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Rhode Island: A Brief State of the State

Rhode Island: A Brief State of the State. D Roxanne Richards May 24, 2012. Today’s Objectives. Rhode Island Characteristics Demographics Economy Workforce characteristics Current Primary Care Workforce Training milieu Primary Care Infrastructure Mapping Need Key Disparities Trends

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Rhode Island: A Brief State of the State

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  1. Rhode Island:A Brief State of the State D Roxanne Richards May 24, 2012

  2. Today’s Objectives • Rhode Island Characteristics • Demographics • Economy • Workforce characteristics • Current Primary Care Workforce • Training milieu • Primary Care Infrastructure • Mapping Need • Key Disparities • Trends • In the News • Recent Legislative Actions and Agency Programs

  3. Rhode Island Characteristics

  4. State of Rhode Island and Providence Plantations Rhode Island in United States (zoom) (extra close) (US48).svg from Wikimedia Commons1

  5. Metropolitan vs.Non-metropolitan Areas “The Health of Rhode Island Non-Metropolitan Communities”, Office of Primary Care and Rural Health, November 2011.

  6. Ethnicity Composition Census 2010 Quick Facts: Rhode Island

  7. Metropolitan vs.Non-metropolitan “The Health of Rhode Island Non-Metropolitan Communities”, Office of Primary Care and Rural Health, November 2011; Fact Finder 2, US Census Bureau

  8. Mapping Poverty:Population at or below 100% FPL UDS Mapper, http://www.udsmapper.org, accessed May 23, 2012

  9. Insurance Rates andHealthcare Expenditures • Insured by public plan: 21% (US average 20%)4 • Total Uninsured: 199,100 (13%) (US average 18%)4 • Uninsured under 100% FPL: 41% (US average 41%) • Uninsured 100-138% FPL: 10% (US average 13%) • Uninsured 139-250% FPL: 24% (US average 24%) • Uninsured 251-399% FPL: 12% (US average 13%) • Uninsured 400%+ FPL: 13% (US average 10%) • HC expenditures per capita (2009): $8309 (US average $6815)4

  10. Insurance Rates andHealthcare Expenditures Kaiser Family Foundation, StateHealthFacts.org

  11. Insurance Rates:Compared to Neighboring States Fact Finder 2, US Census Bureau

  12. Economy and Politics • Based in service industries7 • Healthcare (1st) • Tourism (2nd) • Manufacturing (3rd) • Recent Tax Reform (June 2010)2 • Make RI more business-friendly • Reliably Democratic state2 • Has voted for Democratic nominees for president in all but 7 elections since 1908

  13. Health Reform:Where is RI at in the process? • HIE established • State is active purchaser • PCIP in place • Currently 149 enrollees • Medicaid Expansion Estimates (KFF.org): • % change in enrollment: + 20.0% (US average +27.4%) • % change in STATE spending: +0.7% (US average +1.4%) • % change in FEDERAL spending: 14.6% (US average +22.1%) Kaiser Family Foundation, StateHealthFacts.org

  14. Workforce Characteristics

  15. Current PC Provider Supply:Total Active Physicians per Population AAMC Physician Workforce State Profiles

  16. Current PC Provider Supply:Active PC Physicians per Population AAMC Physician Workforce State Profiles

  17. Current Nurse Practitioner Supply “Total Nurse Practitioners, 2011”, Kaiser Family Foundation

  18. Current Physician Assistant Supply “Total Physician Assistants, 2011”, Kaiser Family Foundation,

  19. Distribution of All RI Physicians:RI AHEC Primary Care Mapping Project (2008) RI AHEC Primary Care Mapping Project (2008)

  20. Distribution of PC Physicians:RI AHEC Primary Care Mapping Project (2008) RI AHEC Primary Care Mapping Project (2008)

  21. Physician Density by Municipality:RI AHEC Primary Care Mapping Project (2008) RI AHEC Primary Care Mapping Project (2008)

  22. Physician Training:UME in New England Region26 RI: one private (Brown University, Alpert Medical School) MA: one public, three private CT: one public, one private NH: one private VT: one public ME: one private NY: five public, eight private Tuition and Student Fees Reports, AAMC, 2010

