8 - CHA Economic Development

CHA Economic Development | 1

Economic Development

COMMUNITY HEALTH ASSESSMENT

Prepared by:

HealtheConnectionsHealthPlanning

November 2013


Economic Development

TABLE OF CONTENTS

Background ................................................................................................................................ 1

Profile ......................................................................................................................................... 2

Introduction ............................................................................................................................... 3

OPPORTUNITY 1: IMPROVE ACCESS TO MENTAL AND BEHAVIORAL HEALTH .......................... 6

OPPORTUNITY 2: ADDRESS HEALTHCARE WORKFORCE SHORTAGE ...................................... 8

OPPORTUNITY 3: IMPROVE ACCESS TO PRIMARY CARE ....................................................... 10

OPPORTUNITY 4: EXPAND LONG TERM CARE AND ELDERLY HOUSING ................................. 11

OPPORTUNITY 5: IMPROVE ACCESS TO DENTAL HEALTH ..................................................... 15

OPPORTUNITY 6: IMPROVE INFORMATION TECHNOLOGY INFRASTRUCTURE ....................... 16

OPPORTUNITY 7: IMPROVE ACCESS TO TRANSPORTATION .................................................. 17


BACKGROUND The Prevention Agenda 2013-17 is New York State's health improvement plan for 2013 through 2017, developed by the Public Health and Health Planning Council (PHHPC) at the request of the Department of Health. This five-year plan was designed to demonstrate how communities across the state can work together to improve the health and quality of life for all New Yorkers. This serves as a guide for man-dated Community Health Assessments and Community Health Improvement Plans. It features five pri-ority areas:

Prevent chronic diseases Promote healthy and safe environments Promote healthy women, infants and children Promote mental health and prevent substance abuse Prevent HIV, sexually transmitted diseases, vaccine-preventable diseases and healthcare-associated Infections

Madison County, through previous county level and regional planning efforts, recognizes the significant relation-ship between economic development and health, especially health care services as an economic engine. Conse-quently, the county expanded its community assessment activities and subsequent health improvement plan by adding a section on health care economic development. Analysis of the economic structure of a region compliments community health improvement planning. Healthy community is essential to a strong economy and likewise, a strong economy contributes to the improved health of a community. The health sector plays a doubly important role in local economic development by both creating jobs and income for residents through the normal operations of hospitals and other health‐related enterprises, and by providing services that improve a person’s health. Health care is one of the largest industries in Madison County. The health sector represents a vital component of a community’s economic activity and can be responsi‐ble for generating considerable employment and income in other businesses in the community, while simultane-ously improving the health of our residents. Rural access to medical, dental and behavioral care not only helps improve health outcomes, but acts as an important economic development strategy for many rural communities. Three related issue briefs were developed by HealtheConnections to guide Madison County’s review of health and economic development opportunities. The documents are entitled:

Opportunities to Improve Access to Healthcare

Healthy People Help Produce a Healthy Economy, and The Healthcare Industry is a significant part of the Madison County Economy.


PROCESS

In February of 2013, an economic development Advisory Group comprised of regional healthcare pro-fessionals, providers, public health representatives and government planning experts assembled in Hamilton to discuss potential economic development as it pertains to improvement in health and healthcare in Madison County. The stakeholders provided insight into possible business ventures and economic opportunities in the region where several themes began to emerge. A list of possible oppor-tunities was generated. In June of 2013 the Advisory Group reassembled to identify priority issues, areas, and projects as well as potential entities to operationalize the strategies in the priority areas identified.

