Chapter Four, Finger Lakesl DSRIP Region Needs Assessment

Chapter Four

Finger Lakes DSRIP Region Needs Assessment

New York State Office of Mental Health

Executive Summary This community needs assessment of the New York State Finger Lakes DSRIP region summarizes specific health care service data to identify mental health and substance use disorder treatment needs in the region. The data included are intended to enable planners and others to identify service gaps and disparities and plan for improved service delivery.

Population Socioeconomic Characteristics The Finger Lakes DSRIP region includes Chemung, Livingston, Monroe, Ontario, Schuyler, Seneca, Steuben, Wayne, and Yates counties. Approximately 1.28 million people live in the region and six of the nine counties are designated urban. The socioeconomic characteristics of the region’s population may be more indicative of need than those in other DSRIP regions. Its median household income of $50,317 is well below the state median of $58,687. Fifteen percent of the region’s population live below the poverty level, and 4% are on cash public assistance, which is the highest percentage among DSRIP regions. Food stamps/SNAP benefits are received by 12% of the population and 12% of adults are without a high school diploma.

A third of the region’s population are on some type of public health insurance, 23% are Medicaid beneficiaries and 8% have no health insurance coverage. Special populations include 13% that are disabled and 9% that are Veterans. Six percent of the region’s population are foreign born and 10% speak a primary language other than English.

Health Care Resources Maldistributions and shortages of health care providers in the Finger Lakes region are recognized by federal Health Resources and Services Administration (HRSA) health professional shortage area (HPSA) designations. Livingston, Schuyler, Seneca, Wayne and Yates counties each has a whole county primary health care shortage designation. All counties, except Chemung, have primary health care Medically Underserved Area/Population (MUA/P) designations. Primary health care MUP designations include Steuben County’s Medicaid eligible population and the low income populations in Monroe and Ontario counties. Chemung, Schuyler, Seneca, Steuben and Yates counties each has a whole county mental health (MH) professional shortage designation. All counties have MH professional MUA/P designations, and the Medicaid eligible populations in all counties, except Livingston and Schuyler, have been designated MH professional MUPs. There are no psychiatrists in Livingston and Schuyler counties and no psychologists in Seneca County.

Total psychiatric bed capacity in the region is 40 per 100,000 adults and 33 per 100,000 children. Psychiatric beds for children are located in Chemung and Monroe counties. The total average daily census (ADC) per 100,000 adults is 36 and the total ADC per 100,000 children is 32. The region’s acute care hospitals have no chemical dependence detox beds.

There are six inpatient SUD crisis programs located in Monroe, Ontario and Steuben counties; six inpatient rehabilitation programs located in Chemung, Monroe, Ontario, Seneca and Steuben counties; and 27 residential programs located in Chemung, Monroe, Ontario, Steuben and Wayne counties. These programs have a total capacity of seven per 10,000 and an average daily enrollment (ADE) of six per 10,000. The region has three opioid treatment programs located in Monroe County. Schuyler, Steuben and Yates counties have no physicians certified in addiction medicine.

Health Status Challenges Among all DSRIP regions, the Finger Lakes region has the highest: 1) Average death rate from malignant neoplasms. Yates County has the highest rate in any NYS

county.

Finger Lakes DSRIP Region Needs Assessment – December 2016

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2) Average percentage of adults that reported poor mental health for 14 or more days in the last month. Chemung County has the highest percentage in any NYS county (24%).

Compared to all other regions, the region has the second highest average percentage of adults with angina, heart attack or stroke, and average death rate due to chronic lower respiratory disease. Among all NYS counties, Livingston County has the second highest percentage of adults with asthma and Schuyler County has the third highest rate of alcohol related motor vehicle injuries and deaths.

Behavioral Health Care Utilization Challenges Compared to all DSRIP regions, the Central region has the largest percentages of Medicaid beneficiaries with:

1. Inpatient admissions for depressive disorders. 2. ER visits for opioid use disorder.

Unmet Service Needs Measures of behavioral health medication management suggest unmet need in the region. More than half (59%) of adults with schizophrenia adhere to anti-psychotic medications (41% do not). Region-wide, 49% of individuals with major depression remain on anti-depressant medication during the entire acute treatment phase (the lowest percentage in any DSRIP region), and 35% remain on these medications during continuation phase treatment (65% do not). Less than half (44%) of children prescribed ADHD medication have one follow-up visit with a practitioner within 30 days after starting the medication (56% do not). Fifty-two percent of children with a new prescription for ADHD medication remain on the medication for seven months and/or have at least two follow-up visits in the nine month period after the initiation phase. Among all DSRIP regions, the Finger Lakes region has the lowest percentages of ADHD initiation and continuation follow-up care.

Follow-up care after hospitalization for mental illness within 7 or 30 days of hospital discharge and engagement in alcohol and other drug dependence (AOD) treatment also suggest unmet need. Region-wide, 51% of individuals have follow-up care within 7 days of discharge (49% do not) and 69% follow-up within 30 days. Twenty-three percent of individuals engage in AOD treatment within 30 days after initiation (77% do not).

With regard to physical health, high rates of potentially avoidable hospital admissions for diabetes and circulatory conditions in the Finger Lakes region suggest a need for further outpatient resources.

Consumer and Provider Input Finger Lakes region counties’ surveys of consumer and provider stakeholders to assess local needs indicate that access to crisis services and transportation are issues that need attention for the population with mental health concerns and access to crisis services is an issue that needs attention for the population chemical dependency concerns.

Strong Memorial Hospital surveyed 177 consumers and two providers in the Finger Lakes region to assess local needs. The needs most frequently reported by both consumers and providers included: transportation to health care services; reduced wait times for appointments; assistance with paying for services; convenient provider hours (evenings and weekends); language barriers; inpatient mental health; and housing.


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I. Description of Communities to Be Served

1. Geographic Service Area The Finger Lakes DSRIP region is immediately east of western New York State. It includes nine counties: Chemung, Livingston, Monroe, Ontario, Schuyler, Seneca, Steuben, Wayne, and Yates.

Approximately 1.28 million people live in the Finger Lakes region (Table 1). Three of the region’s nine counties have been designated rural by the U.S. Office of Management and Budget (OMB).1 Rural Schuyler County has the smallest population and lowest population density, while urban Monroe County has the largest population and highest population density.

Table 1. Finger Lakes Region: Population Size, Density and Urban/Rural County Designations

County US Census ACS 2010-2014 Est.

Population

Population Density per Square Mile

OMB Urban/Rural

Designation1

Chemung 88,772 217.9 Urban Livingston 65,305 103.4 Urban Monroe 743,535 1,131.4 Urban Ontario 107,226 166.5 Urban Schuyler 18,496 56.3 Rural Seneca 35,325 109.1 Rural Steuben 98,837 71.1 Rural Wayne 93,502 154.8 Urban Yates 25,295 74.8 Urban

Totals 1,276,293 239.7 Data is from the U.S. Department of Health and Human Services, Health Resources Services Administration Data Warehouse. Retrieved April 14, 2016 from http://datawarehouse.hrsa.gov/ tools/analyzers/geo/Rural.aspx

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2. Population Characteristics

A. Gender, Race, Ethnicity and Age In the Finger Lakes region, slightly more than half (51%) of the population are female (Table 2). County percentages of females range from a low of 48% in Seneca to a high of 52% in Monroe.

Table 2. Finger Lakes Region: Gender, Race/Ethnicity and Age


Population

American Community Survey Data 2010-2014 Gender Race/Ethnicity Age

Male Female White African

American Asian Other*

Hispanic or Latino Ethnicity

19 and Under

65 and Over

Chemung 88,772 50% 50% 89% 6% 1% 4% 3% 25% 15% Livingston 65,305 50% 50% 94% 2% 1% 2% 3% 25% 13% Monroe 743,535 48% 52% 77% 15% 3% 5% 7% 26% 13% Ontario 107,226 49% 51% 94% 2% 1% 3% 4% 25% 15% Schuyler 18,496 50% 50% 97% 1% 0% 2% 1% 23% 16% Seneca 35,325 52% 48% 93% 5% 1% 2% 3% 23% 15% Steuben 98,837 50% 50% 95% 2% 1% 2% 1% 26% 15% Wayne 93,502 49% 50% 93% 4% 1% 2% 4% 26% 14% Yates 25,295 49% 51% 97% 1% 0% 1% 2% 28% 16%

Totals 1,276,293 49% 51% 84% 10% 2% 4% 5% 26% 14% *Other includes American Indian and Alaska Native, Native Hawaiian and other Pacific Islander, some other race, and two or more races

The population in the region is primarily White with percentages varying from a low of 77% in Monroe County to a high of 97% each in Schuyler and Yates counties. Monroe County is more racially diverse than the other counties in the region. Fifteen percent of Monroe County’s population are African American compared to 1% each in Schuyler and Yates counties. Only 2% of the region’s population are Asian and 4% identify as some other race. Five percent of the region’s population identifies as of Hispanic or Latino ethnicity.

Twenty six percent of the Finger Lakes region’s population are age 19 and under and 14% are age 65 and over. The largest percentage of persons age 19 and under is in Yates County (28%) and the largest percentages of persons age 65 and over are in Schuyler and Yates counties (16% each).

B. Income, Education, Unemployment and Poverty The median household income in the Finger Lakes region is $50,317 (Table 3). Median household incomes range from a low of $46,112 in Steuben County to a high of $56,758 in Ontario County. The Finger Lakes median household income is lower than the New York State median household income of $58,687.2



Table 3. Finger Lakes Region: Income, Education, Unemployment and Poverty


Population

American Community Survey Data 2010-2014

Median Household

Income

Educational Attainment1 Unemployment and Indicators of Poverty

Less than High School

Bachelor's Degree or Higher Unemployed2 Below Poverty

Level On Cash Public

Assistance On Food Stamps/

SNAP Benefits

Chemung 88,772 47,542 12% 22% 6% 16% 3% 14% Livingston 65,305 52,977 11% 24% 5% 15% 3% 10% Monroe 743,535 52,232 11% 35% 5% 15% 4% 13% Ontario 107,226 56,758 9% 31% 5% 10% 3% 8% Schuyler 18,496 47,856 12% 17% 7% 13% 2% 9% Seneca 35,325 47,936 16% 18% 5% 13% 3% 9% Steuben 98,837 46,112 12% 21% 6% 16% 3% 12% Wayne 93,502 52,927 12% 21% 5% 12% 2% 10% Yates 25,295 48,518 14% 23% 5% 15% 3% 13%

Totals 1,276,293 50,317 12% 24% 5% 15% 4% 12% 1 Educational attainment are calculated based on population 25 years and older. 2 Unemployment data is the average for 2015 and is from the NYS Department of Labor.

Twelve percent of the Finger Lakes region population age 25 and older do not have a high school diploma, and 24% of this population have a bachelor’s degree or higher. Educational attainment varies by county. Adults without a high school diploma range from a low of 9% in Ontario County to a high of 16% in Seneca County. Adults with a bachelor’s degree or more range from a low of 17% in Schuyler County to a high of 35% in Monroe County.

The Finger Lakes region has a 5% unemployment rate and 15% of the region’s population live below the poverty level. Chemung and Steuben counties have the highest percentages living below poverty level (16% each) and Ontario County has the lowest (10%). Four percent of the Finger Lakes region’s population are on cash public assistance and 12% receive food stamps/SNAP benefits. Food stamps/SNAP beneficiaries range from a low of 8% in Ontario County to a high of 14% in Chemung County.

C. Health Insurance Status In the Finger Lakes region, 32% of the population are on some type of public health insurance3 and 8% have no health insurance coverage (Table 4). Percentages of the population on public health insurance range from a low of 29% in Livingston County to a high of 37% each in Chemung and Steuben counties. Those with no health insurance range from a low of 6% in Livingston County (the lowest percentage in any NYS county) to a high of 19% in Yates County (the second highest percentage in any NYS county).



Table 4. Finger Lakes Region: Health Insurance Status


Population

American Community Survey Data 2010-2014

Public Health

Insurance1

Coverage

No Health Insurance Coverage

Unemployed w/Public Health

Insurance

Unemployed w/No Health Insurance

Chemung 88,772 37% 8% 39% 32% Livingston 65,305 29% 6% 31% 19% Monroe 743,535 32% 7% 34% 25% Ontario 107,226 30% 8% 32% 24% Schuyler 18,496 36% 13% 27% 35% Seneca 35,325 33% 12% 26% 36% Steuben 98,837 37% 11% 32% 34% Wayne 93,502 31% 9% 27% 32% Yates 25,295 34% 19% 34% 32%

Totals 1,276,293 32% 8% 33% 27% 1 Public coverage includes Medicare, Medicaid and other federal medical assistance programs; VA Health Care; the Children’s Health Insurance Program (CHIP); and individual state health plans.

Among the region’s unemployed, 33% are on public health insurance and 27% have no health insurance. While the rates of the unemployed on public health insurance are largely comparable to those of the general population, the rates of the unemployed with no health insurance are more than three times as high as those in the general population (27% compared to 8%).

Medicaid Population More than one fifth (23%) of the estimated population in the Finger Lakes region are Medicaid beneficiaries (Table 5). By county, Medicaid beneficiaries range from a low of 17% of the population in Livingston County to a high of 27% of Chemung County’s population.

Table 5. Finger Lakes Region: Medicaid Beneficiaries as Percentage of Total Population

County US Census

ACS 2010-2014 Est. Population

Total # Medicaid Beneficiaries

% Est. Population Receiving Medicaid

Chemung 88,772 24,114 27% Livingston 65,305 11,017 17% Monroe 743,535 175,174 24% Ontario 107,226 19,040 18% Schuyler 18,496 4,722 26% Seneca 35,325 6,456 18% Steuben 98,837 23,215 23% Wayne 93,502 18,587 20% Yates 25,295 5,245 21%

Totals 1,276,293 287,570 23% Data is from the NYS Department of Health’s Medicaid Beneficiaries Inpatient Admissions and Emergency Room Visits data base; 2012 data. Retrieved May 12, 2016 from https://health.data.ny.gov/ Health/Medicaid-Beneficiaries-Inpatient-Admissions-and-Em/m2wt-pje4#About



In the region, 64% of Medicaid beneficiaries are adults and 36% are children, which is the second highest percentage in any DSRIP region (Table 6). By county, adult Medicaid beneficiaries range from a low of 64% each in Chemung, Monroe, Seneca, and Wayne counties to a high of 67% each in Livingston and Schuyler counties.

Table 6. Finger Lakes Region: Medicaid Beneficiaries by Population and Eligibility Type

County All Medicaid Beneficiaries

Medicaid Population Eligibility Type

Adults Children Medicaid Only Dual Medicaid and Medicare

# # % # % # % # % Chemung 24,114 15,533 64% 8,581 36% 19,611 81% 4,503 19% Livingston 11,017 7,349 67% 3,668 33% 9,148 83% 1,869 17% Monroe 175,174 112,302 64% 62,872 36% 146,646 84% 28,528 16% Ontario 19,040 12,386 65% 6,654 35% 15,554 82% 3,486 18% Schuyler 4,722 3,172 67% 1,550 33% 3,835 81% 887 19% Seneca 6,456 4,149 64% 2,307 36% 5,291 82% 1,165 18% Steuben 23,215 15,286 66% 7,929 34% 18,907 81% 4,308 19% Wayne 18,587 11,831 64% 6,756 36% 15,116 81% 3,471 19% Yates 5,245 3,419 65% 1,826 35% 4,191 80% 1,054 20%

Totals 287,570 185,427 64% 102,143 36% 238,299 83% 49,271 17% Data is from the NYS Department of Health’s Medicaid Beneficiaries Inpatient Admissions and Emergency Room Visits data base; 2012 data. Retrieved May 12, 2016 from https://health.data.ny.gov/ Health/Medicaid-Beneficiaries-Inpatient-Admissions-and-Em/m2wt-pje4#About

Medicaid beneficiaries include individuals that receive Medicaid only and dual-eligible individuals that receive both Medicare and Medicaid benefits by virtue of their age or disability and low incomes.4 In the Finger Lakes region, 83% of Medicaid beneficiaries receive Medicaid only and 17% are dual-eligible. Medicaid only beneficiaries range from a low of 80% in Yates County to a high of 84% in Monroe County.

D. Special Populations, Foreign Born and Primary Language In the Finger Lakes region, 13% of the population are disabled and 9% are Veterans (Table 7). Percentages of individuals with disabilities range from a low of 12% each in Livingston, Monroe, and Ontario counties to a high of 16% in Steuben County (the highest percentage in any NYS county). Veterans range from a low of 8% in Monroe County to a high of 13% in Steuben County.

There are 808 children 19 years and younger in foster care and 2,295 individuals in jail in the Finger Lakes region. Six percent of the population are foreign born. Monroe County has the largest population and population density in the region and is also home to the largest percentage (8%) of foreign born individuals.



Table 7. Finger Lakes Region: Special Populations and Foreign Born


Population

American Community Survey Data 2010-2014 Special Populations

Foreign Born Disabled Veterans

In Foster

Care1 In Jail2

Chemung 88,772 14% 12% 86 169 3% Livingston 65,305 12% 10% 40 137 3% Monroe 743,535 12% 8% 389 1,341 8% Ontario 107,226 12% 11% 87 210 3% Schuyler 18,496 13% 12% 13 16 2% Seneca 35,325 15% 11% 43 81 2% Steuben 98,837 16% 13% 79 180 2% Wayne 93,502 13% 10% 41 114 3% Yates 25,295 13% 10% 30 47 2%

Totals 1,276,293 13% 9% 808 2,295 6% 1 Foster care data includes individuals 19 and under during the 2014 calendar year and is from the NYS Office of Children and Families. 2Jail data is for 2014 calendar year and is from the NYS Division of Criminal Justice Services.

Table 8 describes the primary languages spoken at home and those who speak English less than ”very well” in the population aged five years and older. In the Finger Lakes region, 90% of this population speak English as their primary language, 4% each speak other Indo-European languages or Spanish, 2% speak Asian and Pacific Islander languages, 1% speak some other language and 3% speak English less than “very well”.

Table 8. Finger Lakes Region: Primary Language Spoken at Home

County

US Census ACS 2010-2014 Est. Population 5

Years and Older

American Community Survey Data 2010-2014 Language Spoken at Home

Speak English less than "very

well" English Spanish

Other Indo-European

Asian and Pacific

Islander Other

Chemung 83,475 96% 2% 2% 0% 0% 1% Livingston 62,147 95% 2% 2% 1% 0% 1% Monroe 701,770 87% 5% 4% 2% 1% 5% Ontario 102,028 94% 3% 2% 1% 0% 2% Schuyler 17,623 97% 1% 2% 0% 0% 1% Seneca 33,373 93% 2% 4% 0% 0% 2% Steuben 93,135 95% 1% 2% 1% 0% 1% Wayne 87,991 95% 3% 2% 0% 0% 2% Yates 23,779 89% 1% 9% 0% 0% 5%

Totals 1,205,322 90% 4% 4% 2% 1% 3%



Percentages of the population aged five and over that speak English as their primary language vary from a low of 87% in Monroe County to a high of 97% in Schuyler County (the highest percentage in any NYS county). Those who speak English less than “very well” range from a low of 1% each in four counties to a high of 5% each in Monroe and Yates counties.

