The Affordable Care Act and Childhood Immunization Delivery in Rural Communities

Transcription

1 PHSSR Research-In-Progress Series: Bridging Health and Health Care Wednesday, July 1, pm ET/ 9-10am PT The Affordable Care Act and Childhood Immunization Delivery in Rural Communities To download today s presentation & speaker bios, see the Resources box in the top right corner of the screen. PHSSR NATIONAL COORDINATING CENTER AT THE UNIVERSITY OF KENTUCKY COLLEGE OF PUBLIC HEALTH

2 Agenda Welcome: C.B. Mamaril, PhD, Research Assistant Professor, Health Management & Policy, University of Kentucky College of Public Health The Affordable Care Act and Childhood Immunization Delivery in Rural Communities Presenter: Van Do-Reynoso, MPH, PhD Candidate, U. of California, Merced and Public Health Director, Madera County, California Commentary: Paul Brown, PhD, Chair of Public Health; U. of California, Merced Susan Buckley, RN, PHN, MPH, Public Health Director, Humboldt County, CA Questions and Discussion

3 Presenter Van Do-Reynoso, MPH PhD Candidate, Public Health Services and Systems Research University of California, Merced Public Health Director Madera County, California Pre-doctoral Scholar in Public Health Delivery, 2014 PHSSR Award

4 The Affordable Care Act and Childhood Immunization Delivery in Rural Communities: Phase 1 Van Do-Reynoso, MPH Doctoral Candidate in Public Health UC Merced July 1, 2015

5 Robert Wood Johnson Foundation Public Health Services and Systems Research Pre-Doctoral Scholar Award PHSSR National Coordinating Center Mentor Paul Brown, PhD, UC Merced Reference Group Humboldt, Kings, Merced, Nevada, and Fresno Counties 5

6 2014: ~3 million newly enrolled in Medi-Cal > 1 million newly enrolled in private coverage via Covered California Not yet available gains from employment-based coverage 2.7 to 3.4 million people under 65 years will remain uninsured by 2019 Up to 50% will be undocumented immigrants Remaining uninsured will be eligible, but unenrolled due to barriers Which Californians will Lack Health Insurance under the Affordable Care Act? CA Simulation of Insurance Market (CalSIM) Report, Jan

7 For children 0-17: Uninsured 8.3% Publically insured 39.0% Privately insured 55.8% 7

8 31 out of 58 counties are small and rural Responsible for uninsured or indigent population by Welfare & Institution Code Decreasing Health Realignment revenues due to economy Decreasing state funding for immunization program Changing federal vaccine guidelines New role? 8

9 To evaluate whether the ACA has led to an increase in childhood immunizations in rural counties, and to define the role of the local public health department in this new era. 9

10 Literature review Reviewed work related to expanded health coverage, immunization rates, health care access rural communities, and changing role of LHDs Identified common themes to address in key informant interviews & survey Phase 1: Key Informant Interviews 14 participants in 4 counties Public Health, FQHC, & RHC In-person, via WebEx, and via telephone using semi-structured format Qualitative analysis to find common and unique themes 10

11 ACA, Medi-Cal Expansion, 317 vaccines Key themes: Increased number of children eligible for services Decrease in publically-insured children seeking LHDs 11

12 Immunization rates Key themes: Under-insured children face barriers to timely immunizations Personal Belief Exemptions affect rates in local communities 12

13 Access to immunizations Key themes: Lack of immediate community and private providers Community partnerships crucial to improve rates Not an issue for uninsured children 13

14 Funding for immunization Key themes: Decrease in state funding to LHDs Insufficient reimbursements for private providers Contracts with private insurance available to some LHDs 14

15 Cost of immunizations as a barrier Key themes: High cost for under-insured children 317s & VFCs readily available for non-insured or publically-insured children 15

16 Role of LHDs Key themes: Decreased role in direct service for publicallyinsured children Increased role in outreach and education Maintaining capacity to serve safety net populations Seeking new funding to maintain capacity 16

