Healthcare Workforce Clearinghouse: Annual Report to the ... · PDF fileHealth and Safety Code §128052 (Senate Bill 139, Chapter 522, Statutes of 2007) directs the Office of Statewide

Healthcare Workforce Clearinghouse: Annual Report to the Legislature March 2017

Executive Summary Health and Safety Code §128052 (Senate Bill 139, Chapter 522, Statutes of 2007) directs the Office of Statewide Health Planning and Development (OSHPD) to establish the healthcare workforce clearinghouse (Clearinghouse) to serve as the central source of healthcare workforce and educational data in the state. OSHPD works with various state departments to collect and make public Clearinghouse data. OSHPD analyzes data to identify education and employment trends, and assess the healthcare workforce. OSHPD is required to prepare an annual report to the Legislature that: • Identifies healthcare professions education and employment trends. • Reports on the current supply and demand for healthcare workers in California and

gaps in the education pipeline. • Recommends state policy needed to address workforce shortage and distribution

issues. This report highlights OSHPD’s progress in meeting these requirements in 2016 and summarizes: • OSHPD’s healthcare workforce supply, demand, and education data that support the

Clearinghouse. • Clearinghouse data that OSHPD contributes to California Health and Human

Services Agency’s (CHHS) Open Data Portal. • Fact Sheets that display healthcare professions education and employment trends. • OSHPD’s California Primary Care Needs Assessment, which identifies workforce

shortage areas in California.

OSHPD’s progress in obtaining data to populate the Clearinghouse has allowed it to shift focus this year to expand its research. In addition to producing Clearinghouse Fact Sheets highlighting the supply and demand of various healthcare professionals, OSHPD also produced the California Primary Care Needs Assessment. The needs assessment identified 85 California Medical Service Study Areas that are not designated as Federal Health Professional Shortage Areas, but have unmet healthcare needs. The needs assessment examined the relationship between education, poverty, and chronic disease health outcome indicators to identify the 85 areas of unmet need. The information gained from the needs assessment will allow other interested entities to make informed policy decisions and structure their efforts to address healthcare disparities.

In the next year, OSHPD will conduct additional research to determine whether there is a lack of primary care providers in the areas identified in the needs assessment, or some other unmet health need. In addition, OSHPD will expand its research capacity and develop a research agenda to articulate its research priorities.

http://oshpd.ca.gov/HWDD/Clearinghouse.html

Clearinghouse Supply Data The Department of Consumer Affairs (DCA) and the California Department of Public Health (CDPH) serve as the main sources of Clearinghouse healthcare workforce supply data. DCA administers 19 healing arts licensing programs and CDPH is the licensing agency for 13 healthcare occupations. DCA and CDPH provide OSHPD with basic data related to licensees’ demographics, practice site, and educational background. OSHPD makes DCA data available to the public via the Clearinghouse and incorporates these data into Fact Sheets, highlighting the supply of healthcare workforce in California. Department of Consumer Affairs (DCA) In 2016, OSHPD and DCA revised their existing data sharing agreements to create a DCA department-wide agreement. This new agreement provides OSHPD uniform access to 16 healing arts boards under DCA, a 100 percent increase in the number of boards providing data. In FY 2014-15, OSHPD had access to data from the following healing arts boards: • Board of Registered Nursing • Board of Vocational Nurses and Psychiatric Technicians • Dental Board of California • Dental Hygiene Committee of California • Medical Board of California • Osteopathic Medical Board of California • Physician Assistant Board • Respiratory Care Board The new data sharing agreement will provide OSHPD with access to data from the following additional healing arts boards: • Board of Behavioral Sciences • Board of Chiropractic Examiners • Naturopathic Medicine Committee • Board of Occupational Therapy • Board of Optometry • California State Board of Pharmacy • Physical Therapy Board of California • Speech-Language Pathology and Audiology and Hearing Aid Dispensers Board

California Department of Public Health, Licensing and Certification (CDPH-LC) In 2016, OSHPD revised its data sharing agreement with CDPH-LC for licensing data collected on certified nurse aides, home health aides, and nursing home administrators. The restructured data sharing agreement provides OSHPD with aggregated reports on CDPH-LC licensee data. OSHPD is reviewing these new reports to determine how best to incorporate this information into the Clearinghouse. Clearinghouse Demand Data

