.
Future State of OHP Funding
Jan 2011
ABHA
State Of Oregon DHS
•
.11 41
H COIHS
•
•
•
.
Physical Health
Providers
— — — — — Mental Health Contract & Funding
• Physical Health Contract & Funding
Behavioral Health (MH+CD) Contract & Funding
ABHA intends to:
1. Modify its Inter -Governmental Agreement with Crook, Deschutes and Jefferson
Counties so that they cover behavioral health services.
2. Modify governing and advisory structures so that they address the full range of
behavioral health services.
3. Modify reporting and oversight processes for services delivered in Central
Oregon so that they address the full range of behavioral health services delivered
by Central Oregon providers. This will include utilizing client screening
instruments and implementing objectives of the Project.
4. Modify sub -capitation payments to the identified counties to include funding for
chemical dependency services as well as mental health services.
5. Not renew its contract with the State for Crook, Deschutes and Jefferson Counties
as of January 1, 2011 and request that the State direct its capitation funding to
COIHS as of this date.
COIHS intends to:
1. Enter into contracts with the State -to provide physical health and behavioral
health services for OHP members residing in Central Oregon.
2. Subcontract with ABHA for mental health and chemical dependency services for
the OHP members residing in Central Oregon.
3. Pass along to ABHA all capitation payments received from the State for such
services and for administration. COIHS will retain the provider tax revenue and
pay related taxes.
4. Invest funds from COIHS or ABHA or both, in mental health and chemical
dependency interventions with the goal of avoiding preventable physical health
conditions. Savings from physical health will fund the expansion of mental health
and chemical dependency services in Central Oregon. The amount of savings
reinvested will be determined by considering the best allocation of resources for
all services. The specifics of this arrangement will set forth in the COIHS contract
with ABHA.
5. In collaboration with ABHA and other Central Oregon stakeholders will develop
and implement various clinical and system redesign projects that are designed to
improve clinical care and generate savings. Prior to the commencement of each
project, a specific methodology for determining and apportioning savings will be
agreed to by all relevant parties. The following are general principles to be
followed:
(a) When savings are created, those who made the financial investments which
made them possible should be paid back prior to the payout of the balance.
(b) Balances should be paid out in proportion to the percentage of measurable
effort that created them. They will be determined prior to the start of a
project as part of the process of designing interventions and assigning
responsibilities and expected outcomes.
(c) It is understood that it for many projects, it will not be possible to
determine 100% of the accountability for outcomes to individual
organizations. To the extent that this is the case, stakeholders will use a
general formula for dividing such savings based on their collective
understanding of how savings are likely to be generated.
(d) Payouts will be made at least annually by the organizations who have
realized savings.
(e) COIHS will have overall responsibility for documenting and tracking these
processes.
Crook, Deschutes and Jefferson Counties intend to:
1. Work towards the full integration of the management, delivery, and oversight of
BH services.
2. Have the infrastructure in place to prioritize access for HIP clients.
Deschutes County intends to:
1. Not renew its CDO contract with the State as of January 1, 2011 and request that
the State direct its capitation to-COIHS as of this date and consistent with this
MOU.
St. Charles Health System intends to:
1. Modify its service and administrative protocols (as needed) to achieve the clinical
and system objectives of the HIP.
The State intends to:
1. Sign the Memorandum of Understanding, thereby providing a clear statement to
all interested parties of the OHA's support for this pilot and its potential link to
other reform efforts in Oregon.
2. Convene a "Lean Process" workgroup to:
(a) Develop administrative simplification recommendations and implement
consensus agreement with the RHA. This workgroup will include
representatives of the RHA partners. Extensive review to include but not
be limited to items in the Memorandum of Understanding. The workgroup
will review county reporting requirements under the Public Health
Authority and Local Mental health Authority and those reporting
requirements in the Medicaid contracts. This workgroup will convene
within 60 days from the date of this concept paper being approved by the
Transitional Board and complete its recommendations no later than six
months from inception; and
(b) Review Medicaid procurement processes.
3. Wherever feasible, consolidate and streamline health planning requirements by
OHA Divisions that are not required by the Federal and State governments.
Assist the RHA in discussions with other state agencies regarding alignment of
other social service plans with the Health Improvement Plan schedule.