1 Urban areas (metro areas) are geographic entities defined by the U.S. Office of Management and Budget (OMB) for use by Federal statistical agencies in collecting, tabulating, and publishing Federal statistics. An urban area includes one or more counties containing a core urban area of 50,000 or more people, together with any adjacent counties that have a high degree of social and economic integration (as measured by commuting to work) with the urban core. The OMB defines rural as all counties outside metropolitan areas based on 2010 census data. There are currently 24 counties designated rural in New York State. Retrieved April 14, 2016 from http://datawarehouse.hrsa.gov/tools/analyzers/geo/Rural.aspx 2 Retrieved April 14, 2016 from http://www.census.gov/quickfacts/table/RHI225214/36 3 Public coverage includes the federal programs Medicare, Medicaid and other medical assistance programs, VA Health Care; the Children’s Health Insurance Program (CHIP); and individual state health plans. Retrieved April 14, 2016 from https://www.census.gov/hhes/www/hlthins/methodology/definitions/acs.html4 In this analysis dual status was based upon the last month of enrollment/eligibility during the year. If the Medicaid beneficiary was indicated as being eligible for Part A, B, C or D Medicare services they are classified as dual eligible. The dual-eligible Medicare and Medicaid population is diverse and includes individuals with multiple chronic conditions, physical disabilities, and cognitive impairments such as dementia, developmental disabilities, and mental illness. It also includes some individuals who are relatively healthy. Retrieved May 12, 2016 from http://www.medpac.gov/documents/data-book/january-2015-medpac-and-macpac-data-book-beneficiaries-dually-eligible-for-medicare-and-medicaid.pdf


http://www.medpac.gov/documents/data-book/january

https://www.census.gov/hhes/www/hlthins/methodology/definitions/acs.html

http://www.census.gov/quickfacts/table/RHI225214/36

http://datawarehouse.hrsa.gov/tools/analyzers/geo/Rural.aspx


II. Physical and Behavioral Health Care Resources

This section describes physical and behavioral health care resources in the Finger Lakes DSRIP region. Its findings should be considered with those in Sections V and VI of this report, which describe unmet service need by DSRIP region.

Physical Health Care Resources

1. Inpatient Physical Health Care Facilities The Finger Lakes DSRIP region has 16 acute care hospitals and 71 nursing homes that provide inpatient health care (Table 1).

Table 1. Finger Lakes Region: Inpatient Physical Health Care by Certified Beds

County

Acute Care Hospitals Nursing Homes

# Hospitals

# Certified Beds # Nursing

Homes

# Certified Beds Total # All Bed Types

Chemical Dependence

Rehab

Chemical Dependence

Detox Psychiatric Total Beds

BH Intervention Beds

Chemung 2 391 20 0 25 5 736 0 Livingston 1 67 0 0 0 3 354 0 Monroe 6 2,009 40 0 163 39 4,145 15 Ontario 3 399 30 0 18 7 623 0 Schuyler 0 − − − − 1 120 0 Seneca 0 − − − − 2 280 0 Steuben 3 115 0 0 0 6 451 0 Wayne 1 120 0 0 16 6 561 20 Yates 0 − − − − 2 196 0

Totals 16 3,101 90 0 222 71 7,466 35 Acute care hospital data is from the NYS Open Data Health Facility General Information dataset. Retrieved April 12, 2016 from https://health.data.ny.gov/Health/Health-Facility-General-Information/vn5v-hh5r . Nursing home data is from the NYS Open Data Nursing Home Profile dataset. Retrieved April 12, 2016 from https://health.data.ny.gov/Health/Nursing-Home-Profile/dypu-nabu

In the Finger Lakes region all counties, except Schuyler, Seneca and Yates, have at least one acute care hospital. Monroe County has six acute care hospitals, Ontario and Steuben counties each have three, Chemung has two, and Livingston and Wayne each have one. The region has a total of 3,101 beds where physical health care is the primary type of care provided. More than 2,000 of these beds are located in Monroe County. Among the 3,101 beds are 222 psychiatric beds, 90 chemical dependence rehab beds and no chemical dependence detox beds.

All counties in the region have nursing homes. The region’s 71 nursing homes have a total of 7,466 beds, which includes 35 behavioral health intervention beds.1 More than 4,000 of the nursing home beds are located in Monroe County. Only Monroe and Wayne counties have behavioral health intervention beds.



2. Outpatient Physical Health Care Facilities In the Finger Lakes region, home health care is provided only in Chemung, Monroe, Ontario, and Steuben counties (Table 2). Each of these counties has at least one certified home health care facility (n=7) and three have at least one long-term home health care facility (n=6). Chemung and Monroe counties have ambulatory surgical centers (n=2 and n=8 respectively).

Table 2. Finger Lakes Region: Outpatient Physical Health Care

County

Home Health Care Ambulatory

Surgical Centers

Primary Health Care

Certified Home Health

Long-term Home Health

School-based Health Centers

Diagnostic and Treatment Centers

Federally Qualified

Health Centers # Facilities

Chemung 1 1 2 1 3 0 Livingston 0 0 0 0 2 0 Monroe 4 4 8 13 17 9 Ontario 1 1 0 0 2 2 Schuyler 0 0 0 0 1 0 Seneca 0 0 0 0 1 1 Steuben 1 0 0 0 1 1 Wayne 0 0 0 1 3 1 Yates 0 0 0 1 2 2

Totals 7 6 10 16 32 16 Ambulatory surgical center data is from the NYS HCRA Provider List dataset. Retrieved April 12, 2016 from https://www.health.ny.gov/regulations/hcra/provider/provamb.htm. Federally qualified HC data is from the HRSA Data Warehouse. Retrieved April 21, 2016 from http://datawarehouse.hrsa.gov/tools/hdwreports/Filters.aspx?id=60#. All other data is from the NYS Open Data Health Facility General Information dataset. Retrieved April 12, 2016 from https://health.data.ny.gov/Health/ Health-Facility-General-Information/vn5v-hh5r .

There are three types of institutional providers that provide primary care: school-based health centers, diagnostic and treatment centers,2 and federally qualified health centers.3 Collectively, Chemung, Monroe, Wayne and Yates counties have 16 school- based health centers. All counties have at least one diagnostic and treatment center, and six counties have at least one federally qualified health center. The greatest concentration of primary health care providers is in Monroe County.

3. Physical Health Care Practitioners Physical health care providers include primary care providers, medical specialists, dentists, and physical rehabilitation specialists. Health practitioners in primary care and medical specialties include physicians, physician assistants, and nurse practitioners.

Primary Care Providers In the Finger Lakes region, family medicine providers include 726 physicians and a total of 442 nurse practitioners and physician assistants (Table 3). The number of family



medicine providers of all types is lowest in Schuyler County (n=17) and highest in Monroe County (n=689).

Internal medicine providers include 1,122 physicians and a total of 589 nurse practitioners and physician assistants. The number of internal medicine physicians is highest in Monroe County (n=785) and lowest in Schuyler County (n=8). Internal medicine nurse practitioners and physician assistants are found in the greatest numbers in Monroe County (n=418) and the fewest are in Chemung and Schuyler counties (n=2 each).

Table 3. Finger Lakes Region: Primary Care Providers

County US Census


Family Medicine

Internal Medicine

Pediatrics Total

Total per 10,000

population MD/DO NP/PA MD/DO NP/PA MD/DO NP/PA

Chemung 88,772 29 1 77 2 38 12 159 18 Livingston 65,305 32 30 17 22 12 15 128 20 Monroe 743,535 449 240 785 418 539 225 2,656 36 Ontario 107,226 74 56 93 70 29 15 337 31 Schuyler 18,496 14 3 8 2 4 0 31 17 Seneca 35,325 19 26 21 11 3 0 80 23 Steuben 98,837 34 32 30 12 16 15 139 14 Wayne 93,502 50 30 66 36 41 21 244 26 Yates 25,295 25 24 25 16 6 5 101 40

Totals 1,276,293 726 442 1,122 589 688 308 3,875 30 MD=medical doctor; DO=doctor of osterpathy; NP=nurse practitioner; PA=physician assistant. Data is from the DSRIP Managed Care Provider Network Database. Retrieved April 21, 2016 from https://www.health.ny.gov/health_care/ medicaid/redesign/providernetwork/

Pediatric health care providers are the smallest group of primary care providers in the region. Throughout the Finger Lakes region there are 688 physicians providing pediatric care and a total of 308 pediatric nurse practitioners and physician assistants. The number of pediatric health providers is highest in Monroe County (n=764) and lowest in Seneca County (n=3).

The maldistribution of primary care providers in the Finger Lakes region is made clearer by looking at the number of providers per 10,000 population in the region’s counties. Steuben County has 14 primary care providers per 10,000 population, while Yates and Monroe counties have 40 and 36 respectively.

This maldistribution is also recognized by designations of county health professional shortage areas (HPSAs) made by the federal Health Resources and Services Administration (HRSA).4 In addition to county wide shortage area designations, HRSA also makes county census tract, special population, and health care facility shortage designations. Table 3a describes all of the HRSA primary care professional shortage designations for the counties in the Finger Lakes region.



Table 3a. Finger Lakes Region: HRSA Federal Primary Care Professional Shortage Designations

County Whole County Census tract,

populations or facilities

Medicaid Eligible population

Low Income Population

Chemung Livingston Yes Yes Monroe Yes Yes Ontario Yes Yes Schuyler Yes Yes Seneca Yes Yes Steuben Yes Yes Wayne Yes Yes Yates Yes Yes HRSA federal shortage designations retrieved March 17, 2016 from http://datawarehouse.hrsa.gov/tools/analyzers/hpsafind.aspx

Livingston, Schuyler, Seneca, Wayne and Yates counties each has a whole county primary care shortage designation. All of the counties, except Chemung, have a census tract, population or facility designated as a primary care Medically Underserved Area/Population (MUA/P). In Steuben County the Medicaid eligible population has been designated a primary care MUP and the low income populations in Monroe and Ontario counties have also been designated primary care MUPs.

Physical Health Medical Specialists The Finger Lakes region has a total of 1,826 physical medical health specialists or 14 providers per 10,000 population (Table 4).

Table 4. Finger Lakes Region: Physical Medical Specialists

County US Census ACS

2010-2014 Est. Population

Allergy and Immunology

Cardiology and Other Cardiology

Specialties

Endocrinology and Other Endocrinology Related Specialties

Obstetrics and Gynecology

General Surgery Total

Total per 10,000

populationMD/DO NP/PA MD/DO NP/PA MD/DO NP/PA MD/DO NP/PA MD/DO NP/PA

Chemung 88,772 6 5 18 4 2 1 13 3 20 0 72 8 Livingston 65,305 8 3 36 6 0 0 6 0 11 1 71 11 Monroe 743,535 69 24 236 47 32 5 433 197 169 118 1,330 18 Ontario 107,226 7 1 37 7 2 1 33 11 25 10 134 12 Schuyler 18,496 1 0 10 1 0 0 0 0 3 0 15 8 Seneca 35,325 0 0 2 0 0 0 3 2 0 2 9 3 Steuben 98,837 2 0 28 8 3 1 14 6 12 2 76 8 Wayne 93,502 4 8 21 3 4 1 24 10 10 10 95 10 Yates 25,295 0 0 7 1 0 0 3 3 3 7 24 9

Total 1,276,293 97 41 395 77 43 9 529 232 253 150 1,826 14 MD=medical doctor; DO=doctor of osterpathy; NP=nurse practitioner; PA=physician assistant. Data is from the DSRIP Managed Care Provider Network Database. Retrieved April 21, 2016 from https://www.health.ny.gov/health_care/medicaid/redesign/providernetwork/



Endocrinology providers (n=52) and allergy and immunology providers (n=138) are in shortest supply, while those in obstetrics and gynecology are most prevalent (n=761), followed by cardiology (n=472) and general surgery (n=403). Monroe County has the highest total number of medical specialists (n=1,330) and highest number per 10,000 (n=18), while Seneca County has the lowest total number of medical specialists (n=9) and the lowest number per 10,000 (n=3).

Dentists In the Finger Lakes region there is a total of 605 dentists serving the population of nearly 1.3 million residents (Table 5). The number of dentists ranges from a low of two in Schuyler County to a high of 427 in Monroe County. Region wide there are five dentists per 10,000 population.

Table 5. Finger Lakes Region: Dentists

County US Census


Number of Dentists Per 10,000 Population

General Dentist

Specialist Dentist

Total

Chemung 88,772 18 7 25 3 Livingston 65,305 19 3 22 3 Monroe 743,535 326 101 427 6 Ontario 107,226 35 8 43 4 Schuyler 18,496 1 1 2 1 Seneca 35,325 8 0 8 2 Steuben 98,837 11 8 19 2 Wayne 93,502 33 3 36 4 Yates 25,295 21 2 23 9

Totals 1,276,293 472 133 605 5 Data is from the DSRIP Managed Care Provider Network Database. Retrieved April 21, 2016 from https://www.health.ny.gov/health_care/medicaid/redesign/providernetwork/

Physical Rehabilitation Specialists In the Finger Lakes region there is a total of 884 physical rehabilitation specialists serving the population of nearly 1.3 million residents (Table 6).

In the region, speech therapists (n=70) and occupational therapists (n=75) are in shortest supply, while physical therapists are most prevalent (n=739). The number of physical rehabilitation specialists ranges from a low of two in Schuyler County to a high of 730 in Monroe County. Region-wide there are seven physical rehabilitation specialists per 10,000 population, the third lowest rate among all DSRIP regions.



Table 6. Finger Lakes Region: Physical Rehabilitation Specialists


Population

Occupational Therapy

Physical Therapy

Speech Therapy

Total Total per

10,000 population

Chemung 88,772 2 12 0 14 2 Livingston 65,305 0 47 0 47 7 Monroe 743,535 67 596 67 730 10 Ontario 107,226 4 28 1 33 3 Schuyler 18,496 0 2 0 2 1 Seneca 35,325 0 6 0 6 2 Steuben 98,837 1 3 0 4 0 Wayne 93,502 0 43 2 45 5 Yates 25,295 1 2 0 3 1

Totals 1,276,293 75 739 70 884 7 Data is from the DSRIP Managed Care Provider Network Database. Retrieved Aprilhttps://www.health.ny.gov/health_care/medicaid/redesign/providernetwork/

21, 2016 from

Behavioral Health Care Resources

4. Inpatient Behavioral Health Care Facilities and Programs The data presented in this section is by county of provider location, with the exception of psychiatric inpatient average daily census, which is by patient county of residence. Individuals may access services in a county other than the county in which they reside.

Mental Health Inpatient Facilities The Finger Lakes region has a total of 371 adult psychiatric beds and 108 psychiatric beds for children (Table 7).5 Adult psychiatric beds are located in Chemung, Monroe, Ontario, Wayne and Yates counties. Psychiatric beds for children are located in Chemung and Monroe counties.

Monroe County has the largest numbers of adult beds (n=248) and beds for children (n=108). Total psychiatric bed capacity in the region is 40 per 100,000 adults and 33 per 100,000 children.

In the Finger Lakes region the total inpatient average daily census (ADC) for adult beds is 333, while the ADC for child beds is 107. Monroe County has the highest total ADC for adults (n=226) and Yates County has the lowest (n=3). Monroe County also has the highest total ADC for children (n=51) and Schuyler County has the lowest (n=1).



Table 7. Finger Lakes Region: Total Psychiatric Inpatient Bed Capacity by Provider County and Average Daily Census by Patient County of Residence

County

- Adults - - Children -Total

Inpatient

Beds1

Total Bed Capacity per

100,000

Total Inpatient

ADC2,3

Total ADC

per 100,0004

Total Inpatient

Beds1

Total Bed Capacity per

100,000

Total Inpatient

ADC

Total ADC

per 100,0004

Chemung 79 120 35 53 15 67 17 77 Livingston 0 0 7 15 0 0 3 18 Monroe 248 46 226 42 93 48 51 26 Ontario 18 23 15 19 0 0 11 39 Schuyler 0 0 5 33 0 0 1 13 Seneca 0 0 7 26 0 0 3 33 Steuben 0 0 20 27 0 0 11 42 Wayne 16 23 15 22 0 0 8 32 Yates 10 56 3 18 0 0 3 45

Totals 371 40 333 36 108 33 107 32 Notes: 1. Includes General Hospital, Private Psychiatric Hospital and State Psychiatric Centers’ budgeted capacity for the county of the providers. Children’s capacity includes residential treatment facility (RTF) beds for the county of the providers. 2. Average Daily Census (ADC) covers General, Private Psychiatric, State Psychiatric hospital and RTF (children only). 3. ADC is shown for patient county of residence. 4. The ADC per 100,000 population of adults or children as indicated. Data Sources: Capacity -- General Hospital and Private Psychiatric Hospital current capacity: NYSOMH CONCERTS database, 10/2015. Current capacity includes all beds licensed for operation as of that date. State Psychiatric Center budgeted capacity: NYSOMH MHARS EHR, 10/2015. RTF capacity: NYSOMH CAIRS database, 10/2015. US Census 2014 Est. Populations. Average Daily Census -- General Hospital (Art. 28): SPARCS, CY 2014. Private Psychiatric Hospital (Art. 31): Medicaid, CY 2014. Institutional Cost Report (ICR), CY 2014: county distribution using the 2013 Patient Characteristics Survey (PCS). State Psychiatric Centers: MHARS, CY 2014. RTF: CAIRS, CY 2014. US Census 2014 estimates.

In the region, the total ADC per 100,000 adults is 36, while the total ADC per 100,000 children is 32. For adults the total ADC per 100,000 adults is highest for residents of Chemung County (n=53) and lowest for residents of Livingston County (n=15). In comparison, the total ADC per 100,000 children is highest for residents of Chemung County (n=77, the second highest among all NYS counties) and lowest for residents of Schuyler (n=13).

Substance Use Disorder Inpatient Programs In New York State substance use disorder (SUD) inpatient programs include crisis, inpatient rehabilitation, and residential programs.6 In the Finger Lakes region (Table 8) there are six SUD crisis programs located in Monroe, Ontario and Steuben counties; six inpatient rehabilitation programs located in Chemung, Monroe, Ontario, Seneca and Steuben counties; and 27 residential programs located in Chemung, Monroe (n=17), Ontario, Steuben and Wayne counties.



Table 8. Finger Lakes Region: Substance Use Disorders Inpatient Program Capacity

County

US Census ACS 2010-2014 Est.

Population

Inpatient Programs Total

Capacity per 10,000

Crisis Inpatient

Rehabilitation* Residential Total

Capacity

# Programs Capacity # Programs Capacity # Programs Capacity

Chemung 88,772 – – 1 20 1 25 45 5 Livingston 65,305 – – – – – – – – Monroe 743,535 3 25 2 80 17 399 504 7 Ontario 107,226 2 22 1 30 5 96 148 14 Schuyler 18,496 – – – – – – – – Seneca 35,325 – – 1 30 – – 30 8 Steuben 98,837 1 25 1 20 2 36 81 8 Wayne 93,502 – – – – 2 42 42 4 Yates 25,295 – – – – – – – –

Totals 1,276,293 6 72 6 180 27 598 850 7Notes and Data Sources: *Includes State Addiction Treatment Centers. Data is from the NYS Office of Alcoholism and Substance Abuse Services (OASAS) Provider Directory System. Includes programs that were operational as of April 2, 2016. More information about OASAS inpatient programs is available at http://www.oasas.ny.gov/hps/state/CD_descriptions.cfm

The region’s crisis capacity is 72, inpatient rehabilitation capacity is 180 and residential capacity is 598. The regional capacity per 10,000 for all SUD inpatient programs is seven, the third highest rate in DSRIP regions.

Table 9 describes the average daily enrollment (ADE) in these programs. The ADE in the region for crisis is 59, inpatient rehabilitation is 146 and residential is 520. The regional ADE per 10,000 for these programs is six, the third highest rate in DSRIP regions.

Table 9. Finger Lakes Region: Substance Use Disorders Inpatient Program Average Daily Enrollment

County


Population

Inpatient Programs

Crisis Inpatient

Rehabilitation* Residential

Total Avg. Daily

Total Avg. Daily

Enrollment

# Programs Avg. Daily Enrollment



Enrollment per 10,000

Chemung 88,772 – – 1 15 1 24 38 4 Livingston 65,305 – – – – – – – – Monroe 743,535 3 26 2 72 17 344 441 6 Ontario 107,226 2 19 1 22 5 83 124 12 Schuyler 18,496 – – – – – – – – Seneca 35,325 – – 1 27 – – 27 8 Steuben 98,837 1 14 1 10 2 30 54 6 Wayne 93,502 – – – – 2 40 40 4 Yates 25,295 – – – – – – – –

Totals 1,276,293 6 59 6 146 27 520 725 6 *Includes State Addiction Treatment Centers. Data is from the NYS Office of Alcoholism and Substance Abuse Services (OASAS) Provider Directory System. Includes programs that were operational as of April 2, 2016.



