Know the Facts: Informing Health Care Decisions with Data Nov. 30, - - PowerPoint PPT Presentation

Know the Facts:

Informing Health Care Decisions with Data

• Nov. 30, 2017

Mike Geeslin, President and CEO, Central Health Katie Coburn, Manager, Regional Healthcare Partnership, Central Health Christie Garbe, Vice President and Chief Strategy Officer, Central Health Jaeson T. Fournier, CEO, CommUnityCare JP Eichmiller, Director of Strategic Communications, Central Health

RHP 7 2017 Community Needs Assessment

Katie Coburn, MPH, PMP

Purpose of Assessment

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v Required component of Region 7’s RHP Plan Update, due to THHSC next spring

v Approved RHP Plan Update necessary for Waiver/DSRIP participation, funds

v Fresh look at social, economic, and health environment for Medicaid and low income populations in RHP 7 v Foundation for DSRIP providers’ planning v RHP 7: Bastrop, Caldwell, Fayette, Hays, Lee, Travis counties

Summary of Themes

• Affordable Housing and Migration
• Economic and Health Disparities
• Chronic Conditions, Prenatal Care, Sexually

Transmitted Infections

• Behavioral Health
• Accessibility of Health Care and Transportation

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Median Monthly Housing Costs, Renter-Occupied

$786 $848 $695 $615 $807 $593 $891 $882 $917 $765 $701 $973 $760 $1,054

Texas Bastrop Caldwell Faye>e Hays Lee Travis 2010 2015

DATA SOURCE: U.S. Census Bureau, American Community Survey 5-Year Es?mates, 2006-2010 and 2011-2015

“The price of housing - If you’re on a fixed income like me, they won’t rent to you.”

• Community Member Focus Group ParLcipant

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Median Household Income, by Race/ Ethnicity, 2015

$0 $10,000 $20,000 $30,000 $40,000 $50,000 $60,000 $70,000 $80,000

Texas Bastrop Caldwell Faye>e Hays Lee Travis White, non-Hispanic Black or African American Hispanic or LaLno, any race

DATA SOURCE: U.S. Census Bureau, American Community Survey 5-Year Es?mates, 2011-2015

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Self-Reported High Blood Pressure by Race/Ethnicity, 2015

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30.5% 33.8% 42.3% 23.8% 21.0% 26.7% 28.2% 44.7% 19.8% 21.7% Overall White, non- Hispanic Black, non- Hispanic Hispanic Other/MulLracial, non-Hispanic Texas RHP 7

DATA SOURCE: Texas Behavioral Risk Factor Surveillance Survey (BRFSS), 2011-2015 NOTE: Survey data based upon self-report

“We can’t con?nue to see the health dispari?es in the African-American community get worse. It’s about the needs being met.”

• Key Informant Interviewee

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Percent of Adults without a Personal Doctor or Provider, by Race/Ethnicity, 2015

32.8% 21.3% 30.2% 48.6% 34.5% 31.2% 22.0% 25.8% 49.2% 34.9% Overall White, non- Hispanic Black, non-Hispanic Hispanic Other/MulLracial, non-Hispanic Texas RHP 7

DATA SOURCE: Texas Behavioral Risk Factor Surveillance Survey (BRFSS), 2011-2015 NOTE: Survey data based upon self-report 8

Leading Causes of Mortality - 2015

DATA SOURCE: Centers for Disease Control and Prevention, National Center for Health Statistics, Underlying Cause of Death 1999-2015 on CDC WONDER Online Database, 2015

Texas Bastrop County Caldwell County Fayette County Hays County Lee County Travis County

1 Heart disease Heart disease Cancer Heart disease Heart disease Cancer Cancer 2 Cancer Cancer Heart disease Cancer Cancer Heart disease Heart disease 3 Cerebrovascu lar diseases Accidents N/A Cerebrovascu lar diseases Accidents N/A Accidents 4 Chronic lower respiratory diseases Alzheimer's disease N/A N/A Chronic lower respiratory diseases N/A Cerebrovascu lar diseases 5 Alzheimer's disease Chronic lower respiratory diseases N/A N/A Alzheimer's disease N/A Chronic lower respiratory diseases

Chronic Condi*ons, Prenatal Care, STIs

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Premature Births, 2012 and 2014

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12.4% 11.7% 11.9% 11.1% 11.0% 9.0% 10.6% 12.3% 11.7% 15.7% 17.6% 10.2% 9.8% 10.1%

Texas Bastrop Caldwell Faye>e Hays Lee Travis 2012 2014

DATA SOURCE: Texas Department of State Health Services, Center for Health Sta?s?cs, Texas Health Data, Vital Sta?s?cs Annual Report, 2012 and 2014 NOTE: Premature birth defined as prior to the 37th week of gesta?on Shown as Percent of Total Births

• 63% of providers that responded to the stakeholder survey

rated access to prenatal/maternal care as ‘Hard’ or ‘Very Hard’ for the low-income community in RHP 7.