1 Includes but may not be limited to ORS 417.775 (the Local Coordinated Comprehensive Plan), ORS 417.855 (Local
High Risk Juvenile Crime Prevention Plan, ORS 423.560 Local Public Safety Coordinating Council involvement with the
Juvenile Crime Prevention Plan and ORS 417.777 Early Childhood Development Plan. A comprehensive approach to state
required plans is intended to help address the critical, social determinants of health.
Establish a framework for a comprehensive regional Health Improvement Plan
and biennial progress reports. The process will include a strong data driven,
community assessment process at the region, county and community levels.
4. Assure continuing access to leadership at the OHA and regional level to advance
the RHA and eliminate barriers to its success.
5. Maintain close consultation between the OHA and the RHA (or Transitional
Board) on any legislation that may impact the new RHA and its operation (within
OHA's established timelines).
6. Assist the RHA in identifying non -state funding source(s) during start up (as well
as for ongoing operation) to successfully carry out the required responsibilities,
including potential private or public funders, reviewing federal grant
opportunities and providing letters of support.
7. Use the regional Health Improvement Plan and progress reports to inform
decision making for State budgets, policy decisions and program priorities;
8. Provide technical and knowledge transfer to make the Triple Aim concept
operational.
9. Agree to using stable metrics developed by the OHA and RHA in evaluation of
system changes.
10. Continue efforts, within available resources, to develop robust data systems.
This MOU is signed on behalf of each Central Oregon Health Integration Project Party.
It may be executed in several counterparts, each of which shall be deemed an original
and all of which shall constitute but one and the same instrument:
Bruce Goldberg, M.D. Date
Director -designee, Oregon Health Authority
Ken Fahlgren, Commissioner
Board of Commissioners
Crook County
Date
Tammy Baney, Commissioner
Board of Commissioners
Deschutes County
Mike Ahern, Commissioner
Board of Commissioners
Jefferson County
James A. Diegel, FACHE
President and CEO
St. Charles Health System, Inc.
Don Lindly, Chair
Governing Council
Accountable Behavioral Health Alliance
Ken Provencher
President and CEO
Central Oregon Individual Health Solutions, Inc.
Date
Date
Date
Date
Date
Letter of Understanding
Regarding
Medicaid/CHIP Managed Care Contract Changes
For the Central Oregon Health Integration Project
September 7, 2010
This Letter of Understanding (Letter) describes the intent of the parties to integrate
the Medicaid/CHIP prepaid managed care organization contracts in Crook County,
Deschutes County, and Jefferson County, collectively known as the "Participating
Counties," as part of a health services integration demonstration project, known as
the "Health Integration Project".
The parties to this Letter are:
1. The State of Oregon by and through its Department of Human Services
(DHS), Division of Medical Assistance Programs (DMAP) and Addictions
and Mental Health Division (AMH);
2. Crook County;
3. Deschutes County (inclusive of the designated north Klamath zip codes);
4. Jefferson County;
5. Accountable Behavioral Health Alliance (ABHA); and
6. Central Oregon Individual Health Solutions, Inc. (COIHS).
An objective of this demonstration project is integration of physical health services
provided by a fully capitated health plan (FCHP) with mental health and chemical
dependency services currently provided through the county -directed mental health
organization (MHO) and chemical dependency organization (CDO) managed care
contracts. The parties anticipate that this Health Integration Project will result in
better health outcomes for Oregon Health Plan enrollees and cost savings that can
be reinvested in improved integrated service delivery systems in the participating
counties.
Transition to an appropriately integrated system begins with the integration of
these Medicaid/CHIP managed care services, as part of the Health Integration
Project. Effective January 1, 2011, the following contract changes are anticipated:
1. Deschutes County will not renew its CDO contract with DHS/DMAP.
2. COIHS will amend its FCHP contract with DHS/DMAP to add chemical
dependency services in Deschutes County.
3. ABHA will not renew its MHO contract with DHS/AMH for service areas in
Crook, Deschutes and Jefferson Counties.
Page 1 of 4
Letter of Understanding
Regarding Medicaid Managed Care Contract Changes
September 7, 2010
4. COIHS will enter into an MHO contract with DHS/AMH for the
Participating Counties.