  23. Physician Retention: UME AAMC Physician Workforce State Profiles

  24. Physician Training:GME in New England Region ACGME data from AMA-MF

  25. Physician Retention: GME AAMC Physician Workforce State Profiles

  26. Migration of Physicians into RI:Most Common GME States,All Physicians ACGME data from AMA-MF

  27. Migration of Physicians into RI:Most Common GME States,PC Physicians ACGME data from AMA-MF

  28. Primary Care Infrastructure

  29. Mapping Need in RI:HPSA’s UDS Mapper, udsmapper.org

  30. Mapping Need in RI:MUA’s/MUP’s UDS Mapper, udsmapper.org

  31. Mapping Need in RI:Section 330 Grantee Access Points UDS Mapper, udsmapper.org

  32. Key Disparities in RI • GIS mapping used to target resources30 • Lead poisoning in children • At-risk populations for Tobacco Abuse "Using Geographic Information to Target Health Disparities: State Experience”, 2011.

  33. Key Disparities in RI • 2011 Health Disparities Profiles31 • “Rhode Island has one of the highest rates of death due to coronary heart disease” (rank 48th in US) • “Some of the lowest rates of death due to stroke (3rd), unintentional injuries (11th) and suicide (6th)…obesity (10th)…and a relatively low rate or current smoking (14th)” • High rates of preventive care (cholesterol screening, routine check up in last 2 years, dental visit in last year; placing 3rd in each), but large disparity in rate of cholesterol screening for Hispanic population • High rates of insurance (17th), but significantly lower in Hispanic population “Health Disparities Profiles: 2011 Edition.” Washington, DC: DHHS Office on Women’s Health. 2011

  34. Key Disparities in RI • Office of Primary Care and Rural Health (OPCRH) • Possible Barriers Identified: • Access to Care • HPSA’s • Insurance/Ongoing Source of Care • Public Transportation

  35. Key Disparities in RI • Office of Primary Care and Rural Health (OPCRH) • Possible Barriers Identified: • Access to Care • HPSA’s • Insurance/Ongoing Source of Care • Public Transportation

  36. Key Disparities in RI • Office of Primary Care and Rural Health (OPCRH) • Possible Barriers Identified: • Access to Care • HPSA’s • Insurance/Ongoing Source of Care • Public Transportation

  37. Key Disparities in RI • Office of Primary Care and Rural Health (OPCRH) • Possible Barriers Identified: • Access to Care • HPSA’s ??? • Insurance/Ongoing Source of Care • Public Transportation

  38. Key Disparities in RI • Office of Primary Care and Rural Health (OPCRH) • Five Barriers to ACCESSING Care • Inadequate capacity of dental services • Inadequate supply of mental health services • Lack of knowledge of resources • Individual stigma around receiving services and benefits • Inadequate public transportation

  39. Trends in Rhode Island

  40. In The News…

  41. “Reed Urges RI Nursing and Med Students to Apply for Newly Expanded Scholarship Designed to Expand RI’s Primary Health Care Workforce” May 17, 2011, http://www.senate.gov “RI Foundation Grant Supports Inspiring Mentorships” April 2011, http://www.giving.brown.edu37 “Poverty Institute in last-ditch fight to prevent RIte Care cuts” June 14, 2011, http://blogs.wpri.com “UnitedHealthcare donates $250K to physicians loan forgiveness program” October 11, 2011, http://www.pbn.com “House approves bill for osteopathic medicine school” May 16, 2012, http://www.rilin.state.ri.us “RI to receive $6.2M in grants from Affordable Care Act” May 1, 2012, http://www.pbn.com “A Focus on Primary Care: Effective Strategies for Recruiting Students” Medicine & Health, August 2011. “Federal Grants to Transform Primary Care at Memorial” 2011, http://www.mhri.org

  42. Recent RI Legislative Actions and DOH Programs New Osteopathic School Approved by RI House, May 16, 201236 Letter from “Rhode Island Primary Care Physician Advisory Committee” to RI DOH Director Dr Michael Fine, January 9, 201242 RI Medicaid Global Waiver Program (2008-2013)43

