Charlotte/Sarasota County Health Status Review & Recommendations

1. Charlotte/Sarasota County Health Status Review & Recommendations Zac Bielling Peace River Regional Medical Center Jack Lagrace Fawcett Memorial Hospital Lindsey Cooke Charlotte Regional Medical Center Shreeta Quantano Sarasota Memorial Hospital

2. AGENDA • Purpose • Overview of Health Issues • Statistics • Access to Care • Obesity • Mental Health • Recommendations • Next Steps

3. Purpose • Provide insight to critical health issues affecting Charlotte and Sarasota Counties • Offer recommendations that will ultimately improve the health of the community by: • Increasing access to healthcare resources • Better focus on prevention and health education for chronic illnesses • Prevent unnecessary ER visits and hospitalizations

4. AGENDA • Purpose • Overview of Health Issues • Statistics • Access to Care • Obesity • Mental Health • Recommendations • Next Steps

5. Overview of Health Issues • Residents of Sarasota and Charlotte counties suffer from: • Barriers to access care • Lack of coverage and public awareness of available healthcare resources • Insufficient supply of physicians caring for the growing number of under and un-insured residents, as well as those on Medicaid • High prevalence of chronic diseases linked to inadequate nutrition and sedentary lifestyles • These behaviors are initiated at younger ages where there is a lack of resources to counteract these trends (i.e. lack of school-based programs that encourage physical activity and proper nutrition) • Increasing rate of mental illness • High and growing rate of mental health-related issues (i.e. intentional injuries, hospitalizations). These disorders often are undiagnosed and untreated. There is a lack of resources to support counter-acting these trends.

6. AGENDA • Purpose • Overview of Health Issues • Statistics • Access to Care • Obesity • Mental Health • Recommendations • Next Steps

7. Statistics: Access to Care Health coverage: • Charlotte county: 21.8% • Sarasota county: 18.1% • Florida: 18.7% CHIP Health Survey findings: • 14% of all respondents report someone in family used ER for non emergent care • 32.6% of those who used ER for non emergent care did so because doctor was closed • 81% indicate not knowing of any clinics that treat the uninsured (2006, Sarasota County Survey) • 64.3% reported they were not aware of community programs to help become healthier (2006) • 41% indicated they did not have a dental exam or receive dental hygiene in the past year due to cost • Fewer than 10 physicians are providing services to more than 45% of the Medicaid population in Sarasota County Florida Health Insurance Study, 2004

8. Statistics: Obesity Related • Interesting facts about America • Obesity is less prevalent in Charlotte and Sarasota counties, although currently trending toward Florida and US levels • Approximately 1 in 4 people do not exercise regularly • 75% of the population does not consume appropriate levels of fruits and vegetables

9. Statistics: Obesity Hospitalizations related to Obesity Source: CHIP Project, Health Profile for Sarasota and Charlotte Counties, 2002 data *U.S. is 2001 Data • In the United States alone, the combined direct and indirect costs of obesity were estimated to be $123 billion in 2001.1 1 Hossain, P (2007).Obesity and diabetes in the developing world — A growing challenge. The New England Journal of Medicine. 356, 213-215.

10. Statistics: Mental Health Source: CDC/NCHS, 2004 Mortality Data. Death rates on annual basis per 100,00. Age-adjusted rates per 100,000. Source: Florida Department of Health, 2005 Resident Deaths.

11. Statistics: Mental Health • While hospitalization data (hospitalizations due to depressive disorders and psychoses) have steadily declined for Charlotte and Sarasota counties, rates are believed to reflect both missed diagnosis and limited availability of psychiatric beds • It is estimated that one in five Americans suffer from moderate to severe mental illness, but do not seek treatment due to continuing social stigma

12. Statistics: Mental Health • County-level trends reflects increasing age-adjusted death rate for suicide

13. AGENDA • Purpose • Overview of Health Issues • Statistics • Access to Care • Obesity • Mental Health • Recommendations • Next Steps

14. Recommendations: Access to CareModels 1. Sarasota County’s Health Care Access • Potential framework and foundation for Charlotte County 2. Hillsborough County Healthcare Plan, FL 3. Project Access, Dallas, TX

15. Recommendations: Access to CareModels 1. Sarasota County Health Care Access • Target uninsured residents at or below 200% FPL • Universal referral system and patient information among network providers • Establish volunteer health care provider network • Case management services for uninsured patients • Reduce unnecessary ED utilization/avoidable hospitalization • Increase access to low/no cost medications for uninsured Primary objective of enhancing community’s awareness regarding availability of healthcare resources for uninsured

