1. Primary Care Alternatives PRC Results

2. Primary Care Alternatives
Health Insurance
Difficulty Accessing Healthcare
ER Utilization
Specific Source of Ongoing Care
PRC Assessment Findings
Primary Care Alternatives

3. Lack of Healthcare Insurance Coverage (Among Adults Age 18-64)
Lee County At-Risk
Higher uninsured:
Low-income residents (<200% FPL) = 35.0%
Hispanic residents = 35.1%
African American residents = 34.7%
Market Area 2 residents = 29.0%
Adults age = 28.9%
Best coverage found in Market Area 4
not statistically significant
% [Age 18-64] Lack Health Insurance
Sources: ● PRC Community Health Surveys, Professional Research Consultants, Inc. [Item 194]
● Behavioral Risk Factor Surveillance System Survey Data. Atlanta, Georgia. United States
Department of Health and Human Services, Centers for Disease Control
and Prevention (CDC): 2012 Florida data.
● PRC National Health Survey, Professional Research Consultants, Inc.
● US Department of Health and Human Services.  Healthy People December 2010.
[Objective AHS-1]
Notes: ● Asked of all respondents under the age of 65.
Another 8.3% of insured adults went without coverage at some point in the past year.

4. Experienced Difficulties or Delays of Some Kind in Receiving Needed Healthcare in the Past Year
Lee County At-Risk
Greater difficulty:
African American residents = 60.6%
Low-income residents (<200% FPL) = 56.0%
Market Areas 1 (47.3%) and 2 (46.3%)
Adults age (54.0%) or (43.8%)
% Difficulty Accessing Healthcare in Past Year (Composite)
Sources: ● PRC Community Health Surveys, Professional Research Consultants, Inc. [Item 198]
● PRC National Health Survey, Professional Research Consultants, Inc.
Notes: ● Asked of all respondents.
● Represents the percentage of respondents experiencing one or more barriers to accessing healthcare in the past 12 months.

5. Barriers to Access Have Prevented Medical Care in the Past Year
This indicator increased significantly between and 2011 and has since held steady.
% Difficulty Accessing Healthcare in Past Year (Composite)
% Inconvenient Hrs Prevented Dr Visit in Past Year
% Cost Prevented Getting Prescription in Past Year
% Cost Prevented Physician Visit in Past Year
% Difficulty Getting Appointment in Past Year
% Difficulty Finding Physician in Past Year
% Transportation Hindered Dr Visit in Past Year
Sources: ● 2014 PRC Community Health Survey, Professional Research Consultants, Inc. [Items 8-12, 16]
● 2013 PRC National Health Survey, Professional Research Consultants, Inc.
Notes: ● Asked of all respondents.

6. Lack or Type of Insurance Coverage Prevented Medical Care at Some Point in the Past Year
Reasons given:
No health insurance coverage (38.5%)
Problems with coverage limits (20.8%)
Cost of services (16.8%)
Insurance not accepted (9.6%)
Problem with type of insurance (3.5%)
% Lack/Type of Insurance Prevented Care
Sources: ● PRC Community Health Surveys, Professional Research Consultants, Inc. [Items 18-19]
Notes: ● Asked of all respondents.

7. Lack or Type of Insurance Coverage Prevented Medical Care at Some Point in the Past Year (Lee County, 2014)
Lee County At-Risk
Other segments with high impact:
African American residents = 34.2%
Low-income residents (<200% FPL) = 33.7%
Adults age = 29.8%
% Lack/Type of Insurance Prevented Care
Sources: ● 2014 PRC Community Health Survey, Professional Research Consultants, Inc. [Item 18]
Notes: ● Asked of all respondents.
● Hispanics can be of any race. Other race categories are non-Hispanic categorizations (e.g., “White” reflects non-Hispanic White respondents).
● Income categories reflect respondent's household income as a ratio to the federal poverty level (FPL) for their household size. “Low Income” includes households
with incomes up to 200% of the federal poverty level; “Mid/High Income” includes households with incomes at 200% or more of the federal poverty level.

8. Have a Specific Source of Ongoing Medical Care
Lee County At-Risk
Lower among:
African American residents = 62.8%
Hispanic residents = 66.7%
Low-income residents (<200% FPL) = 67.7%
Adults age = 64.7%
Market Area 2 residents = 70.3%
Men = 71.2%
% [Age 18+] Have a Specific Source of Ongoing Care
% [Age 18-64] Have a Specific Source of Ongoing Care
% [Age 65+] Have a Specific Source of Ongoing Care
Sources: ● PRC Community Health Surveys, Professional Research Consultants, Inc. [Item 195]
● PRC National Health Survey, Professional Research Consultants, Inc.
● US Department of Health and Human Services.  Healthy People December [Objective AHS-5.1]
Notes: ● Asked of all respondents.

