2017 Annual Outcomes Report

Transcription

1 2017 Annual Outcomes Report Improving the health & well-being of the uninsured in North Carolina Made possible by the generous support from

2 2017 NCAFCC ANNUAL OUTCOMES SURVEY RESULTS Each year in February, NCAFCC members complete the NCAFCC Annual Outcomes Survey based on the prior year s services provided. Major Findings... 2 Introduction... 3 Global Clinic Demographics Health Gains Outcomes

3 2017 NCAFCC ANNUAL OUTCOMES SURVEY MAJOR FINDINGS Patient Volume: The total number of patients = 80,450 (59 clinics reported) The total number of patient visits = 166,176, includes medical, behavioral health & dental visits (52 clinics reported) Number of Volunteers: (59 clinics reported) Total number of volunteers = 11,082 Total number of hours volunteers worked = 299,085 hours Number of Prescription Medications Provided: (55 clinics reported) 946,135 (30-day supply or less) prescription medications were provided Diabetes Hemoglobin A1c Poor Control: (40 clinics reported, *n = 4,661) 28.1% of diabetic patients most recent HbA1c level was > 9% or no A1c test was performed during the year **2016 NC HRSA reported, 31.9% of diabetic patients with A1c level > 9% or no A1c test was performed during the year Controlling High Blood Pressure: (41 clinics reported, *n = 8,038) 63.3% of patients with a diagnosis of hypertension, last blood pressure measurement was < 140/90 **2016 NC HRSA reported, 61.3% of patients with diagnosis of hypertension, last blood pressure measurement was < 140/90 Value of Investment: For every $1 spent, $7.86 in healthcare services were provided Average cost per patient was $388 Average value of service provided to each patient was $3,053 Estimated hospital emergency department diversion savings was $152,855,000*** *n = number of patients measured **US Dept. of Health & Human Services Human Resources & Services Administration (HRSA) Community Health Centers (Federally Qualified Health Centers) track a variety of information, including patient demographics, services provided, staffing, clinical indicators, utilization rates, costs and revenues NC HRSA Program Data NC HRSA Program data to be updated as 2017 information is made public. ***BCBSNC Annual Outcomes Survey Page 2

4 INTRODUCTION The North Carolina Association of Free and Charitable Clinics (NCAFCC) is a private, nonprofit, 501(c)(3) tax-exempt organization that conducts advocacy, research, public relations, resource development, training and technical assistance on behalf of its members and the people they serve. As of December 31, 2017, NCAFCC was comprised of 66 member organizations, operating 87 clinic and or pharmacy sites, serving 76 counties across the state. It is NCAFCC s mission to assure that the medically underserved in North Carolina have access to affordable, quality healthcare. The NCAFCC Annual Outcomes Survey allows our member organizations the ability to enhance their quality of care, strengthen their positions as healthcare safety-net providers and demonstrate to the philanthropic community that their investments make a difference. NCAFCC was the first in the national free and charitable clinic sector to implement a measurable health outcomes program, representing the availability of free and charitable clinic and pharmacy patients to receive care on par with those who receive care from private providers. We ve come a long way since first implementing the Annual Outcomes Survey and we ve witnessed some remarkable achievements by our member organizations. The NCAFCC Annual Outcomes Survey process exhibits our commitment to helping and improving the health of the medically underserved in North Carolina. It is our hope to build upon earlier achievements while expanding our vision to create new ones. In the end, it is our belief that the free and charitable clinics and pharmacies in North Carolina have a compelling story to tell and the NCAFCC Annual Outcomes Survey will continue to serve as the tool for telling that story Annual Outcomes Survey Page 3

5 FREE & CHARITABLE CLINICS PATIENTS AGE GENDER 2% 6% 40% <18 yrs old yrs old 65+ yrs old 60% Females Males 92% 2017 Annual Outcomes Survey Page 4

6 FREE & CHARITABLE CLINICS PATIENTS 0.4% 1.4% 0.1% 3% RACE/ETHNICITY Non-Hispanic White Hispanic/Latino 27% 46% Black/African American Asian American Indian/Alaska Native 22% Native Hawaiian/Other Pacific Islander Other 2017 Annual Outcomes Survey Page 5