Economic Development Advisory Group Members

Sam Barr Madison County Board of Health Lynne Bird VNA Options Sara Wall Bollinger HealtheConnections David Bottar CNY Regional Planning & Development Board Christine Coe Madison County Department of Public Health Teisha Cook Madison County Department of Mental Health Judy Daniel HCR Tom Dennison Syracuse University Mark Duheme HCR Home Care Gerry Edwards Heritage Family Medicine John Endres Madison County Board of Health Sean Fadale Community Memorial Hospital Eric Faisst Madison County Department of Public Health Susan Healy-Kribs United Healthcare Kipp Hicks Madison County Industrial Development Agency Kristen Mucitelli Heath St, Joseph’s Hospital Health Center Scott Ingmire Madison County Planning Department Jeff Jenkins HCR Home Care Robert Martiniano Center for Health Workforce Studies Ralph Monforte Cazenovia Town Supervisor Marguerite Lynch Excellus BC BS Gene Morreale Oneida Healthcare Nate Philo Madison County Department of Mental Health Karen Romano HealtheConnections - RHIO John Salka Brookfield Town Supervisor Paul Scopac Oneida Healthcare Kathy Same Cazenovia College Jim Simmons Heritage Farms Carol Tytler CNY AHEC Eve VandeWal Excellus BlueCross BlueShield Terry VanDyke St. Joseph’s Hospital Health Center Tony Vitagliano Excellus BlueCross BlueShield Edward Weeks Long-Term Care Consultant Deb Welch St. Joseph’s Hospital Health Center Stephen Wu Hamilton College Nancy Zlomek Morrisville College


INTRODUCTION

The healthcare sector, which is composed of hospitals, private practitioners, small businesses and not-for-profit agencies, is a large employer and provides a range of economic opportunities that will strengthen Madison County going forward. This document seeks to shed light on the healthcare indus-try in Madison County, providing insight on strategies to increase utilization of healthcare services in-county, thereby simultaneously improving access to care and creating healthcare related jobs. Healthcare is a large factor in the economy of Madison County. According to the U.S. Census, healthcare and social assistance account for 12% of Madison County’s 1,417 established businesses; employ 18% of the 17,233 employees working in Madison County; and generate 20% of all Madison County payroll earnings.

Source: U.S. Census Bureau, 2011 County Business Patterns.


While Madison County has a basic, core healthcare delivery structure in place, it recognizes that there are inefficiencies and gaps in the local public health and health care systems that may provide opportu-nities for service improvements along with economic benefits. The County further recognizes that the foundational structure of the local health care system is and will be undergoing significant changes as we navigate the implementation of the federal Affordable Care Act, state Medicaid redesign efforts, and the regionalization of healthcare. Understanding healthcare issues and the important impact of these key initiatives is helpful as our community assesses and plans for the role of health care in the local economy.


Patient Origin Patterns, Madison County Hospitals - 2011

Oneida Healthcare

Total Discharges By Service

Number Percent

Distribution

Medical Surgical Obstetric Pediatric Psychiatric

Total 3,003 98.1% 1241 1056 567 110 29

Madison 1,595 52.1% 699 523 294 59 20

Oneida 1,257 41.1% 494 480 230 46 7

Oswego 69 2.3% 22 24 18 3 2

Onondaga 56 1.8% 24 19 11 2 0

Chenango 26 0.8% 2 10 14 0 0

Community Memorial


Number Percent

Distribution

Medical Surgical Obstetric Pediatric Psychiatric

Total 1,634 95.5% 704 897 0 28 5

Madison 725 42.4% 406 300 0 15 4

Chenango 424 24.8% 218 195 0 10 1

Oneida 396 23.1% 67 326 0 3 0

Herkimer 49 2.9% 2 47 0 0 0

Otsego 40 2.3% 11 29 0 0 0

Source: Statewide Planning and Research Cooperative System (SPARCS), Annual Report Generator Tool, 2011

A large percentage of County residents receive health care services in neighboring Onondaga and Onei-da Counties. Likewise, resident healthcare workers commute to jobs located outside of Madison Coun-ty. Some of the primary and preventative services, such as clinical screenings, counseling, lab work, therapies and rehabilitation services may present business opportunities for providers to deliver locally within the County. Moreover, there are areas of healthcare where expansion and new development are needed because services currently available are not adequate to meet present and/or anticipated need.

Oneida Healthcare Center and Community Memorial Hospital draw strongly from Oneida County and 25% of Community Memorial patients are from Chenango County. However, only 37% of all hospitali-zations of Madison County residents were at these two facilities. Forty-five percent (45%) of Madison County residents were hospitalized in Onondaga County and 11% in Oneida County.

