The Enabling Services Accountability Project Heidi Park, PhD The - PowerPoint PPT Presentation

The Enabling Services Accountability Project Heidi Park, PhD The New York Academy of Medicine Rosy Chang Weir, PhD The Association of Asian Pacific Community Health Organizations Presented at the NACHC Annual Conference and Community Health Institute San Francisco, CA September 21, 2004 1

Project Goals � Develop new database and data collection protocol for enabling services at health centers � Describe the utilization of enabling services by AAPIs at health centers � Assess health needs of enabling services users 2

Costs for Enabling Services Increased from 2000 to 2003 both at AAPCHO Health Centers and Nationally Source: UDS Average Financial Cost of Enabling Services (Total cost after allocation of facility and administration) 00-03 Diff=$207,218 or 16% $1,600,000 $1,400,000 AAPCHO 00 $1,200,000 AAPCHO 01 00-03 Diff = AAPCHO 02 $1,000,000 $112,163 or 23% AAPCHO 03 $800,000 NATIONAL 00 NATIONAL 01 $600,000 NATIONAL 02 NATIONAL 03 $400,000 $200,000 $0 Total Cost Enabling Services 3

Background � Enabling services are critical to access to care for health center patients � Enabling services are not reimbursed and are often underfunded � Need for better data on enabling services and their impact on health 4

Background – 2 � Budgetary pressures and rising health care costs � Racial/ethnic disparities in health � National focus on quality of care 5

Health Center Participants � Waianae, Hawaii � Honolulu, Hawaii � New York, New York � Seattle, Washington 6

AAPCHO Health Center Overview 2003 UDS FQHCs AAPCHO CHC #1 CHC #2 CHC #3 CHC #4 Average 1 FQHCs # of 12,376 12,764 24,777 9,589 7,665 23,612 medical users # of 42,463 52,960 124,940 35,614 32,571 107,156 medical encounters % AAPI 60% 72% 96% 87% 63% 77% (minority) % at or 56% 58% 77% 70% 67% 65% below 100% FPL % 39% 37% 25% 25% 50% 18% uninsured 1 BPHC, National Rollup, 2004 7

ESAP Definitions Our categories: (modified from MGMA Report, 2000) 1. Case management-assessment 2. Case management-treatment & facilitation 3. Case management-referral 4. Eligibility Assistance/Financial Counseling 5. Health Education 6. Interpretation 7. Outreach Services 8. Transportation 9. Other 8

Encounter Form With patient data fields Sample encounter form 9

Implementation varied by health center needs and existing procedures + + ES Structure Data Systems Existing Processes 10

Pilot Data Overview (3 months) CHC # 1 CHC # 2 CHC # 3 CHC # 4 Total ESAP* Total ESAP Total ESAP Total ESAP number of 14,457 724 5,551 2,424 5,353 1,154 12,167 1,558 users number of 36,102 1,151 11,588 3,995 11,559 2,036 17,705 2,638 encounters percent 97% 99% 90% 96% 82% 93% 80% 76% AAPI percent 12% 17% 20% 20% 40% 33% * * 14% 23% uninsured *only includes ES provided by **does not include uninsured who the social services department are covered by IHI 11

12 Demographic Data

Age of ES Users CHC 1 CHC 2 120 300 100 80 200 60 Median=27 Median=47 40 100 Std. D ev = 21.09 Std. D ev = 23.53 20 Mean = 29 Mean = 44 N = 724.00 N = 2425.00 0 0 0 10 20 30 40 50 60 70 80 90 100 0 10 20 30 40 50 60 70 80 90 100 CH C 2 - Age CH C 1 - Age CHC 3 CHC 4 120 300 100 80 200 60 40 100 Median=47 Median=29 Std. D ev = 22.07 Std. D ev = 20.63 20 Mean = 44 Mean = 33 N = 1154.00 N = 1558.00 0 0 0 10 20 30 40 50 60 70 80 90 100 0 10 20 30 40 50 60 70 80 90 100 CH C 3 - Age CH C 5 - Age 13