16. Recommendations: Access to CareModels 2. Hillsborough County Healthcare Plan • Comprehensive managed care plan for uninsured with incomes up to 100% FPL • Competitive contracts with providers and enrollees are integrated into system • Funding support via state authorized sales tax (1/2 cent sales tax and later reduced to ¼ cent) Outcomes: • Reduced per patient costs by 65% • Estimated savings of $100 million over 10 years • $10 million Emergency care, $90 million medical expenses • Reduced hospital admission rates for chronic diseases Strong emphasis on early intervention and health education

17. Recommendations: Access to CareModels 3. Project Access, Dallas, TX • Developed in 2001, Dallas County Medical Society and community partners • Provides care for uninsured up to 200% FPL • Physicians, hospitals, and other providers care for a set number of patients/year Outcomes: • FY 2005 ED direct and indirect cost savings $553,375 • PAD patients visit ED 61% less and spend 75% less days in hospital post-enrollment • Enrollees visited ED 1.8/year before enrolling, 0.7/year post-enrollment • FY 2005 total hospital savings by avoided uncompensated utilization estimated at $3,059 per enrollee/year

18. Recommendations: Obesity • Partner with Key Stakeholders for Prevention Strategies • Collaborate with Local Schools and Community Agencies • Develop Childhood Obesity Prevention Strategies • Research Funding for Prevention Strategies Financing Childhood Obesity Prevention Programs: Federal Funding Sources and Other Strategies by The Finance Project September 2004

19. Recommendations: Obesity -Stakeholders & Strategies • Key Stakeholders • Childhood Obesity Prevention Strategies • Encouraging Healthy Lifestyles • Providing Fitness and Nutrition Education • Ensuring Access to Safe Environments • Ensuring Access to Adequate Amounts of Healthy Food Financing Childhood Obesity Prevention Programs: Federal Funding Sources and Other Strategies by The Finance Project September 2004

20. Recommendations: Obesity - Schools • Nutrition and Eating Behaviors • Ensure all school meals meet dietary guidelines • Develop, implement and evaluate pilot programs to expand school meal funding • Remove junk food from vending machines and limit availability of machines during school hours • Physical Activity • Intramural and interscholastic sports programs • Partnering with local community centers forafter schooland summer programs • Incorporate nutritional lessons into gym class lesson plans Koplan, J and IOM Committee on Progress in Preventing Childhood Obesity, Preventing Childhood Obesity: Health in Balance, Overview and Next Steps

21. Recommendations:Mental Health • Partner with Key Stakeholders for Mental Health Prevention Strategies • Charlotte and Sarasota County Department’s of Health • Florida Department of Children and Families • Senior Friendship Centers • Parents, Family Members • Schools • Media Outlets • Develop Depression and Mental Health Prevention Strategies • Research/Develop Mental Health Funding Pathways

22. Recommendations:Mental Health - Strategies • Target: All ages • Strategy Objective: Ensuring treatment of mental health disorders – Community Based Pharmacies • Forge strategic partnerships with pharmaceutical companies • Streamline enrollment/application process for medication • Ensure adherence to treatment protocol • Reduce/eliminate financial barriers

23. Recommendations:Mental Health - Strategies • Targeted Population: Elderly • Strategy Objective: Reduce feelings of social isolation and encourage maintenance of active lifestyles • Best Practice Model: PEARLS (CDC-PRC Sponsored Initiative) • Home-based depression sessions • Initiate senior-centered exercise programs

24. Recommendations: Mental Health - Strategies • Targeted Population: Youth • Strategy Objective: Implement school-based mental health promotion programs • Promote social/emotional competencies • Emphasize development of positive character • Emphasize skills and attitudes consistent with positive lifestyles

25. Recommendations: Mental Health – Funding Pathways • Substance Abuse and Mental Health Services Administration • Provides funding opportunities to improve the quality and availability of mental health services • Florida statewide initiative to transform the publicly funded mental health system • Florida’s Mental Health Transformation • Consumer and family-driven system

26. AGENDA • Purpose • Overview of Health Issues • Statistics • Access to Care • Obesity • Mental Health • Recommendations • Next Steps

27. Next Steps: Access to Care Case Study Common Themes: 1. Volunteer healthcare provider network 2. Case management services -Cross agency case management (JaxCare) 3. Collaboration of several groups essential to leveraging resources • County objectives should focus on expanding Sarasota Health Care Access program while developing a viable plan for Charlotte County • Schedule future meetings with exemplary organizations for benchmarking • Charlotte County restructure Access to Care Task Force and seek future Lower Income Funding support and other grant opportunities