5. Outpatient Behavioral Health Care Services The data presented here is by county of provider location. Individuals may access services in a county other than the county in which they reside.

Mental Health Outpatient and Clinic Programs

Adults Adult mental health outpatient programs include: assertive community treatment (ACT), clinic, continuing day treatment (CDT), intensive psychiatric rehabilitative treatment (IPRT), partial hospitalization (PH), and personalized recovery-oriented services (PROS). The Finger Lakes region’s capacity and service use in these programs are presented in Table 10.

Table 10. Finger Lakes Region: Adult Mental Health Outpatient Capacity and Service Use by Provider County

County

Outpatient Programs (PH, IPRT, CDT, PROS, ACT)

Clinics: Total Number of Adults

Locally Operated Clinics Recipients in

State-operated

Clinics4

Clinic Treatment per 100,000

Adults5Capacity1

(Slots)

Slots per 100,000

Adults5

Medicaid

Recipients2

Non-Medicaid

Recipients

(Estimated #)3

Chemung 190 289 1,289 348 208 2,810 Livingston ─ ─ 586 556 ─ 2,369 Monroe 640 118 10,362 5,924 198 3,029 Ontario 48 60 984 628 37 2,074 Schuyler 48 343 331 144 ─ 3,391 Seneca ─ ─ 444 176 238 3,212 Steuben 115 159 813 112 ─ 1,275 Wayne ─ ─ 851 448 ─ 1,899 Yates ─ ─ 152 64 ─ 1,204

Totals 1,041 111 15,812 8,400 681 2,656 Notes and Data Sources: Clinics are not licensed for specific slot capacities, therefore size is measured by estimated total number of persons served annually. 1. Includes the total capacity for Partial Hospitalization (PH), Intensive Psychiatric Rehabilitative Treatment (IPRT), Continuing Day Treatment (CDT), Personalized Recovery-Oriented Services (PROS) and Assertive Community Treatment (ACT) (Data Source: New York State Office of Mental Health (NYSOMH) CONCERTS database, 10/2015). 2. Includes adults and children enrolled in Medicaid and served annually in non-State clinic programs (Data Source: Medicaid, CY 2014). 3. Includes annual estimate of adults not receiving Medicaid and served in non-State clinics during the NYSOMH 2013 Patient Characteristics Survey (PCS). 4. Includes adults served annually in State-run clinics (Data Source: NYSOMH MHARS database, CY 2014). 5. US Census ACS 2010-2014 Est. Population.

In the region outpatient programs (other than clinic) are located in Chemung, Monroe, Ontario, Schuyler and Steuben counties. Among these counties, capacity is largest in Monroe County (n=640 slots) and smallest in Ontario and Schuyler counties (n=48 slots each). There is a total of 1,041 non-clinic outpatient program slots in the region or 111 slots per 100,000 adults.

Clinics may be locally- or state-operated. All counties in the Finger Lakes region have locally-operated clinics. These clinics served a total of 15,812 adult Medicaid recipients and 8,400 adult non-Medicaid recipients. The largest numbers of adult Medicaid



recipients (n=10,362) and adult non-Medicaid recipients (n=5,924) were served in Monroe County. In comparison, the smallest numbers of adult Medicaid recipients (n=152) and adult non-Medicaid recipients (n=64) were served in Yates County.

The Finger Lakes region has state-operated clinics in Chemung, Monroe, Ontario and Seneca counties which together served 681 adults.

In the region 2,656 adults received clinic treatment per 100,000 adults. Schuyler County’s rate of 3,391 adults per 100,000 adults is the highest in region. Yates County’s service rate of 1,204 adults per 100,000 adults is the lowest in the region.

Children Mental health outpatient programs that serve children include: assertive community treatment (ACT), clinic, day treatment (DT), and partial hospitalization (PH). The Finger Lakes region’s capacity and service use in these programs are presented in Table 11.

In the region there are child outpatient programs other than clinic in Chemung, Monroe, Ontario and Steuben counties. Among these counties, capacity is largest in Monroe County (n=285 slots) and smallest in Ontario County (n=42 slots). There is a total of 448 non-clinic outpatient program slots in the region or 136 slots per 100,000 children, which is the highest rate in all DSRIP regions.

Table 11. Finger Lakes Region: Child Mental Health Outpatient Capacity and Service Use by Provider County

County

Outpatient Programs (PH, DT, ACT)

Clinics: Total Number of Children Locally Operated Clinics

Recipients in State-operated

Clinics4

Clinic Treatment per 100,000

Children5Capacity1

(Slots)

Slots per 100,000

Children5

Medicaid

Recipients2

Non-Medicaid

Recipients

(Estimated #)3

Chemung 55 247 461 200 123 3,528 Livingston ─ ─ 155 168 ─ 1,969 Monroe 285 147 1,950 1,952 ─ 2,013 Ontario 42 154 64 12 ─ 279 Schuyler ─ ─ 109 68 ─ 4,086 Seneca ─ ─ 82 108 ─ 2,293 Steuben 66 258 325 132 ─ 1,787 Wayne ─ ─ 251 196 ─ 1,838 Yates ─ ─ 73 116 ─ 2,666

Totals 448 136 3,470 2,952 123 1,987 Notes and Data Sources: Clinics are not licensed for specific slot capacities, therefore size is measured by estimated total number of children served annually. 1. Includes the total capacity for Partial Hospitalizations (PH), Day Treatment (DT) and Children's Assertive Community Treatment (ACT) (Data Source: New York State Office of Mental Health (NYSOMH) CONCERTS database, 10/2015). 2. Includes children enrolled in Medicaid and served annually in locally-operated (non-State) clinic programs (Data Source: Medicaid, CY 2014). 3. Includes annual estimate of children not receiving Medicaid and served in locally-operated (non-State) clinics during the week of the NYSOMH 2013 Patient Characteristics Survey (PCS). 4. Includes children served annually in State-run clinics (Data Source: NYSOMH MHARS database, CY 2014). 5. US Census ACS 2010-2014 Est. Population.



All counties in the Finger Lakes region have locally-operated clinics. These clinics served a total of 3,470 child Medicaid recipients and 2,952 child non-Medicaid recipients. The largest number of child Medicaid recipients (n=1,950) was served in Monroe County and the smallest number (n=64) was served in Ontario County. Similarly, the largest number of child non-Medicaid recipients (n=1,952) was served in Monroe County and the smallest number (n=12) was served in Ontario County.

The Finger Lakes region has state-operated clinics in Chemung County which served 123 children. In the region, 1,987 children received clinic treatment per 100,000 children. Schuyler County’s rate of 4,086 children per 100,000 children is the highest in the region, while Ontario County’s service rate of 279 children per 100,000 children is the lowest.

Mental Health Emergency and Community Support Programs

Adults Table 12 describes Finger Lakes region’s service use in adult mental health emergency and community support programs. A total of 297 adults were served in emergency programs located in Chemung, Monroe, Ontario and Steuben counties. In the region 32 adults received emergency services per 100,000 adults, which is the highest rate in any DSRIP region.

Table 12. Finger Lakes Region: Adult Mental Health Emergency Programs and Community Support Programs by Provider County

County Emergency Programs Community Support Programs

# Adults Served # Served per

100,000 Adults # Adults Served

# Served per 100,000 Adults

Chemung 3 4 142 207 Livingston ─ ─ 64 124 Monroe 249 42 812 139 Ontario 34 39 131 151 Schuyler ─ ─ 81 544 Seneca ─ ─ 182 652 Steuben 1 1 377 492 Wayne ─ ─ 55 76 Yates 10 52 66 342

Totals 297 32 1,910 204 Data Sources: Includes adults receiving emergency services and support services (e.g., vocational, self-help, care coordination) as reported by the New York State Office of Mental Health 2013 Patient Characteristics Survey (PCS). US Census ACS 2010-2014 Est. Population. Service use is reported because there are no licensed capacities for nearly all of these programs.

In comparison, there are adult community support programs (e.g., vocational, self-help and care coordination) in each county in the Finger Lakes region which collectively served 1,910 adults. In the region 204 adults per 100,000 adults received services from community support programs. In the counties service rates per 100,000 adults ranged



from a low of 76 in Wayne County to a high of 652 in Seneca County, which is the highest rate among all NYS counties.

Children The Finger Lakes region’s service use in child mental health emergency and community support programs is presented in Table 13. One hundred and twenty eight children received emergency services from programs in Chemung, Monroe, Ontario, Seneca and Yates counties. In the region 39 children received emergency services per 100,000 children, which is the second highest rate in any DSRIP region.

Community support programs for children (e.g., vocational, home-based family treatment, and residential treatment facility transition) are located in all counties in the Finger Lakes region and together served 731 children. These programs served 222 children per 100,000 children, which is the third highest rate in any DSRIP region. In the counties service rates per 100,000 children ranged from a low of 70 in Ontario County to a high of 1,218 in Yates (the highest rate in any NYS county).

Table 13. Finger Lakes Region: Child Mental Health Emergency Programs and Community Support Programs by Provider County

County Emergency Programs

Community Support Programs

# Children Served

# Served per 100,000 Children

# Children Served

# Served per 100,000 Children

Chemung 2 10 32 167 Livingston ─ ─ 10 76 Monroe 107 65 357 218 Ontario 9 39 16 70 Schuyler ─ ─ 19 529 Seneca 5 72 8 115 Steuben ─ ─ 201 925 Wayne ─ ─ 16 80 Yates 5 85 72 1,218

Totals 128 39 731 222 Data Sources: Includes children receiving emergency services and support services (e.g., vocational, home-based family treatment, residential treatment facility transition) as reported by the New York State Office of Mental Health 2013 Patient Characteristics Survey (PCS). US Census ACS 2010-2014 Est. Population. Service use is reported because there are no licensed capacities for nearly all of these programs.

Behavioral Health Housing Programs

Adults In New York State adult behavioral health housing services are provided in licensed beds in family care, congregate treatment and apartment treatment programs, and in unlicensed beds in housing support and supported housing programs. More information



about these programs is available on the NYS Office of Mental Health web page at http://bi.omh.ny.gov/adult_housing/index.

These adult housing services in the Finger Lakes region are described in Table 14. In the region licensed family care beds (n=264) are located in all counties except Livingston, and congregate treatment (n=587) and apartment treatment (n=384) beds are located in all counties except Livingston, Schuyler and Yates. While there are no unlicensed housing support program beds in the Finger Lakes region, unlicensed supported housing beds (n=1,027) are available in all counties.

The housing capacity per 100,000 adults in the region is 241, which is the second highest rate in any DSRIP region. In the counties housing capacity per 100,000 adults ranged from a low of 79 in Schuyler County to a high of 363 in Seneca County.

Table 14. Finger Lakes Region: Adult Behavioral Health Community-Based Housing Capacity by Provider County

County

Licensed Beds Unlicensed Beds Housing

Family Care

Congregate Treatment

Apartment Treatment

Housing Support

Programs

Supported Housing

Capacity per 100,000 Adults

Chemung 38 14 36 ─ 135 340 Livingston ─ ─ ─ ─ 40 83 Monroe 91 479 263 ─ 528 250 Ontario 42 28 22 ─ 71 205 Schuyler 4 ─ ─ ─ 7 79 Seneca 25 14 26 ─ 32 363 Steuben 7 38 30 ─ 127 279 Wayne 30 14 7 ─ 76 186 Yates 27 ─ ─ ─ 11 212

Totals 264 587 384 ─ 1,027 241 Data Sources: Licensed and unlicensed beds: New York State Office of Mental Health CONCERTS database; data as of 10/2015. US Census ACS 2010-2014 Est. Population.

Children In New York State, child behavioral health housing services are provided in licensed beds in teaching family homes and child and youth community residences, and in home and community-based services (HCBS). These child housing services in the Finger Lakes region are described in Table 15.

The region has no teaching family home beds. Licensed child and youth community residence beds (n=41) are located in all counties except Livingston, Schuyler, Seneca and Yates. The Finger Lakes region has a capacity of 12 child and youth community residence beds per 100,000 children, which is the second highest rate in any DSRIP region.


http://bi.omh.ny.gov/adult_housing/index


Table 15. Finger Lakes Region: Child Behavioral Health Community-Based Housing Capacity and Home & Community-Based Services (HCBS) Slots by Provider County

County

Number of Licensed Housing Beds HCBS Slots

Teaching Family Home

Child & Youth Community Residence

Capacity per 100,000

Children

Number of Slots

Slots per 100,000 Children

Chemung ─ 9 40 12 54 Livingston ─ ─ ─ 8 49 Monroe ─ 8 4 72 37 Ontario ─ 8 29 18 66 Schuyler ─ ─ ─ 6 139 Seneca ─ ─ ─ 9 109 Steuben ─ 8 31 15 59 Wayne ─ 8 33 18 74 Yates ─ ─ - 6 85

Totals ─ 41 12 164 50 Data Sources: New York State Office of Mental Health databases. Licensed housing capacity: CONCERTS, 10/2015. Home & Community-based Services (HCBS): CAIRS, CY 2014. US Census ACS 2010-2014 Est. Population.

All counties in the region have HCBS slots (n=164) ranging from a high of 72 in Monroe County to a low of six each in Schuyler and Yates counties. The region’s HCBS slots served 50 children per 100,000 children. In the counties HCBS slots per 100,000 children ranged from a low of 37 in Monroe County to a high of 139 in Schuyler County.

Substance Use Disorder Outpatient Programs New York State has a variety of substance use disorder (SUD) outpatient programs including clinic and rehabilitation. In the Finger Lakes region all counties have SUD outpatient programs. The average daily enrollment (ADE) in these programs (n=5,388) is described in Table 16.

In the region Monroe County has the highest ADE (n=3,582), while Yates has the lowest (n=64). Region-wide these SUD programs have an ADE of 42 per 10,000, which is the second highest rate in any DSRIP region. In the counties ADE per 10,000 ranged from a low of 25 each in Steuben and Yates counties to a high of 48 in Monroe County.



Table 16. Finger Lakes Region: Substance Use Disorders Outpatient Program Average Daily Enrollment


Population

Outpatient Avg. Daily Enrollment

Total Per 10,000

Chemung 88,772 328 37 Livingston 65,305 215 33 Monroe 743,535 3,582 48 Ontario 107,226 419 39 Schuyler 18,496 75 40 Seneca 35,325 122 35 Steuben 98,837 252 25 Wayne 93,502 331 35 Yates 25,295 64 25

Totals 1,276,293 5,388 42 Notes and Data Sources: Outpatient programs (OP) include Medically Supervised Outpatient, Outpatient Rehabilitation, Specialized OP – Traumatic Brain Injury, Outpatient Chemical Dependency for Youth, Specialized OP – Mobile, and Specialized Services OP Rehabilitation. Data is from the NYS Office of Alcoholism and Substance Abuse Services (OASAS) Provider Directory System. Includes programs that were operational as of April 2, 2016.

New York State also has outpatient opioid treatment programs (Table 17). The Finger Lakes region has three opioid treatment programs located in Monroe County, which have a combined capacity of 750 and an ADE of 618. Region-wide the program has a capacity of six per 10,000 and an ADE of five per 10,000.

Table 17. Finger Lakes Region: Substance Use Disorders Outpatient Opioid Treatment Program Capacity and Average Daily Enrollment

County US Census


Number of Programs

Opioid Treatment (Methadone) Capacity Avg. Daily Enrollment

Total Per 10,000 Total Per 10,000

Chemung 88,772 – – – – – Livingston 65,305 – – – – – Monroe 743,535 3 750 10 618 8 Ontario 107,226 – – – – – Schuyler 18,496 – – – – – Seneca 35,325 – – – – – Steuben 98,837 – – – – – Wayne 93,502 – – – – – Yates 25,295 – – – – –

Totals 1,276,293 3 750 6 618 5 Data is from the NYS Office of Alcoholism and Substance Abuse Services (OASAS) Provider Directory System. Includes programs that were operational as of April 2, 2016.



6. Care Coordination New York State’s Medicaid health home initiative is designed to expand and improve care management for beneficiaries with intensive, high-cost service needs. The health home model provides the basis for unified systems of care to coordinate and integrate physical and behavioral health care, and social services provided to health home members.

In the Finger Lakes region there are two Health Home providers. All counties are served by one provider, except Monroe, which is served by two (Table 18).

7. Behavioral Health Care Practitioners

Table 18. Finger Lakes Region: Health Homes Serving Medicaid Enrollees by County

County Total # Health Homes

Serving Region # Health Homes Serving County

Chemung

2

1 Livingston 1 Monroe 2 Ontario 1 Schuyler 1 Seneca 1 Steuben 1 Wayne 1 Yates 1 Data is from the NYS Department of Health Designated Health Homes Web page. Retrieved May 4, 2016 from https://www.health.ny.gov/health_care/ medicaid/program/medicaid_health_homes/contact_information/list_by_county.htm #clinton

Licensed Mental Health Professionals In New York State, the licensed mental health (MH) workforce includes psychiatrists, psychologists, clinical or master level social workers, nurse practitioners–psychiatry, marriage and family therapists, mental health counselors, psychoanalysts, and creative arts therapists.7 The number and distribution of these practitioners in the Finger Lakes region is presented in Table 19.

Table 19. Finger Lakes Region: Licensed Mental Health Professionals

County


Population

Psychiatrists Psychologists LCSWs LMSWs Mental Health

Counseling

Nurse Practitioner -

Psychiatry *Other Total Per 10,000

Chemung 88,772 16 12 75 89 24 3 4 223 25 Livingston 65,305 0 10 45 45 16 2 4 122 19 Monroe 743,535 213 330 668 1,091 295 98 176 2,871 39 Ontario 107,226 15 30 100 108 33 13 20 319 30 Schuyler 18,496 0 5 21 15 2 0 2 45 24 Seneca 35,325 3 0 30 19 8 1 1 62 18 Steuben 98,837 8 23 65 64 20 5 4 189 19 Wayne 93,502 5 6 39 82 35 3 9 179 19 Yates 25,295 3 3 9 23 3 2 1 44 17

Totals 1,276,293 263 419 1,052 1,536 436 127 221 4,054 32 Data for psychiatrists is from the American Board of Psychiatry and Neurology, Inc. and was retrieved from https://application.abpn.com/verifycert/verifycert.asp on July 15, 2014. Data for all other professions is as of June 2, 2014 and was provided by the Office of the Professions at the New York State Education Department. *Other category includes marriage and family therapists, psychoanalysts, and creative arts therapists.



The Finger Lakes region has a total of 4,054 licensed MH professionals or 32 per 10,000 population. There are maldistributions of MH professionals across the region’s counties. Yates County has the lowest county distribution of MH professionals ─ 17 per 10,000 compared to Monroe County which has the highest ─ 39 per 10,000. In addition, Livingston and Schuyler counties have no psychiatrists and Seneca County has no psychologists.

MH Professional Shortage Designations The maldistribution of licensed MH professionals in the Finger Lakes region i s recognized by federally designated health professional shortage areas (HPSAs). HPSAs are designated on the county level by the federal Health Resources and Services Administration (HRSA). HPSAs are designated using several criteria, including population-to-clinician ratios. This ratio is usually 6,000 to 1 for mental health care.

In the Finger Lakes region, Chemung, Schuyler, Seneca, Steuben and Yates counties each has a whole county MH professional shortage designation (Table 19a). All counties in the region, except Steuben, have a census tract, population or facility designated as a MH Medically Underserved Area/Population (MUA/P). In addition, the Medicaid eligible populations in all counties, except Livingston and Schuyler, have also been designated MH MUPs.

Table 19a. Finger Lakes Region: HRSA Federal Mental Health Professional Shortage Designations

County Whole County Census tract,

populations or facilities

Medicaid Eligible population

Chemung Yes Yes Yes Livingston Yes Monroe Yes Yes Ontario Yes Yes Schuyler Yes Yes Seneca Yes Yes Yes Steuben Yes Yes Wayne Yes Yes Yates Yes Yes Yes HRSA federal shortage designations retrieved March 17, 2016 from http://datawarehouse.hrsa.gov/tools/analyzers/hpsafind.aspx

Certified and Credentialed Substance Use Disorder Professionals In New York State, the certified and credentialed substance use disorder (SUD) workforce includes physicians and counselors. The number and distribution of these practitioners in the Finger Lakes region is presented in Table 20. All counties in the Finger Lakes region have SUD professionals.