Race/Ethnicity of ES users CHC 1 CHC 2 1600 800 1400 1200 600 1000 t n t n u o u 800 C o 400 C 600 400 200 200 0 0 C F J K V O S O A W H B M O a h i o i t a t m i l t l e h s a i C V O W O p p r h m h x h i t p c n i a e n e e e i t e e h i n k e t h t e n a r o r r e a d r h h o a i i s a c n / n t e i e e n m A P A - R n t a O e e e s n c i a r r s a f a e e n r t s A R i c / i m s a L c h c e s i I a a e e e a e n f n i i r / a c c d t n E s i e n - e n I i t s a o A / h E l n a m n / t i h n A e c n d l i a r t i i c y c s i t y Eth n icity Eth n icity CHC 3 CHC 4 1000 400 800 300 600 t n t n u u o o 200 C C 400 100 200 0 0 C F J K V O N S O W H B M O C F J K V O N G S O A W H B M M O i a h ilp a o ie a a m is la h l o i t a a t i l i t th u th ix ix th e h s a p h p p r h m h x h in r t a m i t t p c t p c n i a e e i e i e e in a e n e iv e e i te e e e n n v t m k e o e a k d e o r a d d n a r r r n a a r e r r o a e / o ic n / s n a n A - s n a a A - - e m A P R e m A H P R O e n a i A O e s H n c i s n c s a f a s a fr a e r e e n A th e i a / t ia a ia /L a c L i h c c ic c s c s w I P w i e if e e n f a a e e n n n a a e ic I a i r / a /C r / c t n E d tin n E i i n iia i I - Is ia - a A t h A th s o h o n l m n a la n a n m n /A i m n e c n ic e d r i a d la r ity t i y ic c r ro s Eth n icity Eth n icity 14

Primary language of ES users CHC 1 CHC 2 400 1200 1000 300 800 n t u n t o 200 u C o 600 C 400 100 200 0 0 E C M V O n a i a t e h g n n t E C H J K K L M S S T T T V O n e l t i d n a m a h o a a p a h o i s o r a t a p e h h n a g n m r o m a g a n m P n t r o a e t a i g n e e l t n i r i n e i d o n e s o n a a r s i i l a a m r a a s o e s h n g e n n n m P e r n h g e a s i n r s e e i r m y e s e a L a r y n g L a u a n g Prim ary Lan gu age u a Prim ary Lan gu age CHC 3 CHC 4 300 2000 1500 200 n t t n u u o o 1000 C C 100 500 0 0 E C H J K L M S S T T V V O a a E K M S S T O n a m o a p a o i i t a e s a p o g n h n o a p t g n r n m a a a o e t g r m a g h l a t n a g n e n i t i d y e e o n n a a o r l n a s i l a a i d a a s o a s a o r h n g e n n P i l n m n h n a a s o e r n h g P s i r r h g n n s e e i i r m n s i e m e a a r y r y L L a n a n g g u u a a Prim ary Lan gu age Prim ary Lan gu age 15

Insurance coverage of ES users CHC 1 CHC 2 600 1000 500 800 400 600 t t n n u u o 300 o C C 400 200 200 100 0 0 M M O S O M M O P S O e e t e t e e t r e t i h l h h v l h d d f d d f e e e e - a - i i P i i P c c r r c c r t r a a a a a e a P C P C i r y i r y d e u a d e u a b r b r l r l r i i i i c e c e r r I n su ran ceCarrierCategory I n su ran ceCarrierCategory CHC 3 CHC 4 500 800 700 400 600 500 300 t n t n u u o 400 o C C 200 300 200 100 100 0 0 M M P S O M M O P S r e e e t t r e i h e e i v l h v l d d f d d f a - e e a - i i c c P r i i P t c c r t e e a a a C a a P a i r d y i r y e a d e u r b r i l e i c r In su ran ceCarrierCategory In su ranceCarrierCategory 16

17 Utilization Data

Type of Services Provided 4000 3000 Number 2000 1000 0 Case Mgmt Assessment Case Mgmt Treatm Case Mgmt Referral Financial Counseling Health Ed/Supp Couns Interpretation Svcs Outreach Services Transportation Svcs Other Enabling Svcs ent 18 Enabling Service

Service Use by Age Group CM FC HE Int Out Trans other 100% 80% 60% 40% 20% 0% less than 1 to 14 15 to 24 25 to 44 45 to 64 65 and 1 years years years years over Age Group 19

Average Length of Services All 22.3 Other 12.9 Trans 33.1 Type of Service Out 16.8 Int 19.7 HE 23.0 FC 23.1 14.9 CM-r CM-t 18.6 CM-a 19.0 0 5 10 15 20 25 30 35 minutes 20

Provider Type by Enabling Service CM-a CM-t CM-r FC HE Interp Out Trans other 9 Medical Assistant 9 ES Provider 8 Community Health Worker 7 Nurse 7 Administration/Clerk 7 Outreach Worker 7 Eligibility Worker 5 Pharmacist 3 Interpreter 3 Case Manager 2 Other 2 Health Educator 1 Transportation Provider 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% 21

Project Evaluation – Feedback � Enabling services staff were interested in showing how their services impacted their patients’ health � Enabling services staff were willing to provide information about their work � Enabling services staff were involved with improving processes � Health centers faced many similar challenges and benefits with the project 22