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The Colorado Safety Net Indicators and Monitoring System

<!--PICOTITLE=“Monitoring the health of Colorado’s safety net”--><!--PICODATESETMMDDYYYY=05212008-->. The Colorado Safety Net Indicators and Monitoring System. Monitoring the health of Colorado’s safety net. CCMU Annual Meeting May 21, 2008. Overview of presentation.

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The Colorado Safety Net Indicators and Monitoring System

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  1. <!--PICOTITLE=“Monitoring the health of Colorado’s safety net”--><!--PICODATESETMMDDYYYY=05212008--> The Colorado Safety Net Indicators and Monitoring System Monitoring the health of Colorado’s safety net CCMU Annual Meeting May 21, 2008

  2. Overview of presentation • The Colorado Health Institute: Who are we? • The Safety Net Monitoring System • Development • Objectives • Methods • What is the value of a monitoring system? • Completing the policy puzzle • Initial results: school-based health centers

  3. The Colorado Health Institute (CHI) • Nonprofit 501(c)3 organization located in Denver • Mission - To advance the overall health of the people of Colorado by serving as an independent and impartial source of reliable and relevant health-related information for sound decision-making. • Core functions: • Information clearinghouse • Analysis and research • Information dissemination

  4. CHI’s past reports on-line http://www.coloradohealthinstitute.org/documents/sn/rhc_report.pdf 4

  5. http://www.coloradohealthinstitute.org/safetynet

  6. The Safety Net Monitoring System: Background IOM Description of the Nation’s Safety Net, 2000: “A highly localized and fragmented patchwork of health care providers that face increasing financial stress and capacity constraints in providing health care to vulnerable populations.” -- Institute of Medicine. 2000. America’s Health Care Safety Net: Intact but Endangered

  7. The Safety Net Monitoring System: Background IOM Recommendation: “The committee recommends that concerted efforts be directed to improving this nation’s capacity and ability to monitor the changing structure, capacity, and financial stability of the safety net to meet the health care needs of the uninsured and other vulnerable populations.” -- Institute of Medicine. 2000. America’s Health Care Safety Net: Intact but Endangered

  8. The Safety Net Monitoring System: Development • Multi-year effort • Initial funding provided by The Colorado Health Foundation • Focus on basic physical, mental, and dental health care services • Diverse communications portfolio including Web site, symposia, publications

  9. The Safety Net Monitoring System: Methods • Convened project Advisory Committee • Identified objectives and policy issues • Established definitions, Identified data gaps • Selected population-based and provider-based data indicators • Conduct on-going analysis of indicators and dissemination of information • Conduct community-wide case studies

  10. The Safety Net Monitoring System: Objectives Objectives: • Build comprehensive databases • Assess the viability and sustainability of Colorado’s health care safety net providers • Provide reliable and timely information on which sound policy decisions can be based

  11. The Safety Net Monitoring System: Value • Data-driven reporting system of statewide value • Will identify, describe and monitor the ability of Colorado’s safety net providers to meet the health care needs of vulnerable populations • Determine what variations exist among Colorado communities in the organization and financing of safety net services • Inform policymakers about the changing dynamics of Colorado’s safety net system More information: http://www.coloradohealthinstitute.org/safetynet/project_description.html

  12. Completing the policy puzzle

  13. The Safety Net Puzzle

  14. Unmet needs: An elusive piece ?

  15. Defining the safety net Providers of primary physical, mental, and dental health care: • Community and public hospital emergency departments • Local health departments • Non-federally qualified clinics and family practice residency programs • Rural health clinics • School-based health centers • Community health centers • Low-income dental clinics and public oral health programs • Community mental health centers • Migrant health centers

  16. Dimensions of vulnerability • Low income—less than 300% of the FPL • No or insufficient health insurance • Enrollment in publicly financed health care programs • Geographic isolation • No regular source of primary care • Cultural, language or other social barriers

  17. 43% of Coloradans are below 300% of FPL, 2003-05 Source: U.S. Bureau of the Census, Current Population Survey

