Cowley County, Kansas: Community Health Needs Assessment Jacqueline Hill, MPH, CHES & Lori Timmons, MA Ray & Associates, LLC July 2012
Agenda • Cowley County Overview • Planning Grant Purpose and R&A Role • Data Collection Methods • Findings • Summary Ray & Associates, LLC | July 2012 | 2
Cowley County Population Statistics Statistic Cowley County State of Kansas Total population 1 36,311 2,853,118 Caucasian race 1 89.8% 87.4% 65+ years old 1 16.1% 13.3% Has bachelor’s degree or higher 1 19.5% 29.3% Median household income 1 $40,749 $49,424 Lives at or below 200% FPL 2 37.6% 14.6% Has children in single-parent households 3 33.0% 28.0% Qualifies for free/reduced lunches 4 61.0% 47.4% FPL = federal poverty level; In 2011, FPL = $10,980 for an individual or $22,350 for a family of four. 5 Ray & Associates, LLC | July 2012 | 3
Cowley County Population Statistics Percent of Uninsured Adults 3 20% 16% Cowley County 12% Kansas National Benchmark 8% 4% 0% 2010 2011 2012 Ray & Associates, LLC | July 2012 | 4
Cowley County Population Statistics • Cowley County ranks in the bottom 20% of ranked Kansas counties on summary health scores: 5 - Health outcomes (82 of 99 counties) - Health behaviors (86 of 99 counties) National Severe Cowley Statistic 5 Benchmark Benchmark County Age-adjusted diabetes rate 6.5% 7.8% 8.0% High blood pressure diagnoses 24.8% 27.7% 35.8% Cigarette use during pregnancy 10.7% 14.3% 26.2% 870/ 1,056/ Age-adjusted death rate n/a 1,000,000 1,000,000 Ray & Associates, LLC | July 2012 | 5
Federal Planning Grant • Vision 20/20 Strategic Plan • Planning grant from Health Services Resources Administration (HRSA) in August 2011 • Purpose of grant is to support development of community heath centers (CHCs) 6 • Before applying for additional federal funding, Ray & Associates, LLC conducted a needs assessment 7 to determine: - Consumer health care needs - Resident access to care - Community receptivity to health center Ray & Associates, LLC | July 2012 | 6
Data Collection Methods • Collected quantitative and qualitative data 8 • Guided by input from Steering Committee • Gathered information on perceived health needs and barriers to care access in county: - Provider Surveys - Stakeholder Interviews - Community Surveys - Focus Groups • Used to formally establish priorities and community support 7 Ray & Associates, LLC | July 2012 | 7
Provider Survey • 20 practice-level telephone surveys performed by nurse volunteers in April 2012 • Surveys encompassed 58 providers: - 21 physicians - 10 physician assistants/nurse practitioners - 1 midwife - 12 dentists - 14 hygienists Ray & Associates, LLC | July 2012 | 8
Provider Survey Findings • Appointments for Medicaid patients: - 20% dedicate specific slots to Medicaid patients - 65% of providers, 40% of dentists accept Medicaid • Of those who accept Medicaid patients: - 30% accept children (ages 0-21) - 69% have the same wait times as other patients - 31% have to wait more than 2 weeks for an appointment • Providers receive daily (40%) and weekly (25%) requests to accept new Medicaid patients Ray & Associates, LLC | July 2012 | 9
Provider Survey Findings • 80% have had to turn patients away: - 25% for payment issues or being Medicaid patient - 15% for prescription drug abuse or full schedules • 45% have patients who have been unable to pay, primarily because of high deductibles or no insurance • Provider accommodations for patient payments: - 15% have a sliding-fee scale for patients - 25% make payment arrangements with patients - 80% have difficulty collecting patient payments Ray & Associates, LLC | July 2012 | 10
Stakeholder Interviews • 12 semi-structured individual interviews conducted with key stakeholder representatives in March 2012 • Interviewees included: - Physicians and hospital administrators - Education officials and community organization representatives - Local business owners and city managers Ray & Associates, LLC | July 2012 | 11
Common Interview Threads • Emergency rooms are used a source of primary medical care • Those with insurance often have high deductibles that prevent them from seeking care • Transportation concerns, taking time off work, and low health literacy levels are barriers to seeking care • After hours and weekend care would help working families • Affordable primary care, dental care, mental health, and case management services are needed • Agreement that CHC would 1) not be threat to busy provider community, 2) reduce inappropriate ED use, and 3) provide medical home for under/uninsured Ray & Associates, LLC | July 2012 | 12