The Employment Development Department (EDD) – Labor Market Information Division (LMID) provides healthcare workforce demand data to the Clearinghouse. EDD-LMID provides the Clearinghouse with the federal Department of Labor’s Bureau of Labor Statistics (BLS) Occupational Employment Statistics survey data. The data provide information about healthcare workforce wages, employment trends, and staffing patterns by occupation and industry. EDD-LMID data represent 101 Standard Occupational Classifications (SOC). The SOC provide a uniform way of capturing and reporting occupational data. OSHPD makes these data available to the public via the Clearinghouse and incorporates these data into Fact Sheets, highlighting the demand for healthcare workforce in California. Clearinghouse Education Data Historically, the Clearinghouse received some healthcare workforce education pipeline data from California Postsecondary Education Commission (CPEC). After CPECs closure in 2011, the Clearinghouse retrieved data from the Integrated Postsecondary Educational Data System (IPEDS). Although IPEDS data are insightful, its use is limited because only educational institutions receiving federal student financial aid are required to report data and data are aggregated at the institutional level and not by discipline. This makes degree program capacity and demand difficult to determine. OSHPD entered into a data sharing agreement with the California Community Colleges Chancellor’s Office (CCCCO). The data sharing agreement expands the Clearinghouse to include specific data on California community college student demographics, enrollment in health-related degree courses, and graduates from health degree programs. Open Data Portal CHHS launched its Open Data Portal in 2015 as a platform for sharing CHHS departments’ non-confidential data. In 2016, OSHPD provided four datasets and visualizations based on Clearinghouse data to the Open Data Portal. The datasets provide demographic information for:

• Physicians and Surgeons by Gender and Practice Location

• Physicians and Surgeons by Foreign Languages Spoken and Practice Location • Physicians and Surgeons by Race/Ethnicity and Practice Location • Physician Assistants by Gender and Practice Location

Fact Sheets OSHPD published seven Fact Sheets in 2016 summarizing healthcare workforce supply and demand data. The following healthcare workforce Fact Sheets are published on OSHPD’s website: • Doctors of Osteopathy • Licensed Vocational Nurses • Physicians and Surgeons • Registered Dental Assistants • Registered Dental Hygienists • Registered Nurses • Respiratory Care Practitioners

California Primary Care Needs Assessment OSHPD produced a “California Primary Care Needs Assessment” (Appendix A) for 2016. The document outlines primary care related challenges and needs in California. The needs assessment studied the relationship between poverty and health outcome indicators for chronic disease to identify the communities above the median values for the two factors. Additionally, the needs assessment validates the correlation between poverty, health outcomes, and educational attainment rates. The study found 85 communities above the median value for all three factors that do not currently have a federal Health Professional Shortage Area designation. Further study within these 85 communities is needed to understand the healthcare infrastructure and workforce needs. The needs assessment allows OSHPD’s California Primary Care Office to target its provider recruitment and retention efforts to the 85 communities and gain an understanding of additional causes of the health disparities. The information gained from the needs assessment also allows other interested entities to make informed policy decisions and structure their efforts to address healthcare disparities. Next Steps Historically, the Clearinghouse has focused on making healthcare workforce data available to the public. In the next year, the program will complete a comprehensive research agenda to guide its research priorities. OSHPD will use these priorities to direct its data collection efforts, working with internal and external stakeholders to gain access to standardized healthcare workforce data. These data will support the work products of the research agenda, including infographics and white papers.

http://oshpd.ca.gov/HWDD/Clearinghouse.html

Appendix A

California Primary Care Needs Assessment 2016

Table of Contents Abstract I. Introduction II. Background and Methodology III. Findings/Community Analysis IV. Recommendations Appendix B

MSSAs above Median, Non-HPSA Glossary Endnotes

9 10

11 16 23 24 24 31 33


9

Abstract Health Professional Shortage Areas (HPSA) measure the workforce shortages of communities throughout the United States. HPSA designations account for shortages of providers, however, they do not assess whether underlying health disparities exist within HPSA and non-HPSA communities. In California, studies have not been conducted to identify communities with significant health disparities lacking HPSA designations. The California Primary Care Office (PCO) needs assessment studies the relationship between poverty and health outcome indicators for chronic disease to identify the communities that are above the median values for the two factors. Additionally, the needs assessment validates the correlation between poverty, health outcomes, and educational attainment rates. The study found 85 communities without a HPSA designation above the median value for all three factors. Further study within these 85 communities is needed to understand the healthcare infrastructure and workforce needs. The needs assessment allows the PCO to target its provider recruitment and retention efforts to the 85 communities and gain an understanding of additional causes of the health disparities. The information gained from the needs assessment allows other interested entities to make informed policy decisions and structure their efforts to address healthcare disparitie


10

I. Introduction The California PCO is the state liaison to the Bureau of Health Workforce within the federal Health Resources and Services Administration (HRSA). The PCO is located within OSHPD, Healthcare Workforce Development Division. It is funded through a cooperative agreement grant from HRSA to carry out the following objectives within the state: • Statewide primary care1 needs assessment • Shortage designation coordination • Technical assistance and collaboration that seeks to expand access to primary care:

o Coordination of NHSC program and provider recruitment and retention o Collaboration in health center planning and development o Collaboration with other HRSA partners and organizations to support access to

primary care services

One of the PCO’s objectives is to conduct a statewide needs assessment to identify communities with unmet healthcare needs and determine the disparities that exist in these communities leading to issues with healthcare access. As the state entity with the responsibility of designating HPSAs and Medically Underserved Areas and Populations (MUA/MUP), the PCO reviews healthcare workforce data within the state to determine workforce shortages. Currently, California has 216 primary care HPSAs. This needs assessment focuses on gaining an understanding of the state’s primary care needs, identifying communities that have significant healthcare disparities, to guide the PCO’s activities on shortage designation. HPSA designations define access to care as a shortage of providers and do not account for underlying factors, such as socio-economics and health outcomes, that may contribute to disproportionate access to care. This needs assessment identifies the communities without HPSA designations, that also have significant disparities in health quality outcomes. The findings of this needs assessment can assist the PCO in pro-actively working with the communities exhibiting disparities in healthcare access. Other state and federal workforce programs can use the findings of this assessment to conduct further research into the causes of the health disparities and focus their workforce efforts into the communities that demonstrate the greatest need.

