BASELINE SCENARIOS May 24, 2012
SHOULD WE ADD STRESS AND COACHING TO THE KEY DYNAMICS?
SHOULD WE SEPARATE PHARMA COSTS FROM VISITS, SINCE THEY MAY MOVE IN OPPOSITE DIRECTIONS RELATIVE TO THE ADEQUACY OF PREVENTIVE AND CHRONIC CARE?
A 40-year story in graphs, with reference to data and comparison with other communities.
•Whatcom’s model is now online for your review and testing
–Quick tour so you see how it works
•The foundation for meaningful scenario analyses is to understand the Baseline
–Does it capture the essence of challenges and opportunities in Whatcom county?
–The question is not, how precise are the estimates – each one can certainly be refined through further study. And this tool is yours to improve and recalibrate over time.
–For this pilot engagement, we want to confirm that the mosaic of indicators paints a realistic portrait of conditions in Whatcom. Does it ring true? Does it offer an adequate platform for thinking about future scenarios? Is it misleading in any way?
•Walk through the baseline story.
–What are the main features? What do they mean? How did we get the info?
•Answer technical questions
–Far from being a black box, this model is very transparent, but it has many layers. We will begin with the top layer, and go as deeply as you wish in the steps ahead
•Consider interventions and discuss critical assumptions for initial lever setting
•Plan next steps
Each local configuration of the ReThink Health model draws from a variety of data sources to create a broad and balanced profile of the health and health care system in a particular region. Data for Whatcom County currently address…
• Population composition, divided by 10 subgroups according to age, insurance status, and income, and projections for aging and overall growth through 2040;
• Population health status, including the prevalence of physical and mental illness (by population subgroup);
• Health risks, including fractions of the population with high risk behaviors, environmental hazards, and high crime (by population subgroup);
• Provider resources, including office-based primary care providers (private and safety net) and specialists, and acute care hospital beds;
• Health care utilization, including safety net PCP visits, hospital ER and OPD visits and inpatient stays (by Whatcom residents and non-residents), and other inpatient metrics: re-admissions, discharges to SNF and home health, and bed occupancy;
• Hospital patient revenue, broken out by ER, OPD, and inpatient.
Some of the main sources for understanding conditions in Whatcom County are…
•Census and Vital Statistics
•St. Joseph’s Hospital utilization and revenue data for 2011
•Washington State CHARS database for understanding hospital utilization by patient county of origin, including patient flows to and from other counties for 2010
•Whatcom Alliance data on physician resources
•Interfaith FQHC data on safety net visits broken out by insurance type for 2009-2011
In addition, certain estimates were either calculated or cross-checked using local adjustments from national sources such as…
•National Ambulatory Medical Care Survey (NAMCS)
•National Hospital Ambulatory Medical Care Survey (NHAMCS)
•National Survey of Children’s Health (NSCH)
•National Nursing Home Survey (NNHS)
•National Home Health Care Survey (NHHCS)
Definitions for every element in the model are included in technical documents. Some of the most common concepts are defined as follows for Whatcom (v1):
• Age Group: Youth=0-17; Working Age=18-64; Seniors=65+
• Insurance Status: Medicare; Medicaid; Commercial; Uninsured
• Poverty Status: Disadvantaged<=200% federal poverty
• High Risk Behavior: Adults=obese, no activity, current smoker, binge drinking 2+ times per month, missing 6+ permanent teeth. Child=Overweight or obese, no activity, smoker in the house, oral health problems
• Environmental Hazards: Neighborhood has litter, garbage, or dilapidated housing.
• High Crime: Feel safe in your community, neighborhood, or school; Neighborhood has broken windows or graffiti.
• Chronic Physical Illness: Mild=Self-rated “good”; Severe= Self-rated “fair” or “poor”
• Chronic Mental Illness: Adults=Kessler 6=6+; Adolescents=10+; Child=difficulties with emotions, concentration, behavior in past 6 months
• Safety Net Primary Care Provider: Physicians and physician-equivalents serving disadvantaged people in community health centers or FQHCs
• Non-Urgent Acute ER Visit: “Ambulatory sensitive” visits that could have been seen at a doctor’s office if one had been available.
ASSUMPTIONS FOR BASELINE SCENARIO
We make the following assumptions for the Whatcom baseline scenario:
• Birth and migration rates: No change in birth rate after 2010; migration rate declines during 2010 to 2020 (allowing simulated population to match Census) and is flat thereafter
• Death rates: Historical reduction 2000-2010 (likely due to improved quality of urgent care) continues through 2040 (applying equally to all population subgroups) but decelerates
• Rate at which working age become seniors (age 65+): Increases steadily through 2020, then plateaus by 2030; adjusted to fit Census projection of age distribution through 2040
• Net movement from Advantaged to Disadvantaged: None (within age groups)
• Net movement from Insured to Uninsured: None (within age groups)
• Change in per-capita number of PCPs or specialists: None
• Change in % of Safety Net PCP slots available to uninsured: None
• Change in % of Private PCP slots available to Medicaid patients: None
• Growth in use of St. Joseph’s by non-Whatcom residents: Assumed to mimic growth of Whatcom population (1.8% per year in 2000 slowing to 1.0% by 2040)
• Fraction of hospital-acquired infections not reimbursed by insurers: Zero until 2010, at which time it steps up to 15%, then expands up to 55% by 2020, based on estimates from the CDC Division of Healthcare Quality Promotion (2010).
Other items not mentioned above are either model outputs, or are input parameters held constant over time.