Assessment of the Need for Assessment of the Need for Safety Net Primary Care in Harris Safety Net Primary Care in Harris

CountyCounty

Community Clinics Committee (Alliance)Community Clinics Committee (Alliance) Project Safety Net (St. Luke’s Episcopal Health Charities)Project Safety Net (St. Luke’s Episcopal Health Charities)

Houston Health Services Research Collaborative (UTSPH)Houston Health Services Research Collaborative (UTSPH)

ObjectivesObjectives

Obtain and analyze meaningful data Obtain and analyze meaningful data to prioritize areas of the County in to prioritize areas of the County in greatest need for safety net greatest need for safety net primary care.primary care.

1.1. Use data from the ED Algorithm Study to Use data from the ED Algorithm Study to identify the Northeast quadrant.identify the Northeast quadrant.

2.2. Use uninsurance data, primary care use Use uninsurance data, primary care use data, and Project Safety Net to determine data, and Project Safety Net to determine demand/supply gap for primary care. demand/supply gap for primary care.

2004 ED Algorithm Report2004 ED Algorithm Report

54.5% of ED visits primary care sensitive54.5% of ED visits primary care sensitive

37.8% of PCS ED visits by uninsured37.8% of PCS ED visits by uninsured– Is it a lack of primary care resources?Is it a lack of primary care resources?– Are people not aware of safety-net providers or Are people not aware of safety-net providers or

do they need more help deciding when to seek do they need more help deciding when to seek care or how to manage illnesses?care or how to manage illnesses?

– Are the providers in the area performing Are the providers in the area performing suboptimally?suboptimally?

Community Clinics Committee – focus on Community Clinics Committee – focus on primary care capacityprimary care capacity

Method for Assessing DemandMethod for Assessing Demand– Latest estimates of the low-income Latest estimates of the low-income

uninsured at the ZIP code-leveluninsured at the ZIP code-level– Multiplied by the latest annual number Multiplied by the latest annual number

of primary care visits to HCHD clinics: of primary care visits to HCHD clinics: 2.12.1

– Summed for each quadrantSummed for each quadrant

Estimated Demand by QuadrantEstimated Demand by Quadrant

Low income Low income (<200% FPL) (<200% FPL)

annual annual demanddemand

Low income Low income (<200% FPL) (<200% FPL)

monthly monthly demanddemand

NortheastNortheast 390,511390,511 32,54332,543

NorthwestNorthwest 351,011351,011 29,25129,251

SoutheastSoutheast 313,107313,107 26,09226,092

SouthwestSouthwest 392,130392,130 32,67732,677

TotalTotal 1,446,7591,446,759 120,563120,563

Estimated Supply Estimated Supply Project Safety Net clinicsProject Safety Net clinics– Provide free and/or discounted primary care Provide free and/or discounted primary care

and serve as a medical homeand serve as a medical home– Services available at least 20 hours per weekServices available at least 20 hours per week

2005 primary care visits 2005 primary care visits – Seen by physician or mid-level practitionerSeen by physician or mid-level practitioner– Does not include immunizations or medication Does not include immunizations or medication

refillsrefills

Provided to the uninsuredProvided to the uninsured– Does not include visits of patients with public Does not include visits of patients with public

or private coverageor private coverage

Estimated Supply by QuadrantEstimated Supply by Quadrant

AnnualAnnual MonthlyMonthly

NortheastNortheast 177,218177,218 14,76814,768

NorthwestNorthwest 237,831237,831 19,81919,819

SoutheastSoutheast 183,610183,610 15,30115,301

SouthwestSouthwest 307,019307,019 25,58525,585

TotalTotal 905,678905,678 75,47375,473

Supply/Demand GapSupply/Demand GapUnmet Unmet

demand- demand- Annual visits Annual visits

low inc. low inc. uninsured uninsured

pop.pop.

Unmet Unmet demand-demand-

Monthly visits Monthly visits low inc unins.low inc unins.

pop.pop.

Unmet Unmet demand – demand – percent of percent of

demand low demand low inc. unins. inc. unins.

Pop.Pop.

NortheastNortheast 213,293213,293 17,77417,774 54.62%54.62%

NorthwestNorthwest 113,180113,180 9,4329,432 32.24%32.24%

SoutheastSoutheast 129,497129,497 10,79110,791 41.36%41.36%

SouthwestSouthwest 85,11185,111 7,0937,093 21.70%21.70%

TotalTotal 541,081541,081 45,09045,090 37.4%37.4%

LimitationsLimitationsSupply overestimates capacity since Supply overestimates capacity since patients may use clinics outside their patients may use clinics outside their quadrantquadrantSupply for the uninsured is based on Supply for the uninsured is based on unproven assumptions about payer mixunproven assumptions about payer mixUnmet demand of the uninsured Unmet demand of the uninsured underestimates clinic visits needed since underestimates clinic visits needed since clinics cannot survive if only serving the clinics cannot survive if only serving the uninsureduninsuredSupply underestimates capacity since it Supply underestimates capacity since it does not include charity care of private does not include charity care of private physicians physicians

Next StepsNext StepsMid-October meeting of safety net Mid-October meeting of safety net providers in Northeast quadrantproviders in Northeast quadrantExplore existing and potential expansion Explore existing and potential expansion plansplansDevelop mechanisms for soliciting support Develop mechanisms for soliciting support for additional capacity from health for additional capacity from health systems, public agencies, legislative systems, public agencies, legislative bodies, and othersbodies, and othersRefine PSN data request from providersRefine PSN data request from providers