1 For the purposes of this assessment the term primary care refers to physicians actively practicing in the fields of Family Practice, General Internal Medicine, Pediatrics, Obstetricians/Gynecology.


11

II. Background and Methodology California is home to 12 percent of the U.S. population. The healthcare needs of California’s 38 million people are extensive and vary based on demographics, socio-economics, and environment. The variances in the population demographics and socio-economics are the most significant determinants of healthcare access and quality of life for California’s population. Apart from a distinct and diverse population, California’s geography varies from large, high density urban communities, populous farming communities, rural desert and mountainous communities, and sparsely populated frontier communities. The range of land use in the state and the diversity of the population requires a healthcare infrastructure flexible enough to meet the needs of its population and expansive enough to provide access to everyone. The PCO currently uses a number of data elements and processes to identify variations in populations and geography. This needs assessment builds upon the PCO’s current process, identifying additional areas of unmet need by using the following data and methodologies: • Medical Service Study Areas • 2009-2013 American Community Survey estimates • Prevention Quality Indicators • Grouping analysis • Educational attainment

Medical Service Study Areas Medical Service Study Areas (MSSA) are sub-county and sub-city areas of the state developed nearly 40 years ago, through state legislation, for the purposes of identifying healthcare workforce issues. The legislation authorizes the California Healthcare Workforce Policy Commission (CHWPC) within OSPHD to develop the method to create the MSSAs. The PCO adopted MSSAs for the purposes of designating HPSAs because California’s counties have wide-ranging differences in size and population. There are 38 million people dispersed across 58 counties, each with wide disparities in socio-economics and demographics at the city and community level. OSHPD, in particular the PCO, reassess MSSAs every ten years to determine if the boundaries appropriately match the community’s needs. The PCO receives approval from HRSA to use MSSAs as the pre-defined rational service areas in designating HPSAs and MUA/MUPs. The MSSA creation and reconfiguration process is an extensive data-driven activity involving county officials and stakeholders in each county. Currently there are 542 MSSAs in California (Figure 1). The rules for the MSSAs are as follows: General MSSA requirements: • Each MSSA consists of one or more complete census tracts • MSSAs cannot cross county lines


12

• All population centers within the MSSA are within a 30-minute travel time to the largest population center

• MSSAs cannot exceed 200,000 in population size

Specific MSSA requirements by size: • Urban MSSAs should:

o Be within a population range of 75,000 to 125,000 o Represent a recognized community and neighborhood boundaries o Have a similar demographic and socio-economic characteristic o Measure at least five square miles in area.

• Rural MSSAs should be:

o Population density of less than 250 persons per square mile o No population center can exceed 50,000

• Frontier MSSAs should be:

o Population density of less than 11 persons per square mile

MSSA data enables the PCO to review census data, health quality indicators, and workforce data at a granular level, delivering a clearer picture of healthcare workforce needs in California. Currently, 216 MSSAs are Primary Care HPSAs covering 6.2 million people. The HPSA and MUA/MUP designations allow the state to draw down state, federal, and private funds to expand healthcare workforce and safety net programs, and for provider payment. 2009-2013 American Community Survey Estimates The current MSSA dataset is based on the U.S. Census 2009-2013 American Community Survey (ACS) 5-year estimates. The ACS 5-year estimates contain poverty and demographic data at the census tract level. This MSSA dataset enables the PCO to identify key indicators indicative of communities with workforce shortages. Federal HPSA regulations use the 200 percent Federal Poverty Level (FPL) rate and population counts as the qualifying factor in low-income HPSA designations. Prevention Quality Indicators The MSSAs provide a baseline to compare the healthcare needs of the state based on actual neighborhood and community boundaries. The PCO’s accessibility to data within OSHPD, such as hospital discharge data and quality healthcare indicators, allows for the comparison of MSSAs to build an effective state needs assessment. Prevention Quality Indicators (PQI) is a federally standardized dataset collected annually to measure quality health indicators in communities. “The PQIs are a set of measures that can be used with hospital inpatient discharge data to identify ‘ambulatory care sensitive


