Community Health Access Program

1. Community Health Access Program Heather Bittner Fagan, MD James M. Gill, MD MPHYu Ling, MA Delaware Health Care Commission Meeting July 20, 2005

2. Community Health Access Program(CHAP) • Matches low-income uninsured Delawareans with established health homes • Goal of program is to improve health by integrating services and improving access to existing resources

3. CHAP Evaluation 2004/2005 • Health Care outcomes • Preventive care measures • Hospital Utilization • Role of CHAP in the Safety Net • Interaction with Screening for Life program • Geographical implications • Distribution of CHAP enrollees (demand) • Distribution of physicians (supply)

4. Preventive Care Outcomes • Data from 6/11/2001 to 10/15/2004 • Analysis of two groups of CHAP patients • 6 months continuous enrollment (n=1394) • 1 year continuous enrollment (n=512) • Measures used in previous analysis • Breast cancer screening (mammogram, breast exam), cervical cancer screening (pap smear) , colorectal cancer screening (sigmoidoscopy, blood stool), cholesterol, adult immunizations (Pneumovax, influenza), hospital utilization (ER use and hospitalization)

5. Breast Cancer Screening Baseline Follow Up * P < 0.05

6. Cervical Cancer Screening * P < 0.05

7. Colorectal Cancer Screening Baseline Follow Up * p<0.05

8. Cholesterol Screening * P<0.05

9. Adult Immunizations Baseline Follow Up * P < 0.05

10. Hospitalization Utilization Baseline Follow Up *P < 0.05

11. CHAP and SFL • Attempted to isolate the effects of CHAP and SFL to examine interaction of programs using index dates* • Looked at population as they entered CHAP (i.e. before “CHAP intervention”) to estimate the influence of SFL • Looked at change in rate in CHAP follow-up records before and after SFL index dates * For women 1/1/02 and for men 10/1/03

12. Interaction of CHAP and SFL Baseline Follow-up • SFL alone 8% increase • CHAP alone estimated 5-8% • Combined effect 8%

13. Understanding the geography of CHAP • Demand: where do CHAP enrollees come from • Supply: where are CHAP physicians and services located

14. Where do Chap enrollees come from?

15. Where are CHAP physicians located

16. Does the supply of CHAP physicians meet the demand of CHAP patients

17. Where do Northern New Castle County CHAP enrollees come from?

18. Where do Southern New Castle County CHAP enrollees come from?

19. Where do Kent County CHAP enrollees come from?

20. Where do Sussex County CHAP enrollees come from?

21. Summary • CHAP improves health outcomes • CHAP in conjunction with SFL leaves CRC screening suboptimal • The distribution of physicians in the CHAP program mirrors the need of CHAP enrollees

22. Future Work • Move away from survey and preventive health outcomes • Move towards disease management • Further understanding of CHAP synergy through the state CRC screening program • Estimate the magnitude of CHAP supply and demand with geo mapping

23. New CHAP model • Disease management • Based on age of population: obesity, smoking, HTN • Measuring the ability of program to help a vulnerable population navigate the health system • Health literacy