Community Surveys • Two point-in-time surveys conducted in March/April 2012 Short Survey Long Survey • 2,700 paper surveys printed • 495 paper surveys printed - 12 questions - 31 questions - English or Spanish - English or Spanish - Distributed throughout county - Distributed via volunteers • 1,872 valid surveys returned (69%) • 252 valid surveys returned (51%) - 1,845 in English (99%) - 226 in English (89%) - 32 web-based surveys completed (2%) Ray & Associates, LLC | July 2012 | 13
Community Survey Demographics Survey Respondent Location (n = 2,214) • 15 total zip codes • 9 city zip codes (82%) • 6 partial zip codes (18%) Ark City 27% Winfield Burden 2% 62% Udall 3% Other Zip Codes 6% Ray & Associates, LLC | July 2012 | 14
Community Survey Demographics Gender Race/Ethnicity Family & Education & Age & Language Household Size & Income • Females (68%) responded Age Group (n = 2,091) to surveys more often than Under 18 males (32%) 12% • Majority of respondents (42%) 65+ were 36-64 years old 17% • Surveys for those under 18 18-35 years of age were typically 29% completed by parents 36-64 42% Ray & Associates, LLC | July 2012 | 15
Community Survey Demographics Gender Race/Ethnicity Family & Education & Age & Language Household Size & Income • Majority of respondents were Self-Reported Race (n = 227) Caucasian (86%) Other 10% • 18% of respondents were of African Hispanic ethnicity American 4% • Respondents reported primarily speaking English (91%), Spanish (8%), and Laotian (1%) at home Caucasian 86% Ray & Associates, LLC | July 2012 | 16
Community Survey Demographics Gender Race/Ethnicity Family & Education & Age & Language Household Size & Income • Respondents’ family sizes Household Status (n = 250) ranged from 1 to 11, with Live-In most common family size Partner 13% being 2 people • Majority of respondents were married (37%) or single (33%) Married Separated 37% 17% Single 33% Ray & Associates, LLC | July 2012 | 17
Community Survey Demographics Gender Race/Ethnicity Family & Education & Age & Language Household Size & Income • Majority of respondents Monthly Household Income (n = 209) finished high school/have GED (37%) or completed $3,000-3,999 some college (38%) $4,000+ 4% 13% • Most respondents’ >$1,000 households earn less than 28% $2,000 per month (65%) $2,000-2,999 18% $1,000-1,999 37% Ray & Associates, LLC | July 2012 | 18
Community Survey Findings Insurance Health Status Providers Appointments ER Use Health Insurance Type (n = 1,859)* • 74% of respondents had 50% health insurance and 45% 40% had dental insurance • 75% of respondents stated 30% they would use fee-based 20% health and dental clinics 10% 0% Medicaid Medicare Private No Insurance Insurance * Some respondents had both Medicare and Medicaid. Ray & Associates, LLC | July 2012 | 19
Community Survey Findings Insurance Health Status Providers Appointments ER Use Self-Rated Health Status (n = 246) • Respondents identified the 50% following needed services to improve their health: 40% - Family doctor (55%) 30% - Dentist (51%) 20% - Eye doctor (43%) - Women’s doctor (36%) 10% - Children’s doctor (27%) 0% Very Good Fair Poor Very Good Poor Ray & Associates, LLC | July 2012 | 20
Community Survey Findings Insurance Health Status Providers Appointments ER Use Primary Health Providers (n = 252)* • Majority of respondents 75% (50%) reported going to 60% the doctor only when they are very sick or hurt 45% • 37% of respondents go to 30% the doctor for regular check-ups 15% 0% Doctor's Hospital Health None Other Office ER Dept Clinic * Some respondents listed more than one provider location. Ray & Associates, LLC | July 2012 | 21
Community Survey Findings Insurance Health Status Providers Appointments ER Use Appointment Difficulties * • Cost Concerns: 60% Immediate Concern - out-of-pocket costs (52%) (n = 1,343) - expensive medication (36%) 45% Regular Check-Up (n = 1,223) - no health insurance (32%) 30% - inadequate insurance (20%) 15% • Appointment Concerns: - availability of times (24%) 0% Can't Appt Don't Know Other - wait times (11%) Afford Time Where * Some respondents listed more than one reason. Ray & Associates, LLC | July 2012 | 22
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