5. COIHS will subcontract with ABHA for mental health and chemical
dependency provider services in the Participating Counties.
6. ABHA will subcontract with the Participating Counties for outpatient mental
health and chemical dependency provider services.
The contracts described in items 4-6 are anticipated to continue in effect with
annual contract renewals until December 31, 2016. Six months prior to the
termination of the Health Integration Project, all parties will convene to consider
extending the term of the Project.
The Participating Counties and affected health care community are evaluating
processes that will lead to the creation of a Regional Health Authority, which will
become the primary decision -maker related to integrated services in these counties.
In addition, the Oregon Health Authority is expected to assume operational
responsibility for DMAP and AMH; when that occurs, references to DHS in this
Letter are deemed to refer to the Oregon Health Authority. The parties will adapt
the Health Integration Project to either of those changes.
During each contract year, the effect of this Health Integration Project will be
measured and monitored to evaluate progress toward agreed upon metrics. An
objective of the parties is to achieve the following metrics by the end of the
demonstration period (December 31, 2016) based on demonstrated trends:
• This section will be redrafted based on Thursday's discussion. New
approved table of trends will be inserted before signature.
On a quarterly basis, evaluation reports will be submitted to the designated staff at
DHS.
During the period of the Health Integration Project, agreements may be modified
with mutual consent to improve service delivery and system efficiency. Contract
amendments for this purpose will be executed with the agreement of the affected
parties.
In the event the parties determine that the Health Integration Project is not
achieving its objectives but could more likely succeed with a project redesign, the
parties will revisit the design of the Health Integration Project. If the parties agree
that the outcomes could be improved with a design change, the parties will
Page 2 of 4
Letter of Understanding
Regarding Medicaid Managed Care Contract Changes
September 7, 2010
undertake reasonable efforts to make agreed-upon changes. If necessary, contract
amendments for this purpose will be executed with the agreement of the affected
parties.
In the event the OHA, COIHS or the Participating Counties determine that the
Health Integration Project is not making significant progress towards meeting its
defined outcomes, the Oregon Health Authority will, in consultation with the local
mental health authorities, return the MHO contract or the CDO contract, or both of
them, to either their former models for service delivery or assign the MHO contract
or the CDO contract, or both of them, to a successor organization. Before this
change occurs, the MHO and/or the CDO, whichever is applicable, must meet all
qualifications for serving as a managed care organization, including but not limited
to financial solvency and reserves requirements and demonstration of provider
capacity and data reporting capabilities. The process of changing contractors would
be deemed to constitute a transfer or re -assignment of contract interests that must
be addressed using applicable processes for assignment and assumption or
ownership changes. In anticipation of the time required to make the necessary
contract changes and assure a qualified contractor, the parties will provide notice 6
months in advance of the expected effective date for the change.
While this letter in and of itself is not a binding contract, it does reflect the
commitment of the parties, within the contracts and contract amendments
described herein, to incorporate language which will carry out the intention of the
parties' understandings. The transactions described in this Letter will not be
binding until the contract and contract amendments described herein are entered
into. Final approval by the Centers for Medicare and Medicaid Services and the
Oregon Department of Justice is required for any contract amendment or other
change to the FCHP, MHO or CDO Agreements.
This LOU is signed on behalf of each of the Parties. It may be executed in several
counterparts, each of which shall be deemed an original and all of which shall
constitute but one and the same instrument.
Bruce Goldberg, M.D.
Director -designee
Oregon Health Authority
Page 3 of 4
Date
Letter of Understanding
Regarding Medicaid Managed Care Contract Changes
September 7, 2010
Ken Fahlgren, Commissioner
Board of Commissioners
Crook County
Tammy Baney, Commissioner
Board of Commissioners
Deschutes County
Mike Ahern, Commissioner
Board of Commissioners
Jefferson County
Don Lindly, Chair
Governing Council
Accountable Behavioral Health Alliance
Ken Provencher
President and CEO
Central Oregon Individual Health Solutions, Inc.