7 FREE & CHARITABLE CLINICS SERVICES & OPERATIONS SERVICES PROVIDED (By # of Clinics) Enabling 49 Behavioral Health 30 Pharmaceutical 49 Dental 17 Medical Operational Hours (On-site) Administrative Hours (On-site) Medical Hours (On-site) Behavioral Health Hours (On-site) Dental Hours (On-site) Licensed Pharmacy Hours (On-site) Total/Week 2,163 1, Average/Week # of Clinic Sites Reporting Annual Outcomes Survey Page 6

8 FREE & CHARITABLE CLINICS VOLUME PATIENT VISITS (% By Type of Visit) 7% 7% Medical Visits Behavioral Health Visits Dental Visits 86% Clinic Volume Unduplicated Patients 59 clinics reported Medical Visits 50 clinics reported Behavioral Health Visits 30 clinics reported Dental Visits 25 clinics reported Total Patient Visits 52 clinics reported Prescription Medications Provided*** 55 clinics reported Total Rx Value Total 80, ,836 11,096 11, , ,135 $159,672,586 Average 1,364 2, ,196 17,202 $2,903,138 *** Prescription medications dispensed as 30 day supplies or less 2017 Annual Outcomes Survey Page 7

9 FREE & CHARITABLE CLINICS VALUE OF INVESTMENT (VOI) ANNUAL OPERATING BUDGETS Per # of Clinics (59 Clinics reporting) 6 6 $1mm+ 15 $500k - 999,999 $100k - 499, < $100k Value of Service* Operational Expense VOI** Total $276,871,132 $31,250,220 $7.86 Average $4,692,731 $529,665 $7.86 Cost per Patient Value of Service per Patient Average $388 $3,053 FOR EVERY $1 SPENT, FREE & CHARITABLE CLINICS PROVIDED $7.86 IN HEALTHCARE SERVICES *Includes services arranged for and directly provided by NC free & charitable clinics **Total Value of Investment (VOI) = (Total Value of Service Operational Expense / Operational Expense) 2017 Annual Outcomes Survey Page 8

10 FREE & CHARITABLE CLINICS FINANCIAL SUPPORT FINANCIAL RESOURCES (% of Income per Source) Individual Donations 16% 16% Fundraising Churches/Civic Groups 8% 20% 7% 5% 4% 5% Corp./Business United Way Foundation Grants State & Local 19% Hospital Support Other Income by Source Individual Donors Fundraising Churches and Civic Groups Corporations and Businesses United Way Foundation Grants State and Local Hospital Support Other Total $5,711,928 $2,416,386 $1,612,693 $1,339,246 $1,623,717 $6,721,611 $6,808,707 $2,956,546 $5,614,770 Average $100,209 $54,918 $32,254 $30,437 $54,124 $124,474 $151,305 $98,552 $110,094 # of Clinics Reporting Annual Outcomes Survey Page 9

11 FREE & CHARITABLE CLINICS STAFFING # of Staff Positions (Full-Time) Physicians Mid-Level (PA's & NP's) Nurses, CMA's & CNA s Pharmacists Pharm- Techs Dentists Hygienists & DA's Executive Director-CEO Total Full- Time Staff (All Positions) Total/Year Average/Year # of Clinics Reporting # of Staff Positions (Part-Time) Physicians Mid-Level (PA's & NP's) Nurses, CMA's & CNA s Pharmacists Pharm- Techs Dentists Hygienists & DA's Executive Director-CEO Total Part- Time Staff (All Positions) Total/Year Average/Year # of Clinics Reporting Annual Outcomes Survey Page 10

12 FREE & CHARITABLE CLINICS VOLUNTEERS # of Volunteers Physicians Mid-Level (PA's & NP's) Nurses, CMA s & CNA s Pharmacists Pharm- Techs Dentists Hygienists & DA's Executive Director-CEO Total Volunteers (All Positions) Total/Year ,082 Average/Year # of Clinics Reporting Volunteers Hours Worked Total for Year 299,085 Average for Year 5,069 # of Clinics Reporting Annual Outcomes Survey Page 11

13 HEALTH GAINS OUTCOMES Tracking and measuring health gains outcomes is an integral part of this survey and greatly contributes to the free and charitable clinic story. It goes beyond reporting numbers of patients and patient visits, to demonstrating that free and charitable clinics provide quality health care. In 2017, clinics providing direct primary chronic care management to patients diagnosed with diabetes and/or hypertension were eligible to report health gains outcomes. For those members that did not provide direct primary chronic care management, therefore not eligible to participate in reporting health gains outcomes on the survey, a supplemental process was developed providing them with the opportunity to demonstrate their distinctive values and methods in promoting health gains Annual Outcomes Survey Page 12