  18. 36% of Coloradans are uninsured or publicly insured Insurance coverage, 2003-05 Sources: Colorado Dept. of Health Care Policy and Financing; U.S. Bureau of the Census, Current Population Survey

  19. 15% of Coloradans live in rural areas Sources: RUCA: University of Washington, Rural Health Research Center; 2005 Population: Claritas

  20. Low income Insurance coverage Geographic isolation Vulnerable populations: A multi-dimensional view

  21. CHI Data Collection and Analysis • Personnel by major service category (FTE) • Demographic characteristics by geographic area • Patients by Zip code • Services offered/referred • Patients by gender and age • Insurance source by age (0-19, 20+ yrs) • Patient family income by FPL threshold • Safety net financial information Emergency Depts. Clinic Net Public health clinics Mental health clinics School based clinics Rural Health Clinics FQHCs Data collection through… • FQHCs: Uniform Data System (UDS) data obtained through data sharing agreements • “UDS-like” elements collected from other safety net providers with data sharing agreements using online survey housed at CHI • Demographic and health data: Sources include US Census Bureau, CO Demography Office, Behavioral Risk Factor Surveillance System (BRFSS) Dental providers

  22. Value to organizations to participate • Inclusion in a uniform data collection effort that will be used to inform policymakers, foundations, and the public about importance of the SN and how it is meeting the needs of vulnerable populations in CO • CHI-produced reports and mapping based on uniform data can be used for future planning • Opportunities for collaboration, identifying gaps and areas of need • Knowledge of how your SN community compares to others

  23. Mapping example: Weld and Larimer Service Areas 23

  24. Weld and Larimer service areas with families poverty profile 24

  25. Initial results: School-based health centers Survey methods: • Web-based survey administered in early 2008 • Completed by SBHC program sponsors • Part 1: Program information • Part 2: Site information • All SBHC programs completed the survey; n = 15 SBHC programs, representing 38 sites

  26. Estimates of access, users, and visits In 2006-07: • 193,153 students had access to a SBHC (n = 38)* • 20,964 students used SBHC services (n = 37) • 66,708 visits were made to SBHCs (n = 38) • 30,442 immunizations were provided (n = 31)** Notes: * To determine the number of students who had access to a SBHC, CHI analyzed responses to a survey item in which respondents were asked to identify eligibility requirements to receive services at their SBHC. 2006-07 school enrollment, feeder school enrollment, or school district enrollment was counted, depending on the eligibility requirements and the availability of SBHC services in each school district. School district enrollment was counted when a respondent indicated that all children (birth to age 21) were eligible to for SBHC services. ** Respondents were asked to count each injection as one immunization. These totals may differ from totals reported in subsequent slides because not all SBHCs were able to report the same level of detail (e.g., unduplicated users by insurance source). Three respondents reported data for CY2007; all others provided 2006-07. Source: CHI analysis of data from 2008 CASBHC and CHI Survey of School-Based Health Centers.

  27. What was the health insurance status of students who visited SBHCs? Number of SBHCs reporting = 32 Source: CHI analysis of data from 2008 CASBHC and CHI Survey of School-Based Health Centers.

  28. Average and total revenue Average revenue (cash) was $179,098 (n = 37); in addition, an estimated average of $68,662 per SBHC was received in in-kind support (n = 36) Source: CHI analysis of data from 2008 CASBHC and CHI Survey of School-Based Health Centers.

  29. Revenue (continued) Total Revenue = $9,098,481 Number of SBHCs reporting = 37 (cash); 36 (in-kind) Source: CHI analysis of data from 2008 CASBHC and CHI Survey of School-Based Health Centers.

  30. What’s next? • Continued outreach to safety net providers • Analysis of survey data • Uniform Data System (UDS) • Web-based survey data • Development of materials and publications • Second round of data collection (early 2009) • Continued enhancement of safety net Web site

  31. Questions/contact information Colorado Health Institute www.coloradohealthinstitute.org 303.831.4200 Jeff Bontrager, Senior Research Analyst (x 205) bontragerj@coloradohealthinstitute.org Susan Roughton, Senior Research Analyst (x 212) roughtons@coloradohealthinstitute.org

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