Health Care Reform Our State: Problems and Perceptions State Medicaid: Issues and Direction A Case...
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Transcript of Health Care Reform Our State: Problems and Perceptions State Medicaid: Issues and Direction A Case...
Health Care ReformOur State: Problems and Perceptions
State Medicaid: Issues and Direction
A Case for Federal Reform
Community Health Centers
WOOD-
FORD
WEBSTER
ADAIR
ALLENBALLARD
BARREN
BATH
BELL
BOONE
BOURBON
BOYLE
BRACKEN
BREATHITT
BULLITT
BUTLER
CALLOWAY
CAMPBELL
CARLISLE
CARROL
CARTER
CASEY
CHRISTIAN
CLARK
CLAY
CLINTON
CRITTENDEN
DAVIESS
ELLIOT
ESTILL
FAYETTE
FLEMING
FLOYD
FULTON
GALLATIN
GRANT
GRAVES
GRAYSON
GREEN
GREENUP
HANCOCK HARDIN
HARLAN
HARRISON
HART
HENDERSON
HENRY
HICKMAN
HOPKINS
JACKSON
JEFFERSON
JOHNSON
KENTON
KNOTT
KNOX
LARUE
LAUREL
LAWRENCE
LEE
Leslie
LETCHER
LEWIS
LINCOLN
LIVINGSTON
LOGAN
LYONMCCREARY
MCLEAN
MADISON
MARION
MARSHALL
MARTIN
MASON
MEADE
MENIFEE
MERCER
MONROE
MORGAN
NELSON
OHIO
OLDHAM
OWEN
OWSLEY
PERRY
PIKE
POWELL
PULASKI
ROWAN
RUSSELL
SCOTT
SHELBY
SIMPSON
SPENCER
TAYLOR
TODD
TRIGG
TRIMBLE
UNION
WARRENWAYNE WHITLEY
WOLFE
CRACKEN
MC- CUMBER-LAND1
NICHOLAS
CUMBER-LAND
MUA/P and HPSA Designations
Boyd
LYON
Designations as of March 2009
CALDWELL
BRECKINRIDGE
EDMONSON
METCALFE
WASHINGTON
ANDERSON
FRANKLIN
GARRARD
JESSAMINE
MONTGOMER
PENDLETON
MAGOFFIN
ROCKCASTLE
MUHLENBERG
Shortage Designation Legend
Medically Underserved Area or Population (MUA/P)
Health Professional Shortage Area (HPSA)
Both MUA/P and HPSA
FORD
ROBERTSON
Health Care Access: Lack of Primary Health Care Provider Kentucky BRFSS 2003 - 2004 Report
Lack of Primary Health Care Provider 2004 BRFSS Data by Area Development District
Lack of Primary Health Care Provider by Nation, Kentucky, and ADD
BRFSS 2003 and 2004
2003
%
National Median*
Total Kentucky
ADDs
Barren River
Big Sandy
Bluegrass
Buffalo Trace
Cumberland Valley
FIVCO
Gateway
Green River
Kentucky River
KIPDA
Lake Cumberland
Lincoln Trail
Northern Kentucky
Pennyrile
Purchase
*National Median is the middle value of the prevalence estimates from all 50 states, Washington D.C., Guam, Puerto Rico, and the U.S. Virgin Islands. The confidence interval is not available. Hawaii was not included in the national median.
49
19.1
17.8
14.7
18.3
18.1
13.2
21.9
18.0
15.5
21.3
17.3
17.9
15.7
18.4
15.6
22.7
14.7
95% (CI)
(16.4 - 19.3)
(10.6-20.1)
(13.6-24.1)
(14.3-22.6)
(9.3-18.4)
(16.9-27.8)
(13.4-23.8)
(12.0-19.8)
(16.7-26.9)
(12.9-22.7)
(13.9-22.7)
(12.3-19.8)
(14.0-23.6)
(12.0-20.0)
(17.9-28.2)
(11.2-19.0)
%
19.3
17.1
19.3
24.1
9.9
12.9
17.1
23.3
21.6
19.2
22.2
17.2
16.3
18.1
13.2
24.3
22.2
2004
95% (CI)
(15.6-18.6)
(14.8-24.7)
(18.7-30.5)
(7.0-13.8)
(9.2-17.7)
(12.7-22.7)
(18.6-28.8)
(17.0-27.2)
(14.2-25.4)
(17.4-27.7)
(12.9-22.7)
(11.5-22.6)
(13.7-23.5)
(9.7-17.7)
(19.1-30.4)
(17.1-28.1)
National Median*
Total Kentucky
ADDs
Barren River
Big Sandy
Bluegrass
Buffalo Trace
Cumberland Valley
FIVCO
Gateway
Green River
Kentucky River
KIPDA
Lake Cumberland
Lincoln Trail
Northern Kentucky
Pennyrile
Purchase
%
14.5
17.1
18.6
27.6
15.7
21.4
23.9
20.2
19.7
16.8
25.4
12.7
22.5
14.0
14.1
18.7
15.7
2003
95% (CI)
(15.8-18.5)
(13.8-24.6)
(22.3-33.5)
(12.1-20.2)
(16.8-26.8)
(18.6-30.1)
(16.0-25.2)
(15.9-24.2)
(12.5-22.1)
(19.9-31.8)
(9.2-17.1)
(18.3-27.4)
(10.5-18.6)
(10.7-18.3)
(14.5-23.9)
(12.1-20.1)
47
%
14.9
14.9
15.3
20.5
8.7
20.0
19.6
20.9
24.7
15.5
26.9
14.0
24.5
12.2
10.9
15.7
16.4
2004
95% (CI)
(13.6-16.4)
(11.0-20.9)
(15.5-26.6)
(5.8-12.8)
(15.5-25.3)
(15.0-25.2)
(16.7-25.7)
(19.6-30.6)
(11.6-20.4)
(21.5-33.0)
(10.2-18.9)
(19.1-30.8)
(9.0-16.4)
(7.9-14.7)
(11.7-20.7)
(12.3-21.4)
Health Care Access: Lack of Health Care Coverage Kentucky BRFSS 2003 - 2004 Report
*National Median is the middle value of the prevalence estimates from all 50 states, Washington D.C., Guam, Puerto Rico, and the U.S. Virgin Islands. The confidence interval is not available. In 2004, Hawaii was not included in the national median.