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STI Rates per 100,000, 2012 and 2015

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477.4 349.9 467.6 271.0 592.0 338.4 610.9 487.3 608.5 809.4 246.9 549.5 254.5 661.8 Texas Bastrop Caldwell Faye>e Hays Lee Travis 2012 2015

CHLAMYDIA

122.9 73.4 64.6 40.4 115.1 36.3 150.4 136.7 151.5 155.5 27.9 86.8 47.3 206.6 Texas Bastrop Caldwell Faye>e Hays Lee Travis 2012 2015

GONORRHEA

Behavioral Health – Majority of Top Five Most Difficult Services to Access

DATA SOURCE: RHP 7 Community Needs Assessment Stakeholder Survey, 2017 NOTE: Community Members responded based upon their own community; provider responses based upon low-income popula?on served.

• InpaLent Psychiatric Care
• InpaLent Alcohol/Substance

Use Treatment

• Specialty Care
• Cancer Treatment
• OutpaLent Alcohol/Substance

Use Treatment

Community Member

• Specialty Care
• InpaLent Psychiatric Care
• InpaLent Alcohol/Substance

Use Treatment

• Dental Care
• OutpaLent Alcohol/Substance

Use Treatment

Provider

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Percent of Population Under 65 Years Old that is Uninsured, 2012 and 2015

25.2% 26.2% 24.9% 25.0% 21.6% 24.7% 21.6% 19.2% 20.7% 22.7% 20.8% 16.0% 20.4% 16.2% Texas Bastrop Caldwell Faye>e Hays Lee Travis 2012 2015

DATA SOURCE: U.S. Census Bureau, Small Area Health Insurance Es?mates, Interac?ve SAHIE Data and Mapping Tool, 2012 and 2015

‘Insurance problems/lack of coverage’ or ‘cost of co-pays’,

had made it harder to access care for approximately 40% of community members that responded to the survey

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Presentation to: Central Health Board of Managers Strategic Planning Committee September 12, 2017 By Stephanie Hayden, Chair, Austin Public Health Cassie DeLeon, Austin Public Health

METHODOLOGY

¢ This CHA was guided by the National

Association for County and City Officials (NACCHO) Mobilizing for Action Through Planning and Partnerships (MAPP) framework.

¢ MAPP includes four assessments:

1.

Community Themes and Strengths

2.

Community Health Status Assessment

3.

Forces of Change

4.

Local Public Health System Assessment

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AREAS OF INTEREST FROM THE 2017 CHA

¢ Even though Travis County is healthy overall,

good health and wellbeing is not experienced equally by all in our community.

¢ Issue areas identified in the CHA — Equity and Health Impact — Education and workforce development — Health care access and affordability — Transportation — Mental health and wellbeing — Access to safe recreation space — Access to healthy food — Environmental health

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Fin Findin ings fr gs from CUC

• m CUC’s

s Comp Compreh ehen ensiv sive Commu e Community ity Health Health Need Needs Assessmen s Assessment t

Jaeson T. Fournier, DC, MPH Chief ExecuLve Officer, CommUnityCare Health Centers

Comp Compreh ehen ensiv sive Commu e Community ity Health Health Need Needs Assessmen s Assessment t

v The Health Center Clusters

Program requires Federally Qualified Health Centers to complete a comprehensive Community Health Needs Assessment at least once every three years to ensure that resources within the service area and the needs of the FQHC’s target populaLon are idenLfied.

v A FQHC must be located in or

serve a high need community as federally designated Medically Underserved Area or PopulaLon.

• Travis County currently 10

census tracts designated as MUAs, all located in downtown

• AusLn. Aus0n’s MUA’s were

last designated in 1994.

