Medical and Dental Care@100%: Innovation 1
Tracking Supply and Demand
The projects presented in the ten innovations areas are all designed to address barriers to vital services. Action teams should review all projects and prioritize those that have the best chance of addressing the barriers identified in the 100% New Mexico countywide survey. Your collaborative and result-focused local work is nothing less than heroic.
Project: Medical and Dental Care.1.1
Project 1: The “assess the situation” project
Most of the time somebody uses a health care provider, that visit is paid for by insurance and data on that visit are collected. The Health Insurance Portability, Access and Accountability Act (HIPAA) means that health visits are reported in the aggregate. You can’t see whether a particular person got care, but you can know how many women aged 30–39 got care, for example. Getting access to health information is harder than other data, because laws and policies see this information as sensitive in part due to the enduring stigma about mental illness. It is also cumbersome for many kinds of health providers to manage billing insurance companies for care, so they make the patient file the claim.
No single number will give you a complete picture of a community’s health. But by gathering multiple data sources and tracking them over time, you should be able to get an idea of how much medical and dental care insecurity there is in your community. Here’s your list:
- Available data: Your state Public Health Department and Human Services Department should have aggregate data for the whole state and maybe some by county.
- Sources of care: Locate sources of health care, both private and public including emergency rooms, urgent care centers, doctor’s offices, hospitals, community health centers, free clinics, school clinics, pastoral counseling centers, social workers and psychiatrists.
- Access limitations: Determine the operating hours and eligibility requirements for every source and determine if they take Medicaid, Medicare or self-pay patients. Do you have to be a US citizen to get care?
- ER data: How many patients does the hospital emergency department serve each year? How many of them are transported by ambulance?
- Community health center: Does your community have one? Does a federally-qualified health center or tribal health center have a fully-functioning health staff?
- Free clinic data: Does your community have a free clinic? How many patients can it handle on average? Is care restricted to certain age groups or other populations?
- Faith-based: Many clergy provide initial counseling for health concerns and support to their members. You may have to call pastors/faith-based organization leaders. Note how many sessions they offer on average.
- Elder service agencies: How many have social workers or other health care providers on staff? Who is eligible for care?
- School districts: Is there a school-based health center in your community? What services are provided, what age group(s) do they serve? How many visits occur in an average month? Do your schools have volunteer or paid school nurses on staff?
- Homeless shelters: Many serve substance-using or mentally ill clients routinely. Who do they call when they can’t manage a client with health or addiction issues?
- Domestic violence shelters: They may track visits to additional care that the shelter program supports. Maybe take a snapshot once per month and track over time.
- Child welfare data: While not easy to acquire, there may be a way to assess data on adult and child clients needing medical and dental health care.
- American Community Survey: The ACS is an ongoing survey that provides vital information on a yearly basis about the United States and its people. Information from the survey generates data that help determine how more than $675 billion in federal and state funds are distributed each year.
As mentioned, this won’t be as simple an assessment as those for some other sectors, but if you get these numbers, you should at least be able to tell if the situation in your community is going in a good or bad direction. In this project, you will be gathering as much data as you can to paint a picture of local behavioral health care: the first step in identifying challenges.
Project: Medical and Dental Care.1.2
Project 2: The “medical/dental care accessibility analysis” project
Your mission is to figure out where people of limited means can access health care. Make a list of all sliding scale clinics, health department operations, public hospitals designated for charity care, school-based health centers and the like, then see what you can learn about how accessible they are. Ask patients, or maybe even the administration, how many days or weeks it would take to get seen by a doctor, or the average wait time for emergency room care. As a bonus, you could call up a few primary care doctors and dental clinics and see if they take Medicaid.
Project: Medical and Dental Care.1.3
Project 3: The “what’s ailing you?” project
This is the advanced project and may not even be possible in your state, but here’s the background: as part of the ongoing effort to identify ways to reduce health care costs, many states have developed something called an all-payer claims database. Your state may be one of them. Basically the idea is that instead of hoarding all this useful information for proprietary reasons, all payers (translation: insurance companies) would be forced to turn over data on medical services they buy to a central state authority for further analysis. These data would of course be anonymized, but in theory, it should spell out, in a helpful level of detail, how many people are getting what types of treatments and what it’s costing them. From this, we can infer the types of medical problems people have.
So if your state has one of these programs and the data are accessible to lay members of the public, you could have an interesting data analysis project on your hands. This varies everywhere; our best advice is to find an expert at the local university to help you out, poke around and see what you can find. Look for leading causes of death, the most expensive procedures, the most common ailments, ways in which your local area deviates from other parts of the state and other interesting trends.
All-payer claims databases: https://aae.how/118
Project: Medical and Dental Care.1.4
Project 4: The “can you get cared for from here?” project
This project might best be done in conjunction with the transportation task force/action team. Here’s the mission: Map out all of your county’s medical facilities, then figure out how accessible they are by just using public transit. Pay special attention to hospitals, primary care doctors, dental offices, and behavioral health operations. Look at service frequency, hours of operation, etc. Try to figure out if an average patient with a doctor’s appointment could make it work without a car. If you feel really creative, create a map in Google Maps showing where services are and where transit goes.
Project: Medical and Dental Care.1.5
Project 5: The “does our care go where it should?” project
Your medical and dental system (notice the term “system,” as it should be one seamless system serving the entire county) should serve all residents, but especially your community’s most critical areas: census areas with high rates of child welfare involvement, low income areas, areas with high unemployment, high schools with low achievement and high dropout rates.