17 100.0% 90.0% 90.4% 89.7% 89.2% 89.5% 88.7% 88.8% 89.2% 80.0% 70.0% 60.0% 50.0% 40.0% Up To Date Personal Medical Exemption Personal Belief Exemption 30.0% 20.0% 10.0% 0.0% 2.6% 2.7% 3.1% 3.2% 3.6% 4.0% 3.4% PME rates: <.2% 17

18 100.0% 90.0% 80.0% 77.5% 73.5% 73.0% 71.6% 72.3% 72.6% 70.0% 66.7% 60.0% 50.0% 40.0% Up To Date Personal Medical Exemption Personal Belief Exemption 30.0% 20.0% 14.4% 18.9% 17.7% 20.3% 22.4% 21.3% 21.6% 10.0% 0.0% 0.1% 0.0% 0.1% 0.0% 0.1% 0.0% 0.5% PME rates: 0 % to.5% 18

19 100.0% 90.0% 80.0% 85.4% 84.2% 81.2% 82.2% 81.3% 77.3% 84.6% 70.0% 60.0% 50.0% 40.0% Up To Date Personal Medical Exemption Personal Belief Exemption 30.0% 20.0% 10.0% 0.0% 4.8% 6.2% 6.4% 8.1% 8.3% 8.6% 7.5% PME rates:.1 % to.5% 19

20 100.0% 90.0% 80.0% 75.2% 77.3% 75.8% 76.6% 75.7% 73.3% 75.7% 70.0% 60.0% 50.0% 40.0% Up to Date Personal Medical Exemption Personal Belief Exemption 30.0% 20.0% 10.0% 0.0% 10.2% 10.3% 10.5% 10.3% 11.5% 11.9% 10.9% 0.5% 0.4% 0.2% 0.2% 0.1% 0.1% 0.4% PME rates:.1% to.5% 20

21 100.0% 90.0% 96.5% 96.5% 96.2% 95.3% 97.3% 97.4% 96.7% 80.0% 70.0% 60.0% 50.0% 40.0% Up To Date Personal Medical Exemption Personal Belief Exemption 30.0% 20.0% 10.0% 0.0% 1.0% 1.4% 1.3% 1.9% 0.8% 0.9% 0.8% PME rates: 0 % to.2% 21

22 LHDs concerns: maintaining capacity for mass vaccination efforts maintaining immunization coverage rates by ability to provide IZ to anyone seeking it Cost estimations: variance in how LHDs and community providers capture cost information for providing immunization services 22

23 Three new arrangements for LHDs in rural areas: Type 1: Does not provide IZ to children covered by Medi-Cal Type 2: Provides IZ services for privately insured children Type 3: More efforts on referrals to other providers; convening coalitions and workgroups to improve rates 23

24 Analyze immunization database of kindergarten entrants from 2008 to 2014 at zip code level Distribute final survey to all 58 jurisdictions Analyze survey responses for themes and costs Construct predictive model for immunization rates 24

25 Cost estimation of childhood immunization services (Fall 2015) Presentations & Briefs on survey findings and predictive model to Immunization Workgroups, Public Health Directors, and Health Officers (Winter 2015/Spring 2016) Dissertation defense (January 2016) 25

26 Commentary Paul Brown, PhD Chair, Public Health Director, Health Sciences Research Institute School of Social Sciences, University of California, Merced Susan Buckley, RN, PHN, MPH Public Health Director Humboldt County, California Questions and Discussion

27 Archives of all Webinars available at: Upcoming Webinars July and August 2015 Wednesday, July 8 (12-1pm ET) NATIONAL EVALUATION OF LEADERSHIP STYLES AND OUTCOMES IN LOCAL HEALTH DEPARTMENTS Laura Cassidy, MS, PhD, Medical College of Wisconsin Wednesday, August 5 (12-1pm ET) APPLYING FAILURE MODES & EFFECTS ANALYSIS TO PUBLIC HEALTH: (RWJF PHS3 award) BREATHE EASY AT HOME PROGRAMS Megan Sandel, MD, MPH, FAAP, Boston Medical Center Margaret Reid, RN, MPA, Director, Healthy Homes and Community Supports, Boston Public Health Commission (RWJF PHS3 award)

28 Thank you for participating in today s webinar! For more information: Ann Kelly, Project Manager [email protected] 111 Washington Avenue #212 Lexington, KY