14 METHODOLOGY Diabetes Patient Criteria: Diagnosed with Type 1 or Type 2 diabetes. The diagnosis may have been made during or prior to the 2017 measurement year, years of age, and Had at least one medical visit during the measurement year. Exclusions: Gestational diabetes or steroid-induced diabetes. Patients diagnosed with secondary diabetes due to another condition were not included. Hypertensive Patient Criteria: Diagnosed with hypertension before June 30 th of the measurement year, years of age, and Had at least one medical visit during the 2017 measurement year. Exclusions: Patients with evidence of end-stage renal disease (ESRD), dialysis or renal transplant before or during the measurement year. Pregnant patients were also excluded. The clinics measured health gains outcomes for their entire patient population or randomly selected 70 cohort patients that met the patient criteria for each diagnosis Annual Outcomes Survey Page 13

15 DIABETES OUTCOMES A1c Control 6.1% of patients did not have an A1c level performed during the measurement year 22.0% of patients most recent A1c level was > 9.0% Total of 28.1% of patients exhibited poor A1c control How clinics compare to each other (by percentage of patients) MOST RECENT A1c < 8% # of clinics MOST RECENT A1c > 9.0% + A1c NOT PERFORMED % % 1 # of clinics 80-89% % % 60-69% % % % % % % < 30% 0 1 Year 2017 Range 14.3% % NCAFCC Average 62.9% 10-19% < 10% 2 8 Year 2017 Range 4.1% % NCAFCC Average 28.1% 2017 Annual Outcomes Survey Page 14

16 HYPERTENSIVE OUTCOMES Blood Pressure Control How clinics compare to each other (by percentage of patients) % % OF PATIENTS WHOSE LAST BP MEASURE WAS < 140/90 1 # of clinics 80-89% % % 50-59% % 30-39% 2 2 < 30% 0 Year 2017 Range % NCAFCC Average 63.3% 2017 Annual Outcomes Survey Page 15

17 2017 ANNUAL OUTCOMES SURVEY TOP PERFORMING CLINICS Uncontrolled Diabetes % of patients whose last A1c level was > 9% (plus those that did not have an A1c performed), results = < 15% of patients. Community Health Services of Union County Free Clinic of Rockingham County John P. Murray Community Care Clinic Mariam Clinic Matthews Free Medical Clinic NCAFCC Average = 28.1% Blood Pressure Control % of patients whose last measured BP was < 140/90, results = > 74% of patients Community Care Clinic - Boone Community Care Clinic - Elizabeth City Community Health Services of Union County Free Clinic of Rockingham County Matthews Free Medical Clinic MERCI Clinic Moore Free and Charitable Clinic Mustard Seed Community Health NCAFCC Average = 63.3% 2017 Annual Outcomes Survey Page 16

18 % of Patients FREE & CHARITABLE CLINICS IN COMPARISON UNCONTROLLED DIABETES: MOST RECENT A1c > 9% + No A1c Test Performed 50% 45% 45.4% 40% 35% 31.9% 30% 28.1% 25% 24.8% 20% 15% 10% 2017 NCAFCC 2016 NC HRSA Health Centers NC Office of Rural Health 2015 HEDIS (Medicaid HMO) Data to be updated when 2017 (or most current) information is available from NC HRSA, NC Office of Rural Health and/or HEDIS (Medicaid HMO) 2017 Annual Outcomes Survey Page 17

19 % of Patients FREE & CHARITABLE CLINICS IN COMPARISON HYPERTENSION CONTROL: BP CONTROL < 140/ % 70.0% 65.0% 63.3% 61.3% 60.0% 57.5% 55.0% 54.7% 50.0% 2017 NCAFCC 2016 NC HRSA Health Centers NC Office of Rural Health 2015 HEDIS (Medicaid HMO) Data to be updated when 2017 (or most current) information is available from NC HRSA, NC Office of Rural Health and/or HEDIS (Medicaid HMO) 2017 Annual Outcomes Survey Page 18

20 Randy Jordan, CEO X104 Mark Scheerer, Deputy Director X101 Cindy Jones, Director of Quality & Clinical Support X103 Allison Kelly, Program Services Manager X105 Katie Yarbrough, Office Manager X Annual Outcomes Survey Page 19