13

conditions’ (ACSC) in adult populations. ACSCs are conditions for which good outpatient care can potentially prevent the need for hospitalization, or for which early intervention can prevent complications or more severe disease.”1 This needs assessment uses the 2014 PQI data specific to chronic disease, the following are the PQI indicators that comprise the PQI 92 composite total used in this needs assessment: • PQI 01 - Diabetes Short-term Complications Admission Rate • PQI 03 - Diabetes Long-term Complications Admission Rate • PQI 05 - Chronic Obstructive Pulmonary Disease or Asthma in Older Adults

Admission Rate • PQI 07 - Hypertension Admission Rate • PQI 08 - Heart Failure Admission Rate • PQI 14 - Uncontrolled Diabetes Admission Rate • PQI 15 - Asthma in Younger Adults Admission Rate • PQI 16 - Lower-Extremity Amputation among Patients with Diabetes Rate

PQIs, being a national standardized data set, allow the assessment of the community health care system through hospital inpatient data, including hospitalization rates for chronic conditions. The data allow reviewers to make inferences about communities having higher than average hospitalization rates for chronic disease as a direct or indirect result of access issues or disparities in services available outside the hospital setting. The relationship between socio-economic components of communities and health quality indicators is well known. A Centers for Disease Control report states that “income is well-recognized to be associated with morbidity and premature mortality internationally and within the United States.”2 While other factors can be involved in the quality of care in communities such as environment or patient participation, this needs assessment uses PQI and poverty to identify communities with health disparities and focus the PCO’s efforts to address issues facing these communities. Grouping Analysis The needs assessment compares the relationship between poverty (200 percent FPL data) and chronic disease prevalence (PQI 92 composite data). The PCO conducted a grouping analysis using the Arc Geographic Information System (ArcGIS) software to find a statistically significant clustering of the data. The analysis used two variable groups and identified non-random clustering for the two variables; the variables identified MSSAs that align above and below the median for poverty and chronic disease. The 200 percent FPL and the PQI 92 Composite score were identified as the two variables most closely clustered together. Additionally, the PCO focused the analysis on MSSAs without HPSA designations.


14

Educational Attainment The Office of Disease Prevention and Health Promotion recognizes educational attainment as a significant factor in health outcomes.3 This needs assessment reviews the educational attainment rates of the MSSA population in comparison to the health outcomes illustrated by the PQI 92 data and 200 percent FPL. The 5-year ACS data provides the educational attainment rates for the MSSAs.


15

Figure 1. 2016 California MSSA Map


16

III. Findings/Community Analysis The PCO identified 236 MSSAs exceeding the median for poverty (200 percent FPL) and chronic disease prevalence (PQI 92). Of the 236 MSSAs identified, 151 MSSAs are current Primary Care HPSAs. The remaining 85 MSSAs were above the medians for poverty and chronic disease prevalence and not designated as HPSAs. Forty-five of the 58 counties have at least one MSSA with poverty and chronic disease above the median. Tables 1 and 2 illustrate the counties and the counts of the MSSAs containing the communities above median and the 85 non-designated communities above median, respectively. Table 1. Number of MSSAs above 200 percent FPL and PQI 92 median, by county

County

# of MSSAs

County

# of MSSAs

Alameda 3 Riverside 15 Amador 1 Sacramento 6 Butte 5 San Bernardino 16 Colusa 2 San Diego 13 Contra Costa 3 San Francisco 2 Del Norte 1 San Joaquin 3 Fresno 12 San Mateo 1 Glenn 3 Santa Barbara 1 Humboldt 3 Santa Clara 2 Imperial 5 Santa Cruz 1 Kern 11 Shasta 6 Kings 3 Siskiyou 2 Lake 5 Solano 1 Lassen 1 Stanislaus 7 Los Angeles 54 Sutter 2 Madera 2 Tehama 4 Mariposa 1 Trinity 2 Mendocino 5 Tulare 7 Merced 6 Tuolumne 2 Modoc 1 Ventura 1 Monterey 3 Yolo 1 Orange 7 Yuba 1 Plumas 3 Total MSSAs 236


17

Table 2. Number of Non-designated MSSAs above 200 percent FPL and PQI 92 median, by county

County # of MSSAs County # of MSSAs Alameda 3 Sacramento 4 Amador 1 San Bernardino 6 Butte 3 San Diego 6 Contra Costa 3 San Francisco 2 Kern 3 San Joaquin 1 Lake 1 Santa Barbara 1 Lassen 1 Santa Clara 2 Los Angeles 24 Shasta 3 Mendocino 2 Stanislaus 4 Monterey 1 Sutter 2 Orange 4 Tuolumne 1 Riverside 6 Yolo 1 Total MSSAs 85