Page 4 of 4
Date
Date
Date
Date
Date
September 15, 2010
Judy Mohr, Division of Medical Assistance Programs
Richard Harris, Addictions & Mental Health Division
State of Oregon Health Authority
500 Summer St. NE E-25
Salem OR 97301-1079
Re: Deschutes County's intent to not renew it's Dependency Organization (CDO) contract
with the State of Oregon effective January 1 2011; request that the state direct the
CDO capitation to COIHS as of this date, consistent with the September 2010 MOU
and planned development of the Central Oregon Regional Health Authority.
Dear Richard and Judy,
The purpose of this letter is to officially notify you that Deschutes County does not intend to
renew our Chemical Dependency Organization contract with the Division of Medical Assistance
Programs for outpatient chemical dependency services provided by and through Deschutes
County to OHP members in our area. This notice is intended to comply with our contractual
obligation to notify the State of Oregon of any change in contract status.
This decision is based on the agreements outlined in the September 2010 Memorandum of
Understanding: Central Oregon Health Integration Project. Our County expects that as of January 1,
2011, we will be jointly providing an array of integrated services to OHP members through an
ABHA behavioral health contract with PacificSource Central Oregon Individual Health
Solutions (COIHS). This will include mental health services currently provided through ABHA
as well as chemical dependency services currently covered under the DHS contracts with
COIHS and the Deschutes County CDO. Our ultimate goal is to deliver integrated healthcare to
our members that results in better outcomes and cost savings.
Additionally, as outlined in the MOU, we are proceeding on this basis understanding that both
the Oregon Health Authority and Central Oregon stakeholders intend to form a Central Oregon
Regional Health Authority which will eventually manage the region's State contract for all
physical health, mental health and chemical dependency services to Oregon Health Plan
members in our region. It is on that basis that this change is requested.
Judy Mohr, Division of Medical Assistance Programs
Richard Harris, Addictions & Mental Health Division
Correspondence: Deschutes County September 15, 2010
CDO Contract
We are very grateful for your leadership in supporting this shared vision and for the potential it
holds for the residents of Central Oregon. We look forward to making this vision a reality over
the next several years.
Sincerely,
Tammy Baney
Deschutes County Board of Commissioners
Chair, RHA Transitional Board
Cc Ken Provencher, PacificSource COINS
Seth Bernstein, ABHA
Jeff Emrick, Deschutes County CDO
COUNTY
Agency Name
Population
Served
Agencies
Service
Call Taker /
DispatcherF
TE
Admin /u;
Support
FTE
Total FTE
4='
911 CALLS
OTHER CALLS
TOTAL CALLS
BAKER
Baker County Dispatch
18,000
27
8.00
2.00
10.00
L
32,263
52,483
84,746
BENTON
Corvallis Regional Comm.
86,120
10
14.00
195
15.95
-
25,191
119,799
144,990
CLACKAMAS
C -COM
294,750
15
28.00
12.00
40.00
r
110,681
217,534
328,215
CLACKAMAS
LOCOM
95,100
3
14.50
3.00
17.50
'':;'
25,246
109,532
134,778
CLATSOP
Astoria 9-1-1
27,000
14
7.00
1.00
8.00
_='
10,730
61,507
72,237
CLATSOP
Seaside PD
12,041
9
6.80
2.20
9.00
4,314
45,804
50,118
COLUMBIA
Columbia 9-1-1
50,595
28
1175
6.00
17.75
.`:
20,485
88,951
109,436
COOS
Coos Bay PD
20,830
3
8.00
0.00
8.00
:'
12,068
83,826
95,894
COOS
Coos County SO
CROOK
Prineville PD
22,775
5
8.00
2.00
10.00
'
8.182
58,529
66,711
CURRY
Brookings PD
16,000
12
7.00
1.00
8.00
:''.
4,177
26,502
30,679
CURRY
Curry County SO
22,000
16
7.00
100
8.00
' _'-:
6,208
68,170
74,378
DESCHUTES
Deschutes 9-1-1
160,810
15
26.00
8.50
34.50
y
59,793
227,323
287,116
DOUGLAS
Douglas County 9-1-1
104,000
38
19.00
0.00
19.00
:-
50,937
139,846
190,783
GILLIAM
TRI -COM
5,310
16
8.00
1.00
9.00
`:;':%_":
2,552
26,853
29,405
GRANT
John Day PD
7,580
17
5.25
0.50
5.75
`' .:;
1,907
24,790
26,697
HARNEY
Burns PD
7,600
8
6.00
0.00
6.00
<3
2,429
2,429
4,858
HOOD RIVER
Hood River Dispatch
22,500
9
13.00
1.00
14.00
'j'
11,217
55,522
66,739
JACKSON
RVCOMM
118,641
6
24.50
150
26.00
�;.w
49,142
205,078
254,220
JACKSON
SORC
205,000
25
17.00
7.00
24.00
`.
