1. Report to the Citizens Blue Ribbon Committee on JPS Health Network Long Range Planning
System Capacity and
Population Need
May 9, 2017
Greg Vachon, MD, MPH, Principal

2. System Capacity and population Need
Key points
Current needs of target populations far exceed the capacity
Capacity cannot be increased to point of meeting all projected need: future need must be partially met through delivery system changes
Primary care and other preventive efforts must be strengthened in order to decrease demand for downstream services

3. Framework for Defining Capacity and need: Population view
Need of target population
Total Need
“There are significant unmet needs, even if total specialists in Tarrant County may be adequate”
Unmet needs
Example:
2 million people need 80 cardiologists 30
Cardiologists
Other systems
“Other systems fulfill unknown amount of the need”
JPS
capacity
“Capacity of JPS could meet 26% of need in target population”
Target population need

4. Using Today’s Percentage to Define Plans
Absolute unmet need increases
Unmet needs
Other systems
Number of cardiologists needed to have capacity to serve same percentage
26%
26%
26%
Now
In 10 years
In 20 years

5. Alternative: plan to meet Need, as a County
Decrease need through technology
Potential to reach 100%
Create partnerships to enable other systems to similarly increase percentage of service
Unmet needs
Other systems
Capacity needed to serve higher percentage
Now
In 10 years
In 20 years

6. A part of Model (except beds) Assumes All Capacity is Directed towards the target Population
Need of target population
Total Need
Example:
2 million people need 80 cardiologists
<250 FPL
Need 31
Portion of population actually served is less than 26% - only that under the curve
Target population need
JPS
capacity
8 cardiologists but serve patient mix above and below 250 FPL

7. Primary Care in All of Tarrant County
2017
2022
2027
2032
2037
Total Needed FTEs
1,043
1,168
1,294
1,437
1,581
Estimated number of primary care physicians in Tarrant County
778
Percent of need
75%
Non-physician PCPs likely make up some of 25%, but data consistent with low primary care capacity
25 FTEs of net PCPs per year will be needed in Tarrant in next five years
1,168 – 1,043 = 125 ÷ 5 years = 25 per year

8. Major training, recruiting and retention of PCPs is essential
Primary Care Needs For Population < 250% FPL Compared to JPS Capacity
2017
2022
2027
2032
2037
Total Needed FTEs
378
423
469
521
573
Number of JPS FTEs to continue same “coverage” 98
(current)
110
122
135
149
Percent of demand met
26%
Number of JPS FTEs needed to reach 50% in 20 years
178
229
287
32%
38%
44%
50%
Primary care is needed as one foundation to achieving prevention, lower hospital rates
Major training, recruiting and retention of PCPs is essential
Concurrent primary care facility expansion/additions will be needed

9. Specialty NEED For Population < 250% FPL
Zero to 30
Scale to 100

10. Specialty access is poor for target population
Specialty Take Home
Specialty access is poor for target population
Long waits of months for non-urgent new appointments
On average, the percent of population need met by JPS is 27% (similar to primary care) but varies by specialty
Planning for expansion must be much more than meeting a particular percentage of population need. Need to assess:
Pediatrics versus adult drivers of need
Other institutions capacity and willingness to meet needs
Ability to attract other payers (degree of subsidy)
Impact of unmet needs per specialty

11. Psychiatric Beds: Public Bed Need In Tarrant County
2017
2022
2027
2032
2037
Best evidence: 70 public beds/100,000
1,414
1,568
1,722
1,893
2,064
Investments in comprehensive behavioral health supports
707
784
861
947
1,032
Beds if 50% of need met by JPS
354
392
431
473
516
JPS actual beds
132
Percent of the 50%
37%
34%
31%
28%
26%
Current beds are woefully inadequate to meet population needs
Three keys:
prevent need/demand (county-wide efforts to prevent mental health problems, identify and treat early in accessible ambulatory settings)
optimize use of beds (e.g., complex patients at JPS)
build inpatient capacity

12. ACUTE Medical Beds
2017
2022
2027
2032
2037
Beds per thousand if no further capacity built in Tarrant County
2.0
1.8
1.7
1.5
1.4
Likely beds needed with current downward trends (assumes investment)
n/a
1.92
1.82
1.73
1.65
Total beds needed in all Tarrant County
219
404
603
770
Beds needed for the new population <250% FPL at final rate of 1.65 per 1,000
154
307
478
648
Investment in primary care and care management need to be made to lower bed utilization rates
Target population bed needs will need to continue to be met by multiple institutions

13. Analysis of Target Population’s Acute Medical Bed Need At JPS
JPS Connection and Medicare < 250% FPL
2017
2022
2027
2032
2037
Beds per thousand adjusted for payer mix and expected bed need reduction
1.547
1.560
1.563
1.553
Total beds needed for target population
659
737
810
890
964
JPS beds likely available (based on 55.1% of beds to Medicare, Connection, Self Pay)
224
Percent of need met for target population
34%
30%
28%
25%
23%
Aging population keeps bed rate steady
Without increasing beds current shortage evidenced by ER holding will be severely exacerbated

14. System Capacity and Population Needs
Question and Answer
Discussion