PHSSR Research-In-Progress Series: Bridging Health and Health Care Wednesday, July 1, 2015 12-1pm ET/ 9-10amPT The Affordable Care Act and Childhood Immunization Delivery in Rural Communities To download today ’ s presentation & speaker bios, see the ‘ Resources ’ b ox in the top right corner of the screen. PHSSR N ATIONAL C OORDINATING C ENTER AT THE U NIVERSITY OF K ENTUCKY C OLLEGE OF P UBLIC H EALTH
Agenda Welcome: C.B. Mamaril, PhD, Research Assistant Professor, Health Management & Policy, University of Kentucky College of Public Health “ The Affordable Care Act and Childhood Immunization Delivery in Rural Communities ” Presenter: Van Do-Reynoso, MPH, PhD Candidate, U. of California, Merced and Public Health Director, Madera County, California vdo-reynoso@ucmerced.edu Commentary: Paul Brown, PhD, Chair of Public Health; U. of California, Merced pbrown3@ucmerced.edu Susan Buckley, RN, PHN, MPH, Public Health Director, Humboldt County, CA sbuckley@co.humboldt.ca.us Questions and Discussion
Presenter Van Do-Reynoso, MPH PhD Candidate, Public Health Services and Systems Research University of California, Merced Public Health Director Madera County, California Pre-doctoral Scholar in Public Health Delivery, 2014 PHSSR Award vdo-reynoso@ucmerced.edu
The Affordable Care Act and Childhood Immunization Delivery in Rural Communities: Phase 1 Van Do-Reynoso, MPH Doctoral Candidate in Public Health UC Merced July 1, 2015
Robert Wood Johnson Foundation Public Health Services and Systems Research Pre-Doctoral Scholar Award PHSSR National Coordinating Center Mentor Paul Brown, PhD, UC Merced Reference Group Humboldt, Kings, Merced, Nevada, and Fresno Counties 5
2014: ~3 million newly enrolled in Medi-Cal > 1 million newly enrolled in private coverage via Covered California Not yet available gains from employment-based coverage 2.7 to 3.4 million people under 65 years will remain uninsured by 2019 Up to 50% will be undocumented immigrants Remaining uninsured will be eligible, but unenrolled due to barriers 6 Which Californians will Lack Health Insurance under the Affordable Care Act? CA Simulation of Insurance Market (CalSIM) Report, Jan 2015
For children 0 -17: Uninsured 8.3% Publically insured 39.0% Privately insured 55.8% 7 www.kidsdata.org
31 out of 58 counties are small and rural Responsible for uninsured or indigent population by Welfare & Institution Code 17000 Decreasing Health Realignment revenues due to economy Decreasing state funding for immunization program Changing federal vaccine guidelines New role? 8
To evaluate whether the ACA has led to an increase in childhood immunizations in rural counties, and to define the role of the local public health department in this new era. 9
Literature review Reviewed work related to expanded health coverage, immunization rates, health care access rural communities, and changing role of LHDs Identified common themes to address in key informant interviews & survey Phase 1: Key Informant Interviews 14 participants in 4 counties Public Health, FQHC, & RHC In-person, via WebEx, and via telephone using semi-structured format Qualitative analysis to find common and unique themes 10
ACA, Medi-Cal Expansion, 317 vaccines Key themes: Increased number of children eligible for services Decrease in publically-insured children seeking immunizations @ LHDs 11
Immunization rates Key themes: Under-insured children face barriers to timely immunizations Personal Belief Exemptions affect rates in local communities 12
Access to immunizations Key themes: Lack of immediate appointments @ community and private providers Community partnerships crucial to improve rates Not an issue for uninsured children 13
Funding for immunization Key themes: Decrease in state funding to LHDs Insufficient reimbursements for private providers Contracts with private insurance available to some LHDs 14
Cost of immunizations as a barrier Key themes: High cost for under-insured children 317s & VFCs readily available for non-insured or publically-insured children 15