Table 20. Finger Lakes Region: Certified and Credentialed Substance Use Disorder Professionals

County US Census


Physicians Counselors

Total Per 10,000 Population Board Certified

Addiction Medicine

Authorized for Buprenorphine

Prescription

Credentialed Alcoholism and Substance Abuse

Certified Rehabilitation

Chemung 88,772 1 6 24 2 32 4 Livingston 65,305 1 8 20 3 31 5 Monroe 743,535 13 107 315 35 457 6 Ontario 107,226 3 11 48 6 65 6 Schuyler 18,496 0 4 2 1 7 4 Seneca 35,325 1 4 17 1 22 6 Steuben 98,837 0 13 24 1 38 4 Wayne 93,502 1 2 31 2 35 4 Yates 25,295 0 1 6 1 8 3

Totals 1,276,293 20 156 487 52 695 5 Data is from the NYS Office of Alcoholism and Substance Abuse Services (OASAS) Human Resources Office and is as of May 13, 2016.

SUD physicians include those board certified in addiction medicine and those authorized to prescribe buprenorphine to treat opioid addiction. In the Finger Lakes region there are 20 physicians certified in addiction medicine, but none in Schuyler, Steuben and Yates counties. All counties have physicians authorized to prescribe buprenorphine.

SUD counselors include those credentialed in alcoholism and substance abuse and those certified in rehabilitation. All counties in the Finger Lakes region have both alcoholism and substance abuse counselors and rehabilitation counselors.

Overall, the Finger Lakes region has a total of 695 certified and credentialed SUD professionals or five per 10,000 population. Yates County has the lowest county distribution of SUD professionals ─ three per 10,000 compared to the highest in Monroe, Ontario and Seneca counties ─ six per 10,000 each.

While there are no HPSA shortage designations for SUD professionals, an area will be considered to have unusually high needs for mental health services if: 1) there is a high prevalence of alcoholism in the population, as indicated by prevalence data showing the area's alcoholism rates to be in the worst quartile of the nation, region, or State; or 2) there is a high degree of substance abuse in the area, as indicated by prevalence data showing the area's substance abuse to be in the worst quartile of the nation, region, or State.8

1 NYS Nursing Home Behavioral Intervention Services: This program must include a discrete unit with a planned combination of services with staffing, equipment and physical facilities designed to serve individuals whose severe behavior cannot be managed in a less restrictive setting. The program’s services are directed at attaining or maintaining the individual at the highest practicable level of physical, affective, behavioral and cognitive functioning. Retrieved April 21, 2016 from https://www.health.ny.gov/facilities/nursing/all_services.htm . 2 Diagnostic and Treatment Centers provide a comprehensive range of primary health care services to a population that includes uninsured individuals.


https://www.health.ny.gov/facilities/nursing/all_services.htm


3 Federally qualified health centers (FQHCs) include all organizations receiving grants under Section 330 of the Public Health Service Act (PHS). FQHCs qualify for enhanced reimbursement from Medicare and Medicaid, as well as other benefits. FQHCs must serve an underserved area or population, offer a sliding fee scale, and provide comprehensive services. 4 A primary care HPSA is a collection of census tracts that has been designated as having a shortage of primary care health professionals. HRSA uses two methodologies to determine whether there are adequate health care resources for specific geographical areas. Aggregate ZIP codes or census tracts can be designated as a Medically Underserved Area/Population (MUA/P) based on an analysis of four criteria: the ratio of primary care medical care physicians per 1,000 population, infant mortality rate, percentage of the population with incomes below the poverty level, and percentage of the population age 65 or over. A medically underserved population faces economic barriers (e.g. low-income or Medicaid-eligible populations), or cultural and/or linguistic access barriers to primary medical care services, and population specific information is assessed according to the above criteria to achieve MUP designation. 5 In this report adults are individuals aged 20 and older and children are individuals aged 19 and younger. 6 More information about OASAS inpatient programs is available at http://www.oasas.ny.gov/hps /state/CD_descriptions.cfm 7 Licensed Mental Health Workforce Data Sources and Limitations: Data for psychiatrists is from the American Board of Psychiatry and Neurology, Inc. and was retrieved from https://application.abpn.com/verifycert/verifycert.asp on July 15, 2014. Data for all other professions is as of June 2, 2014 and was provided by the Office of the Professions at the New York State Education Department. Licensees must be registered in order to practice and use a professional title in NYS; being registered, however, does not necessarily mean the licensee is actively engaged in practice. In addition, NYS licensing data show only “nurse practitioners-psychiatry” as a BH-psychiatric nurse specialty. All other nursing specialties that contribute to the licensed BH workforce are combined in the general category of “nurse” in the NYS licensing data and are not counted in the licensed BH workforce described here. This limitation also extends to other data sources such as professional nursing organizations, which also combine a l l nursing specialties in a general category of “nurse” in their data collection processes.8 HRSA Guidelines for Mental Health HPSA Designation. Retrieved May 24, 2016 from http://bhpr.hrsa.gov/shortage/hpsas/designationcriteria/mentalhealthhpsaguidelines.html


http://bhpr.hrsa.gov/shortage/hpsas/designationcriteria/mentalhealthhpsaguidelines.html

https://application.abpn.com/verifycert/verifycert.asp

http://www.oasas.ny.gov/hps


III. Health Status

This section describes the health status of individuals in the Finger Lakes DSRIP region. Its findings should be considered with those in Sections V and VI of this report, which describe unmet service need by DSRIP region.

1. Disease Prevalence Chronic Health Conditions Among all DSRIP regions, the Finger Lakes region has the second highest average percentage of adults with angina, heart attack or stroke (8%). In the region, Chemung County has the highest percentages of adults with high blood pressure (33%), diabetes and angina, heart attack or stroke (11% each). Wayne County has the highest percentage of adults that are overweight or obese (72%, the highest percentage in any NYS county), and Livingston County has the highest percentage of adults with asthma (16%, the second highest percentage in any NYS county) (Table 1).

Table 1. Finger Lakes Region: Prevalence of Chronic Health Conditions Among Adults

County

Age-adjusted Percentage of Adults

With physician diagnosed diabetes

With physician diagnosed

angina, heart attack or

stroke

Ever told they have high

blood pressure

Overweight or obese

(BMI 25 or higher)

With current asthma

Chemung 11 11 33 70 11 Livingston 10 8 27 62 16 Monroe 9 6 31 63 11 Ontario 7 8 30 56 10 Schuyler 10 8 28 65 11 Seneca 11 9 31 71 9 Steuben 8 7 31 66 14 Wayne 9 8 25 72 8 Yates 9 6 27 66 10 Region Average 9 8 29 65 11

Data Source is the NYS Department of Health Community Health Indicator Reports (CHIRS): Latest Data. Retrieved May 2, 2016 from https://health.data.ny.gov/Health/Community-Health-Indicator-Reports-CHIRS-Latest-Da/54ci-sdfi

In the region Wayne County has the lowest percentages of adults with high blood pressure (25%) and asthma (8%). Ontario County has the lowest percentages of adults with diabetes (7%) and that are overweight or obese (56%).



HIV, AIDS, and Cancer Among all DSRIP regions, the Finger Lakes region has the second lowest AIDS average case rate per 100,000 (n=3). The HIV and AIDS case rates (Table 2) are zero in Yates County and highest in Monroe County (ten and seven respectively). The cancer rate per 100,000 is highest in Chemung and Schuyler counties (n=547 each) and lowest in Livingston County (n=460).

Table 2. Finger Lakes Region: Rates of HIV, AIDS, and Cancer

County

Age-adjusted case rate per 100,000

Age-adjusted all cancers incidence rate

per 100,000 HIV AIDS

Chemung 5 5 547 Livingston 2 2 460 Monroe 10 7 510 Ontario 3 1 504 Schuyler 4 3 547 Seneca 2 1 489 Steuben 3 2 484 Wayne 5 4 526 Yates 0 0 499

Region Average 4 3 507 Data Source is the NYS Department of Health Community Health Indicator Reports (CHIRS): Latest Data. Retrieved May 2, 2016 from https://health.data.ny.gov/Health/Community-Health-Indicator-Reports-CHIRS-Latest-Da/54ci-sdfi

2. Health Behaviors and Risk Factors In the Finger Lakes region, Livingston County has the highest percentages of adults that report binge drinking (19%), housing insecurity in the past 12 months (43%), and poor health (7%, the highest percentage in any NYS county) (Table 3). Steuben County has the highest percentages of adults with food insecurity in the past 12 months (29%), not receiving medical care because of cost in the past 12 months (12%), and that report cigarette smoking among those that report poor mental health (42%). The percentage of current smokers ranges from a low of 14% each in Seneca and Yates counties to a high of 25% each in Chemung and Wayne counties. Chemung County also has the highest percentage of adults that poor mental health for 14 or more days in the past month (24%) in any NYS county.

In any NYS county, Yates County has the lowest percentages of binge drinking (8%), and not receiving medical care because of cost (4%) or food insecurity (14%) in the past 12 months. In the region, Yates County has the lowest percentages of housing insecurity in the past 12 months (29%), current smoking (14%), and poor mental health for 14 or more days in the past month (9%). Seneca County has the lowest percentages of adults that report poor health (2%) in any NYS county and current smoking (14%) in the region.



Among all DSRIP regions, the Finger Lakes region has the highest average percentage (14%) of adults with poor mental health for 14 or more days in the last month, and Chemung County has the highest percentage (24%) in any NYS county. The Finger Lakes region also has the lowest average percentages of adults that report binge drinking (14%) and not receiving medical care because of cost in the past 12 months (9%) compared to all other DSRIP regions. Among all NYS counties, Yates County has the lowest percentages of adults that report binge drinking (8%) and not receiving medical care because of cost in the past 12 months (4%).

Table 3. Finger Lakes Region: Adult Self-Reported Health Behaviors and Risk Factors

County Survey

Sample Size

Percentage of Adults Who Self-Reported:

Binge drinking

during past month

Food insecurity in

past 12 months

Housing insecurity in

past 12 months

Poor health Current smoker

Did not receive medical care

because of cost in past 12 mos

Poor mental health for 14 or more days in last month

Cigarette smoking among those who report poor mental

health

Chemung 3,551 15% 24% 30% 5% 25% 11% 24% 35% Livingston 3,208 19% 25% 43% 7% 23% 9% 12% * Monroe 7,210 18% 22% 35% 3% 15% 11% 11% 31% Ontario 3,590 10% 17% 31% 4% 18% 11% 12% 41% Schuyler 2,848 10% 24% 34% 4% 22% 8% 17% * Seneca 3,430 19% 20% 37% 2% 14% 8% 14% * Steuben 4,522 14% 29% 38% 5% 24% 12% 14% 42% Wayne 3,391 13% 19% 30% 3% 25% 8% 11% * Yates 2,915 8% 14% 29% 4% 14% 4% 9% * Region Total/Avg. 34,665 14% 22% 34% 4% 20% 9% 14% 37% *Suppressed due to small sample size. Data is from the CDC Expanded Behavioral Risk Factor Surveillance System (BRFSS) 2013-14 Survey. Retrieved April 27, 2016 from https://health.data.ny.gov/Health/Expanded-Behavioral-Risk-Factor-Surveillance-Surve/jsy7-eb4n?_sm_au_=iVVnMrPRnsfs8P5M

3. Hospitalization Rates by Disease or Cause Cardiovascular disease is the leading cause of hospitalization for all counties in the Finger Lakes region (Table 4), and the rate per 10,000 is highest in Wayne County (n=161) and lowest in Yates (n=112). In the region, Chemung County has the highest hospitalization rates per 10,000 due to drug-related (n=36), stroke (n=29), diabetes (n=20), self-inflicted injury (n=17), and asthma (n=14). Monroe County has the highest rate of newborn drug-related diagnoses (n=157).

Yates County has the lowest rates of hospitalization for all of the diseases listed, and rates of asthma (n=3) and drug-related hospitalizations (n=10) are the lowest among all NYS counties. Schuyler County has the lowest rate of hospitalization for self-inflicted injury (n=5) in the region.

Among all the DSRIP regions, the Finger Lakes region has the second lowest average rate of hospitalizations per 10,000 for asthma (n=8) and drug-related (n=16).



Table 4. Finger Lakes Region: Hospitalization Rates by Disease or Cause

County

Age-adjusted hospitalization rate per 10,000 Newborn drug-related diagnosis rate per 10,000

newborn discharges

Total hospitalizations

Cardiovascular disease

Cerebrovascular disease (stroke)

Diabetes (primary

diagnosis) Asthma

Self-inflicted injury

Drug-related

Chemung 1,345 149 29 20 14 17 36 104 Livingston 970 130 23 10 7 8 12 67 Monroe 1,062 134 24 16 11 8 16 157 Ontario 965 116 21 12 4 7 11 121 Schuyler 1,086 121 19 11 9 5 17 * Seneca 917 125 19 11 6 6 11 68 Steuben 1,140 142 26 19 8 7 23 45 Wayne 1,140 161 26 13 8 8 11 129 Yates 903 112 19 7 3 6 10 *

Region Average 1,059 132 23 13 8 8 16 99 *Suppressed due to small sample size. Data Source is the NYS Department of Health Community Health Indicator Reports (CHIRS): Latest Data. Retrieved May 2, 2016 from https://health.data.ny.gov/Health/Community-Health-Indicator-Reports-CHIRS-Latest-Da/54ci-sdfi

4. Mortality Rates Premature Mortality In the Finger Lakes region, Wayne County has the highest percentage of premature deaths (40%) and Monroe County has the lowest (36%) (Table 5). Schuyler County has the highest premature death rate per 100,000 from cardiovascular disease (n=111) and Yates County has the lowest (n=82). Ontario County has the highest premature death rate due to stroke (n=20), and Schuyler and Steuben counties have the lowest (n=8 each). Schuyler County has the highest alcohol related motor vehicle injuries and deaths (n=80, the third highest in any NYS county).

Among all DSRIP regions, the Finger Lakes region has the second lowest percentage of premature deaths.



Table 5. Finger Lakes Region: Percentage and Rates of Premature Death and Alcohol Related Motor Vehicle Injuries and Deaths

County

Percentage

premature deaths

(aged less than 75

years)

Rate per 100,000

Premature Death (aged 35-64 years) Alcohol related

motor vehicle

injuries and deaths Cardiovascular

disease

Cerebrovascular

disease (stroke)

Chemung 38 106 14 37 Livingston 38 107 16 51 Monroe 36 100 12 47 Ontario 37 97 20 49 Schuyler 37 111 8 80 Seneca 39 98 14 57 Steuben 38 107 8 53 Wayne 40 97 15 51 Yates 38 82 17 50 Average % or Rate 38 101 14 53 Data Source is the NYS Department of Health Community Health Indicator Reports (CHIRS): Latest Data. Retrieved May 2, 2016 from https://health.data.ny.gov/Health/Community-Health-Indicator-Reports-CHIRS-Latest-Da/54ci-sdfi

Top Ten Causes of Death Among all DSRIP regions, the Finger Lakes region has the highest average death rate per 100,000 from malignant neoplasms (n=168), the second highest average rate due to chronic lower respiratory disease (n=47) and the lowest average rate of deaths due to heart disease (n=159).

Table 6. Finger Lakes Region: 2014 Top Ten Causes of Death — Rates* per 100,000 Population by Resident County

County Heart

Disease Malignant Neoplasms

Cerebrovascular Disease (Stroke)

AIDS Pneumonia

Chronic Lower

Respiratory Disease

Accidents Diabetes Mellitus

Homicide or Legal

Intervention

Cirrhosis of Liver

Suicide

Chemung 211 168 38 7 24 60 26 16 2 8 9 Livingston 124 159 28 0 11 34 23 13 1 5 4 Monroe 143 162 33 1 18 28 30 13 5 7 7 Ontario 149 151 35 0 11 37 30 17 2 9 15 Schuyler 190 186 33 0 17 54 26 15 0 4 7 Seneca 144 159 25 0 12 52 36 16 0 20 16 Steuben 186 183 29 0 20 48 41 18 0 4 16 Wayne 152 151 29 0 15 45 28 27 1 11 9 Yates 135 195 24 4 8 67 36 21 0 7 20 Region Average 159 168 31 1 15 47 31 17 1 8 11

Data is from the NYS Department of Health. Retrieved April 26, 2016 from https://www.health.ny.gov/statistics/vital_statistics/2014/table40.htm *Age-Sex adjusted rates are directly standardized using the age-sex distribution for the United States 2000 Census.



Malignant neoplasms is the number one cause of death in five of the nine counties in the Finger Lakes region, and heart disease is the number one cause in the remaining four counties (Table 6). In the region, Yates County has the highest death rate due to malignant neoplasms (n=195, the highest rate in any NYS county), chronic lower respiratory disease (n=67, the highest rate in any NYS county) and suicide (n=20). Livingston County has the lowest death rate due to suicide (n=4) in any NYS county. Chemung County has the highest death rates due to heart disease (n=211), stroke (n=38), AIDS (n=7), and pneumonia (n=24). Rates of death per 100,000 are highest from accidents in Steuben County (n=41), from diabetes in Wayne County (n=27), and from cirrhosis of the liver in Seneca County (n=20, the highest rate in any NYS county).

5. Patients in the Public Mental Health System Every other year, the NYS Office of Mental Health (OMH) collects information about patients served over a one week period in NYSOMH funded or licensed outpatient and inpatient facilities. Tables 7 and 8 report the chronic health conditions and behavioral health diagnoses of those served in 2015.

Chronic Health Conditions Overall, smoking (29%), obesity, and high blood pressure (17% each) are the leading chronic health conditions for the public mental health population in the Finger Lakes region (Table 7).

Among all DSRIP regions, the Finger Lakes region has the second highest percentage of patients served with obesity (17%).

For patients ages 65 and older, the Finger Lakes region has lowest percentage of current smokers (14%) in all DSRIP regions.

Table 7. Finger Lakes Region:Chronic Health Conditions Among Those Served in the NYS Public Mental Health System

Age Group

Percentage of Patients Served with Chronic Health Conditions

Current Smokers

Diabetes Obesity High Blood Pressure

Hyperlipidemia Had a Heart

Attack Had a Stroke

Under 21 6 1 6 1 0 0 0 21-64 37 11 20 20 12 1 1 65+ 14 20 17 35 28 3 3 Total Average 29 10 17 17 11 1 1 Data is from the NYS Office of Mental Health 2015 Patient Characteristics Survey. Data retrieved April 28, 2016.



Behavioral Health Diagnoses Overall, depressive disorders (25%) and co-occurring disorder (21%) are the leading behavioral health diagnoses for the public mental health population in the region (Table 8).

Table 8. Finger Lakes Region: Behavioral Health Diagnoses Among Those Served in the NYS Public Mental Health System

Age Group

Percentage of Patients Served by Diagnostic Category

Anxiety Disorder

Bipolar and related Disorders

Depressive Disorders

Disruptive Impulse Conduct Disorder

Neurodevelop-mental

Disorders

Schizophrenia Spectrum & other

Psychotic Disorders

Trauma Stress or Adjustment

Not a Mental Illness

With a Co-Occuring Disorder

Under 21 16 10 17 9 22 2 17 4 4 21-64 10 17 28 1 1 22 10 2 28 65+ 8 16 26 0 0 29 3 3 11 Total Average 11 16 25 3 6 18 11 2 21 Data is from the NYS Office of Mental Health 2015 Patient Characteristics Survey. Data retrieved April 28, 2016.

Among all DSRIP regions, the Finger Lakes region has the highest percentage of patients served with anxiety disorders (11%).

Among patients under the age of 21, the region has the highest percentages of those with anxiety disorder (16%) and with a co-occurring disorder (4%) in all DSRIP regions.