Patient Migration Patterns, Madison County Residents - 2011


Number Percent

Distribution

Medical

Surgical

Obstetric

Pediatric Psychiatric

Total 6,128 97.2 % 2,245 2,675 689 232 287

Onondaga 2,821 44.8% 847 1,382 302 149 141

Madison 2,320 36.8% 1,105 823 294 74 24

Oneida 694 11.0% 183 363 42 4 102

Otsego 210 3.3% 60 96 38 3 13 Cortland 83 1.3% 50 11 13 2 7

Source: Statewide Planning and Research Cooperative System (SPARCS), Annual Report Generator Tool, 2011


OPPORTUNITY 1:

IMPROVE ACCESS TO MENTAL AND BEHAVIORAL HEALTH Madison County is designated a Mental Health Professional Short-age Area by the U.S. Health Resources and Services Administration. Access to care is further challenged by insurance policies that limit the number of sessions allowed and/or the licensure of providers. Commercial insurance companies, Medicare and Medicaid have historically limited the types of professionals allowed to be paid for behavioral health care to physicians, psychiatrists and psychologists and have capped the number of therapy sessions allowed per year. Recently social workers have become approved providers, but only after an extensive licensure process. Other mental health profes-sionals such as marriage and family therapists and rehabilitation counselors are rarely paid by third parties. These policies have the effect of making behavioral health care much less available for peo-ple who cannot afford to pay the full price. The Affordable Care Act will require insurance plans to cov-er mental health and substance abuse treatment at a level that is comparable to general health care, beginning in 2014. The need for more mental and behavioral health services for all age groups was identified as a main priority in the 2013 Community Health Improvement Plan. Steps are being taken, to increase the supply of trained clinicians and to expand or develop programming to meet the need. The Madison County Mental Health Department provides the majority of mental health services to county residents. The Department provides individual, group and family therapy; medication manage-ment; court ordered mental health evaluations; sex offender treatment program; forensic mental health services at the county jail; and co-occurring disorder work for clients who have both a mental health diagnosis and a secondary substance abuse problem. Additional agencies provide mental and behavioral health services in Madison County. Family Counsel-ing Services, based in Cortland, opened a mental health and substance abuse counseling clinic on Ce-dar Street in the fall of 2013. Family Counseling Services plans to open school based clinics in subse-quent years and Liberty Resources plans to co-locate mental health counselors with medical practices. Consumer Services has converted their day treatment program to Personalized Recovery Oriented Ser-vices (PROS) and have expressed interest in opening a children’s clinic. Over the past two years, New York's Medicaid program has advanced their health home initiative statewide to address a subset of enrollees who have complex medical, behavioral, and long term care needs that drive a high volume of high cost inpatient and long term institutional care, with the goal of controlling future health care costs and improving health outcomes for this population. A Health Home is a care management service model whereby all of an individual's caregivers communi-cate with one another so that all of a patient's needs are addressed in a comprehensive manner. This is done primarily through a "care manager" who oversees and provides access to all of the services an individual needs to assure that they receive everything necessary to stay healthy, out of the emergency room and out of the hospital. Health records are shared (either electronically or paper) among provid-ers so that services are not duplicated or neglected. The health home services are provided through a network of organizations – providers, health plans and community-based organizations. When all the services are considered collectively they become a virtual “Health Home."1 ______________________________ 1 http://www.health.ny.gov/health_care/medicaid/program/medicaid_health_homes/ Accessed 11/4/13.


Medicaid Health Homes serving Madison County are: St. Joseph’s Care Coordination Network Health Homes of Upstate New York (Onondaga Case Management) Central New York Health Home Network (Upstate Cerebral Palsy)

The Affordable Care Act includes expanded coverage for mental and behavioral health and fosters inte-gration of behavioral and physical health. Primary care practitioners have always provided mental and behavioral health treatment to an extent; in the future it is expected that this will increase. There are opportunities to support local primary care practitioners through this transition. Strategies:

Tailor services to specific needs/constituents such as child psychiatry, family counseling, and sub-stance abuse behavioral change. Madison County can facilitate selection and approval of satellite site locations in Hamilton, Morrisville, Chittenango and Cazenovia for mental health, substance abuse and behavioral health services. These projects may bring new jobs to the county; most of them licensed Social Workers. Possible providers include:

Family Counseling Services Liberty Resources Consumer Services BRiDGES St. Joseph’s Hospital Psychiatric Services Arise It’s About Childhood & Family The Kelberman Center

Implement a telemedicine psychiatry program to bring child, adolescent and geriatric psychiatric

consultation to primary care providers and diagnosed patients without the travel time and expense of going to Syracuse.

