Sacramento Region Health Care Partnership Market Analysis Data Presentation.

Transcription

1 Sacramento Region Health Care Partnership Market Analysis Data Presentation

2 Sierra Health Foundation Health Program 2

3 Tom Meyer/Syndicated cartoonist 3

4 Study Partners 4

5 Study Team The Abaris Group Mike Williams, Project Lead Marsha Regenstein, PhD Alaina Dall Juliana Boyle Mark Zocchi Chuck Baucom Public Health Institute Carmen Nevarez, MD, MPH Project Lead Marisel Brown, MPH, MSBA Elaine Zahnd, PhD Nancy Shemick Amy Neuwelt, MPH Art Chen, MD Hatches Consulting Barrett Hatches, PhD 5

6 Impact of the ACA in the Region Increase insurance coverage 52% (117,947) are expected to receive Medi-Cal coverage and the remainder are expected to find insurance in the individual health insurance exchange. Sacramento Region Insurance Coverage 2009 and Insurance 2009 Percent Movement 2014 Percent Employer 1,108, % 1,108, % Individual 103, % 109, , % Medi Cal 369, % 117, , % Medicare 248, % 248, % Uninsured 303, % (227,557) 75, % Total 2,132,796 2,132,796 Source: MCIC Chicago,

7 CHC Visit Projections Projected (4) increase of community health center visits Projected CHC Visits, , , , , , , , , ,000 Change due to ACA 200,000 Linear Increase 100, Reference Source: OSHPD Primary Care Clinic Utilization Data Files, ; MCIC Chicago; The Abaris Group

8 ACA MAPS Maps 1:7 Uninsured as a Percentage of the Population Sacramento County Within Zip Codes % % 15% 13% 13% 13% % 16% 16% % % % % 19 % % 16% % 19% 16% 18% % % 17 % % % % 14 % % % Sacramento 16 % % % Percentage of Uninsured by Zip Code Suppressed Zips % % 5.01% % 10.01% % % % 15.01% % 8

9 ACA MAPS Maps 1:8 Uninsured as a Percentage of the Population Sacramento County Within Zip Codes Projected for % % 3% % % % 5% % % % Sacramento Percentage of Uninsured by Zip Code Suppressed Zips % % 2.01% % 3.01% % % % 9

10 Percentage of Low Income (<200% FPL) in Sacramento County, % of Sacramento county residents (~430,000 people) are lowincome (<200% FPL) % Low Income Pop at or below 200% FPL, (est.) < 15% 15 30% 30 45% Source: U.S. Census Bureau, American Community Survey yr est % >60% CHC (FQHC) FQHC Look Alike 10

11 Percentage of Low Income Population Using a Federally Funded CHC, 2010 Less than 10% of the lowincome population (<200% FPL) in Sacramento County visited a federally funded CHC in 2010 % of Low Income Using a Federally Funded CHC <20% 20 40% 40 60% 60 80% >80% Rural Health Clinic FQHC Look Alike CHC (FQHC) Source: U.S. Census Bureau, American Community Survey yr estimate, Health Resources and Services Administration (HRSA) Uniform Data System (UDS); 11

12 Change in Utilization of Federally Funded CHCs in Sacramento County, Sacramento County saw a 65.8% increase in utilization of federally funded CHCs between 2008 and 2010 (~12,500 new patients) % Change in Federally Funded CHC Patients % loss 10 50% loss <10% change 10 50% gain 50% or more gain Newly Served Rural Health Clinic FQHC Look Alike CHC (FQHC) Source: Health Resources and Services Administration (HRSA), Uniform Data System (UDS); 12

13 CHC Visits per 1,000 Population Sacramento Region had considerably lower visits to community health centers than the statewide average (411) and several other key counties. CHC Visits per 1,000 Population, 2010 San Diego County Alameda County California 411 Santa Clara County Sacramento region Contra Costa/Solano Counties Orange County Source: OSHPD Primary Care Clinic Utilization Data Files, 2010; 2010 U.S. Cens us

14 CA CHCs per 10,000 Population Comparison The Sacramento Region had the fewest CHCs, including fewer FQHCs in most regions studied. CHCs per 100,000 Population, 2010 Alameda County San Diego County California Contra Costa/Solano Counties Santa Clara County FQHCs FQHC Look Alikes Non FQHC Orange County Sacramento region Source: OSHPD Primary Care Clinic Utilization Data Files, 2010; 2010 U.S. Cens us 14