For patients ages 21-64, it has the second highest percentage of those with anxiety disorder (10%) in all DSRIP regions.

For patients ages 65 and older, the Finger Lakes region has the second highest percentage of those with bipolar and related disorders (16%) in all DSRIP regions.



IV. Behavioral Health Care Utilization

This section describes behavioral health care utilization in hospitals and emergency rooms by Medicaid beneficiaries in the Finger Lakes DSRIP region. Its findings should be considered with those in Sections V and VI of this report, which describe unmet service need by DSRIP region.

1. Medicaid Beneficiaries with Mental Health Diagnoses

Mental Health Diagnosis Inpatient Admissions Table 1 describes the number of Medicaid beneficiaries in the Finger Lakes region with inpatient hospital admissions (n=24,037) by mental health diagnosis. By county, admissions ranged from a high of 15,465 in Monroe to a low of 168 in Schuyler. Region-wide, the largest percentages of Medicaid beneficiaries with a mental health inpatient hospital admission had depressive disorders (48%), followed by other mental health diagnoses (15%), chronic stress and anxiety diagnoses (13%), schizophrenia (12%), bi-polar disorder (8%), and PTSD (3%).

Table 1. Finger Lakes Region: Number of Medicaid Beneficiaries with Inpatient Hospital Admissions by Mental Health Diagnosis

County

Bi-Polar Disorder Depressive Disorders

Schizophrenia Chronic Stress and Anxiety Diagnoses

Post Traumatic Stress Disorder

Other Mental Health Diagnoses

Total Medicaid Beneficiaries with

Number/Percentage of Medicaid Beneficiaries MH Inpatient

N % N % N % N % N % N % Admission

Chemung 293 10% 1,176 41% 291 10% 349 12% 195 7% 546 19% 2,850 Livingston 40 7% 301 52% 53 9% 99 17% 11 2% 79 14% 583 Monroe 1,276 8% 7,563 49% 1,977 13% 1,890 12% 430 3% 2,329 15% 15,465 Ontario 106 8% 599 48% 145 12% 179 14% 29 2% 196 16% 1,254 Schuyler 11 7% 109 65% 15 9% 24 14% 0 0% 9 5% 168 Seneca 48 9% 226 45% 58 11% 68 13% 16 3% 91 18% 507 Steuben 139 9% 806 50% 205 13% 238 15% 15 1% 211 13% 1,614 Wayne 83 6% 687 51% 118 9% 208 15% 37 3% 211 16% 1,344 Yates 9 4% 140 56% 25 10% 45 18% 0 0% 33 13% 252

Totals 2,005 8% 11,607 48% 2,887 12% 3,100 13% 733 3% 3,705 15% 24,037Data is from the NYS Department of Health Medicaid Chronic Conditions and Inpatient Admissions data base, 2012 data. Retrieved May 4, 2016 from https://health.data.ny.gov/ Health/Medicaid-Chronic-Conditions-Inpatient-Admissions-a/2yck-xisk#Export

In the region, the percentages of Medicaid beneficiaries hospitalized for mental health diagnoses were highest by diagnosis in the following counties: bipolar disorder in Chemung County (10%), depressive disorders in Schuyler County (65%, the highest in any NYS county), schizophrenia in Monroe and Steuben counties (13% each), chronic stress and anxiety diagnoses in Yates County (18%), and PTSD (7%, the highest in any NYS county) and some other mental health diagnosis (19%) in Chemung County. Compared to all other DSRIP regions, the Finger Lakes region had the largest percentage of Medicaid beneficiaries hospitalized with depressive disorders (48%).



Table 2 describes the number of Medicaid inpatient hospital admissions in the Finger Lakes region (n=45,272) by mental health diagnosis. By county, admissions ranged from a high of 29,494 in Monroe County to a low of 280 in Schuyler.

Table 2. Finger Lakes Region: Number of Medicaid Inpatient Hospital Admissions by Mental Health Diagnosis

County Bi-Polar Disorder


Schizophrenia Chronic Stress

and Anxiety Diagnoses


Other Mental Health

Diagnoses

Total Number of

MH

Number of Admissions Admissions

Chemung 587 2,288 590 657 340 1,103 5,565 Livingston 63 483 94 205 15 126 986 Monroe 2,489 13,780 3,606 3,698 862 5,059 29,494 Ontario 181 1,020 239 334 70 378 2,222 Schuyler 19 177 28 43 0 13 280 Seneca 101 402 131 97 24 198 953 Steuben 279 1,517 412 452 27 434 3,121 Wayne 148 1,136 208 372 66 341 2,271 Yates 14 212 42 60 0 52 380

Totals 3,881 21,015 5,350 5,918 1,404 7,704 45,272 Data is from the NYS Department of Health Medicaid Chronic Conditions and Inpatient Admissions data base, 2012 data. Retrieved May 4, 2016 from https://health.data.ny.gov/ Health/Medicaid-Chronic-Conditions-Inpatient-Admissions-a/2yck-xisk#Export

Depressive disorders accounted for the largest number of inpatient admissions in all counties and were highest in Monroe (n=13,780). Across counties, admissions were highest in Monroe County for all diagnoses.

Mental Health Diagnosis Emergency Room Visits Table 3 describes the total number of Medicaid beneficiaries in the Finger Lakes region with emergency room visits (n=54,581) by mental health diagnosis. By county, ER visits ranged from a high of 31,907 in Monroe to a low of 797 in Schuyler. Region-wide by diagnosis, the largest percentages of Medicaid beneficiaries with a mental health ER visit were for depressive disorders (43%), followed by other mental health diagnoses (21%), chronic stress and anxiety diagnoses (13%), schizophrenia (12%), bi-polar disorder (8%), and PTSD (4%).

In the region, the percentages of Medicaid beneficiaries with ER visits were highest by diagnoses in the following counties: depressive disorders in Monroe and Schuyler counties (46% each, the highest in any NYS county), bipolar disorder in Chemung County (10%), schizophrenia in Monroe and Steuben counties (13% each), chronic stress and anxiety diagnoses in Schuyler County (16%), and PTSD (8%, the highest in any NYS county) and other mental health diagnoses (27%) in Chemung County.



Table 3. Finger Lakes Region: Number of Medicaid Beneficiaries with Emergency Room Visits by Mental Health Diagnosis



Schizophrenia Chronic Stress and Anxiety Diagnoses


Other Mental Health Diagnoses Total Medicaid

BeneficiariNumber/Percentage of Medicaid Beneficiaries

es with MH ER Visit

# % # % # % # % # % # % Chemung 599 10% 2,029 33% 606 10% 729 12% 482 8% 1,676 27% 6,121 Livingston 148 7% 941 42% 220 10% 335 15% 72 3% 505 23% 2,221 Monroe 2,431 8% 14,602 46% 4,088 13% 3,927 12% 1,037 3% 5,822 18% 31,907 Ontario 326 9% 1,465 40% 406 11% 514 14% 143 4% 835 23% 3,689 Schuyler 54 7% 365 46% 89 11% 130 16% 15 2% 144 18% 797 Seneca 114 8% 522 39% 163 12% 181 13% 51 4% 311 23% 1,342 Steuben 323 8% 1,634 41% 517 13% 594 15% 78 2% 882 22% 4,028 Wayne 252 7% 1,433 40% 356 10% 526 15% 133 4% 912 25% 3,612 Yates 54 6% 380 44% 97 11% 113 13% 23 3% 197 23% 864

Totals 4,301 8% 23,371 43% 6,542 12% 7,049 13% 2,034 4% 11,284 21% 54,581 Data is from the NYS Department of Health Medicaid Chronic Conditions and Emergency Room Visits database, 2012 data. Retrieved May 4, 2016 from https://health.data.ny.gov/Health/Medicaid-Chronic-Conditions-Inpatient-Admissions-a/wybq-m39t

Table 4 describes the total number of Medicaid ER visits in the Finger Lakes region (n=193,155) by mental health diagnosis. By county, ER visits ranged from a high of 119,030 in Monroe County to a low of 2,284 in Schuyler.

Table 4. Finger Lakes Region: Number of Medicaid Emergency Room Visits by Mental Health Diagnosis


Depressive Disorders Schizophrenia

Chronic Stress and Anxiety Diagnoses


Other Mental Health Diagnoses

Total Number of ER Visits

Number of ER Visits

Chemung 2,645 7,771 2,496 3,141 2,046 6,269 24,368 Livingston 485 2,473 616 1,036 216 1,284 6,110 Monroe 10,310 50,929 15,525 15,079 4,466 22,721 119,030 Ontario 1,219 4,443 1,366 1,600 482 2,452 11,562 Schuyler 134 1,074 215 417 67 377 2,284 Seneca 367 1,464 474 473 131 815 3,724 Steuben 1,194 5,123 1,571 1,996 326 2,705 12,915 Wayne 824 4,063 1,136 1,717 477 2,618 10,835 Yates 195 1,015 272 321 62 462 2,327

Totals 17,373 78,355 23,671 25,780 8,273 39,703 193,155 Data is from the NYS Department of Health Medicaid Chronic Conditions and Emergency Room Visits database, 2012 data. Retrieved May 4, 2016 from https://health.data.ny.gov/Health/Medicaid-Chronic-Conditions-Inpatient-Admissions-a/wybq-m39t

Depressive disorders accounted for the largest number of ER visits in all counties and were highest in Monroe (n=50,929). Across counties, ER visits were highest in Monroe County for all diagnoses.



Medicaid Mental Health Beneficiaries Compared to All Medicaid Beneficiaries Table 5 describes Medicaid mental health beneficiaries compared to all Medicaid beneficiaries in the Finger Lakes region. In the region, 8% of all Medicaid beneficiaries had a mental health inpatient hospital admission and 19% had a mental health ER visit. By county, Chemung had the highest percentage of Medicaid beneficiaries with a mental health inpatient admission (12%), while Schuyler had the lowest (4%). Chemung County had the highest percentage of Medicaid beneficiaries with a mental health ER visit (25%) and Yates County had the lowest (16%).

Table 5. Finger Lakes Region: Percentage of Medicaid Population with Mental Health Inpatient Hospital Admission or Emergency Room Visit

County All Medicaid

Medicaid Beneficiaries with MH Inpatient Admission

Medicaid Beneficiaries with MH ER Visit

Beneficiaries Number/Percentage of Medicaid Beneficiaries

N % N %

Chemung 24,114 2,850 12% 6,121 25% Livingston 11,017 583 5% 2,221 20% Monroe 175,174 15,465 9% 31,907 18% Ontario 19,040 1,254 7% 3,689 19% Schuyler 4,722 168 4% 797 17% Seneca 6,456 507 8% 1,342 21% Steuben 23,215 1,614 7% 4,028 17% Wayne 18,587 1,344 7% 3,612 19% Yates 5,245 252 5% 864 16%

Totals 287,570 24,037 8% 54,581 19% Data is from the NYS Department of Health Medicaid Chronic Conditions and Inpatient Admissions data base, 2012 data. Retrieved May 4, 2016 from https://health.data.ny.gov/ Health/Medicaid-Chronic-Conditions-Inpatient-Admissions-a/2yck-xisk#Export

2. Medicaid Beneficiaries with Substance Use Disorders

Substance Use Disorder Inpatient Admissions Table 6 describes the total number of Medicaid beneficiaries in the Finger Lakes region with inpatient hospital admissions (n=10,503) by substance use disorder (SUD). By county, admissions ranged from a high of 8,220 in Monroe to a low of zero in Schuyler. Region-wide, the largest percentage of Medicaid beneficiaries with a SUD inpatient hospital admission had alcohol use disorder (33%), followed by drug abuse: cannabis/NOS/NEC (23%), cocaine use disorder (18%), opioid use disorder (14%), and other SUD diagnoses (12%).

In the region, the percentages of Medicaid beneficiaries hospitalized for SUDs were highest by disorder in the following counties: alcohol use disorder (57%) and drug abuse: cannabis/NOS/NEC (43%) in Yates County, cocaine use disorder in Monroe County (21%, the highest in any NYS county), opioid use disorder in Seneca County (24%), and other SUD diagnoses (17%) in Ontario County.



Table 6. Finger Lakes Region: Number of Medicaid Beneficiaries with Inpatient Hospital Admissions by Substance Use Disorder

County

Cocaine Use Disorder

Alcohol Use Disorder

Opioid Use Disorder

Drug Abuse: Cannabis/ NOS/NEC

Other SUD Diagnoses

Total Medicaid Beneficiaries with

Number/Percentage of Medicaid Beneficiaries Admission SUD Inpatient

# % # % # % # % # %

Chemung 114 12% 335 36% 100 11% 244 26% 145 15% 938 Livingston 0 0% 38 37% 21 20% 32 31% 12 12% 103 Monroe 1,696 21% 2,668 32% 1,135 14% 1,780 22% 941 11% 8,220 Ontario 39 11% 118 32% 76 21% 74 20% 62 17% 369 Schuyler 0 0% 0 0% 0 0% 0 0% 0 0% 0 Seneca 0 0% 32 29% 26 24% 42 39% 9 8% 109 Steuben 40 9% 158 34% 87 19% 113 24% 64 14% 462 Wayne 24 9% 113 41% 34 12% 75 27% 33 12% 279 Yates 0 0% 13 57% 0 0% 10 43% 0 0% 23

Totals 1,913 18% 3,475 33% 1,479 14% 2,370 23% 1,266 12% 10,503 Data is from the NYS Department of Health Medicaid Chronic Conditions and Inpatient Admissions data base, 2012 data. Retrieved May 4, 2016 from https://health.data.ny.gov/ Health/Medicaid-Chronic-Conditions-Inpatient-Admissions-a/2yck-xisk#Export

Table 7 describes the number of Medicaid inpatient hospital admissions in the Finger Lakes region (n=22,602) by substance use disorder. By county, admissions ranged from a high of 17,800 in Monroe County to a low of zero in Schuyler.

Alcohol use disorder accounted for the largest number of inpatient admissions in all counties except Seneca, and were highest in Monroe (n=2,668). Across counties, admissions for all disorders were highest in Monroe County.

Table 7. Finger Lakes Region: Number of Medicaid Inpatient Hospital Admissions by Substance Use Disorder

County

Cocaine Use

Disorder

Alcohol Use

Disorder

Opioid Use

Disorder


Other SUD Diagnoses

Total Number of SUD

Admissions Number of Admissions

Chemung 114 335 100 244 145 2,171 Livingston 0 38 21 32 12 199 Monroe 1,696 2,668 1,135 1,780 941 17,800 Ontario 39 118 76 74 62 668 Schuyler 0 0 0 0 0 0 Seneca 0 32 26 42 9 254 Steuben 40 158 87 113 64 950 Wayne 24 113 34 75 33 515 Yates 0 13 0 10 0 45

Totals 1,913 3,475 1,479 2,370 1,266 22,602 Data is from the NYS Department of Health Medicaid Chronic Conditions and Inpatient Admissions data base, 2012 data. Retrieved May 4, 2016 from https://health.data.ny.gov/ Health/Medicaid-Chronic-Conditions-Inpatient-Admissions-a/2yck-xisk#Export



Substance Use Disorder Emergency Room Visits Table 8 describes the total number of Medicaid beneficiaries in the Finger Lakes region with emergency room (ER) visits (n=17,303) by substance use disorder. By county, ER visits ranged from a high of 11,989 in Monroe to a low of 125 in Yates. Region-wide, the largest percentage of Medicaid beneficiaries with a SUD ER visit were for cocaine use disorder (30%), followed by opioid use disorder (24%), drug abuse: cannabis/NOS/NEC (16%), and alcohol use disorder and other SUD diagnoses (15% each).

In the region, the percentages of Medicaid beneficiaries with ER visits were highest by disorder in the following counties: cocaine use disorder in Wayne and Steuben counties (35% each), alcohol use disorder in Monroe County (18%), opioid use disorder in Schuyler County (30%, the highest in any NYS county), drug abuse: cannabis/NOS/ NEC in Livingston County (28%), and other SUD diagnoses in Ontario and Steuben counties (20% each).

Compared to all other DSRIP regions, the Finger Lakes region had the largest percentage of Medicaid beneficiaries with ER visits for opioid use disorder (24%).

Table 8. Finger Lakes Region: Number of Medicaid Beneficiaries with Emergency Room Visits by Substance Use Disorder

County

Cocaine Use Disorder

Alcohol Use Disorder

Opioid Use Disorder


Other SUD Diagnoses

Total Medicaid

Beneficiaries with SUD ER

Visit

Number/Percentage of Medicaid Beneficiaries

# % # % # % # % # %

Chemung 590 33% 219 12% 452 25% 234 13% 300 17% 1,795 Livingston 114 27% 38 9% 87 20% 119 28% 72 17% 430 Monroe 3,576 30% 2,107 18% 2,872 24% 1,823 15% 1,611 13% 11,989 Ontario 215 26% 79 10% 168 21% 191 23% 163 20% 816 Schuyler 49 34% 0 0% 43 30% 26 18% 25 17% 143 Seneca 77 31% 23 9% 65 26% 46 18% 38 15% 249 Steuben 276 29% 68 7% 195 20% 225 23% 194 20% 958 Wayne 278 35% 80 10% 177 22% 153 19% 110 14% 798 Yates 44 35% 0 0% 25 20% 33 26% 23 18% 125

Totals 5,219 30% 2,614 15% 4,084 24% 2,850 16% 2,536 15% 17,303 Data is from the NYS Department of Health Medicaid Chronic Conditions and Emergency Room Visits database, 2012 data. Retrieved May 4, 2016 from https://health.data.ny.gov/Health/Medicaid-Chronic-Conditions-Inpatient-Admissions-a/wybq-m39t

Table 9 describes the number of Medicaid ER visits in the Finger Lakes region (n=74,092) by substance use disorder. By county, ER visits ranged from a high of 54,182 in Monroe County to a low of 467 in Yates. Cocaine use disorder accounted for the largest number of ER visits in all counties except Livingston and Schuyler, and were highest in Monroe (n=15,093). In Livingston County drug abuse: cannabis/NOS/ NEC accounted for the largest number of ER visits, and in Schuyler County opioid use disorder accounted for the largest number. Across counties, ER visits for all disorders were highest in Monroe County.



Table 9. Finger Lakes Region: Number of Medicaid Emergency Room Visits by Substance Use Disorder

County

Cocaine Use

Disorder

Alcohol Use

Disorder

Opioid Use

Disorder


Other SUD Diagnoses

Total Number of ER Visits

Number of ER Visits

Chemung 2,270 1,052 1,896 1,278 1,611 8,107 Livingston 320 103 297 384 178 1,282 Monroe 15,093 10,739 12,258 7,918 8,174 54,182 Ontario 669 245 548 653 559 2,674 Schuyler 124 0 146 104 105 479 Seneca 207 95 261 168 145 876 Steuben 927 199 824 893 774 3,617 Wayne 821 256 567 457 307 2,408 Yates 147 0 117 126 77 467

Totals 20,578 12,689 16,914 11,981 11,930 74,092 Data is from the NYS Department of Health Medicaid Chronic Conditions and Emergency Room Visits database, 2012 data. Retrieved May 4, 2016 from https://health.data.ny.gov/Health/Medicaid-Chronic-Conditions-Inpatient-Admissions-a/wybq-m39t

Medicaid Substance Use Disorder Beneficiaries Compared to All Medicaid Beneficiaries Table 10 describes Medicaid SUD beneficiaries compared to all Medicaid beneficiaries in the Finger Lakes region.