Train physicians, nurse practitioners and physician assistants at existing/future primary care prac-tices to accurately diagnose, treat and refer people with behavioral and mental health issues. Pos-sible training providers include: CNYAHEC, St. Joseph’s, and SUNY Upstate

Provide practice- and competency-based educational experiences for the future mental health workforce (e.g., psychiatric nurse practitioner, physician assistant and social worker student in-terns), and provide expertise in developing and teaching mental health curricula, through partner-ships with academia.

Promote the National Health Services Corps Loan Repayment program through the US Department of Health and Human Services to potential providers as an incentive for them to practice in Madi-son County. The program offers primary care medical, dental, and mental and behavioral health providers the opportunity to have their student loans repaid while serving in communities with limited access to care.


OPPORTUNITY 2:

ADDRESS HEALTHCARE WORKFORCE SHORTAGE

To determine the relative supply of practitioners in the county the number of licensed health care pro-fessionals residing in the area were compared to Upstate and Statewide norms. Based on this compari-son, Madison County has fewer physicians, midwives, dentists and psychologists relative to its popula-tion. The table below highlights the areas where the relative supply of health care professionals in the County is low (in red), medium (yellow) or high (green). Recruitment efforts should be directed to those practitioners demarcated in red. It is important to note that this data does not account for those licensed professionals living in the county but practicing elsewhere, nor do they account for physicians that may be practicing part-time or are inactive.

Relative Supply of Registered Licensed Practitioners (February 1, 2013)*

New York State Upstate Madison

Need based on Upstate Norm

Number Ratio* Number Ratio* Number Ratio* Number % Met

Population 19,378,102 11,202,969 73,442

Medical Practitioners 96,931 5.002 58,479 5.220 228 3.104 363 59.5

Physicians 70,695 3.648 40,136 3.583 113 1.539 263 42.9

Physician Assistants 9,953 0.514 6,555 0.585 40 0.545 43 93.1

Nurse Practitioners 15,378 0.794 11,261 1.005 74 1.008 74 100.2

Midwives 905 0.047 527 0.047 1 0.014 3 28.9

Nurses 286,967 14.809 208,944 18.651 1,548 21.078 1,370 113.0

Registered Professional Nurses 222,164 11.465 159,084 14.200 1,046 14.243 1,043 100.3

Licensed Practical Nurses 64,803 3.344 49,860 4.451 502 6.835 327 153.6

Dental Practitioners 25,947 1.339 17,690 1.579 119 1.620 116 102.6

Dentists 15,280 0.789 8,982 0.802 32 0.436 59 54.3

Hygienists 9,496 0.490 7,584 0.677 68 0.926 50 136.8

Certified Dental Assistants 1,171 0.060 1,124 0.100 19 0.259 7 257.9

Mental Health Practitioners 65,696 3.390 37,522 3.349 155 2.111 246 63.0

Psychologists 10,486 0.541 5,640 0.503 20 0.272 37 54.1

Social Workers (LMSW) 24,150 1.246 13,484 1.204 58 0.790 88 65.6

Social Workers (LCSW) 23,939 1.235 14,047 1.254 54 0.735 92 58.6

Mental Health Counselors 4,465 0.230 3,075 0.274 13 0.177 20 64.5

Creative Arts Therapists 1,239 0.064 620 0.055 3 0.041 4 73.8

Marriage & Family Therapists 763 0.039 530 0.047 7 0.095 3 201.5

Psychoanalysts 654 0.034 126 0.011 0 0.000 1 0.0

Physical and Occupational Therapy 34,693 1.790 24,285 2.168 124 1.688 159 77.9

Physical Therapists 16,500 0.851 11,446 1.022 60 0.817 75 80.0

Physical Therapist Assistant 4,676 0.241 3,430 0.306 14 0.191 22 62.3

Occupational Therapists 9,793 0.505 6,692 0.597 38 0.517 44 86.6

Occupational Therapy Assistants 3,724 0.192 2,717 0.243 12 0.163 18 67.4

Laboratory Professionals 14,951 0.772 9,841 0.878 57 0.776 65 88.4

Clinical Laboratory Technologists 12,425 0.641 8,052 0.719 44 0.599 53 83.4

Clinical Laboratory Technicians 1,816 0.094 1,263 0.113 10 0.136 8 120.8

Cytotechnologists 492 0.025 378 0.034 3 0.041 2 121.1

Certified Histological Technicians 218 0.011 148 0.013 0 0.000 1 0.0

* Ratio of Practitioners per 1,000 Population. Source: New York State Department of Education Licensure File

* Ratio of Practitioners per 1,000 Population.