  43. Recent DOH Reports Impact of Primary Care on Healthcare Cost and Population Health: A Literature Review, Feb 201246 “An Independent Evaluation of Rhode Island’s Global Waiver”, The Lewin Group, December 6, 201145 The Health of Rhode Island Non-Metropolitan Communities, 201122 Healthy Rhode Island 2010 Healthy RI Task Force: Getting National health Reform Right for Rhode Island, Sept 201032

  44. Summary • Rhode Island Characteristics • Metro vs Non-metro • Barriers to access • Lower participation in programs such as WIC • Wealthier, Younger, more Caucasians, bigger divide in education • Average rates of insurance overall • Above average HC expenditure per capita

  45. Summary • Workforce • Higher numbers of specialists and PC physicians • Lower rates of NP’s and PA’s • Few training programs • Lower rates of retention

  46. Summary • PC Infrastructure • 17 HPSA’s • RI no stranger to GIS mapping • High rates of death from CHD • Lower rates of smoking, obesity than national average • Non-metro areas with barriers to access

  47. In The News Healthcare Reform Medicaid Budget Support for Primary Care via loan forgiveness, mentorship programs, etc

  48. Questions, Discussion…

  49. References(correlate with RI_full_outline.docx) • http://en.wikipedia.org/wiki/Rhode_Island (accessed May 4, 2012) • Census 2010 Quick Facts: Rhode Island, http://quickfacts.census.gov/qfd/states/44000.html (accessed May 4, 2012) • http://news.providencejournal.com/breaking-news/2010/06/carcier-signs-law-changing-inc.html (accessed May 4, 2010) • http://www.statehealthfacts.org/healthreformsource.jsp?rgn=41 (accessed May 3, 2012) • http://www.theagapecenter.com/Hospitals/Rhode-Island.htm#R (accessed May 7th, 2012) • http://blogs.wpri.com/2010/12/21/would-the-feds-file-suit-against-blue-cross-ri/ (accessed May 7th, 2012) • http://blogs.wpri.com/2011/03/15/gallup-ri-has-5th-biggest-rise-in-uninsured-adults/ (accessed May 7th, 2012) • “Focus on Health Reform: How Competitive Are State Insurance Markets? “ Kaiser Family Foundation, Oct 2011. • AAMC Physician Workforce State Profiles, https://www.aamc.org/initisiatives/workforce/reports/profiles/, accessed May 15, 2012 • Christian S, Dower C, O’Neil E, “Overview of Nurse Practitioner Scopes of Practice in the United States – Discussion”, Center for Health Professions, UCSF, 2007. (http://www.acnpweb.org/files/public/UCSF_Discussion_2007.pdf, accessed May 22,2012)

  50. References(correlate with RI_full_outline.docx) • Christian S, Dower C, O’Neil E, “Chart Overview of Nurse Practitioner Scopes of Practice in the United States”, Center for Health Professions, UCSF, 2007. (http://futurehealth.ucsf.edu/Content/29/2007-12_Overview_of_Nurse_Practitioner_Scopes_of_Practice_In_the_United_States_Chart.pdf, accessed May 15, 2012) • “Professional Issues: Physician Assistant Scope of Practice”, American Academy of Physician Assistants, Jan 2010. Pages 2-3 (http://www.aapa.org/uploadedFiles/content/Common/Files/PI_PA_Scope_Practice_v4-052611-UPDATED.pdf, accessed May 22, 2012) • “PA Prescribing Authority By State”, American Academy of Physician Assistants, Jan 2012. Pages 1-2. (http://www.aapa.org/uploadedFiles/content/The_PA_Profession/Federal_and_State_Affairs/Resource_Items/Rx%20Chart%201-12.pdf, accessed May 22, 2012) • “Total Nurse Practitioners, 2011”, Kaiser Family Foundation, http://www.statehealthfacts.org/comparemaptable.jsp?ind=773&cat=8 (accessed May 22, 2012) • “Total Physician Assistants, 2011”, Kaiser Family Foundation, http://www.statehealthfacts.org/comparemaptable.jsp?ind=440&cat=8 (accessed May 22, 2012)

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