9. Have Visited a Physician for a Checkup in the Past Year
Lee County At-Risk
Lower among:
African American residents = 57.8%
Adults age = 65.2%
Market Area 3 residents = 70.8%
Men = 73.6%
% Have Had Routine Checkup in Past Year
Routine checkups for children are higher than for adults and have improved consistently since 2007.
Sources: ● PRC Community Health Surveys, Professional Research Consultants, Inc. [Item 23]
● PRC National Health Survey, Professional Research Consultants, Inc.
Notes: ● Asked of all respondents.

10. Have Used a Hospital Emergency Room More Than Once in the Past Year
Lee County At-Risk
Higher among:
Residents of Market Area 1 (16.5%) or Market Area 2 (14.2%)
Low-income residents (<200% FPL) = 16.4%
Adults age = 14.2%
% Two or More ER Visits in Past Year
Sources: ● PRC Community Health Surveys, Professional Research Consultants, Inc. [Items 32-33]
● PRC National Health Survey, Professional Research Consultants, Inc.
Notes: ● Asked of all respondents.

11. Have Visited a Dentist or Dental Clinic Within the Past Year
% [Age 18+] Dental Visit in Past Year
Sources: ● PRC Community Health Surveys, Professional Research Consultants, Inc. [Item 30]
● 2013 PRC National Health Survey, Professional Research Consultants, Inc.
● US Department of Health and Human Services.  Healthy People December 2010.
[Objective OH-7]
● Behavioral Risk Factor Surveillance System Survey Data. Atlanta, Georgia. United States
Department of Health and Human Services, Centers for Disease Control and Prevention (CDC):
2012 Florida data.
Notes: ● Asked of all respondents.
Dental insurance coverage is low (54.6% vs. 65.6% nationally), although it has improved since 2007.

12. Have Visited a Dentist or Dental Clinic Within the Past Year (Lee County, 2014)
% [Age 18+] Dental Visit in Past Year
Sources: ● 2014 PRC Community Health Survey, Professional Research Consultants, Inc. [Item 30]
● US Department of Health and Human Services.  Healthy People December 2010.
[Objective OH-7]
Notes: ● Asked of all respondents.
● Hispanics can be of any race. Other race categories are non-Hispanic categorizations (e.g.,
“White” reflects non-Hispanic White respondents).
● Income categories reflect respondent's household income as a ratio to the federal poverty
level (FPL) for their household size. “Low Income” includes households with incomes up to
200% of the federal poverty level; “Mid/High Income” includes households with incomes at
200% or more of the federal poverty level.
Among kids, utilization is low (72.1% have had dental care in the past year, versus 81.5% nationally).

13. Primary Care Alternatives Update
Cliff Smith, Ed Houck and
Jorge Quinonez
Co-Champions

14. Primary Care Alternatives
Convene stakeholders to develop a comprehensive, community-based system of primary care alternatives to the Emergency Room, targeting areas of greatest need. (Key elements may include neighborhood centers/clinics, mobile units, 24/7 access, service for under/uninsured, and possible roles for retired physicians and major employers.) Develop a method for educating non-emergent patients to use the appropriate care settings.

15. Primary Care Alternatives Scorecard

16. Continued Rapid Expansion in 2013
Continued Rapid Expansion in 2013
344  Volunteer Specialty Physicians
2100 Free hours of care
Total value of donated care increased 22% -- $6.6 million
Project Dentistry will be added this year

17. Lee Community Healthcare (formerly United Way House Clinics)
In final phase of securing designation as Federally Qualified  Health Center Look-Alike
Opened 3rd clinic in Cape Coral  (other Clinics in Dunbar and North Fort Myers)
Total number of patient visits increased 30% to  -- 14,000
United Way 211 I&R Specialist now deployed at each Clinic

18. 17th United Way House recently opened in Pine Manor
United Way Houses
17th United Way  House recently opened in Pine Manor
83 Agencies provide services in the UW Houses
Over 300,000 client visits in 2013
All UW Houses have a Health and Wellness Programs
HIV/AIDS testing, mobile mammogram, health screenings, etc.

19. Health Care Navigators
Effort spearheaded by Health Planning Council
Partners included Family Health Centers, Lee County Department of Human Services and United Way
Very promising first round of open enrollment

20. Opened new Access Points in Bonita and Estero
3rd new office will open soon in Cape Coral
Over 66,000 patients served in 2013 with over 280,000 direct patient visits
Healthcare for the Homeless Outreach now in 7 locations – helped
New collaboration with Harlem Heights Clinic

21. Opportunities for Improvement
More sites with expanded hours as possible
Target program expansion where possible
Expand Chronic Disease Management services
Expand Patient Centered Medical Homes

22. Primary Care Alternatives to the ED
We are on track to meet our 2017 goal to be similar to or better than the U.S. average for those surveyed with fair or poor health.
Yes No

23. Discussion