New York State has identified Madison County as a shortage area for cardiology, dermatology, gastro-enterology, neurology, ophthalmology, pathology and pulmonary disease providers. However, the Ad-visory Group described the issue well when they concluded that Madison County is “rural but not re‐mote,” meaning that people in Madison County are less than an hour away from almost any specialist they could need. It does not make business sense for narrowly specialized practitioners to locate here. Strategies:

Build/expand workforce training programs at BOCES, Cazenovia College, SUNY Morrisville, Colgate University and Utica School of Commerce in health related professions such as coding specialist, laboratory and radiology technician, quality assurance, electronic records management as well as patient care positions such as certified nursing assistant, registered nurse and physical therapist.

Develop relationships with programs that train the advanced healthcare workforce (NP, PA, MD, PhD) in surrounding counties and utilize student interns and residents who need clinical affilia-tions. This may expand capacity in the short term, and improve recruitment and retention in the long term. Local programs include SUNY IT, Utica College, Upstate Medical University, and Le Moyne College.


OPPORTUNITY 3:

IMPROVE ACCESS TO PRIMARY CARE

Although Madison County is not considered a primary care physician shortage area, physi-cians currently in place are nearing retirement and recruitment for new young physicians has met with limited success. Furthermore, exist-ing medical services are not equitably located throughout the county. Providers tend to lo-cate in the more populated northern half of the county, making it more difficult for residents of the southern townships to access care. Addi-tionally, the expense of medical care remains a barrier for some residents. According to the 2009 Behavioral Risk Factor Surveillance Sys-tem (BRFSS), nearly twelve percent (11.6%) of Madison County adults reported that “cost pre‐vented a visit to the doctor.”

According to the Medicaid Datamart, 66% of Medicaid recipients in Madison County saw a primary care physician during 2012. According to 2013 HealtheConnections survey data and Medicaid Utilization Reports, most of the estimated forty primary care physicians in Madison County take at least one of the Medicaid Managed Care Plans or accept traditional fee for service. Historically, Medicaid paid low rates for primary care services, and required cumbersome paper work to file a claim. According to the NYS Medicaid Datamart, as of May 2013, 47 % of all Medicaid claims and 52% of physician claims in Madison County were through a commercial managed care plan, making the billing process much easi-er for physician practices. The Affordable Care Act requires that Medicaid pay rates comparable to Medicare effective January 1, 2013. The Kaiser Family Foundation estimates that primary care provid-ers will see a 156% increase in their basic visit fees.2 This should make it easier for physicians in private practice to accept new patients with Medicaid insurance. On average, practices have a patient mix that includes approximately 15% Medicaid patients. Fewer than half of the primary care providers in the county are accepting new patients, and most that are, request all insurance information before enrol-ling new individuals into their practice. Many practices are less likely to accept new Medicaid patients in an effort to keep their Medicaid/non-Medicaid patient mix balanced. Furthermore, providers that are accepting Medicaid insured patients tend to have longer wait times for new patients’ first appoint‐ments. Strategy:

Develop outpatient primary care capacity or a hospital extension clinic to provide primary and pre-ventative care in the primary care shortage area for the Medicaid eligible population in the south-ern tier of the County [Towns of Brookfield, Eaton, Georgetown, Hamilton, Lebanon and Madison]. Possible providers include:

Community Memorial

Private Physician

Family Health Network

Bassett Healthcare Network _______________________________ 2 http://kff.org/medicaid/issue-brief/how-much-will-medicaid-physician-fees-for/


OPPORTUNITY 4:

EXPAND LONG TERM CARE AND ELDERLY HOUSING

The median age of the population in Madison County is 39.5 years, slightly older than the New York State median age of 38 years. The population is aging slightly as the median age in 2000 was 37 years and adults over the age of 55 represent the fastest growing sector of the population. Madison County has an adequate supply of skilled nursing home beds but a relatively low supply of Adult Care Facilities (ACF) beds and Assisted Living facilities.