Community Health Needs Assessment - Highlights 18

CommUn CommUnityCar ityCare’ e’s S Ser ervice Ar vice Area ea

• Service Area = Travis County

Community Health Needs Assessment - Highlights 19

CommUn CommUnityCar ityCare’ e’s T Tar arget P Pop

• pula@

la@on

• n
• Target PopulaLon = Travis County Residents with Incomes below 200% of Federal

Poverty (or 2 Lmes poverty)

• EsLmates for 2016 – 322,188 at our below 200% FPL
• Total EsLmated Uninsured for Travis County – 194,290 (16.2% of total populaLon)
• About 40% of Travis County residents with incomes below 200% are uninsured
• FY 2017 CUC Unduplicated PaLents – 96,777

Community Health Needs Assessment - Highlights 20

Community Health Needs Assessment - Highlights 21

Community Health Needs Assessment - Highlights 22

Med Medic ical Ou al Outcomes in

• mes in Au

Aus@ s@n

Clinical Preven0ve Services – Women 65 and Over Rou0ne Medical Check with – 18 Years and Over Colorectal Cancer Screening Rates – Adults 50 -75 Mammography Use – Women 50 - 74

Community Health Needs Assessment - Highlights 23

Pr Pred edic@ ic@ng Fu g Futu ture Need e Need Vu Vulnerable Po Popula@ons Footprint Report

Community Health Needs Assessment - Highlights 24

Total Popula0on - 194,005 Popula0on by Gender Total Percent Male 103,907 53.56 Female 90,098 46.44 Popula0on by Age Groups Total Percent Age 0 to 17 56,819 29.29 Age 18 to 64 126,918 65.42 Age 65 and Up 10,268 5.29 Below 100% of Federal Poverty Level Total Percent* Total PopulaLon in Poverty 59,926 31.60 Children Age 0-17 in Poverty 26,500 47.34 Below 200% of Federal Poverty Level Total Percent* Total PopulaLon in Poverty 115,675 60.99 Educa0onal A]ainment Total Percent** PopulaLon with No High School Diploma 41,809 35.44 Linguis0c Isola0on Total Percent LinguisLcally Isolated PopulaLon 40,428 23.02

Source: U.S. Census Bureau, 2011-2015 American Community Survey 5-Year Es?mates. * Percentage of the popula?on for whom poverty has been determined. ** Percentage of the popula?on age 25 and over

Pr Pred edic@ ic@ng Fu g Futu ture Need e Need Vu Vulnerable Po Popula@ons Footprint Report

Community Health Needs Assessment - Highlights 25

Total Popula0on - 194,005 Popula0on by Race/Ethnicity Total Percent Non-Hispanic White 34,405 17.73 Black or African American 23,017 11.86 Asian 3,092 1.59 NaLve American / Alaska NaLve 232 0.12 NaLve Hawaiian / Pacific Islander 49 0.03 Some Other Race 247 0.13 MulLple Race 2,698 1.39 Hispanic or LaLno 130,265 67.15

Source: U.S. Census Bureau, 2011-2015 American Community Survey 5-Year Es?mates.

Vu Vulnerable Po Popula@ons Footprint Report

Community Health Needs Assessment - Highlights 26

Number of Individuals with Incomes below 200% Poverty Number of Uninsured Individuals Number reported by Zip Code Source: U.S. Census Bureau, 2011-2015 American Community Survey 5-Year Es?mates.

Ov Over erall Fin all Findin ings gs

Community Health Needs Assessment - Highlights 27

Rapid demographic shims in Travis County is challenging CUC’s longstanding service delivery

• model. Similarly, significant

increases in chronic disease burden is challenging CUC’s model of care.

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Poverty by the Numbers

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$12,228

Income threshold for an individual living at 100% of the federal poverty level

$24,563

Income threshold for a family of four living at the poverty level

144,605

Travis County residents living below the poverty level

33,061

Travis County families living below the poverty level

67,121

Central Health-funded patients living below the poverty level

Provider Network/Patient Homes

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Families—2017

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Changes in Families 2017-2022

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Projected Concentrations of Poverty

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Identify Focus Areas

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Focus Area Analysis

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North Central Austin Colony Park/Hornsby Bend

Focus Area Demographics

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Race/Ethnicity Age Gender

Focus Area Demographics

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Transportation— Households without vehicles Affordable Housing— Units to families in poverty

Patient Demographics

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Conclusions

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Common Themes

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Population Growth and Movement

• Concentrations of poverty and migration

Equity and Health Impact

• Access
• Health disparities
• Chronic conditions
• Behavioral/mental health

Social Determinants of Health

• Affordable housing
• Transportation

Access the Full Reports

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RHP 7 2017 Community Needs Assessment h>p://www.texasrhp7.org/wp-content/uploads/2017/09/ Final-Report-with-Appendix-10-31-17.pdf Aus0n/Travis County 2017 Community Health Assessment

h>p://www.ausLntexas.gov/sites/default/files/files/Health/CHA-CHIP/ ATC_CHA_DRAFT_09_26_17__002_.pdf

CommUnityCare Community Health Needs Assessment

Coming soon

2017 Central Health Demographic Report

Available Dec. 1 at: www.CentralHealth.net

512-978-8000 www.centralhealth.net @centralhealthtx