Twenty-four of California’s 58 counties are represented in the count for Table 2. The 85 MSSAs identified represent 7.8 million people, of which 49 percent are living at or below the 200 percent FPL. The MSSAs above the median, regardless of HPSA designations, show a clear pattern of healthcare needs through the eastern portions of southern California into the central valley and through the northern counties. This data is consistent with PCO HPSA designation findings. As illustrated in Figure 2, a majority of the MSSAs above median for both factors have a HPSA designation. The pattern for non-designated MSSAs above median for both factors is not as clearly defined as those regardless of HPSA designations. The 85 MSSAs are scattered through urban, rural, and frontier communities throughout the state. This initial analysis assisted in identifying communities with unmet healthcare needs, but further study was needed to understand the underlying issues in these communities. Education level is one factor known to researchers as correlating with health disparities. According to research from the Agency for Healthcare Research and Quality, “Of the various social determinants of health that explain health disparities by geography or demographic characteristics (e.g., age, gender, race-ethnicity), the literature has consistently pointed to education. Research based on decades of experience in the developing world has identified educational status as a major predictor of health outcomes, and economic trends in the industrialized world have intensified the relationship between education and health.”4 According to the 5-year ACS estimates, California ranks 49th out of 50 states in the percent of the population that have a high school diploma or higher. Eighteen and a half percent of the state population over 25 years of age does not have a high school diploma. Figure 3 illustrates the areas of the state with low education attainment rates, areas above the state median for poverty (200 percent FPL), and high chronic disease prevalence (PQI 92). A distinct pattern can be seen in the data of MSSAs above the median for both factors, who also have low educational attainment rates.


18

Figure 2. MSSAs above/below median for 200 percent FPL and PQI 92, with HPSA Designations


19

Figure 3. MSSAs, Above Median Poverty, PQI 92 with Educational Attainment


20

In comparing Figures 2 and 3, the areas above median for poverty (200 percent FPL) and chronic disease prevalence (PQI 92) closely match areas with the highest percentages of the population with less than a high school education, regardless of HPSA designation. This illustrates the connection between education, poverty, and health disparities. Of the 85 MSSAs above the median for poverty and chronic disease prevalence that are not HPSAs, 62 exceed the state median for educational attainment of less than a high school diploma. The correlation between healthcare outcomes and education in California is consistent with larger studies performed by various organizations and the federal government. As previously stated, the PCO categorizes all MSSAs as urban, rural, or frontier using the population of the area. Table 3 illustrates the breakdown of the 85 MSSAs. Table 3. Non HPSA designated MSSAs above median by county: urban, rural, and frontier status

MSSA definition # of MSSAs Urban 71 Rural 12 Frontier 2 Total 85

While rural and frontier areas have health disparities and high poverty, the areas of the state fitting those requirements generally have HPSA designations (Table 4). Table 4. HPSA MSSAs above median by county: urban, rural, and frontier status

MSSA definition # of MSSAs Urban 60 Rural 71 Frontier 20 Total 151

Urban MSSAs consistently pose a challenge to the PCO in the HPSA designation process. Many urban areas, particularly in Los Angeles County and the counties surrounding the San Francisco area, have large numbers of primary care physicians and community health clinics. An analysis of the safety net clinics within the state in relation to the proximity of the MSSAs above median for poverty (200 percent FPL) and chronic disease prevalence (PQI 92) shows that many of the MSSAs have a clinic either surrounding the community or within its boundaries (Figure 4). Table 5 further demonstrates the number of clinics available to the 85 MSSAs. The availability of the clinics in these MSSAs can be a contributing factor to the absence of HPSA designations. An initial review shows that the 85 MSSAs may not meet the federal HPSA criteria, however, PCO staff would need to conduct an in-depth analysis to verify the initial conclusions.


21

This needs assessment shows 236 of the state’s MSSAs have disparities in their health outcomes. Through the PCO’s efforts in designating 151 MSSAs with these disparities, the communities are able to use federal and state programs such as the National Health Service Corps Loan Repayment Program, State Loan Repayment Program, Rural Health Clinic Certification, and New Start/Expansion programs to improve recruitment and retention of providers and expand the safety net clinics. The remaining 85 MSSAs above the median for poverty (200 percent FPL) and chronic disease prevalence (PQI 92) have underlying issues impeding their HPSA designation status. Table 5. Clinics within MSSAs above median for Poverty and PQI 92, by county

County

Clinics within MSSAs above the median for poverty and PQI, not

designated HPSA

County

Clinics within MSSAs above the median for poverty and PQI, not

designated HPSA Alameda 66 San Bernardino 12 Amador 1 San Diego 45 Butte 11 San Francisco 35 Contra Costa

16 San Joaquin 1

Kern 21 San Mateo 1 Lake 1 Santa Barbara 3 Lassen 1 Santa Clara 17 Los Angeles 124 Shasta 15 Mendocino 10 Stanislaus 15 Monterey 15 Sutter 7 Orange 6 Tuolumne 1 Riverside 26 Yolo 2 Sacramento 13