Source: Coordinated Public Transit-Human Service Transportation Plan Madison County, New York, 2010

Source: New York State Department of Health


Madison County recently privatized its home care services. HCR Home Care is now the only Certified Home Health Agency (CHHA) operating in Madison County. The number of enrolled participants has doubled since HCR took over just a year ago and they are enrolling referrals within 24 hours. Reasons why Home Care is preferred over institutional care: 3

It is delivered at home. There are such positive feelings that all of us associate with being home. When we are not feeling well, most of us ask to go home. When we are feeling well, we enjoy the sanctity of our residences and the joy of being with our loved ones. Home care keeps families together. There is no more important social value. It is particularly im-portant in times of illness. Home care serves to keep the elderly independent. None of us want to be totally dependent and helpless. With some assistance, seniors can continue to function as viable members of society. Home care prevents or postpones institutionalization. Few patients choose to be placed in a nurs-ing home, unless it’s the only place where they can obtain the 24-hour care that they need. Home care promotes healing. There is abundant evidence that patients heal more quickly at home. Home care allows a maximum amount of freedom for the individual. Hospitals and nursing homes offer more regimented, regulated environments. Home care offers a reassuring, individual-ized setting. Home care is personalized care. Home care is tailored to the needs of each individual. It is deliv-ered on a one-to-one basis. Home care involves the individual and the family in the care that is delivered. The patient and his family are taught to participate in their health care. They are taught how to get well, and how to stay that way. Home care reduces stress. Unlike most forms of health care which can increase anxiety and stress, home care frequently has the opposite effect. Home care is one of the most effective forms of health care. There is very high consumer satisfac-tion associated with care delivered in the home. Home care is an efficient form of health care. By bringing health services home, the patient does not generate board and room expenses. The patient and/or his family supply the food and tend to the individual’s other needs. Technology now has developed to the point where many services, once only available in a hospital, can be offered at home. Home care is given by special people. By and large, employees of home care agencies look at their work, not as a job or profession, but as a calling. Home care workers are highly trained and dedi-cated to their work. Home care is, in many cases, less expensive than other forms of care. The evidence is convincing that, for many services, home care is less expensive than other forms of care. In general, home care costs only one-tenth as much as hospitalization and only one-fourth as much as nursing home placement to deal with comparable health problems. Home care extends life. A study by the U.S. General Accounting Office has established that people receiving home care tend to live longer and have a better quality of life. Home care helps not only add years to life, but “life to years.” Home care is the preferred form of care, even for individuals who are terminally ill. There is a growing public acceptance and demand for hospice care, which is home care for individuals who are terminally ill.

_____________________________

3 http://www.The Senior Choice.com accessed 11-12-13.


According to the U.S. Centers for Disease Control and Prevention (CDC) about 7.6 million people in the United States receive community-based care to help with post-acute and chronic conditions, disabili-ties, or terminal illnesses. This number is expected to increase as the population ages and the desire to ‘‘age in place’’ continues. Older Americans will increasingly constitute a larger percentage of the popu‐lation in the future—from about 12% in 2006 to almost 20% in 2030. The majority of people using home health and hospice care services are over age 65 years. Most of them have multiple chronic con-ditions, and home health and hospice care services enable many of them to receive services in their homes and communities. Home health care includes a range of medical and therapeutic services as well as other services deliv-ered at a patient’s home or in a residential setting for promoting, maintaining, or restoring health, or maximizing the level of independence, while minimizing the effects of disability and illness. Hospice care emphasizes relieving pain and uncomfortable symptoms of persons with terminal illness and providing emotional and spiritual support to both the terminally ill and their family members. Strategies:

Advocate to the New York State Department of Health for the Hamilton Manor to be approved to convert a portion of beds from Adult Home to Medicaid Assisted Living Program (ALP). ALP fund-ing is more comprehensive than Adult Home funding because ALP pays for staff assistants to aid residents. This will immediately add new jobs providing assistance to seniors, and improve the quality of care available to residents of the Hamilton Manor.