44,889
123,145
168,034
JEFFERSON
Jefferson County SO
21,000
4
7.00
110
8.10
<
9,134
45,133
54,267
JEFFERSON
Warm Springs PD
JOSEPHINE
Josephine County 9-1-1
83,290
10
15.00
2.00
17.00,?
50,197
51,745
101,942
KLAMATH
Klamath County 9-1-1
70,100
27
1100
4.00
15.00
: _
48,306
65,584
113,890
LAKE
LETS
8,000
20
9.00
0.25
%25
5,569
5,569
11,138
LANE
Central -Lane
325,065
36
37.00
13.50
5050
152,731
174,735
327,466
LANE
Eastem Lane 9-1-1
4,874
11
4.00
1.00
5.00`,
2,103
18,904
21,007
LANE
South Lane 9-1-1
25,000
5
5.00
3.43
8.43
7,235
31,842
39,077
LANE
Western Lane 9-1-1
17,500
6
7.00
0.30
7.30
7,566
7,658
15,224
LINCOLN
Lincoln City PD
7,400
2
8.50
1.00
9.50
8,259
53,404
61,663
LINCOLN
LinCom
48,000
14
1100
3.50
14.50
17,299
82,846
100,145
LINCOLN
Toledo PD
5,000
2
4.50
0.50
5.00
1,542
16,557
18,099
LINN
Linn Co. S.O.
115,348
10
16.00
6.00
22.00
F
76,051
109,114
185,165
MALHEUR
Malheur County SO
20,240
18
6.00
0.20
6.20
4,669
58,860
63,529
MALHEUR
Ontario PD
15,300
4
6.75
0.00
6.75
'
5,318
58,518
63,836
MARION
NORCOM
74,000
13
14.00
2.00
16.00
32,539
75,168
107,707
MARION
Santiam Canyon 9-1-1
41,243
16
8.00
2.00
10.00
'
13,438
37,042
50,480
MARION
WVCC
326,800
18
52.00
7.00
59.00
"'
154,513
157,701
312,214
MORROW
Morrow County SO
13,000
7
10.00
100
1100
6,134
65.835
71,969
MULTNOMAH
City of Portland, BOEC
720,219
7
115.00
28.00
143.00
r
464,084
283,466
747,550
TILLAMOOK
Tillamook 9-1-1
24,300
13
1100
3.00
14.00.
11,521
8,908
20,429
UMATILLA
Hermiston PD
30,000
5
9.00
100
10.00
rs. F
10,333
11,271
21,604
UMATILLA
Milton-Freewater
11,500
5
6.00
0.00
6.00
#;:"e
2,032
21,516
23,548
UMATILLA
Umatilla Co. S.O.
54,254
21
15.00
3.00
18.00
;.a}'
20,996
127,727
148,723
UNION
Union County 9-1-1
25,000
22
10.50
1.00
1150
°°
9,488
45,407
54,895
WALLOWA
Wallowa Co. S.O.
7,300
9
5.00
1.00
6.00
1,640
2,597
4,237
WASCO
Wasco County 9-1-1
24,000
13
9.00
100
10.00
-
21,907
54,253
76,160
WASHINGTON
WCCCA
525,000
19
63.00
25.40
88.40
WI
141,974
290,495
432,469
YAMHILL
Newberg PD
32,563
2
9.00
0.50
9.50
12,027
67,740
79,767
YAMHILL
YCOM
68,617
14
13.00
4.00
17.00
C
29,537
65,743
95,280
TOTALS
4,040,565
629.00
736.05
168.33
904.38
1,810,553
3,832,961
5,643,514
TOTALS FROM 07-08
4,076,175 631.00 741.40 166.23 907.63
1,724,407 4,265,702 5,990,109
Population served does not include 'seasonal'
population as this was optional to report
Coos County and Warm Springs failed to report