28. Next Steps: Obesity • Meeting with School Superintendents • Vending Machines with Healthy Food Options & Limited Accessibility • Healthy Cafeteria Options • Increased Physical Activity at each grade level • Meeting with Local Community Centers • Educate parents and facilitate healthy lifestyles

29. Next Steps: Mental Health • Increase awareness of mental health illness/reduce stigma • Eliminating Barriers Initiative – Pilot Program with Florida participation • Involves various stakeholders and increases awareness of mental health issues and resources • Meet with Community Organizations • Develop community based pharmacies • Develop more mental health outreach programs • Meet with School Superintendents • Discuss implementation of school-based mental health promotion programs

30. THANK YOUQUESTIONS?

31. References Behavioral Risk Factor Surveillance System, 2001 Behavioral Risk Factors Telephone Survey 2002 from Health Planning Council of Southwest Florida http://www.hpcswf.com/PlanningProjects.asp Community Health Improvement Partnership. Health profile for Sarasota and Charlotte Counties. 2003 and 2004. Community Health Improvement Partnership. Summary of best practices. 2006 Elimination of Barriers Initiative – Modules and toolkits to reduce mental health stigma http://www.dcf.state.fl.us/mentalhealth/ebi/index.shtml Florida Health Insurance Study. 2004 Health Planning Council of Southwest Florida. Accessed http://www.hpcswf.com/PlanningProjects.asp July, 2007 U.S. Census Bureau, State and County Quick Facts

32. Appendix

33. Appendix A Behavioral Risk Factors Telephone Survey, 2002 Health Planning Council of Southwest Florida

34. Appendix B Top Five Avoidable Hospital Admissions rates, Charlotte County 1 Area 8 represents data for the seven SW Florida Counties: Charlotte, Collier, DeSoto, Glades, Hendry, Lee and Sarasota

35. Appendix C Top Five Avoidable Hospital Admissions rates, Sarasota County 1 Area 8 represents data for the seven SW Florida Counties: Charlotte, Collier, DeSoto, Glades, Hendry, Lee and Sarasota

36. Appendix D Obesity Census Data Source: U.S. Census Bureau, State and County Quick Facts

37. Appendix E Prevalence of Overweight and Obese by Ethnicity Source: 2001 BRFSS, Behavioral Risk Factor Surveillance System

38. Appendix FObesity and Diabetes 1 Behavioral Risk Factors Telephone Survey 2002 from Health Planning Council of Southwest Florida http://www.hpcswf.com/PlanningProjects.asp • Prevalence of diabetes is increasing due to the escalation of the overweight and obese population.2 • More than 1.1 billion adults worldwide are overweight, and 312 million of those are obese. 2 2 Hossain, P (2007).Obesity and diabetes in the developing world — A growing challenge. The New England Journal of Medicine. 356, 213-215.

39. Appendix GBarriers to Establishing a Volunteer Physician Network • Physician perspectives: • Too many referrals, too few volunteers • Concerns for malpractice litigation • Not equitable among community providers • Other services not available to patients • Lack of patient responsibility • Low appreciation/recognition • Inconsistent Administrative Support

40. Appendix HPotential Solutions to Establishing a Volunteer Network • Equitable distribution of referrals to physicians • Malpractice immunity (Access to Healthcare Act) • Shared community responsibility • Access to prescriptions for patients in specialty care • Increased patient responsibility • Recognition of profession • Consistent Administrative Support

41. Appendix IRecommendations: Obesity - Schools • Healthy Schools – Nutrition and Eating Behaviors • Develop and implement nutritional standards for all food and beverages sold or served • Ensure all school meals meet dietary guidelines • Develop, implement and evaluate pilot programs to expand school meal funding • Remove junk food from vending machines and limit availability of machines during school hours • Provide more nutritious options for school lunches Koplan, J and IOM Committee on Progress in Preventing Childhood Obesity, Preventing Childhood Obesity: Health in Balance, Overview and Next Steps

42. Appendix JObesity - Examples of Funding *Currently Florida receives funding for the Florida Diabetes Prevention and Control Program (DPCP) since 1996

43. Appendix KRecommendations: Obesity – Schools • Healthy Schools – Physical Activity • Intramural and interscholastic sports programs • After school use of school facilities • Use of schools as community centers • Partnering with local community centers for after school and summer programs • Incorporate nutritional lessons into gym class lesson plans Koplan, J and IOM Committee on Progress in Preventing Childhood Obesity, Preventing Childhood Obesity: Health in Balance, Overview and Next Steps