Total 465


22

Figure 4. Safety Net Clinics with MSSAs above median for poverty, PQI 92


23

IV. Recommendations

California’s diverse population and geography are served through a complex healthcare infrastructure heavily reliant on Medicaid. Recent estimates show over 31 percent of the state’s population enrolled in state Medicaid or the Children’s Health Insurance Program.5 The large number of Medicaid enrollment, along with 36 percent of the population at or below 200 percent FPL, has significantly impacted the healthcare safety net of the state. One of the objectives of this primary care needs assessment is to develop a baseline for analyzing health outcomes related to shortage designations. The advantage of developing a baseline analysis is to create the structure for further studies using additional variables. As outlined in this needs assessment, poverty, health quality outcomes, and educational attainment are a small but significant factor to measure the healthcare needs of a population. A number of other factors, such as environment, nutrition, provider accessibility, and language barriers can contribute to the results found in this assessment. These findings allow the PCO to focus its shortage designation activities and provide technical assistance on provider recruitment and retention to the clinics within these 85 communities. Further study by the PCO will help identify whether other factors have a causal relationship to the health disparities of those communities. An analysis of the workforce environment is necessary to understand if the healthcare workforce in the 85 MSSAs is sufficient for the population. One element that may help the PCO in future assessments is claims data. In the coming year, the PCO will pursue and analyze claims data to assess workforce capacity for the state and, in particular, the 85 MSSAs. Additional objectives include using newly acquired data to update the primary care needs assessment and provide an improved framework for understanding the health disparities facing the state. In due course, the PCO can use updated PQI and ACS data to review changes to the MSSAs health outcomes and measure the impact of the PCO’s focus on the 85 MSSAs. Lastly, the PCO anticipates that this needs assessment will provide a structure for HRSA and other states to use in shortage designation policy decisions and workforce development.


24

Appendix B MSSAs above median for Poverty (200 percent FPL) and chronic disease prevalence (PQI 92), non-HPSA

County and MSSA PQI92 composite

200% FPL

EDUCATIONAL ATTAINMENT 25 years and over, Less than high school

EMPLOYMENT STATUS: 16 years and over Unemployed

Alameda

2c

Oakland West Central 0.0075914 53.92 25.21 15.34 2d

Fruitvale/Melrose/Oakland Airport 0.0080265 52.37 31.10 16.80 2h

Ashland/Brookfield Village/Castro Valley South/Elmhurst/Hayward Northeast/San Leandro North Central/San Lorenzo East

0.0068056 39.14 23.32 13.06

Amador

4

Ione/Jackson/Pine Grove/Sutter Creek

0.0077204 30.56 6.91 17.02

Butte

7.1

Chapmantown/Chico 0.0060145 43.80 8.99 11.73 8

Magalia/Paradise/Stirling City 0.0068865 37.46 9.10 14.90 9

Biggs/East Biggs/Gridley 0.0080768 42.87 26.65 19.97 Contra Costa

18b

Concord West/Martinez East/Martinez Waterfront/Pacheco/Pleasant Hill East

0.0061624 35.88 16.17 10.89

18d

Antioch North and West/Nichols/Pittsburg Central and East/West Pittsburg

0.0087235 49.22 24.43 14.57

18f

Richmond Central/San Pablo Central

0.0078311 48.81 31.39 13.85


25


200% FPL



Kern

66a

Bakersfield Northeast/Oildale 0.008277 45.49 19.83 15.04 66b

Bakersfield East/Lakeview/La Loma 0.0077644 70.48 46.15 20.59 66c

Bakersfield Southwest 0.0049156 40.95 22.36 12.02 Lake

71.1

Clearlake/Clearlake Oaks 0.0100543 63.55 18.35 21.70 Lassen

75

Westwood 0.0057855 42.28 8.92 26.84 Los Angeles

78.2b

Pico-Union 0.0053858 72.66 48.03 13.55 78.2cc

Van Nuys Central 0.006462 54.63 29.89 12.49 78.2ccc

Huntington Park/South Gate West/Walnut Park

0.0046767 59.84 54.67 15.13

78.2e

Country Club Park/Koreatown/Mid-City East

0.00428 37.15 24.79 12.70

78.2ee

Atwater Village/Glendale Central/Glendale Southwest/Griffith Park

0.0075105 38.15 15.52 11.57

78.2ff

Glassell Park/Glendale Southeast/Silverlake North

0.0065611 48.44 25.61 12.04

78.2ffff

Boyle Heights Northwest/Chinatown/Downtown Northwest/Little Tokyo/Westlake

0.0070291 65.95 41.47 12.27

78.2gg

Angeles National Forest West/Kagel Canyon/Lake View Terrace/San Fernando East/Sylmar