Create subsidized and non-subsidized physically accessible senior housing. Supports would include: housekeeping, transportation, day activities, medication monitoring, meal delivery and socializa-tion. These should be located in villages such as Hamilton, Morrisville, Canastota, Chittenango or Cazenovia, near shops and services. Encourage a real estate developer to build new facilities or renovate existing buildings.

Encourage Crouse Community Center and/or Stonehedge Health and Rehabilitation Center to de-velop an Assisting Living facility. These facilities provide a higher level of support than senior apart-ments, but less care than is provided at the skilled nursing level. Members of the Advisory Group observed that Assisted Living is a financially challenging model of service. It was suggested that these facilities can be successful if private-pay residents who can fully cover costs are attracted to live there. An alternative/ supplemental approach is to obtain grant funding to lower up-front and mortgage expenses, such as Regional Economic Development Council funding.

A likely business model would be composed of 25% ALP apartments and 75% private pay. People with the ability to pay may be more selective about the housing location and the services offered; therefore it will be important to plan carefully.

It is difficult to support people who are cognitively impaired at the Assisted Living level of care, yet these residents generally do not qualify for skilled nursing placement. It would be wise for the en-tity that develops this new facility to have ‘memory care’ placement opportunities prepared to accept individuals who have been living in the Assisted Living apartments when they are no longer safe living independently.

Evaluate the need for an additional Certified Home Health Agency (CHHA). Currently Madison County has only one CHHA. The Advisory Group noted that it is NYS policy to have at least two CHHA providers in each county to provide choice to consumers and stabilize capacity in the event that one provider has service delivery issues. However, this NYS policy was not based on a need


for services, and it remains unclear that additional CHHA providers are needed in Madison County or can even be supported by the local population base. The number of Certified Home Health Agencies in any county is determined by the NYSDOH. A moratorium on approving further CHHA Certificates of Needs (CONs) within a county has been reinstituted effective April 1, 2012.

Explore adding a Medicaid Managed Long Term Care Plan. Visiting Nurses Association Homecare Options is a local Medicaid managed care plan currently developing its network in Madison County. Patients keep their own primary care doctor, but the rest of their care is coordinated by a care manager. This will reduce errors and improve continuity of care. This is a new business that will bring new jobs to Madison County. Under Medicaid Redesign, traditional long-term care programs will be ending and all Medicaid-insured residents in need of care for longer than 120 days will be enrolled in a Medicaid managed care plan.


OPPORTUNITY 5:

IMPROVE ACCESS TO DENTAL HEALTH Access to dental care across all ages was identified as a priority issue in the Community Health Im-provement Plan. Although Madison County is not designated as a dental health professional short-age area, there is a shortage of dentists serving Medicaid recipients. Few dentists take Medicaid-insured patients, an issue that has been anecdotally attributed to cumbersome paperwork and poor and untimely reimbursement. Recently, Medicaid has moved to a managed care approach, to en-sure that paperwork related to the fee-for-service billing system is less of a barrier. Most Medicaid-insured patients present with an insurance card from a commercial insurance carrier. Only 25.7% of Medicaid recipients utilized a dental service in 2012 (Medicaid Datamart). Dental providers tend to locate in areas of high population density and relative affluence. The Advi-sory Group suggested that recruitment of a private dentist to serve low income and Medicaid-insured residents is unlikely to be successful. Strategies:

Explore the option to operate a mobile dental clinic. The Madison County Department of Health will engage with Oneonta-based American Mobile Dental to explore the possibility of a multi-county (Madison, Oneida, Lewis and Herkimer) CNY dental van service, hosted in Madison Coun-ty, to serve people located at county jails, nursing homes, juvenile detention and foster care fa-cilities, day care centers, group residences, senior day programs and community centers. Ameri-can Mobile Dental will allocate time to general community outreach at senior centers, fire sta-tions, pre-schools and schools as long as their basic business model is covered by ‘institutional’ clients with reliable billing. American Mobile Dental has an office in Cayuga County providing these types of services. They accept Medicaid, Medicare, commercial insurance and self-pay.