Table 10. Finger Lakes Region: Percentage of Medicaid Population with Substance Use Disorder Inpatient Hospital Admission or Emergency Room Visit

County All Medicaid

Medicaid Beneficiaries with SUD Inpatient Admission

Medicaid Beneficiaries with SUD ER Visit

Beneficiaries Number/Percentage of Medicaid Beneficiaries

N % N %

Chemung 24,114 938 4% 1,795 7% Livingston 11,017 103 1% 430 4% Monroe 175,174 8,220 5% 11,989 7% Ontario 19,040 369 2% 816 4% Schuyler 4,722 0 0% 143 3% Seneca 6,456 109 2% 249 4% Steuben 23,215 462 2% 958 4% Wayne 18,587 279 2% 798 4% Yates 5,245 23 0% 125 2%

Totals 287,570 10,503 4% 17,303 6% Data is from the NYS Department of Health Medicaid Chronic Conditions and Inpatient Admissions data base, 2012 data. Retrieved May 4, 2016 from https://health.data.ny.gov/ Health/Medicaid-Chronic-Conditions-Inpatient-Admissions-a/2yck-xisk#Export



In the region, 4% of all Medicaid beneficiaries had a SUD inpatient hospital admission and 6% had a SUD ER visit. By county, Monroe County had the highest percentage of Medicaid beneficiaries with a SUD inpatient admission (5%), while Schuyler and Yates have the lowest (0% each). Chemung and Monroe counties had the highest percentage of Medicaid beneficiaries with a SUD ER visit (7% each) and Yates County had the lowest (2%).

3. Medicaid Beneficiary Hospital Inpatient Admissions and Emergency Room Visits

Medicaid Beneficiaries by Eligibility Type In the Finger Lakes region 23% of the estimated population are Medicaid beneficiaries (Table 11). By county, Medicaid beneficiaries range from a high of 26% of the estimated population in Schuyler County to a low of 17% of the estimated population in Livingston.

Medicaid beneficiaries include individuals that receive only Medicaid and individuals that are dually-eligible for Medicare and Medicaid benefits because of their age or disability and low incomes.1 In the Finger Lakes region, 83% of Medicaid beneficiaries receive Medicaid only and 17% are dual-eligible. Medicaid only beneficiaries range from a low of 80% in Yates County to a high of 84% in Monroe.

Table 11. Finger Lakes Region: Medicaid Beneficiaries by Eligibility Type

County


Population

Total Medicaid Beneficiaries

Medicaid Only Dual Medicaid and Medicare

# %

Total Pop # % Total Medicaid

Bene. #

% Total Medicaid

Bene.

Chemung 88,772 24,114 27% 19,611 81% 4,503 19% Livingston 65,305 11,017 17% 9,148 83% 1,869 17% Monroe 743,535 175,174 24% 146,646 84% 28,528 16% Ontario 107,226 19,040 18% 15,554 82% 3,486 18% Schuyler 18,496 4,722 26% 3,835 81% 887 19% Seneca 35,325 6,456 18% 5,291 82% 1,165 18% Steuben 98,837 23,215 23% 18,907 81% 4,308 19% Wayne 93,502 18,587 20% 15,116 81% 3,471 19% Yates 25,295 5,245 21% 4,191 80% 1,054 20%

Totals 1,276,293 287,570 23% 238,299 83% 49,271 17%

Data is from the NYS Department of Health’s Medicaid Beneficiaries Inpatient Admissions and Emergency Room Visits data base; 2012 data. Retrieved May 11, 2016 from https://health.data.ny.gov/Health/Medicaid-Beneficiaries-Inpatient-Admissions-and-Em/m2wt-pje4#About

Medicaid Beneficiary Hospital Inpatient Admissions Medicaid beneficiary hospital inpatient admissions in the Finger Lakes region are described in Table 12.2 In the region, 10% of Medicaid only beneficiaries and 15% of Medicaid/Medicare dual-eligible beneficiaries experienced at least one hospital inpatient admission.



Table 12. Finger Lakes Region: Medicaid Hospital Inpatient Admissions by Beneficiary Type

County

Number of BeneficiariesNumber of Beneficiaries with

Inpatient Admissions Total Inpatient

Hospital Admissions

Medicaid Only

Dual Medicaid and Medicare


Medicaid Only


# # # % # % # #

Chemung 19,611 4,503 2,285 12% 793 18% 3,249 1,067 Livingston 9,148 1,869 737 8% 248 13% 973 335 Monroe 146,646 28,528 14,943 10% 4,277 15% 20,927 5,876 Ontario 15,554 3,486 1,418 9% 508 15% 1,821 698 Schuyler 3,835 887 351 9% 120 14% 447 152 Seneca 5,291 1,165 493 9% 156 13% 668 198 Steuben 18,907 4,308 2,040 11% 602 14% 2,761 799 Wayne 15,116 3,471 1,435 9% 491 14% 1,882 650 Yates 4,191 1,054 355 8% 143 14% 429 174

Totals 238,299 49,271 24,057 10% 7,338 15% 33,157 9,949 Data is from the NYS Department of Health’s Medicaid Beneficiaries Inpatient Admissions and Emergency Room Visits data base; 2012 data. Retrieved May 11, 2016 from https://health.data.ny.gov/Health/Medicaid-Beneficiaries-Inpatient-Admissions-and-Em/m2wt-pje4#About

Percentages of Medicaid only beneficiaries with hospital inpatient admissions ranged from a high of 12% in Chemung County to a low of 8% each in Livingston and Yates counties. In comparison, hospital inpatient admissions in the dual-eligible Medicaid/Medicare population ranged from a low of 13% each in Livingston and Seneca counties to a high of 18% in Chemung.

Medicaid Beneficiary Emergency Room Visits Emergency room (ER) visits among Medicaid beneficiaries in the Finger Lakes region are described in Table 13.3 In the region, 32% of Medicaid only beneficiaries and 20% of Medicaid/Medicare dual-eligible beneficiaries experienced at least one ER visit.

Percentages of Medicaid only beneficiaries with ER visits ranged from a low of 29% in Seneca County to a high of 37% in Chemung. In comparison, ER visits for the Medicaid/Medicare dual-eligible population ranged from a low of 16% each in Seneca and Wayne counties to a high of 25% in Chemung.



Table 13. Finger Lakes Region: Medicaid Emergency Room Visits by Beneficiary Type

County

Number of Beneficiaries Number of Beneficiaries

with ER Visits Total ER Visits



Medicaid Only


# # # % # % # #

Chemung 19,611 4,503 7,243 37% 1,112 25% 17,834 2,763 Livingston 9,148 1,869 2,776 30% 320 17% 5,640 675 Monroe 146,646 28,528 47,341 32% 5,788 20% 106,276 14,830 Ontario 15,554 3,486 4,654 30% 759 22% 9,537 1,694 Schuyler 3,835 887 1,324 35% 175 20% 2,736 405 Seneca 5,291 1,165 1,550 29% 188 16% 2,969 336 Steuben 18,907 4,308 6,233 33% 943 22% 13,119 2,222 Wayne 15,116 3,471 4,473 30% 542 16% 9,033 1,219 Yates 4,191 1,054 1,474 35% 196 19% 2,888 337

Totals 238,299 49,271 77,068 32% 10,023 20% 170,032 24,481Data is from the NYS Department of Health’s Medicaid Beneficiaries Inpatient Admissions and Emergency Room Visits data base; 2012 data. Retrieved May 11, 2016 from https://health.data.ny.gov/Health/Medicaid-Beneficiaries-Inpatient-Admissions-and-Em/m2wt-pje4#About

In conclusion, in the Finger Lakes region the Medicaid only population had a higher percentage of ER visits than the Medicaid/Medicare dual-eligible population, while the Medicaid/Medicare dual-eligible population had a higher percentage of hospital inpatient admissions than the Medicaid only population.

1 In this analysis, dual status was based upon the last month of enrollment/eligibility during the year. If the Medicaid beneficiary was indicated as being eligible for Part A, B, C or D Medicare services they are classified as dual eligible. The dual-eligible Medicare and Medicaid population is diverse and includes individuals with multiple chronic conditions, physical disabilities, and cognitive impairments such as dementia, developmental disabilities, and mental illness. It also includes some individuals who are relatively healthy. Retrieved May 12, 2016 from http://www.medpac.gov/documents/data-book/january-2015-medpac-and-macpac-data-book-beneficiaries-dually-eligible-for-medicare-and-medicaid.pdf 2 In this analysis, inpatient utilization was based on all Medicaid inpatient admissions. To avoid duplication, admissions are counted per Medicaid beneficiary, per hospital, per admission. 3 Emergency room utilization was based on all Medicaid fee-for-service and managed care emergency room visits. To avoid duplication with multiple provider claims on a single ER visit for a Medicaid beneficiary, visits were counted per unique recipient per day.


http://www.medpac.gov/documents/data-book/january


V. Unmet Service Needs

Access to an adequate amount of outpatient care and community resources can reduce hospitalizations and emergency room (ER) visits for both behavioral and physical health problems. For example, high rates of potentially avoidable ER visits and hospital admissions suggest a need for further outpatient resources in the community. This section describes the unmet service needs of individuals in the Finger Lakes DSRIP region.

Quality indicators are one of several ways to measure the unmet needs of a community. Unmet service need is reported here using measures of initiation and engagement in behavioral health treatment and measures of potentially avoidable hospitalizations and ER visits. Further information about these measures is included below. Additional information about unmet need in the Finger Lakes DSRIP region from needs assessments of local issues conducted by counties in the region is also included.

1. Behavioral Health Treatment Mental Health Medication Adherence and Management Adherence to Antipsychotic Medications for Individuals with Schizophrenia, and Antidepressant Medication Management are two Healthcare Effectiveness Data and Information Set (HEDIS)/New York State Quality Assurance Reporting Requirement (QARR) measures collected by Performing Provider Systems in the DSRIP program.

Adherence to Antipsychotic Medications for Individuals with Schizophrenia refers to the percentage of members, ages 19 to 64 years, with schizophrenia who were dispensed and remained on an antipsychotic medication for at least 80% of their treatment period.

Antidepressant Medication Management Effective Acute Phase Treatment refers to the percentage of members who remained on antidepressant medication during the entire 12-week acute treatment phase.

Antidepressant Medication Management Effective Continuation Phase Treatment refers to the percentage of members who remained on antidepressant medication for at least six months.

For adults with schizophrenia in the Finger Lakes region, 59% adhere to antipsychotic medications (41% do not). In the region, the percentage with adherence to antipsychotic medications ranges from a low of 57% in Monroe County to a high of 66% each in Chemung, Ontario and Wayne counties (Table 1).

In the region, 49% of individuals remain on antidepressant medication during the acute phase and 35% remain on antidepressant medication during the continuation phase (65% do not). Adherence to antidepressants is lowest in Monroe County for both the acute (46%, the lowest in any NYS county) and continuation (32%) phases. Adherence is highest in Steuben and Yates counties (59% each) for the acute phase and highest in Schuyler (43%) for the continuation phase. Among all DSRIP regions, the Finger Lakes



region has the lowest percentage of individuals adhering to antidepressants in the acute phase.

Table 1. Finger Lakes Region: Mental Health Medication Adherence and Management

County Adherence to Antipsychotic

Medications for Individuals with Schizophrenia

Antidepressant Medication Management

Effective Acute Phase Treatment

Effective Continuation Phase Treatment

Chemung 66% 54% 36% Livingston * 52% 35% Monroe 57% 46% 32% Ontario 66% 53% 40% Schuyler * 56% 43% Seneca * 50% 33% Steuben 65% 59% 40% Wayne 66% 55% 40% Yates * 59% 42%

Region Avg. % 59% 49% 35% *Sample size too small to report. Notes and Data Sources: Data is from the NYS Department of Health -Medicaid clinical metrics for Clinical Improvement Projects (Domain 3) of the DSRIP Program database, measurement year 2014 data.

Mental Health Follow-up Care This section presents HEDIS/QARR measures related to mental health follow-up care.

Follow-up after Hospitalization for Mental Illness within 7 Days refers to the percentage of members who were seen on an ambulatory basis or who were in intermediate treatment with a mental health provider within 7 days of hospital discharge.

Follow-up after Hospitalization for Mental Illness within 30 Days refers to the percentage of members who were seen within 30 days of hospital discharge.

Follow-Up Care for Children Prescribed ADHD Medication Initiation Phase refers to the percentage of children with a new prescription for ADHD medication who had one follow-up visit with a practitioner within the 30 days after starting the medication.

Follow-Up Care for Children Prescribed ADHD Medication Continuation & Maintenance Phase refers to the percentage of children with a new prescription for ADHD medication who remained on the medication for 7 months and who, in addition to the visit in the Initiation Phase, had at least 2 follow-up visits in the 9-month period after the initiation phase ended.

In the Finger Lakes region, 51% of individuals follow-up after hospitalization for mental illness within seven days (49% do not) and 69% follow-up within 30 days (Table 2). In the region, Chemung County has the lowest percentages for both seven day (39%) and 30 day (52%) follow-up after hospitalization for mental illness. Steuben County has the



highest percentages for both seven day (58%) and 30 day (75%) follow-up after hospitalization for mental illness. Among all DSRIP regions, the Finger Lakes region has the second highest percentage of 30 day follow-up after hospitalization for mental illness (69%).

Table 2. Finger Lakes Region: Mental Health Follow-Up Care

County

Follow-up After Hospitalization for Mental Illness

Follow-Up Care for Children Prescribed ADHD Medication

Within 7 Days Within 30 Days Initiation Phase Continuation Phase

Chemung 39% 52% 53% 54% Livingston 52% 71% 45% 39% Monroe 53% 72% 41% 49% Ontario 46% 64% 40% 46% Schuyler 56% 71% * * Seneca 48% 61% 50% * Steuben 58% 75% 53% 57% Wayne 57% 71% 47% 61% Yates 53% 75% 51% *

Region Avg. % 51% 69% 44% 52% *Sample Size Too Small to Report. Notes and Data Sources: Data is from the NYS Department of Health -Medicaid clinical metrics for Clinical Improvement Projects (Domain 3) of the DSRIP Program database, measurement year 2014 data.

In the Finger Lakes region 44% of children prescribed ADHD medication have follow-up care during the initiation phase (56% do not) and 52% have follow-up care during the continuation phase. The percentage of children prescribed ADHD medication with follow-up care for the initiation phase is lowest in Ontario County (40%) and highest in Chemung and Steuben counties (53% each). It is lowest for the continuation phase in Livingston County (39%) and highest in Wayne (61%).

Among all DSRIP regions, the Finger Lakes region has the lowest percentages of ADHD initiation and continuation follow-up care.

Alcohol and Other Drug Dependence Initiation and Engagement in Treatment Performing Provider Systems in the DSRIP program also collect two Alcohol and Other Drug (AOD) Dependence Treatment HEDIS/QARR measures: Initiation and Engagement in treatment.

The Initiation measure is the percentage of members who initiate treatment within 14 days of the diagnosis of AOD dependence.

The Engagement measure is the percentage of members who engage in treatment within 30 days after initiation.



Table 3. Finger Lakes Region: Alcohol and Other Drug Dependence Treatment

County Alcohol and Other Drug Dependence Treatment

Initiation Engagement

Chemung 45% 22% Livingston 46% 26% Monroe 47% 23% Ontario 40% 20% Schuyler 49% 24% Seneca 52% 24% Steuben 41% 23% Wayne 44% 20% Yates 41% 14%

Region Avg. % 46% 23% Notes and Data Sources: Data is from the NYS Department of Health - Medicaid clinical metrics for Clinical Improvement Projects (Domain 3) of the DSRIP Program database, measurement year 2013 data.

In the Finger Lakes region, 46% of individuals initiate AOD treatment within 14 days of diagnosis (54% do not) and 23% of individuals engage in AOD treatment within 30 days after initiation (77% do not). Ontario County has the lowest percentage of initiation of AOD treatment (40%), and Seneca County has the highest (52%) (Table 3). Seneca County has the lowest percentage of engagement in AOD treatment (14%) and Livingston County has the highest (26%).

2. Potentially Avoidable Hospitalizations The Agency for Healthcare Research and Quality (AHRQ) Prevention Quality Indicators (PQIs) are a set of population-based measures that can be used with hospital inpatient discharge data to identify conditions for which good outpatient care can potentially prevent the need for hospitalization, or for which early intervention can prevent complications. PQIs provide a good starting point for assessing quality of health services in the community.

All PQIs apply only to adult populations (individuals over the age of 18 years). The Observed Rate (per 100,000 people) is the number of PQI discharges

divided by the population, multiplied by 100,000. The Expected Rate (per 100,000 people) is the number of PQI discharges

adjusted by age group, gender and race/ethnicity divided by the population, multiplied by 100,000. Lower ratios of observed to expected rates represent better results.

Diabetes Chronic Conditions In the Finger Lakes region’s Medicaid only population, Steuben County has the highest observed to expected ratio for diabetes short-term complications (187/122) and Schuyler County has the highest ratio for long-term complications (155/106) (Table 4a).



Schuyler County has the lowest observed to expected ratios for diabetes short-term complications (39/121) and Livingston County has the lowest ratio for long-term complications (14/108).

Table 4a. Finger Lakes Region: Diabetes Short and Long-Term Complications Inpatient Prevention Quality Indicators by Medicaid Eligibility

County

Diabetes Short-term Complications Diabetes Long-term Complications



Rates per 100,000

Observed Expected Observed Expected Observed Expected Observed Expected


Totals 123 128 147 106 79 111 119 266 Notes and Data Sources: Data is from the NYS Department of Health Quality Prevention Quality Indicators – Adult (AHRQ PQI) for Medicaid Enrollees database, discharge year 2014 data. Retrieved May 6, 2016 from https://health.data.ny.gov/Health/Medicaid-Inpatient-Prevention-Quality-Indicators-P/6kjt-7svn

In the dual Medicaid and Medicare population, Steuben County has the highest observed to expected ratios for diabetes short-term complications (219/64) and Seneca County has the lowest (72/103). All counties have lower observed than expected rates for diabetes long-term complications in the dual population. Among all DSRIP regions, the Finger Lakes region has the second highest observed to expected ratio for diabetes short-term complications in the dual population (147/106) and the lowest ratio for diabetes long-term complications in the dual population (119/266).

Table 4b describes uncontrolled diabetes and lower-extremity amputation rates among patients with diabetes. In the Medicaid only population, Yates County has the highest observed to expected ratio for uncontrolled diabetes (36/16, the highest ratio in any NYS county) and Schuyler and Wayne counties have the lowest (zero each). For lower-extremity amputations in this population, Schuyler County has the highest observed to expected ratio (39/12) and Ontario, Seneca, Steuben and Yates counties have the lowest (zero each).



Table 4b. Finger Lakes Region: Diabetes Chronic Conditions Inpatient Prevention Quality Indicators by Medicaid Eligibility

County

Uncontrolled Diabetes Lower-Extremity Amputation

among Patients with Diabetes



Rates per 100,000

Observed Expected Observed Expected Observed Expected Observed Expected


Totals 18 19 45 37 10 12 31 42 Notes and Data Sources: Data is from the NYS Department of Health Quality Prevention Quality Indicators – Adult (AHRQ PQI) for Medicaid Enrollees database, discharge year 2014 data. Retrieved May 6, 2016 from https://health.data.ny.gov/Health/Medicaid-Inpatient-Prevention-Quality-Indicators-P/6kjt-7svn

In the dual population, Ontario County has the highest observed to expected ratio for uncontrolled diabetes (157/37, the highest ratio in any NYS county) and Schuyler, Seneca and Wayne counties have the lowest (zero each). Seneca County has the highest ratio for lower-extremity amputation among patients with diabetes (72/40) in the dual population and Livingston, Schuyler and Yates counties have the lowest (zero each). Among all DSRIP regions, the Finger Lakes region has the highest observed to expected ratio (45/37) for uncontrolled diabetes in the dual population.

Cardiac Chronic Conditions In the Medicaid only population in the Finger Lakes region (Table 5a), Chemung County has the highest observed to expected ratio for hypertension (109/46, the highest ratio in any NYS county), Yates County has the highest ratio for heart failure (290/95, the highest ratio in any NYS county), and Seneca County has the highest ratio for angina without procedure (25/12). In this population all counties with a zero observed rate have the lowest rates for these cardiac chronic conditions.

In the region’s dual Medicaid and Medicare population all counties have a smaller observed than expected rate for hypertension. The highest ratio for heart failure is in Monroe County (890/737) and the lowest ratio is in Steuben County (263/578). For angina without procedure, the highest ratio is in Seneca County (72/22) and the lowest rates are in Schuyler, Steuben, Wayne and Yates counties (zero each).