Lack of Health Care Coverage 2004 BRFSS Data by Area Development District
Lack of Health Care Coverage by Nation, Kentucky, and ADD
BRFSS 2003 and 2004
National Median*
Total Kentucky
ADDs
Barren River
Big Sandy
Bluegrass
Buffalo Trace
Cumberland Valley
FIVCO
Gateway
Green River
Kentucky River
KIPDA
Lake Cumberland
Lincoln Trail
Northern Kentucky
Pennyrile
Purchase
%
12.0
17.9
21.6
24.8
16.7
21.6
25.9
21.5
19.0
19.9
22.4
13.0
24.4
13.9
15.5
20.1
16.1
2003
95% (CI)
(16.6-19.3)
(16.9-27.2)
(20.3-29.8)
(13.1-21.0)
(17.2-26.8)
(20.5-32.2)
(17.2-26.6)
(15.1-23.6)
(15.6-25.1)
(17.7-28.0)
(9.6-17.4)
(20.2-29.1)
(10.5-18.3)
(11.8-20.0)
(16.1-24.8)
(12.5-20.4)
51
%
12.8
17.8
14.4
32.3
16.1
14.7
24.4
19.3
18.3
15.1
27.5
14.7
23.1
15.6
14.6
17.8
22.4
2004
95% (CI)
(16.4-19.3)
(10.8-18.9)
(26.4-38.7)
(12.1-21.0)
(11.3-18.9)
(19.6-30.0)
(15.3-23.9)
(14.5-22.8)
(11.6-19.6)
(22.5-33.3)
(11.1-19.1)
(18.0-29.1)
(12.1-20.0)
(11.3-18.8)
(13.7-22.9)
(17.4-28.3)
Health Care Access: Cost as a Barrier to Health Care Kentucky BRFSS 2003 - 2004 Report
*National Median is the middle value of the prevalence estimates from all 50 states, Washington D.C., Guam, Puerto Rico, and the U.S. Virgin Islands. The confidence interval is not available. In 2004, Hawaii was not included in the national median.
Cost as a Barrier to Health Care 2004 BRFSS Data by Area Development District
Cost as a Barrier to Health Care by Nation, Kentucky, and ADD
BRFSS 2003 and 2004
Cunningham, Peter J., and Laurie E. Felland, Falling Behind: Americans’ Access to Medical Care Deteriorates, 2003-2007, Tracking Report No. 19, Center for Studying Health System Change, Washington, D.C. (June 2008).
