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Critical Health Areas Project (CHAP) NewsletterVolume 1, Issue 5September 5, 2006
Chronic Care and Quality
In May, The first phase offers chronic disease management to Medicaid beneficiaries. By 2009, the goal is to extend chronic care management to all chronically ill citizens of Vermont. It is estimated that chronic conditions account for 75 percent of the state's health care costs. Another component of the plan the creation of an statewide electronic database for Medicaid beneficiaries. The database will be used by the state Department of Health to identify those with chronic health conditions and connect those with individuals with disease management programs. The goal is to improve health and save the state money. This Act also creates Catamount Health, which is a state subsidized product that will be sold by private insurance companies for uninsured citizens. Catamount Health participants will be eligible to receive chronic health management similar to that provided to Medicaid enrollees. Resources:
Healthcare Access
In-Store Retail Health Clinics Expand Access to Care Retail clinics are poised for explosive growth, according to a survey of the industry released in July by the California HealthCare Foundation – expected to grow from 90 today to several thousand by the end of 2007. Located next to pharmacies in drugstores, grocery stores and “big box” super-centers such as Wal-Mart, these clinics staffed by nurse practitioners and physician assistants use evidence-based diagnosis protocols to treat common ailments like sore throats and ear infections. Patients with complex problems are referred to doctors in the community. (Go to the recent State Health Notes article for details). At the country’s largest retail clinic chain, two-thirds of patients say they chose the retail clinics instead of a traditional doctor’s office. 50-70 percent of MinuteClinic visits occur outside traditional doctor’s hours. Regulations that affect retail clinics include:
At the national level, physician groups have issued guidelines (AAFP guidelines / AMA guidelines) that they hope the clinics will follow. Further Resources:
NCSL Experts:
Florida Legislator Holds “Idearaiser” for the Uninsured Florida State Representative Holly Benson shared with us a recent “Idearaiser” she sponsored in her district to generate ideas about how to expand coverage for the uninsured. “[It] was a great success,” she says. “We had 170 or so from across the country spend the afternoon in Pensacola working on creative ideas for this challenge.”
Addiction Prevention and Treatment
Underage Binge Drinking Lowest in Areas of D.C., Detroit, Los Angeles, Utah, Tennessee, Maryland; Highest in Parts of North Dakota, South Dakota, Montana, Rhode Island, Wisconsin A report by the Substance Abuse and Mental Health Services Administration (SAMHSA) estimates that three areas in Washington, D.C.; Prince Georges County and Baltimore City, Md.; Detroit; Wilmington, Del.; Los Angeles County; two areas of Utah; Shelby County and central Tennessee; and parts of Mississippi, Florida, and Georgia have some of the lowest rates of underage binge drinking in the country. The highest rates of underage binge drinking occurred in Washington, D.C.’s Ward 3, Western Wisconsin, four regions of North Dakota, three regions of South Dakota, three areas of Montana, Washington, Bristol and Newport counties, R.I., and part of Wyoming. The report, “Substate Estimates from the 2002-2004 National Surveys on Drug Use and Health”, is an online compendium of alcohol and substance abuse in over 340 substate areas designated by the states. Binge drinking is defined as having five or more drinks within a couple of hours on at least one day in the 30 days prior to the survey. Underage drinking encompasses persons ages 12-20 years old. Among all persons ages 12 and older, an accompanying short report, “Alcohol Dependence or Abuse in Substate Areas”, which extracts data from the larger report, estimates that Albany and Carbon counties in Wyoming have the highest rate of alcohol abuse or dependence in the nation, 13.5 percent of the population, while southern Utah and north central Florida had the lowest rate at 5.4 percent. The localities with the highest rates of underage alcohol use include sections of the District of Columbia, Wards 2 and 3. In contrast, areas with the lowest rates of underage binge drinking include Washington D.C.’s Wards 4, 7 and 8. Parts of North Dakota, South Dakota, Montana, Wyoming, Western and Northern Wisconsin, and Rhode Island were also among those with the highest rates of underage alcohol use. Thirteen of the highest 15 areas for underage binge alcohol use were the same as those for underage alcohol use: North Dakota (Northeast, Southeast, North Central and Northwest, Badlands and West Central), South Dakota (Regions 5 and 7), Montana (Regions 4 and 5), Rhode Island (Washington, Bristol and Newport counties), District of Columbia (Ward 3), Wisconsin (Western), and Wyoming (District 2). The localities with the highest rates of past year alcohol dependence or abuse among both adolescents and adults (ages 12 and older) were sections of Montana, Nebraska, New Mexico, North Dakota, South Dakota, Wisconsin, Wyoming, Rhode Island and Washington, D.C. The District of Columbia, North Dakota, South Dakota and Wisconsin all had more than one of its substate areas in the top 15 areas for alcohol abuse or dependence in the nation. The full report contains estimates for 22 measures of substance use including illicit drug use, tobacco use, substance dependence or abuse, needing but not receiving treatment and serious psychological distress. The short report on alcohol dependence or abuse is available on the web at http://www.oas.samhsa.gov/. The complete substate report is available on the web at http://oas.samhsa.gov/substateList.htm. Providers and Workforce
The State of Emergency Departments
In July 2006, the Institute of Medicine released three reports on the future of emergency care in the United States. They bring to light a national crisis that is just beginning to get the attention it demands. Problems include serious emergency department (ED) overcrowding, fragmentation and a lack of coordination between EDs and the Many other organizations have produced their own reports examining the problems surrounding emergency departments. In July, the National Health Policy Forum released Don’t Bring Me Your Tired, Your Poor: The Crowded State of America’s Emergency Departments, which highlights a number of potential ways to ease crowding at both the health system and the individual hospital level. The Center for Studying Health System Change produced a report examining the demographics of those who use EDs; they found that contrary to popular belief, communities with the highest levels of ED use generally did not have the highest numbers of uninsured, low-income, racial/ethnic minorities or immigrant residents. The Center for Workforce Studies came out with The Emergency Care Workforce in the U.S. this month, which focuses on emergency care provider shortages. In 2005, New York introduced a bill that would limit boarding in the ED to 4 hours and also limit diversion to other hospitals. See other state actions here: http://www.acep.org/webportal/Advocacy/state/crowding/chapstrategies.htm.
Resources:
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