Role of LHDs Key themes: Decreased role in direct service for publically- insured children Increased role in outreach and education Maintaining capacity to serve safety net populations Seeking new funding to maintain capacity 16
100.0% 90.4% 89.7% 89.5% 89.2% 89.2% 88.7% 88.8% 90.0% 80.0% 70.0% 60.0% Up To Date 50.0% Personal Medical Exemption Personal Belief Exemption 40.0% 30.0% 20.0% 10.0% 4.0% 3.6% 3.4% 3.1% 3.2% 2.7% 2.6% PME rates: < .2% 0.0% 2008 2009 2010 2011 2012 2013 2014 17
100.0% 90.0% 77.5% 80.0% 73.5% 73.0% 72.6% 72.3% 71.6% 66.7% 70.0% 60.0% Up To Date 50.0% Personal Medical Exemption Personal Belief Exemption 40.0% 30.0% 22.4% 21.6% 21.3% 20.3% 18.9% 17.7% 20.0% 14.4% 10.0% PME rates: 0.5% 0.1% 0.1% 0.1% 0.0% 0.0% 0.0% 0 % to .5% 0.0% 2008 2009 2010 2011 2012 2013 2014 18
100.0% 90.0% 84.2% 84.6% 82.2% 81.2% 81.3% 85.4% 77.3% 80.0% 70.0% 60.0% Up To Date 50.0% Personal Medical Exemption Personal Belief Exemption 40.0% 30.0% 20.0% 6.2% 8.6% 8.3% 6.4% 8.1% 7.5% 10.0% 4.8% PME rates: .1 % to .5% 0.0% 2008 2009 2010 2011 2012 2013 2014 19
100.0% 90.0% 75.8% 76.6% 77.3% 80.0% 75.2% 75.7% 75.7% 73.3% 70.0% 60.0% Up to Date 50.0% Personal Medical Exemption Personal Belief Exemption 40.0% 30.0% 20.0% 11.9% 11.5% 10.9% 10.5% 10.2% 10.3% 10.3% 10.0% PME rates: 0.5% 0.4% 0.4% 0.2% 0.2% 0.1% 0.1% .1% to .5% 0.0% 2008 2009 2010 2011 2012 2013 2014 20
100.0% 97.3% 95.3% 97.4% 96.7% 96.5% 96.5% 96.2% 90.0% 80.0% 70.0% 60.0% Up To Date 50.0% Personal Medical Exemption Personal Belief Exemption 40.0% 30.0% 20.0% 10.0% 1.9% 1.4% 1.3% 1.0% 0.8% 0.9% 0.8% PME rates: 0.0% 0 % to .2% 2008 2009 2010 2011 2012 2013 2014 21
LHDs concerns: maintaining capacity for mass vaccination efforts maintaining immunization coverage rates by ability to provide IZ to anyone seeking it Cost estimations: variance in how LHDs and community providers capture cost information for providing immunization services 22
Three new arrangements for LHDs in rural areas: Type 1: Does not provide IZ to children covered by Medi-Cal Type 2: Provides IZ services for privately insured children Type 3: More efforts on referrals to other providers; convening coalitions and workgroups to improve rates 23
Analyze immunization database of kindergarten entrants from 2008 to 2014 at zip code level Distribute final survey to all 58 jurisdictions Analyze survey responses for themes and costs Construct predictive model for immunization rates 24
Cost estimation of childhood immunization services (Fall 2015) Presentations & Briefs on survey findings and predictive model to Immunization Workgroups, Public Health Directors, and Health Officers (Winter 2015/Spring 2016) Dissertation defense (January 2016) 25
Commentary Paul Brown, PhD Chair, Public Health Director, Health Sciences Research Institute School of Social Sciences, University of California, Merced pbrown3@ucmerced.edu Susan Buckley, RN, PHN, MPH Public Health Director Humboldt County, California sbuckley@co.humboldt.ca.us Questions and Discussion
Archives of all Webinars available at: http://www.publichealthsystems.org/phssr-research-progress-webinars Upcoming Webinars – July and August 2015 Wednesday, July 8 (12-1pm ET) N ATIONAL E VALUATION OF L EADERSHIP S TYLES AND O UTCOMES IN L OCAL H EALTH D EPARTMENTS Laura Cassidy, MS, PhD, Medical College of Wisconsin (RWJF PHS3 award) Wednesday, August 5 (12-1pm ET) A PPLYING F AILURE M ODES & E FFECTS A NALYSIS TO P UBLIC H EALTH : B REATHE E ASY AT H OME P ROGRAMS Megan Sandel, MD, MPH, FAAP, Boston Medical Center Margaret Reid, RN, MPA, Director, Healthy Homes and Community Supports, Boston Public Health Commission (RWJF PHS3 award)
Thank you for participating in today ’ s webinar! For more information: Ann Kelly, Project Manager Ann.Kelly@uky.edu 111 Washington Avenue #212 Lexington, KY 40536 859.218.2317 www.publichealthsystems.org
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