Table 5a. Finger Lakes Region: Cardiac Chronic Conditions Inpatient Prevention Quality Indicators by Medicaid Eligibility

County

Hypertension Heart Failure Angina Without Procedure




Rate per 100,000

Observed Expected Observed Expected Observed Expected Observed Expected Observed Expected Observed Expected

Chemung 109 46 82 83 131 122 719 606 15 13 21 24 Livingston 28 40 0 73 71 104 422 559 0 12 47 23 Monroe 42 65 68 125 220 171 890 737 9 16 13 29 Ontario 0 40 26 79 53 103 627 594 0 12 26 23 Schuyler 39 38 0 74 232 98 417 592 0 13 0 22 Seneca 25 39 0 66 50 105 362 547 25 12 72 22 Steuben 22 36 44 72 97 96 263 578 7 12 0 23 Wayne 28 39 0 77 151 102 586 574 9 12 0 24 Yates 0 35 0 75 290 95 533 600 0 12 0 23

Total 33 42 24 81 144 110 535 599 7 13 20 24 Notes and Data Sources: Data is from the NYS Department of Health Quality Prevention Quality Indicators – Adult (AHRQ PQI) for Medicaid Enrollees database, discharge year 2014 data. Retrieved May 6, 2016 from https://health.data.ny.gov/Health/Medicaid-Inpatient-Prevention-Quality-Indicators-P/6kjt-7svn

Asthma Chronic Conditions Asthma chronic conditions are described in Table 5b. Livingston County has the highest observed to expected ratio for asthma in younger adults in the Medicaid only population (87/81), and all other counties in the Finger Lakes region have lower observed than expected rates. In the dual population, Yates County has the highest ratio (862/114, the highest ratio in any NYS county), and all counties with zero observed rates have the lowest.

Among all DSRIP regions, the Finger Lakes region has the lowest observed to expected ratio (39/90) for asthma in younger adults in the Medicaid only population.

Table 5b. Finger Lakes Region: Asthma Chronic Conditions Inpatient Prevention Quality Indicators by Medicaid Eligibility

County

Asthma in Younger Adults


Rate per 100,000

Observed Expected Observed Expected

Chemung 68 90 356 155 Livingston 87 81 0 140 Monroe 81 122 164 271 Ontario 69 87 0 136 Schuyler 0 77 0 116 Seneca 0 81 0 116 Steuben 47 76 0 114 Wayne 0 120 59 83 Yates 0 74 862 114

Total 39 90 160 138 Notes and Data Sources: Data is from the NYS Department of Health Quality Prevention Quality Indicators – Adult (AHRQ PQI) for Medicaid Enrollees database, discharge year 2014 data. Retrieved May 6, 2016 from https://health.data.ny.gov/Health/Medicaid-Inpatient-Prevention-Quality-Indicators-P/6kjt-7svn



Composite PQIs Tables 6 and 7 report observed and expected composite PQIs by county in the Adirondacks region.

The Chronic Composite PQI includes: Diabetes Short-Term and Long-Term Complications Admission Rates, the Asthma in Younger and Older Adults Admission Rates, the Hypertension Admission Rate, the Congestive Heart Failure (CHF) Admission Rate, the Angina without Procedure Admission Rate, the Uncontrolled Diabetes Admission Rate, and the Rate of Lower-Extremity Amputation among Patients with Diabetes.

The Acute Composite includes: the Dehydration Admission Rate, the Bacterial Pneumonia Admission Rate, and the Urinary Tract Infection Admission Rate.

The Overall Composite PQI refers to all PQI measures within the Chronic and Acute Composites.

In the Finger Lake region’s Medicaid only population, Chemung County has the highest observed to expected ratios for the overall composite (1,542/1,038) and acute composite (575/272, the highest ratio in any NYS county) indicators, and Schuyler County has the highest ratio for the chronic composite indicator (927/694). The lowest observed to expected ratios for these indicators are in Livingston County (overall composite, 680/969 and chronic composite, 453/704) and Yates County (acute composite, 217/269).

Table 6. Finger Lakes Region: Prevention Quality Overall, Acute, and Chronic Composite Indicators by Medicaid Eligibility

County

Overall Composite Acute Composite Chronic Composite




Rate per 100,000


Chemung 1,542 1,038 4,212 3,127 575 272 1,623 1,154 967 766 2,589 1,973 Livingston 680 969 2,484 3,017 227 265 1,031 1,143 453 704 1,453 1,874 Monroe 1,223 1,251 3,027 3,540 289 296 870 1,133 934 955 2,157 2,408 Ontario 914 988 3,761 3,097 373 272 1,593 1,163 541 716 2,168 1,935 Schuyler 1,236 966 5,521 3,095 309 272 3,542 1,191 927 694 1,979 1,905 Seneca 1,051 964 3,329 2,968 375 265 2,026 1,135 676 699 1,302 1,833 Steuben 944 954 2,629 3,048 232 270 1,183 1,173 711 684 1,446 1,875 Wayne 1,030 968 3,238 3,039 312 268 1,453 1,118 718 700 1,785 1,921 Yates 869 945 3,819 3,095 217 269 1,865 1,207 651 676 1,954 1,888

Totals 1,054 1,005 3,558 3,114 323 272 1,687 1,157 731 733 1,870 1,957Notes and Data Source: Data is from the NYS Department of Health Quality Prevention Quality Indicators – Adult (AHRQ PQI) for Medicaid Enrollees database, discharge year 2014 data. Retrieved May 6, 2016 from https://health.data.ny.gov/Health/Medicaid-Inpatient-Prevention-Quality-Indicators-P/6kjt-7svn



In the Finger Lakes region’s dual population, Schuyler County has the highest observed to expected ratios for the overall (5,521/3,095, the highest ratio in any NYS county) and acute (3,542/1,191, the highest ratio in any NYS county) composite indicators and Chemung County has the highest ratio for the chronic composite indicator (2,589/1,973). The lowest ratios for these indicators are found in Livingston County (overall composite indicator, 2,484/3,017), Monroe County (acute composite indicator, 870/1,133) and Seneca County (chronic composite indicator, (1,302/1,833). Among all DSRIP regions, the Finger Lakes region has the highest observed to expected ratio (1,687/1,157) for the acute composite indicator in the dual population.

Table 7 describes the all diabetes, circulatory and respiratory composite indicators. In the Finger Lakes region’s Medicaid only population, the highest observed to expected ratios for these indicators are found in Chemung County (all diabetes composite, 335/285), Yates County (all circulatory composite, 290/142, the highest ratio in any NYS county), and Schuyler County (all respiratory composite, 464/295). The lowest ratios for these indicators are in Yates (all diabetes composite, 36/249, lowest in any NYS county), Ontario (all circulatory composite, 53/155) and Livingston (all respiratory composite, 227/287) counties. Among all DSRIP regions, the Finger Lakes region has the highest all circulatory composite observed to expected ratio in the Medicaid only population (184/165).

Table 7. Finger Lakes Region: Prevention Quality All Diabetes, Circulatory, and Respiratory Composite Indicators by Medicaid Eligibility

County

All Diabetes Composite All Circulatory Composite All Respiratory Composite




Rate per 100,000


Chemung 335 285 411 455 255 182 822 714 385 305 1,356 822 Livingston 127 267 281 434 99 155 469 655 227 287 703 801 Monroe 353 331 513 620 270 252 971 892 319 379 685 917 Ontario 186 259 522 449 53 155 679 697 302 306 966 805 Schuyler 232 256 208 409 270 149 417 688 464 295 1,354 824 Seneca 300 268 217 425 100 156 434 635 275 280 651 788 Steuben 262 252 438 409 127 144 307 673 322 293 723 809 Wayne 236 258 229 455 189 153 586 676 302 293 969 807 Yates 36 249 266 399 290 142 533 697 326 290 1,155 807

Total 230 269 343 451 184 165 580 703 325 303 951 820 Notes and Data Sources: Data is from the NYS Department of Health Quality Prevention Quality Indicators – Adult (AHRQ PQI) for Medicaid Enrollees database, discharge year 2014 data. Retrieved May 6, 2016 from https://health.data.ny.gov/Health/Medicaid-Inpatient-Prevention-Quality-Indicators-P/6kjt-7svn

In the Finger Lakes region’s dual population, Chemung County has the highest all circulatory (822/714) and all respiratory (1,356/822) composites and Ontario County has the highest all diabetes composite (522/449). The lowest ratios for these indicators are in Wayne (all diabetes composite, 229/455), Steuben (all circulatory composite, 307/673), and Monroe (all respiratory composite, 685/917) counties.



3. Potentially Avoidable Emergency Room Visits In the Finger Lakes region, Chemung County has the highest observed to expected ratio (35/20) of potentially preventable ER visits (Table 8) and Livingston County has the lowest (16/18).

Table 8. Finger Lakes Region: All Payers Potentially Preventable Emergency Room Visits

County ER Discharges 2013: Rate per 100,000

Observed Expected

Chemung 35 20 Livingston 16 18 Monroe 24 22 Ontario 19 18 Schuyler 31 17 Seneca 21 18 Steuben 30 17 Wayne 21 18 Yates 24 17

Total 25 18 Notes and Data Sources: Data is from the NYS Department of Health All Payer Potentially Preventable Emergency Visit (PPV) database. Rates by patient county, SPARCS data 2013. Retrieved May 6, 2016 from https://health.data.ny.gov/Health/All-Payer-Potentially-Preventable-Emergency-Visit-/f8ue-xzy3#About

Among all DSRIP regions, the Finger Lakes region has the second highest observed to expected ratio (25/18) for potentially preventable ER visits.

4. Local Assessment of Need by Finger Lakes Region Counties New York State Mental Hygiene Law requires the Office of Mental Health (OMH) and the Office of Alcoholism and Substance Abuse Services (OASAS) to guide and facilitate the process of local planning. As part of the planning process, New York State counties and New York City (local governmental units [LGUs]) conduct a needs assessment of local issues impacting populations with mental illness and chemical dependency. These issues include prevention, treatment, and recovery support service needs, including other individualized person-centered supports and services. The issues of workforce retention and recruitment and coordination/integration with other systems are also included.

Table 9 summarizes the results of the LGUs’ needs assessments for the Finger Lakes region. The data were collected from LGUs from March 1, 2015 through June 1, 2015. For each need issue listed, the LGUs indicated the extent to which it is an area of need at the local level for each population by identifying high, moderate or low need.



Table 9. Finger Lakes Region: Assessment of Needs by Population and Issue Assessment of Local Need (N=9 Counties)

Youth (<21) Adults (21+) High Need

Moderate Need

Low Need

Missing High Need

Moderate Need

Low Need

Missing

Selected Issues Mental Illness Population Access to Prevention Services 0% 44% 33% 22% 0% 22% 56% 22% Access to Crisis Services 44% 11% 22% 22% 33% 33% 11% 22% Access to Treatment Services 22% 22% 44% 11% 22% 11% 44% 22% Access to Supported Housing 33% 11% 33% 22% 44% 44% 0% 11% Access to Transportation 11% 67% 11% 11% 33% 44% 11% 11% Access to Home/Community-based Services 0% 44% 33% 22% 0% 22% 56% 22% Access to Other Support Services 0% 33% 33% 33% 11% 33% 22% 33% Workforce Recruitment and Retention 22% 11% 33% 33% 33% 33% 11% 22% Coordination/Integration with Other Systems 22% 44% 11% 22% 22% 33% 22% 22% Selected Issues Chemical Dependency Population Access to Prevention Services 0% 33% 44% 22% 0% 22% 56% 22% Access to Crisis Services 44% 0% 33% 22% 33% 11% 33% 22% Access to Treatment Services 11% 11% 56% 22% 22% 11% 44% 22% Access to Supported Housing 11% 22% 44% 22% 44% 33% 0% 22% Access to Transportation 11% 56% 22% 11% 33% 44% 11% 11% Access to Home/Community-based Services 0% 22% 56% 22% 0% 22% 56% 22% Access to Other Support Services 0% 22% 44% 33% 11% 33% 22% 33% Workforce Recruitment and Retention 11% 11% 44% 33% 22% 33% 22% 22% Coordination/Integration with Other Systems 11% 44% 22% 22% 22% 33% 22% 22%

Mental Illness Population High Needs In the Finger Lakes Region mental illness population the largest rates of high need vary by age group. Among youth (<21) the area of highest need is access to crisis services followed by access to transportation. For adults (21+) the area of highest need is access to supported housing followed by access to crisis services, transportation, and workforce recruitment and retention.

Chemical Dependency Population High Needs In the Finger Lakes region chemical dependency population the largest rates of high need also vary by age group. Among youth (<21) the area of highest need is access to crisis services. For adults (21+) the areas of highest need are access to supported housing followed by crisis services and transportation.



VI. Consumer and Provider Input

This section summarizes the Finger Lakes region’s consumer and provider input regarding community behavioral health needs. Input for this region was collected by Strong Memorial Hospital, which serves Monroe and Livingston counties.

Methods To collect data, clinics used focus group templates and/or anonymous surveys created by NYSOMH. These instruments are included in Appendix IV. Collectively, these data collection instruments focus on behavioral health concerns, available programming and services, potential disparities in service access and use, evidence-based practices, trauma-informed services, and recommendations regarding strategies to promote improved community health.

Clinics utilized the instruments to collect consumer, family, caregiver and provider input. Once collected, clinics aggregated and submitted the consumer and provider input to NYSOMH. The consumer survey was made available in English and Spanish.

Participating clinics were asked to gather input from consumers and providers in and outside of the clinic, including:

Clinic consumers ages 15 and older; parents or guardians of consumers younger than 15; and family members or caregivers of consumers. Consumer information was also collected from Veterans and individuals in foster care or homeless shelters who receive services from secondary related agencies that make referrals to behavioral health services.

Provider surveys were administered to and focus groups were conducted with both clinics and secondary related agency providers.

When reporting survey multiple choice item results to NYSOMH, clinics recorded the frequency for each response option. The percentages reported in the tables below are based on those numbers as indicated. For open-ended questions, clinics recorded the most frequently occurring responses or “themes”. All responses to open-ended survey questions are stated as they were submitted to NYSOMH by Strong Memorial, and include response frequencies. A complete list of open-ended responses is included in Appendix B.

Participant Descriptions and Demographics Demographics and information about participating consumers and providers are reported in Tables 1 and 2 respectively. Strong Memorial surveyed 177 consumers and two providers. A majority of consumers were ages 18-64 (91%), 7% were age 65 or older and 1% were under age 18. Half of provider respondents practice at Strong Memorial, and all consumer respondents were patients there.



Table 1. Finger Lakes Region: Consumer Input – Consumer Demographics

Participant Information (n=177) % Survey Participants 100% Focus Group Participants 0% Not patients at the Clinic 0% Live in the Clinic county 71% Age (n=147) Under 18 1% 18-64 91% 65 or older 7% Gender (n=152) Male 41% Female 59% Race/Ethnicity* (n=150)

White 67% Black/African-American 21% Asian 3% Other Race 0% Hispanic/Latino Ethnicity 7% *The race/ethnicity question was asked only in the survey, not in the focus groups. Participants were instructed to select all that apply. Percentage is the number within each group divided by the number who responded to the question.

Table 2. Finger Lakes Region: Provider Input

Participant Information (n=2) % Survey Participants 100% Focus Group Participants 0% Do not practice at the Clinic 50% Practice within the Clinic county 100% Have a Master’s degree or higher 100%

Findings The consumer and provider input is organized into four domains:

1. Service Utilization, Perceived Service Needs, Barriers to Access, and Disparities in Access

2. Scope of Services in Treatment 3. Provider Training Needs 4. Participants Feel Welcome where they Receive Services

1. Service Utilization, Perceived Service Needs, Barriers to Access, and Disparities in Access

A. Service Utilization Table 3 shows the distribution of behavioral health services that respondents reported using (question 6, consumer survey).



Table 3. Finger Lakes Region: Consumer Survey Input (n=177) – Behavioral Health Services Used

Service Category %* Mental Health Services a. Outpatient mental health services - (e.g., outpatient clinic) 80% b. Inpatient treatment 36% c. Medication for mental health problems 67% d. Residential treatment 22% Substance Use Disorder Services e. Outpatient substance use disorder services (e.g., outpatient clinic) 16% f. Inpatient rehabilitation 6% g. Detoxification 7% h. Residential treatment 8% i. Medication for substance use problems (e.g., methadone or buprenorphine to treat opioid addiction) 9% Other Services j. Case managers or providers who will meet individuals outside of an agency setting (e.g., in the home, church, school, homeless shelter, foster care setting, ER, recreational facility, jail) if necessary 33% k. Providers who will meet with patients via phone or webcam 18% l. Help with finding or maintaining employment 11% m. Help with advancing education or seeking job training 8% n. Help with finding, maintaining, or improving housing 15% o. Education about mental health and substance use issues 14% p. 24-hour crisis phone line 17% q. 24-hour mobile crisis teams 15% r. Peer delivered services (services provided by people who have experienced behavioral health problems and who work to help others with behavioral health problems; e.g., self-help groups, warmlines, and peer specialist services) 19% s. Education and supports (e.g., support groups) for families of individuals in behavioral health treatment 11% *These service categories are not mutually exclusive; one individual could be receiving more than one service.

The most frequently reported services received include outpatient mental health services (80%), medication for mental health problems (67%), and inpatient mental health treatment (36%). The least frequently reported services include SUD inpatient rehabilitation (6%), SUD detoxification (7%), SUD residential treatment and help with advancing education or seeking job training (8% each), and medication for SUD (9%). At least 16% of the consumer respondents reported receiving some kind of SUD services.



B. Perceived Service Needs Consumers’ reported unmet service needs (consumer survey, question 9) include the following:

Access to providers outside of a clinical setting Access to transportation and housing A lack of psychiatrists who are accepting new patients

Providers reported the following types of behavioral health services that they thought would be beneficial in their communities, but are currently unavailable (provider survey, question 7).

1. There are care management programs to target and engage the homeless population but not clinical programs. There are programs who have identified the forensic population is one of interest, or even specialty, but yet not much involvement in the forensic side of things (going to see clients in jail, attending court dates, etc.) With productivity demands and caseload sizes as they are it is difficult to get an appointment quickly when in crisis or need, where utilizing more walk in hours would be helpful to avoid unnecessary ED visits.

2. Local, easily accessible urgent care/walk-in clinics with extended hours for mental health concerns. Expanded Mobile Crisis Teams (24/7) so more people can be seen in the community before they need Psych E.D. services. Peer Bridger Services to meet people while they are inpatient and help them get connected to community resources/follow-up once discharged. Same day appointments for substance use/detox. More community crisis/respite beds.

C. Perceived Barriers Table 4a presents the percentages of consumers and providers that reported barriers to accessing behavioral health treatment (consumer survey, question 7; provider survey, question 4).

The barriers most frequently reported by both providers and some consumers are: took too long to get an appointment, provider hours are not convenient, and service providers don’t speak patient’s preferred language. One provider and some consumers reported the following barriers: problems with transportation, problems with paying for services, and service providers not sensitive to other cultures.



Table 4a. Finger Lakes Region: Consumer and Provider Input -- Barriers to Accessing Behavioral Health Treatment

Perceived Barrier Consumers

(n=177) Providers

(N=2)

% Took too long to get an appointment 8% 100% Provider hours are not convenient 5% 100% Service providers don’t speak my (or the patient’s) preferred language 2% 100% Problems with transportation 6% 50% Problems paying for services 5% 50% Service providers are not sensitive to other cultures 1% 50% Nearest service provider is too far away 4% 0% No service provider in the area 2% 0% Local provider does not serve individuals with these particular problems 3% * Services were not accessible to people with disabilities 1% 0% Services were not available to Veterans or members of the armed forces 1% * Services were not available to children or the elderly 1% * Other 6% 50%

D. Disparities in Access Table 4b describes disparities in access to behavioral health services reported by providers (provider survey, question 5). One of the two providers reported that services are not available for homeless and incarcerated individuals.