0.0056226 40.66 32.66 11.96


26


200% FPL



78.2h

Boyle Heights Central/City Terrace West

0.0067161 67.91 55.38 15.52

78.2hhh

Altadena West/Pasadena Northwest 0.0065553 39.56 21.65 12.00 78.2hhhh

Canoga Park Northeast/Winnetka 0.0052883 51.28 31.35 9.95 78.2i

El Sereno North/Highland Park/Montecito Heights/Monterey Hills

0.0052011 53.62 39.94 14.66

78.2iii

North Long Beach 0.0070453 50.26 32.39 17.11 78.2jjjj

Norwalk/Studebaker 0.0078846 37.00 27.48 11.68 78.2kk

North Hills/Northridge North 0.0055012 41.11 22.04 11.50 78.2nnn

Crenshaw/Culver City East/Mid-City South/West Adams

0.0087408 58.76 34.41 14.73

78.2p

Long Beach Port/San Pedro East/Wilmington

0.0055813 55.02 35.90 15.33

78.2q

Del Aire/Inglewood West/Los Angeles International Airport

0.0076547 36.31 19.60 10.72

78.2qqq

Rosemead/San Gabriel South/South El Monte West/Temple City West

0.005367 51.96 39.96 11.88

78.2uu

La Habra Heights/Whittier 0.0084278 27.05 15.78 8.60 78.2v

Carson/Compton West/Rancho Dominguez

0.0077122 31.53 21.05 14.72

78.2yyy

Bassett/Industry West/La Puente 0.0060752 41.14 36.23 10.97 78.2zz

Northridge South/Reseda North 0.0058473 45.39 27.65 12.33


27


200% FPL



78.2zzz

Baldwin Park/Irwindale 0.0057242 41.19 33.54 13.05 Mendocino

92

Covelo/Dos Rios 0.008365 67.73 14.79 21.68 93.1

Ukiah 0.0056112 51.07 18.40 15.64 Monterey

109.2

Salinas/Spreckels 0.0041971 51.23 39.08 11.55 Orange

116b

Santa Ana Central 0.003922 62.69 58.43 10.46 116i

Garden Grove South/Santa Ana West 0.004823 50.36 37.72 11.93 116l

Anaheim Central 0.0053918 51.27 36.42 13.61 116s

Huntington Beach North/Seal Beach East/Westminster

0.005481 42.25 25.81 12.36

Riverside

128

Arabia/Coachella/Desert Beach/Flowing Wells/Indio South/La Quinta East/Mecca/Oasis/Thermal

0.0043109 61.19 43.53 20.71

129.4

Cathedral City Southeast/Palm Desert North/Palm Springs South/Rancho Mirage North

0.0069084 48.72 21.65 13.68

134

Banning/Beaumont/Cabizon/Calimesa/Cherry Valley

0.0063656 36.09 16.65 12.95

135c

Casablanca/Riverside Central 0.0055601 47.39 26.64 15.47 135d

Arlington/Corona East/Home Gardens/La Sierra/Riverside Southwest

0.0049851 47.26 30.07 15.62


28


200% FPL



135g

Moreno Valley 0.0052763 44.79 21.79 14.39 Sacramento

139c

Antelope/Citrus Heights/Foothill Farms

0.0061565 39.26 12.72 14.41

139d

Arcade/Arden/Town and Country Village

0.0067797 32.72 8.30 13.39

139f

Florin/Fruitridge/Oak Park/Parkway/South Sacramento

0.0077165 60.80 29.97 19.97

139k

Freeport/Meadowview 0.0088546 58.05 28.80 18.36 San Bernardino

144.1

USMC Air-Ground Combat Training Center

0.0053899 44.35 1.53 12.20

151c

Montclair/Ontario Northwest/Upland South

0.0079186 52.05 33.39 14.61

151f

Bloomington/Colton Central and West/Fontana South/Rialto South

0.0046102 55.84 38.38 15.79

151g

Muscoy/San Bernardino Central 0.0074385 63.93 38.31 20.35 151h

Fontana Central/Rialto Central 0.0050827 58.33 39.04 19.10 151k

Highland/San Bernardino East 0.0070665 58.69 31.55 16.11 San Diego

156d

Oceanside East/San Marcos West/Vista

0.004397 44.23 25.62 8.97

156e

Escondido Central and South/San Marcos Central and East

0.004667 53.12 34.35 10.46

161e


29


200% FPL



College Heights/Hillcrest Southeast/Kensington/Rolando North/University Heights

0.005316 42.04 9.72 9.63

161j

Castle Park/Chula Vista Southwest/Imperial Beach West/Nestor East/Palm City/San Ysidro/South San Diego

0.0066337 45.64 27.89 15.36

161k

Chula Vista Central and Northwest/National City West

0.0076087 56.65 32.55 14.58

161u

Bostonia/Glenview/Granite Hills/Hillsdale/Johnstown/Lakeside/Riverview/Winter Gardens

0.007498 29.97 12.35 11.85

San Francisco

162a

Chinatown/Civic Center/Inner Mission/North Beach/South of Market/Tenderloin/Western Addition

