2. A Presentation of the Colorado Health Institute 1576 Sherman Street, Suite 300 Denver, Colorado 80203-1728 www.coloradohealthinstitute.org The Colorado Safety Net Indicators and Monitoring System Monitoring the health of Colorado’s safety net CCMU Annual Meeting May 21, 2008

3. Overview of presentation The Colorado Health Institute: Who are we? The Safety Net Monitoring System –Development –Objectives –Methods What is the value of a monitoring system? Completing the policy puzzle Initial results: school-based health centers 2

4. The Colorado Health Institute (CHI) Nonprofit 501(c)3 organization located in Denver Mission - To advance the overall health of the people of Colorado by serving as an independent and impartial source of reliable and relevant health-related information for sound decision-making. Core functions: –Information clearinghouse –Analysis and research –Information dissemination 3

5. CHI’s past reports on-line 4 http://www.coloradohealthinstitute.org/documents/sn/rhc_report.pdf 4

6. http://www.coloradohealthinstitute.org/safetynet 5

7. The Safety Net Monitoring System: Background IOM Description of the Nation’s Safety Net, 2000 : “A highly localized and fragmented patchwork of health care providers that face increasing financial stress and capacity constraints in providing health care to vulnerable populations.” -- Institute of Medicine. 2000. America’s Health Care Safety Net: Intact but Endangered 6

8. The Safety Net Monitoring System: Background IOM Recommendation: “The committee recommends that concerted efforts be directed to improving this nation’s capacity and ability to monitor the changing structure, capacity, and financial stability of the safety net to meet the health care needs of the uninsured and other vulnerable populations.” -- Institute of Medicine. 2000. America’s Health Care Safety Net: Intact but Endangered 7

9. The Safety Net Monitoring System: Development Multi-year effort Initial funding provided by The Colorado Health Foundation Focus on basic physical, mental, and dental health care services Diverse communications portfolio including Web site, symposia, publications 8

10. The Safety Net Monitoring System: Methods Convened project Advisory Committee Identified objectives and policy issues Established definitions, Identified data gaps Selected population-based and provider-based data indicators Conduct on-going analysis of indicators and dissemination of information Conduct community-wide case studies 9

11. The Safety Net Monitoring System: Objectives Objectives: Build comprehensive databases Assess the viability and sustainability of Colorado’s health care safety net providers Provide reliable and timely information on which sound policy decisions can be based 10

12. The Safety Net Monitoring System: Value Data-driven reporting system of statewide value Will identify, describe and monitor the ability of Colorado’s safety net providers to meet the health care needs of vulnerable populations Determine what variations exist among Colorado communities in the organization and financing of safety net services Inform policymakers about the changing dynamics of Colorado’s safety net system More information: http://www.coloradohealthinstitute.org/safetynet/project_descri ption.html 11

13. Completing the policy puzzle 12

14. The Safety Net Puzz le 13

15. Unmet needs: An elusive piece ? 14

16. Defining the safety net Providers of primary physical, mental, and dental health care: –Community and public hospital emergency departments –Local health departments –Non-federally qualified clinics and family practice residency programs –Rural health clinics –School-based health centers –Community health centers –Low-income dental clinics and public oral health programs –Community mental health centers –Migrant health centers 15

17. Dimensions of vulnerability Low income—less than 300% of the FPL No or insufficient health insurance Enrollment in publicly financed health care programs Geographic isolation No regular source of primary care Cultural, language or other social barriers 16

18. 43% of Coloradans are below 300% of FPL, 2003-05 Source: U.S. Bureau of the Census, Current Population Survey 17

19. 36% of Coloradans are uninsured or publicly insured Insurance coverage, 2003-05 Sources: Colorado Dept. of Health Care Policy and Financing; U.S. Bureau of the Census, Current Population Survey 18

20. 15% of Coloradans live in rural areas Sources: RUCA: University of Washington, Rural Health Research Center; 2005 Population: Claritas 19