15 Demand: CHC Payer Mix Only 1.3% of all CHC visits are paid for by private insurance. Medi Cal is the largest payer group for CHCs in Sacramento County and now covers 43. of all CHC visits. Medicare visits have also grown from 4.3% of all visits in 2006 to 8.1% in Percentage of CHC Encounters by Payer Source, 2006 to Medi Cal % 20% 40% 60% 80% 100% Sliding Scale, Self Pay & Free Indigent Other Medicare Private Sacramento County Primary Care Clinic Payer Mix, 2006 to 2010 Avg. Annual Payer Source % Change Medicare 4.3% 3.9% 8.1% 6.6% 8.1% 17. Medi Cal 24.2% % 42.9% % Indigent 1.0% 1.0% 1.3% 0.8% 0.7% 7.6% Private % 1.5% 1.7% 1.3% 1.5% Self Pay & Free 10.7% 10.2% 6.8% 6.2% 9.8% 2.1% Other 58.5% 53.8% 47.0% 41.8% 36.6% 11.0% Source: OSHPD Primary Care Clinic Utilization Data Files, Note: "Other" includes breast cancer, Child Health and Disability Prevention Program, Expanded Access to Primary Care, and Family PACT encounters. 15

16 Demand: Preventable/Avoidable ED Discharges 41.8% of all ED discharges were either nonemergent conditions or conditions that could have been treated in a primary care setting. Sacramento County Residents Emergency Department Visits, Estimates of Preventable/Avoidable Visits, 2010 Visit Classification: All Patients Total % Visits Classified as ED Care Not Needed: 89, % Non emergent 45, % Emergent/Primary Care Treatable 43, % Visits Classified as ED Care Needed: 38, % Emergent ED Care Needed Preventable/Avoidable 12, % Emergent ED Care Needed Not Preventable/Avoidable 25, % Other Categories Not Classified by Algorithm: 84, % Drug/Alcohol 2, % Psych 5, % Injury 49, % Unclassified 27, % Source: OSHPD 2010 Emergency Department Data & NYU ED Algorithm Region Average 40. Definitions under ED Care Not Needed: Non emergent The patient s initial complaint, presenting symptoms, vital signs, medical history, and age indicated that immediate medical care was not required within 12 hours; Emergent/Primary Care Treatable Based on information in the record, treatment was required within 12 hours, but care could have been provided effectively and safely in a primary care setting. The complaint did not require continuous observation, and no procedures were performed or resources used that are not available in a primary care setting (e.g., CAT scan or certain lab tests); 16

17 Demand: Preventable/Avoidable ED Discharges by Payer Mix Compared with other payers, Medi Cal and self payers had a higher percentage of ED visits that were either non emergent or could have been seen in a primary care setting. Sacramento County Residents Emergency Department Visits, Estimates of Preventable/Avoidable Visits, 2010 Payer Visit Classification: Self Pay Medi Cal Commercial Medicare Total % Total % Total % Total % Visits Classified as ED Care Not Needed: 16, % 30, % 27, % 13, % Non emergent 8, % 15, , % 6, % Emergent/Primary Care Treatable 7, % 14, % 13, % 6, % Visits Classified as ED Care Needed: 5, % 10, % 13, % 8, % Emergent ED Care Needed Preventable/Avoidable 2, % 4, % 3, % 2, % Emergent ED Care Needed Not Preventable/Avoidable 3, % 6, % 9, % 5, % Other Categories Not Classified by Algorithm: 14, % 23, % 30, % 14, % Drug/Alcohol % % % % Psych 1, % 1, % 1, , % Injury 8, % 12, , % 6, % Unclassified 4, % 8, % 7, % 5, % Source: OSHPD 2010 Emergency Department Data & NYU ED Algorithm Region Average 41.9% (Self Pay) 46.1% (Medi Cal) 17