Table 4b. Finger Lakes Region: Providers Input -- Access to Behavioral Health Services by Special Populations

Special Population Total #

Respondents % Answered

"No"*

Veterans or members of the armed forces 2 0% Children 2 0% Children in foster care 2 0% Elderly 2 0% Homeless 2 50% Incarcerated 2 50% *Percentage is the number who responded "No" divided by the total number of respondents.



2. Scope of Services in Treatment Table 5 describes consumers’ experiences with evidence-based services, care coordination, and integrated care while receiving care from behavioral or physical health providers (consumer survey, question 8).

Table 5. Finger Lakes Region: Consumer Survey Input -- Scope of Services in Treatment

Provider Service Total #

Respondents % Answered

"Yes"*

a. Screen for history of traumatic life events or abuse? 140 64% b. Screen for depression, anxiety, substance abuse, or another behavioral health problem? 174 66% c. Screen for physical health problems? 148 77% d. Assess your strengths, abilities, preferences, and goals? 142 66% e. Talk with other providers about your care? 129 75% f. Talk to you about the relationship between thoughts, behaviors, and feelings? 140 80% g. Provide clear information about:

i. How to get treatment for mental health and substance use issues? 125 79% ii. How to cope with mental health and substance use issues? 121 76% iii. Crisis management? 130 67%

h. Met all of your health care needs? 144 75% *Percentage is the number that responded "Yes" divided by the total number of respondents.

The least frequently provided services are screening for history of traumatic life events or abuse (64%); screening for depression, anxiety, substance abuse, or another behavioral health problem; and assessing strengths, abilities, and goals (66% each). For all other services listed, more than two-thirds of consumer respondents reported receiving them.

3. Provider Training Needs Providers reported the following training needs (provider survey, question 6).

While many have been trained, ironically, some of our more seasoned providers have not been trained in recent, more strength-based and recovery-oriented approaches since their orientation is well past and they are accustomed to using a skill set learned over their years.

Trauma informed practice training and motivational interviewing trainings is available but not attended by nearly enough clinicians. Trauma influences many more clients than we recognize. Motivational interviewing training is only part of it, training in general on how to build rapport and engage with your clients, creating less of an us versus them mentality and more of an us. Additional training to better understand the process and nuances in the criminal justice system would be beneficial as it seems like the CJ system functions parallel to the mental health system even though we work with the same clients, especially as more and more of our clients are involved in both systems.



4. Participants Feel Welcome where they Receive Services As shown in Table 6, only 1% of consumers reported not feeling welcome in the places where they receive behavioral health services (consumer survey, question 10).

Table 6. Finger Lakes Region: Consumer Input (n=177) -- Feeling Welcome where you Receive Behavioral Health Services

Total # Respondents % Answered "No"*

139 1% *Percentage is the number who responded "No" divided by the total number of respondents.

Some of the things that make them feel welcome include:

Professional and safe environment Supportive provider and staff Good services

Summary Strong Memorial surveyed 177 consumers and two providers. For both consumers and providers, the frequently reported needs included:

Transportation to health care services Reduced wait times for appointments Assistance with paying for services Language barriers Inpatient mental health Housing Convenient provider hours (evenings and weekends)



Appendix A. Highlights of Finger Lakes Region Needs Assessment Findings

Appendix A summarizes needs assessment findings that may impact providers meeting the health care service needs of the target consumer population in the Finger Lakes region.

I. Population Characteristics Summary Highlights

Finger Lakes Region: Population Characteristics Characteristic Region Region/County Comparison Median household income

$50,317 Compared to all DSRIP regions, the Finger Lakes region’s median household income is below the state median of $58,687.

Education 12% of adults in region are without a high school diploma

Poverty 15% of region’s population live below poverty level

4% of the region’s population are on cash public assistance and 12% receives food stamps/SNAP benefits.

Public Health Insurance/ Medicaid/ Beneficiaries/ No Health Insurance

32% of region’s population are on public health insurance, 22% are Medicaid beneficiaries and 8% have no health insurance.

36% of Medicaid beneficiaries are children, which is the second highest percentage in any DSRIP region

Special Populations 13% of the region’s population are disabled and 9% are Veterans.

Foreign Born 6% of the population are foreign born.

Primary Language other than English

10% of the region’s population speak a primary language other than English.

II. Health Care Resources Summary Highlights

A. Finger Lakes Region: Health Care Professional Supply and Shortages Domain Region/County Region/County Comparison Supply of Primary Health Care Providers

1. The region has 3,875 primary care providers or 30 per 10,000 population.

1. There is a mal-distribution of these providers (see HPSAs below)

Supply of Physical Health Care Specialists

1. The region has 1,826 physical medical health specialists or 14 providers per 10,000 population.

Supply of Licensed Mental Health (MH) Professionals

1. The region has 4,054 licensed MH professionals or 32 per 10,000 population.

1. There is a mal-distribution of these providers (see HPSAs below).

2. There are no psychiatrists in Livingston and Schuyler counties and no psychologists in Seneca County.

Substance Use Disorder (SUD) Professionals

1. The region has a total of 695 cert i f ied and credentialed SUD professionals or five per 10,000 population.

1. There are no physicians certified in addiction medicine in Schuyler, Steuben and Yates counties.

Region’s HPSA County Designations Federal Health Professional Shortage Areas (HPSAs)

Primary Health Care: Livingston, Schuyler, Seneca, Wayne and Yates counties each has a whole county shortage designation. All counties except Chemung have Medically Underserved Area/Population



Appendix A. Highlights of Finger Lakes Region Needs Assessment Findings A. Finger Lakes Region: Health Care Professional Supply and Shortages Domain Region/County Region/County Comparison

(MUA/P) designations. In Steuben County, the Medicaid eligible population has been designated a MUP, and in Monroe and Ontario counties the low-income populations have been designated MUPs. Mental Health Professionals: Chemung, Schuyler, Seneca, Steuben and Yates counties have a whole county shortage designation. All counties have a Medically Underserved Area/Population (MUA/P). In addition, the Medicaid eligible populations in all counties except Livingston and Schuyler have been designated MUPs.

B. Finger Lakes Region: Facility- and Program-based Health Care Supply, Service Rates and Constraints Facility/Program Region Region/County Comparison Physical Health Acute Care Hospitals

1. The region’s nursing homes have 35 behavioral health intervention beds located in Monroe and Wayne counties.

2. The region’s acute care hospitals have no chemical dependence detox beds.

Mental Health Inpatient Facilities

1. Total psychiatric bed capacity in the region is 40 per 100,000 adults and 33 per 100,000 children.

1. Psychiatric beds for children are in only Chemung and Monroe counties.

Substance Use Disorder (SUD) Inpatient Programs

1. In the region, there are six inpatient SUD crisis programs located in Monroe, Ontario and Steuben counties; six inpatient rehabilitation programs that are in Chemung, Monroe, Ontario, Seneca and Steuben counties; and 27 residential programs located in Chemung, Monroe, Ontario, Steuben and Wayne counties.

1. Collectively, for all SUD inpatient programs the capacity is 7 per 10,000 and average daily enrollment is 6 per 10,000.

Mental Health Outpatient and Clinic Programs

1. Adult outpatient programs (other than clinic) are in all counties. There are a total of 1,041 non-clinic outpatient program slots in the region or 111 slots per 100,000 adults.

2. In addition to locally-operated clinics in all counties, the region has state-operated clinics in Chemung, Monroe, Ontario and Seneca counties serving adults and a state-operated clinic in Chemung County serving children.

3. In the region, only Chemung, Monroe, Ontario and Steuben counties have child outpatient programs other than clinic. These programs have a capacity of 448 slots or 136 slots per 100,000 children region wide.

MH Emergency and Community Support Programs

1. In the region emergency programs located in Chemung, Monroe, Ontario and Steuben counties and 32 adults received emergency services per 100,000 adults. In addition, 39 children received emergency services per 100,000 children.

1. The adult emergency services rate is the highest in any DSRIP region and the child emergency services rate is the 2nd highest in any region.



Appendix A. Highlights of Finger Lakes Region Needs Assessment Findings B. Finger Lakes Region: Facility- and Program-based Health Care Supply, Service Rates and Constraints Facility/Program Region Region/County Comparison

2. In the region, 204 adults per 100,000 received services from community support programs.

3. Community support programs in the region served 222 children per 100,000.

2. The child community support program service rate is the 2nd highest in any DSRIP region.

SUD OutpatientPrograms

1. In the region, all counties have SUD outpatient programs. The average daily enrollment (ADE) is 42 per 10,000.

2. The region has 3 opioid treatment programs located in Monroe County.

1. The region’s SUD ADE which is the 2nd

highest rate in any NYS DSRIP region.

III. Health Status Finger Lakes Region: Health Status Challenges/Strengths Domain Region/County Comparison Disease Prevalence Among all DSRIP regions, the region has the 2nd highest average percentage of adults Chronic Health with angina, heart attack or stroke.Conditions Livingston County has the 2nd highest percentage of adults with asthma among all NYS

counties. Health Behaviors and Among all DSRIP regions, the region has the highest average percentage of adults with Risk Factors poor mental health for 14 or more days in the last month, and Chemung County has the

highest percentage in any NYS county. The region also has the lowest average percentages of adults that report binge drinking

and not receiving medical care because of cost compared to all DSRIP regions. Yates County has the lowest percentages of adults that report binge drinking and not

receiving medical care because of cost in any NYS county. Hospitalization Rates by Of all DSRIP regions, the region has the 2nd lowest average rate of hospitalizations per Disease or Cause 10,000 for asthma and drug-related.

Yates County’s rate of drug-related hospitalizations is the lowest among all NYS counties.

Mortality Among all DSRIP regions, the Finger Lakes region has the second lowest percentage of premature deaths.

Schuyler County has the 3rd highest rate of alcohol related motor vehicle injuries and deaths in any NYS county.

Among all DSRIP regions, the region has the highest average death rate per 100,000 from malignant neoplasms, the 2nd highest average rate due to chronic lower respiratory disease, and the lowest average rate of deaths due to heart disease.

Yates County has the highest death rate due to malignant neoplasms in any NYS county.

Patients in the Public Mental Health System

Behavioral Health Diagnoses: Among all NYS DSRIP regions, the region has the highest percentage of patients served with anxiety disorders.



Appendix A. Highlights of Finger Lakes Region Needs Assessment Findings

IV. Behavioral Health Care Utilization A. Finger Lakes Region: Medicaid Beneficiary Health Care Utilization by Behavioral Health Diagnosis Domain Utilization by Diagnosis Region

Medicaid Inpatient Admissions

Mental Health Diagnosis Region-wide, the largest percentages of Medicaid beneficiaries with a mental health inpatient hospital admission had depressive disorders (48%), followed by other mental health diagnoses (15%), chronic stress and anxiety diagnoses (13%), schizophrenia (12%), bi-polar disorder (8%), and PTSD (3%).

Compared to all other DSRIP regions, the Finger Lakes region had the largest percentage of Medicaid beneficiaries hospitalized with depressive disorders (48%).

Substance Use Disorder Region-wide, the largest percentage of Medicaid beneficiaries with a SUD inpatient hospital admission had alcohol use disorder (33%), followed by drug abuse: cannabis/NOS/NEC (23%), cocaine use disorder (18%), opioid use disorder (14%), and other SUD diagnoses (12%).

Medicaid Emergency Room Visits

Mental Health Diagnosis Region-wide by diagnosis, the largest percentages of Medicaid beneficiaries with a mental health ER visit were for depressive disorders (43%), followed by other mental health diagnoses (21%), chronic stress and anxiety diagnoses (13%), schizophrenia (12%), bi-polar disorder (8%), and PTSD (4%). Substance Use Disorder Region-wide, the largest percentage of Medicaid beneficiaries with a SUD ER visit were for cocaine use disorder (30%), followed by opioid use disorder (24%), drug abuse: cannabis/NOS/NEC (16%), and alcohol use disorder and other SUD diagnoses (15% each).

Compared to all other DSRIP regions, the Finger Lakes region had the largest percentage of Medicaid beneficiaries with ER visits for opioid use disorder (24%).

B. Finger Lakes Region: Medicaid Mental Health and Substance Use Disorder Beneficiaries Compared to All Medicaid Beneficiaries Domain Utilization MH Medicaid In the region, 8% of all Medicaid

beneficiaries had a mental health inpatient hospital admission and 19% had a mental health ER visit.

SUD Medicaid In the region, 4% of all Medicaid beneficiaries had a SUD inpatient hospital admission and 6% had a SUD ER visit.



Appendix A. Highlights of Finger Lakes Region Needs Assessment Findings C. Finger Lakes Region: Medicaid Beneficiary Health Care Utilization by Eligibility Type Domain Utilization by Eligibility Region Medicaid Inpatient Admissions

In the region 10% of Medicaid only beneficiaries and 15% of Medicaid/Medicare dual-eligible beneficiaries experienced at least one hospital inpatient admission.

Medicaid Emergency Room Visits

In the region 32% of Medicaid only beneficiaries and 20% of Medicaid/Medicare dual-eligible beneficiaries experienced at least one ER visit.

V. Unmet Service Needs Finger Lakes Region: Summary Highlights of Unmet Service Needs in Behavioral Health Treatment Domain Measure Region/County Comparison

Mental Health Medication Adherence and Management

1. Adherence to antipsychotic medications for individuals with schizophrenia for at least 80% of their treatment period.

1. For adults with schizophrenia in the Finger Lakes region, 59% adhere to antipsychotic medications (41% do not).

2. Antidepressant medication management effective acute phase treatment.

2. Region-wide 49% of individuals remain on their medication during the entire acute treatment phase.

Among all DSRIP regions, the Finger Lakes region has the lowest percentage of individuals adhering to antidepressants in the acute phase.

3. Antidepressant medication management effective continuation phase treatment.

3. Region-wide 35% of individuals remain on their medication during continuation phase treatment (65% do not).

Mental Health Follow-up Care

1. Follow-up care after hospitalization for mental illness within 7 or 30 days of hospital discharge.

1. Region-wide 51% of individuals follow-up after hospitalization for mental illness within seven days (49% do not) and 69% follow-up within 30 days.

Among all DSRIP regions, the Finger Lakes region has the 2nd highest percentage of 30-day follow-up after hospitalization for mental illness.

2. Follow-up care for children prescribed ADHD medication initiation phase.

2. Region-wide 44% of children prescribed ADHD medication have one follow-up visit with a practitioner within 30 days after starting the medication (56% do not).

3. Follow-up care for children 3. Region-wide 52% of children with a new prescription prescribed ADHD medication for ADHD medication remain on the medication for 7 continuation and months and/or have at least 2 follow-up visits in the maintenance phase. 9-month period after the initiation phase.

Among all DSRIP regions, the Finger Lakes region has the lowest percentages of ADHD initiation and continuation follow-up care.

Alcohol and other Drug Dependence (AOD) Initiation and EngagementTreatment

1. AOD Initiation 1. Region-wide 46% of individuals initiate AOD treatment within 14 days of diagnosis.

2. AOD Engagement 2. Region-wide 23% of individuals engage in AOD treatment within 30 days after initiation (77% do not).

Potentially Avoidable Hospitalizations/ER Visits (Conditions for which good outpatient care can

1. Diabetes Short-Term Complications

1. Among all DSRIP regions, the Finger Lakes region has the 2nd highest observed to expected ratio for diabetes short-term complications in the dual Medicaid/Medicare population (147/106).

2. Diabetes Chronic Conditions 2. Among all DSRIP regions, the region has the highest



Appendix A. Highlights of Finger Lakes Region Needs Assessment Findings Finger Lakes Region: Summary Highlights of Unmet Service Needs in Behavioral Health Treatment Domain Measure Region/County Comparison potentially prevent the need for hospitalization or for which early intervention can prevent complications)

observed to expected ratio (45/37) for uncontrolled diabetes in the dual population.

3. Circulatory Composite Indicator

3. Among all DSRIP regions, the region has the highest all circulatory composite observed to expected ratio in the Medicaid only population (184/165).

4. Potentially Avoidable ER visits

4. Among all DSRIP regions, the Finger Lakes region has the second highest observed to expected ratio (25/18) for potentially preventable ER visits.

VI. Consumer and Provider Input Finger Lakes region counties’ surveys of consumer and provider stakeholders to assess local needs indicate that access to crisis services and transportation are issues that need attention for the population with mental health concerns and access to crisis services is an issue that needs attention for the population chemical dependency concerns.

Strong Memorial Hospital surveyed 177 consumers and two providers in the Finger Lakes region. The needs most frequently reported by both consumers and providers include: transportation to health care services; reduced wait times for appointments; assistance with paying for services; convenient provider hours (evenings and weekends); language barriers; inpatient mental health; and housing.



Appendix B: Finger Lakes Region Survey/Focus Group Responses to Open Ended Questions

Appendix B contains comprehensive lists of responses to the open-ended questions posed to consumers and providers during focus groups conducted by Strong Memorial Hospital in the Finger Lakes region. Responses are organized first by question and then by clinic. Surveys and focus group forms can be found in Appendix IV.

Consumer focus group #9: Are there any particular behavioral health services that you (or anyone you know) want but are unable to access within one hour drive of where you live?

No, very satisfied. OCD Specialist. The one in Rochester does not take CHP or Medicaid. To see a psychiatrist that is accepting new patients. To have access to providers

outside of clinical setting. Rehabilitation programs (inpatient, longer term 90 day programs) Asperger specific programs. Many programs are geared toward lower functioning

or younger age groups. Age limit usually 12, but Asperger’s emotionally mature slower than their developmental age.

I need a hands on case manager that would include transportation because I don't drive and I have a phobia of public transportation, but I need other services as well, money management, housing, appointment.

Continuing day treatment programs or daily activity programs More MH Social Recreation Talk and meds are not enough for me There is no one qualified to work with OCD at Strong Ties. I had to advocate

extensively to be seen by a psychologist at Strong Behavioral Health at a different location.

Consumer focus group #11: What makes (or would make) you feel welcome? Employees Deaf community Professionalism of the employees where I go for therapy The HIPAA laws The warmth of staff at reception over the phone. The understanding of support

staff and quick response. The helpfulness and direction provided by service provider - not being treated as a number. The warmth and listening skills of the psychiatrist? Prescriber to where they do not blow you off or just leave it all to the LCSW.

I have a wonderful therapist and N/P at Strong. They make me feel like I am just more of a number, I feel they really care about my health. Taken time to find the right meds, and treatment programs.

Already feel welcomed Friendly staff, calm environment and warm I am lucky to be greeted and helped by a wonderful group of people who care



Appendix B: Finger Lakes Region Survey/Focus Group Responses to Open Ended Questions Everyone is so welcoming. For myself they make me feel like they understand

what I'm going through It was a very safe environment for me to come to Smile on people face! Willing to help if need be. Everyone is very pleasant. My therapist is awesome, and is always very

welcoming. I have not had any issues with this facility Friendly, caring, compassionate staff. Staff who are able to put themselves in our

shoes and try to at least understand where we are struggling. Free Wi-Fi would make the time pass quickly for the siblings of children receiving

services The workers Compassion and patients I feel when I talk with them Good health services Say my name, friendly Staff Friendly staff They try to help me They press attention of my need They are professional I get the help I need with any of my problems The environment is organized It makes me happy when the staff are happy to see me People when want to help by real and not just because is there job Help getting a kind, caring case manager Cheerful friendly staff accepting of mental health issues. I am satisfied with my

care and the availability of services Attention to client Helping meet my needs and family needs, comforted by worker All of, well most of the counselors are very nice and understanding, at least most

of the ones we had contact with Nice friendly workers; bad attitude people stay outside Open and non-judgmental environment It depends on the facility - some do, some don't No one’s chased me out yet I feel I receive excellent help and support with my therapist and Strong Ties

Pharmacy. The clerical staff are also friendly and supportive. Personal checkups. If someone like myself has missed an appointment or gone a

certain period of time without being seen, calling me to see how I am and/or schedule an appointment to address problems/concerns.

Add direct way to make appointments at Strong Ties - no answering service, allow set weekly appointments.


Chapter Four, Finger Lakesl DSRIP Region Needs Assessment

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