21. Vulnerable populations: A multi-dimensional view Low income Geographic isolation Insurance coverage 20

22.  FQHCs: Uniform Data System (UDS) data obtained through data sharing agreements “UDS-like” elements collected from other safety net providers with data sharing agreements using online survey housed at CHI  Demographic and health data: Sources include US Census Bureau, CO Demography Office, Behavioral Risk Factor Surveillance System (BRFSS) Data collection through… Emergency Depts. Clinic Net Dental providers Public health clinics Mental health clinics School based clinics Rural Health Clinics FQHCs Patients by gender and age Insurance source by age (0-19, 20+ yrs) Patient family income by FPL threshold Safety net financial information Personnel by major service category (FTE) Demographic characteristics by geographic area Patients by Zip code Services offered/referred CHI Data Collection and Analysis 21

23. Value to organizations to participate Inclusion in a uniform data collection effort that will be used to inform policymakers, foundations, and the public about importance of the SN and how it is meeting the needs of vulnerable populations in CO CHI-produced reports and mapping based on uniform data can be used for future planning Opportunities for collaboration, identifying gaps and areas of need Knowledge of how your SN community compares to others 22

24. Mapping example: Weld and Larimer Service Areas 23

25. Weld and Larimer service areas with families poverty profile 24

26. Initial results: School-based health centers Survey methods: Web-based survey administered in early 2008 Completed by SBHC program sponsors –Part 1: Program information –Part 2: Site information All SBHC programs completed the survey; n = 15 SBHC programs, representing 38 sites 25

27. Estimates of access, users, and visits In 2006-07: 193,153 students had access to a SBHC (n = 38)* 20,964 students used SBHC services (n = 37) 66,708 visits were made to SBHCs (n = 38) 30,442 immunizations were provided (n = 31)** Notes: * To determine the number of students who had access to a SBHC, CHI analyzed responses to a survey item in which respondents were asked to identify eligibility requirements to receive services at their SBHC. 2006-07 school enrollment, feeder school enrollment, or school district enrollment was counted, depending on the eligibility requirements and the availability of SBHC services in each school district. School district enrollment was counted when a respondent indicated that all children (birth to age 21) were eligible to for SBHC services. ** Respondents were asked to count each injection as one immunization. These totals may differ from totals reported in subsequent slides because not all SBHCs were able to report the same level of detail (e.g., unduplicated users by insurance source). Three respondents reported data for CY2007; all others provided 2006-07. Source: CHI analysis of data from 2008 CASBHC and CHI Survey of School-Based Health Centers. 26

28. What was the health insurance status of students who visited SBHCs? Source: CHI analysis of data from 2008 CASBHC and CHI Survey of School-Based Health Centers. Insurance sourceNumberPercent Medicaid6,30532% CHP+1,2316% CHAMPUS, TRICARE, or other govt1421% Private insurance2,11311% Uninsured/self-pay9,05845% Unknown1,0965% Total19,945100% Number of SBHCs reporting = 32 27

29. Average and total revenue Source: CHI analysis of data from 2008 CASBHC and CHI Survey of School-Based Health Centers. Average revenue (cash) was $179,098 (n = 37); in addition, an estimated average of $68,662 per SBHC was received in in-kind support (n = 36) Total Revenue, Colorado SBHCs, 2006-07 Revenue SourceAmountPercent In-kind $ 2,471,84627% Federal $ 1,204,52613% State $ 982,89411% Local $ 137,8162% Private $ 2,272,94125% Medicaid $ 1,509,26117% CHP+ $ 334,5864% CHAMPUS $ 2,035.002% Private insurance $ 28,287.3% Self-pay $ 135,8411% Other patient revenue $ 18,448.2% Total $ 9,098,481100% 28

30. Revenue (continued) Source: CHI analysis of data from 2008 CASBHC and CHI Survey of School-Based Health Centers. Number of SBHCs reporting = 37 (cash); 36 (in-kind) Total Revenue = $9,098,481 29

31. What’s next? Continued outreach to safety net providers Analysis of survey data Uniform Data System (UDS) Web-based survey data Development of materials and publications Second round of data collection (early 2009) Continued enhancement of safety net Web site 30

32. Questions/contact information Colorado Health Institute www.coloradohealthinstitute.org 303.831.4200 Jeff Bontrager, Senior Research Analyst (x 205) bontragerj@coloradohealthinstitute.org Susan Roughton, Senior Research Analyst (x 212 ) roughtons@coloradohealthinstitute.org roughtons@coloradohealthinstitute.org 31