18 Safety Net Capacity: CHC Financial Metrics In 2010, total expenses exceeded gross revenues by 10.6%. 43% (16) community clinic sites reported a loss (avg. = $1.2 million) 5 (20) community clinic sites reported a positive margin (avg. = $520,000) 3% (1) community clinic reported no loss/gain CHC Total Net Revenues, 2010 $15,000,000 $10,000,000 $5,000,000 e u $0 n v e e R $5,000,000 t e N l $10,000,000 ta T o $15,000,000 $20,000,000 $25,000,000 N=16 $20,333,464 Source: Note: OSHPD 1 community Primary clinic Care reported Clinic no Utilization loss/no profitdata file, 2010 $10,401,134 N=20 Total Net Revenues = $(9,932,000) Clinics with Loss Clinics with Positive Margins 18

19 CHC Total Net Revenues, Since 2006, CHC losses have exceed revenues. In 2010, 19 CHC sites reported losses totaling $9.1 million and 18 CHC sites reported positive margins totaling $4.4 million. CHC Total Net Revenues, $4,404,139 N=3 $7,267,579 $6,549,394 $9,130, $4,034,838 $6,150, $3,046,152 $3,044,701 N= $3,598,061 Net Revenues Total CHC Margin % 2.9% 0.9% 4.8% No. of clinics w/ + Margins No. of clinics w/ Margins Source: OSHPD Primary Care Clinic Utilization Data Files, $5,840,320 Clinics with Negative Margins Clinics with Positive Margins 19

20 CHC Payer Mix Projections Medi Cal payers are projected to make up 61. of CHC visits by The percentage of uninsured visits is projected to decline from 15% in 2010 to 2.6% by Note: Projections are based on a decline in the uninsured population and increases in Medi Cal coverage and individuals that will purchase insurance through the health exchange. Projected CHC Payer Mix, 2012 to Medi Cal % 20% 40% 60% 80% 100% Sliding Scale, Self Pay & Free Indigent Other Medicare Private Projected CHC Payer Mix, Payer Source Medicare 9.0% 9.6% 9.7% 10.2% Medi Cal % 58.6% 61. Indigent 4.5% 4.1% 3.5% 3.3% Private 4.8% 4.9% 7.0% 7.1% Self Pay & Free 15.0% 11.8% 2.7% 2.6% Other 26.3% 23.3% Total Visits 472, , , ,745 Source: OSHPD Primary Care Clinic Utilization Data Files, ; MCIC Chicago; The Abaris Group 2012 Notes: "Other" includes breast cancer, Child Health and Disability Prevention Program, Expanded Access to Primary Care, and Family PACT encounters. 20

21 Major Themes Physicians Perspective Access to specialists is related to hospitals desire to avoid patient populations with health coverage that does not provide sufficient reimbursement for hospital based services. Geographic managed care definition of what constitutes a network contributes to patients not being able to access specialists within a reasonable distance. Health information exchange is needed across the region so health information systems can communicate.

22 Ten Key Data Observations 1. While the current safety net in the region has many challenges, the advent of ACA allows the community the opportunity to re-think its approach for primary care for the safety net. 2. Demand will grow and accelerate under ACA for the safety net population. 3. This newly insured population through a Medi-Cal product will likely be sicker and have a significantly higher level of chronic disease. 22

23 Ten Key Data Observations 4. The primary-care capacity (CHCs and EDs) to treat these patients has grown, but likely will reach capacity prior to full adoption of ACA. 5. The number of CHCs has grown, but falls short of many other similar size regions of the state. 6. Medi-Cal as a payer will accelerate under ACA and continue to be the largest payer source for CHCs. 23

24 Ten Key Data Observations 7. There is considerable overuse of expensive hospital services for the safety net and in particular EDs % of the region s CHCs are financially challenged and that number is growing. 24

25 Ten Key Data Observations 9. The number and location of FQHCs in the region are limited and many CHCs are not able to take advantage of a number of financial incentives afforded to FQHCs. 10.The healthcare safety net lacks a lead agency, coordination and integration. 25

26 Project Takeaways Capacity (physical and provider) is a present and continuing challenge to the safety net Current services are fragmented, fragile and financially not sustainable Stakeholders acknowledge that collaboration and leadership are the largest missing components There is a strong willingness to begin a process to solve these key issues 26

27 THANK YOU! wwww.sierrahealth.org/healthcarepartnership