Professional Health Services

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Ambulatory Care per Capita in Whatcom*

(averaged across population segments;
growth over time in base run due only to population aging)

*Rates for Whatcom residents, including hospital visits both in and outside of the county.  Inpatient and extended care utilization shown in later slides.

Sources: For hospital visits: St. Joseph’s Hospital FY2011, WA state DOH CHARS database 2010 (for visits going outside of county); For non-hospital visits: inferred from NAMCS (national) and from local provider counts, but no direct state or local data.

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STRATEGIES:

ADD NEW ROLE: COACHES WITH SKILLS AS RESILIENCE TRAINERS TO PROVIDE CHRONIC CARE COACHING, BEHAVIORAL HEALTH COACHING, NAVIGATING, AND CARE COORDINATION.

 

WHAT ABOUT THE COSTS AND BENEFITS OF COMPLEMENTARY CARE WHICH IS MANDATED BY WA STATE INSURANCE COMMISSIONER? WHAT ABOUT THE ROLE OF OTC MEDICATIONS?

MODEL EFFECT OF CHANGES IN SECONDARY SERVICE AREAS?

  Adequacy of routine care*:
Whatcom vs. Other Communities

*Includes visit regularity and self-care, with a national average of about 50%. The differences seen here reflect assumed influences of poverty, uninsurance, and mental illness.

Sources: synthetic calculation based on population segment distribution; assumes the same adherence fractions per segment as estimated for Manchester NH.

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STRATEGIES:

WHAT ARE THE LEVERS HERE?

HOW CAN WE MODEL REMOTE TELEHEALTH AND ENHANCED SELF-CARE?

PREVENTIVE STRATEGIES?

CHRONIC CARE STRATEGIES?

  PCP office visits per capita*:
Whatcom vs. Other Communities

*Routine and acute care visits to PCPs in non-hospital offices

Sources: for Whatcom: inferred from NAMCS and from local PCP provider count; for other communities: NAMCS, CHIS and other state and local sources

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STRATEGIES:

HOW SHOULD WE SHOW AND ACCOUNT FOR THE HIGHER MEDICARE PAYMENTS  (POPULATION COSTS) FOR HOSPITAL BASED CLINIC VISITS?

Specialist office visits per capita*:
Whatcom vs. Other Communities

*Routine and acute care visits to specialists in non-hospital offices, including both own patients and referrals.

Sources: for Whatcom: inferred from NAMCS and from local specialist provider count and from OPD and inpatient referral volume; for other communities: NAMCS, CHIS and other state and local sources

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STRATEGIES:

WHY IS WHATCOM LOWER THAN PUEBLO?

Hospital OPD visits per capita*:
Whatcom vs. Other Communities

*Rates for Whatcom residents, including OPD visits both in and outside of the county.  Routine visits (preventive & chronic care) correspond to a subset of visits to hospital-based clinics in St. Joseph’s data, while tests/procedures correspond to ‘Series’ and ‘AOV’ visits.

Sources: for Whatcom: St. Joseph’s Hospital FY2011, WA state DOH CHARS database 2010 (for visits going outside of county); for other communities: various sources

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STRATEGIES:

WHY IS WHATCOM 3X PUEBLO AND MANCHESTER?

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STRATEGIES:

ER visits per capita*:
Whatcom vs. Other Communities

*Rates for Whatcom residents, including ER visits both in and outside of the county. 

Sources: for Whatcom: St. Joseph’s Hospital FY2011, WA state DOH CHARS database 2010 (for visits going outside of county); for other communities: various sources.

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STRATEGIES:

WHY IS WHATCOM LOWER?

Non-urgent fraction of ER visits*:
Whatcom vs. Other Communities

*Non-urgent refers to “ambulatory sensitive” ER visits that could have been seen at a doctor’s office if one had been available.  (This is not the same as the NHAMCS survey’s “did not need to be seen within 60 minutes”, which gives smaller rates.)  In the model, non-urgent ER visits are more likely for the poor and for that fraction of the poor uninsured lacking access to primary care (next slide).

Sources: for Whatcom: St. Joseph’s Hospital; estimate based on pattern of ER utilization by population segment seen in studies at Catholic Med Ctr (Manchester) and Grady Hospital (Atlanta)

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STRATEGIES:

Sufficiency of PCPs for the poor uninsured*:
Whatcom vs. Other Communities

*Reflects capacity of Safety Net PCPs relative to demand for office-based care by the Disadvantaged Uninsured segment.  Whatcom’s Disadvantaged Uninsured population will decline in size with aging into Medicare, while Safety Net PCP capacity is assumed to grow in steady proportion to total population.     

Sources: inferred from NAMCS (demand by population segment), www.whatcomalliance.org/gettting-healthcare/primary-care (number of Safety Net PCPs), and Interfaith FQHC visit data by insurance segment 2009-11

 

 

 

 

 

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