Innovative Approaches in HealthcareInnovative Approaches in Healthcare
Technology
National Quality Initiative
WOOD-
FORD
WEBSTER
ADAIR
ALLENBALLARD
BARREN
BATH
BELL
BOONE
BOURBON
BOYLE
BRACKEN
BREATHITT
BULLITT
BUTLER
CALLOWAY
CAMPBELL
CARLISLE
CARROL
CARTER
CASEY
CHRISTIAN
CLARK
CLAY
CLINTON
CRITTENDEN
DAVIESS
ELLIOT
ESTILL
FAYETTE
FLEMING
FLOYD
FULTON
GALLATIN
GRANT
GRAVES
GRAYSON
GREEN
GREENUP
HANCOCK HARDIN
HARLAN
HARRISON
HART
HENDERSON
HENRY
HICKMAN
HOPKINS
JACKSON
JEFFERSON
JOHNSON
KENTON
KNOTT
KNOX
LARUE
LAUREL
LAWRENCE
LEE
Leslie
LETCHER
LEWIS
LINCOLN
LIVINGSTON
LOGAN
LYONMCCREARY
MCLEAN
MADISON
MARION
MARSHALL
MARTIN
MASON
MEADE
MENIFEE
MERCER
MONROE
MORGAN
NELSON
OHIO
OLDHAM
OWEN
OWSLEY
PERRY
PIKE
POWELL
PULASKI
ROWAN
RUSSELL
SCOTT
SHELBY
SIMPSON
SPENCER
TAYLOR
TODD
TRIGG
TRIMBLE
UNION
WARRENWAYNE WHITLEY
WOLFE
CRACKEN
MC- CUMBER-LAND1
NICHOLAS
CUMBER-LAND
Section 330 Health Center Sites by Countywith MUA/P and HPSA Designations
Boyd
LYON
Health Center Legend
New Section 330 Health Center sites funded by the ARRA Stimulus Package
Section 330 Health Center Sites by County (Number of sites in the County is indicated in circle)
Shortage Designation Legend
Medically Underserved Area or Population (MUA/P)
Health Professional Shortage Area (HPSA)
Both MUA/P and HPSA
2
10
6
12 1 1
6
21
1
1
3
8
122
2008: 19 grantees with 76 sites in 30 counties
As of March 2009: 20 grantees with 83 sites in 37 counties (The additional sites will be open by July 2009)
CALDWELL
BRECKINRIDGE
EDMONSON
METCALFE
WASHINGTON
ANDERSON
FRANKLIN
GARRARD
JESSAMINE
MONTGOMER
PENDLETON
MAGOFFIN
ROCKCASTLE
MUHLENBERG
3
1
1
1
2
1
1
1
1
1
1
1
1
1
1
What is a Health Center? For more than 40 years, HRSA-supported Health
Centers have provided comprehensive, culturally competent, quality primary health care services to medically underserved communities and vulnerable populations.
Health centers are community-based and patient-driven organizations that serve populations with limited access to health care. These include low income populations, the uninsured, those with limited English proficiency, migrant and seasonal farm workers, individuals and families experiencing homelessness, and those living in public housing.
Health Center Program FundamentalsLocated in or serve a high need community
(designated Medically Underserved Area or Population).
Governed by a community board composed of a majority (51% or more) of health center patients who represent the population served.
Provide comprehensive primary health care services as well as supportive services (education, translation and transportation, etc.) that promote access to health care.
Provide services available to all with fees adjusted based on ability to pay.
Meet other performance and accountability requirements regarding administrative, clinical, and financial operations.
1. Vanceburg
4.Tollesboro
5. Flemingsburg
2. Garrison
3. Laurel
Fleming
County
Lewis
County
Mason
County
6. Maysville
Bracken
County 7.
Robertson County
Augusta
Brooksville
8. Mt. Olivet
Service Sites:
1. Family Medicine Clinic, Pharmacy, Women’s Center, Dental Clinic, Fitness/Rehab
2. Garrison Elementary School Clinic 3. Laurel Elementary School Clinic 4. Tollesboro Clinic, Pharmacy and Tollesboro
Elementary School Clinic 5. Fleming County Family Medicine Clinic 6. Maysville OB/GYN, Family Medicine and Pharmacy 7. Bracken County Family Medicine Clinic 8. Robertson County Family Medicine Clinic (Planned)
Legend: MUA/MUP Counties: Bracken, Lewis, Mason and Robertson HPSA Designation: Bracken, Lewis and Robertson Other FQHCs, CHCs or Groups with Sliding Fee: 0
Internet
T-1
TeleradiologyHospital Portals
PrimaryPlus Vanceburg
T-1 Video Only
PrimaryPlus Robertson County
University of Louisville
PrimaryPlus Flemingsburg
PrimaryPlus Tollesboro
PrimaryPlus Maysville
PrimaryPlus Bracken
University of Kentucky
Insurance
Other Data Sources
Other
Comprehend
Family Med., Women’s Health, Dental, PT and Fitness Center and Pharmacy
T-1 Voice Data TeleHealth
T-1 Voice Data TeleHealth
T-1 Voice Data TeleHealth
T-1 Voice Data TeleHealth
T-1 Voice Data TeleHealth
Family Med., Pharmacy
Family Medicine
OB/GYN, Family Medicine, Pharmacy
Family Medicine
Community ProgramsCommunity Programs
National Quality InitiativeNational Quality Initiative
HOW IS DATA BEING USED TO IMPR0VE CARE IN CHCs
An example is provided by the analysis we performed in linking data on diabetics from Big Sandy’s information system with Medicaid claims data. We accomplished this with the assistance of Artemetrx. We had observed, as stated earlier, that Big Sandy clinicians prescribe 80% of their diabetic patients renal-protective agents. In looking at the Medicaid claims data, however, we find that a full 29% of those patients prescribed such medications never get them filled at a pharmacy. Further analysis of claims data reveals that only 39% of patients prescribed these medications are compliant with the medication at least 75% of the time. With access to this type of information, Big Sandy would be in a position to greatly enhance its already leading edge care management programs.