0.008572 47.47 21.51 9.34

162f

Bayview/Candlestick/Hunters Point/Portola/Visitacion Valley

0.0080437 37.96 27.08 14.18

San Joaquin

166

Lodi 0.0067656 43.08 23.45 14.49 Santa Barbara

180.2

Guadalupe 0.0037164 50.75 53.31 8.93 Santa Clara

183d

Downtown San Jose 0.0067934 50.40 31.59 12.13 183e

Alum Rock South/San Jose East

0.0055246 43.15 32.51 12.99


30


200% FPL



Shasta

186

Anderson/Cottonwood/French Gulch/Happy Valley/Igo/Ono/Platina/Shasta

0.0071429 45.35 16.87 15.68

189.2

Redding 0.0072411 40.30 9.59 12.44 189.3

Bella Vista/City of Shasta Lake 0.0075124 41.10 12.53 12.67 Stanislaus

212.1

Denair/Turlock 0.0063072 39.57 19.37 14.53 215a

Modesto West 0.0070831 38.46 15.75 14.68 215b

Modesto East 0.006898 37.47 13.43 13.62 215c

Ceres/Modesto South Central 0.0083647 63.53 42.50 23.74 Sutter

216

Meridian/Robbins/Yuba City 0.0062235 42.04 20.04 15.41 218

Live Oak 0.00679 55.11 34.02 12.78 Tuolumne

234.2

Columbia/Jamestown/Sonora 0.0072305 41.15 9.33 18.98 Yolo

245

Bryte/Broderick/Clarksburg/Riverview/West Sacramento

0.0058137 39.54 18.19 11.71


31

Glossary Ambulatory care sensitive conditions: Age-standardized acute care hospitalization rate for conditions where appropriate ambulatory care prevents or reduces the need for admission to the hospital. American Community Survey: A national annual survey of population data by the U.S. Census Bureau. Chronic disease: A disease that persists for three months or more (e.g., angina, asthma, chronic obstructive pulmonary disease, diabetes, heart failure, and hypertension). Claims data: The count of services billed by a physician to an insurance company or Medicare/Medicaid. Community health clinics: Outpatient healthcare facilities focused on providing primary care services to all patients regardless of their ability to pay. Federal Poverty Level: A measure of income issued every year by the U.S. Department of Health and Human Services to determine eligibility for certain government programs and benefits. Frontier: A geographically remote area with a population density of 11 people per square mile or less. Health Professional Shortage Areas: A federal classification of geographic areas or a subset of a population in a geographic area that meets federal criteria demonstrating a lack of healthcare providers for primary care, dental health, or mental health. Health Resources and Services Administration: The federal department under the Health and Human Services Agency responsible for the designation of Health Professional Shortage Areas, community health clinics, and assessment of the healthcare workforce nationwide. Medically Underserved Area: A geographic area recognized by the Health Resources and Services Administration as having a lack of access to primary care services. Medically Underserved Population: A subset of population within a geographic area recognized by the Health Resources and Services Administration as having a lack of access to primary care services. New Start/Expansion: Grants provided by the Health Resources and Services Administration to community-based organizations with the intent of expanding or developing new health delivery sites to serve underserved populations.


32

Prevention Quality Indicators: A set of measures that assess quality and access to healthcare in a community. Primary Care Office: State entity that determines Health Professional Shortage Areas and serves as a liaison between the state and parties interested in understanding programs related to Health Professional Shortage Areas. Rational service area: A combination of geographic units within a county that reflect utilization patterns for healthcare. Reconfiguration: The decennial process of reassessing the Medical Service Study Areas to incorporate changes in population shifts and new U.S. Census data. Rural: A geographic area with a population density of less than 250 people per square mile. Safety net clinic: A group of providers or clinics that are responsible for delivering healthcare services to underserved and uninsured populations throughout the state. Urban: A city, neighborhood, or community with 50,000 or more people.


33

Endnotes

1 Prevention Quality Indicators Overview, Agency for Healthcare Research and Quality, http://www.qualityindicators.ahrq.gov/modules/pqi_overview.aspx 2 Disparities in premature mortality between high- and low-income US counties, Preventing Chronic Disease, Erika Cheng, David Kindig, (2012). 3 Social Determinants of Health, Health People 2020, Office of Disease Prevention and Health Promotion, https://www.healthypeople.gov/2020/topics-objectives/topic/social-determinants-of-health . 4 Understanding the Relationship Between Education and Health: A Review of the Evidence and an Examination of Community Perspectives, Agency for Healthcare Research and Quality, Emily B. Zimmerman et al., (2015). 5 Medicaid & CHIP” May 2016 Monthly Applications, Eligibility Determinations and Enrollment Report, Centers for Medicare & Medicaid Services, https://www.medicaid.gov/medicaid/program-information/medicaid-and-chip-enrollment-data/monthly-reports/index.html.

http://www.qualityindicators.ahrq.gov/modules/pqi_overview.aspx

https://www.healthypeople.gov/2020/topics-objectives/topic/social-determinants-of-health

https://www.healthypeople.gov/2020/topics-objectives/topic/social-determinants-of-health

https://www.medicaid.gov/medicaid/program-information/medicaid-and-chip-enrollment-data/monthly-reports/index.html

https://www.medicaid.gov/medicaid/program-information/medicaid-and-chip-enrollment-data/monthly-reports/index.html

Documents

Healthcare Workforce Clearinghouse: Annual Report to the ... · PDF fileHealth and Safety Code §128052 (Senate Bill 139, Chapter 522, Statutes of 2007) directs the Office of Statewide