Explore the option of replicating the successful “Seal a Smile” program operated by the Healthy Capital District Initiative in Albany. This program partners with pre-schools and elementary schools to provide a dental hygienist who travels from school to school with portable dental equipment. With parental permission, the hygienist provides dental screenings and referral ser-vices for children regardless of ability to pay. Children receive oral health education, toothbrush-es, toothpaste and prizes. Children with dental insurance (Medicaid, Child Health Plus or com-mercial insurance) receive fluoride treatments, cleanings and sealants with no co-pay required. Clinical supervision is provided by a local dentist. The program is financially self-sufficient.

Partner with a College of Dentistry to implement an Oral Health Intervention Program. Dental colleges in New York include SUNY Buffalo and Stony Brook, Columbia and NYU. The intention of the program is to reduce dental caries in children from kindergarten through sixth grade. In April 2009, the New York State Health Foundation awarded New York University College of Dentistry (NYUCD) a one-year grant, which was eventually extended to two years, to cover the start-up costs of the program. NYUCD supplied the requisite dental supplies, equipment, clinical re-sources, and administration, while its faculty, postgraduate pediatric dentistry residents, and graduating dental and dental hygiene students served patients. This program was found to be successful. For instance, caries prevalence was 58.8% among five-year-olds at their first visit in February 2010. Of the same children presenting in June 2011, the incidence of new decay was zero. This suggests that decay was prevented in the newly erupted first permanent molars. Madi-son County would like to have a similar program in rural Central New York to serve their resi-dents.


OPPORTUNITY 6:

IMPROVE INFORMATION TECHNOLOGY INFRASTRUCTURE

Madison County is one of the least connected counties in New York State for electronic medical rec-ords. The U.S. Centers for Medicare and Medicaid Services (CMS) Meaningful Use incentives provide revenue to local healthcare providers. The last year to begin participation in the Medicare EHR In-centive Program is 2014. Beginning in 2015, Medicare eligible professionals who do not successfully demonstrate meaningful use will be subject to payment adjustment. The payment reduction starts at 1% and increases each year that a Medicare eligible professional does not demonstrate meaningful use, to a maximum of 5% (CMS). Strategy:

The Madison County Public Health Department will engage with medical, dental and dental/behavioral healthcare providers to collectively select and implement a set of electronic medical record systems that are compatible with each other and with the Regional Health Information Organization (RHIO). The goal is for all Madison County providers to participate with the RHIO and to expand the number of providers who receive meaningful use payments.


OPPORTUNITY 7:

IMPROVE ACCESS TO TRANSPORTATION

Essential to a healthy environment and a growing economy is an infrastructure that provides the sta-bility and access to essential functions needed not only to obtain healthcare, but to improve the overall quality of life in a community. In 2013, County funds for the Madison Transit System were eliminated. Although local transporters continue to operate the MTS, they do so with a diminished capacity. Despite the fact that Medicaid transportation remains intact, the county as a whole and senior citizens in particular are challenged by limited transportation.

Continue the Coordinated Transportation Steering Committee. Madison County developed this committee made up of representatives from county government, municipal governments, local service agencies, hospitals, elder care facilities, institutions of higher education, private consult-ants, and transit operators. The Committee met on a 4‐6 week basis since the summer of 2009 to develop the plan and discuss transportation needs within the County. The work of this commit-tee is important as transportation is a major barrier for residents.

Increase senior residents’ awareness of available transportation options. There are additional options available for seniors such as Madison County Office for the Aging Volunteer Medical Transportation Program, Cris-Cat Volunteer Driver Program, Colgate Cruiser (free service throughout the Village of Hamilton and Colgate University), and the Disabled American Veterans Van. Options to consider increasing awareness:

List public transit options on AgeNet, a public access TV channel shown at libraries and the Office of the Aging Develop radio and TV commercial campaign Department of Health and partner organization websites


For Report Information please contact:

Madison County Department of Health

www.healthymadisoncounty.org © 2013


PO Box 605 • Wampsville, NY 13163

Tel: 315‐366‐2361 • Fax: 315‐366‐2697

[email protected]

For Report Information please contact:


www.healthymadisoncounty.org © 2013


PO Box 605 • Wampsville, NY 13163

Tel: 315‐366‐2361 • Fax: 315‐366‐2697

[email protected]

8 - CHA Economic Development

Documents

Transcript of 8 - CHA Economic Development