Executive Summary and Project Selection The NYHQ PPS DSRIP Community Needs Assessment Primary and Secondary Data 2014 Process Overview and Methods New York Hospital Queens has engaged in a four-month, comprehensive, and collaborative development of a Community Needs Assessment (CNA), led by the CNA Project Workgroup, with significant input from the Project Advisory Committee. Vast amounts of quantitative and qualitative data were collected, refined and analyzed. Thirteen stakeholders and over 80 residents provided valuable qualitative information on their health concerns and health care access and services in Queens. Quantitative data used throughout this analysis was obtained from more than 30 sources. Findings The NYHQ service area is home to a large, incredibly diverse, population base that is growing rapidly. Approximately 1.6M people live in the service area, with growth of 65,000 projected in the next five years. Given the area’s racial and ethnic diversity, stakeholders and residents emphasized the need for culturally and linguistically appropriate care, particularly within the hospital setting. Poverty is an issue of concern for this population – particularly the disparity in poverty rates across the service area. Some portions of the service area see as much as ¼ of the population living in poverty. Poverty rates are highest in neighborhoods within Jamaica, Corona, and Elmhurst. Poverty is a major barrier to access for health care. Focus group participants reported that they often delay or avoid seeking health care due to cost. Approximately 692k persons in the service area are Medicaid beneficiaries. This is 43% of population. An estimated 306,000 persons in the service area are uninsured. In aggregate, there are 1.9M persons in the service area who are either Medicaid beneficiaries or uninsured and, as such, are considered target population for DSRIP. Despite the significant presence of poverty in the service area, mortality rates are relatively low. This may be attributable to several factors, including but not limited to, the following: • Health risk factor data shows that the service area population does not engage in risky behaviors to the extent that populations in comparative geographies engage in these behaviors. • A large percentage of the service area population is Asian (more than 500k Asian residents). Asians are much healthier, as defined by mortality rates, than any other racial/ethnic group. 1 • There are some excellent health care and community resources available to the population base. Two causes of mortality do rank higher in the service area than in other geographies. These are cerebrovascular disease (stroke) and intentional self harm (suicide). Suicide was raised in focus groups and interviews as a major concern, particularly among immigrant groups. The most significant areas of concern from a morbidity, or disease prevalence, perspective are cardiovascular disease and behavioral health. These two diseases result in almost 300k admissions and another 300k ED visits annually in Queens County. Among focus group and interview respondents, mental health was a prominent concern. Changes in the financings of behavioral health services have led to the recent closure of several community-based outpatient mental health clinics in Queens, thereby likely increasing the demand for crises care and hospital-based mental health utilization. The lack of community based mental health services only compounded difficulties seeking care caused by other factors, such as social stigma and lack of insurance or affordability. The service area has a high rate of preventable readmissions, suggesting that there may be difficulty with coordination and transitions of care across providers, and from acute to post acute. Many stakeholders interviewed recommended utilization of supportive services like care coordinators and community health care workers in order to better educate patients about their health conditions, encourage and monitor treatment adherence, and prevent readmissions. Provider demand for the DSRIP population exceeds the supply of safety net providers in the area. Perhaps most concerning are the areas in the west and northwest of the service area that have little to no safety net providers, yet have a high concentration of Medicaid beneficiaries. This quantitative data is supported by the reported difficulties accessing affordable, trustworthy, community-based providers among some focus group participants, particularly as it related to mental health. Geographic disparity in the availability of resources (both health care resources and community resources) is significant. Roll out of new strategies should not be concentrated in the areas with current providers, but should focus on pockets of the service area that are underserved. In addition, given the limitations of both health care and community resources, interview and focus group participants expressed strong interest in community- based services that address the needs of residents holistically in order to prevent hospitalization and promote good health. This included special attention to the role of diet, or “food as medicine”. Demand ratios indicate that the area is not over-bedded as it relates to acute care or SNF beds. Low bed rates and high occupancy may be appropriate as the focus shifts to outpatient and home care. 2 There are not enough behavioral health resources to meet demand. • Fewer than 150 behavioral health beds in area hospitals, yet ~150k behavioral health admissions in the County. Hospitals are forced to admit behavioral health patients to medical surgical beds, rather than behavioral health beds • More than 200k behavioral health ED visits suggest that outpatient resources are inadequate. Community resources are available, but perhaps not at a level to meet demand, particularly with housing and food. Stakeholders promoted existing approaches to offer housing for high utilization Medicaid recipients and other vulnerable populations, such as chronically homeless. Lack of affordable housing was generally recognized as a major concern among stakeholders and participating Queens’ residents; housing was widely recognized as a major social determinant of health. In addition, no areas of Queens have been the focus of federal or state funding to improve the built environment or increase access to healthy food and physical activity, such as New York State Department of Health’s Creating Healthy Places grant. Stakeholders and residents agreed that community engagement was important to health care planning, especially in order to consider the needs of vulnerable populations. Prevention services offered through culturally infused and linguistically competent providers that address people’s health holistically are both highly valued and desired. Project Selection The New York Hospital Queens PPS began the project selection process by arraying findings from the Community Needs Assessment with the project Domains presented by the state. This first step was high-level, in an attempt to identify the project buckets, or groups of projects, that were most closely aligned with the Community Needs Assessment findings. Next, criteria were applied to potential projects, according to Domain, to assist NYHQ in selecting which projects will be pursued. See criterion and descriptions below: • Magnitude – size, as measured by the number of people impacted by the intervention • Alignment – alignment with community needs and priorities • Ability to Impact – degree to which the NYHQ PPS intervention may effect significant change • Value – project points as assigned by the NY State Department of Health • Sustainability – degree to which the intervention continues beyond waiver • Community resources – depth and breadth of community resources aimed at addressing the issue 3 CAN findings were applied to each domain to determine which projects were best aligned with community need, thereby narrowing the number of potential projects in each domain. Next, the above criteria were applied to potential projects, resulting in a ranking/scoring of the projects, as shown below: Note: Palliative care is a significant issue in the service area, although difficult to quantify. NYHQ will also pursue project 3.g.ii – Integration of Palliative Care into the Nursing Home. 4 NEW YORK HOSPITAL QUEENS COMMUNITY NEEDS ASSESSMENT: REPORT OF THE PRIMARY DATA COMPONENT OCTOBER 21, 2014 INTRODUCTION The goal of the Delivery System Reform Incentive Payment (DSRIP) program is to promote community-level collaborations and focus on system reform in order to reduce avoidable inpatient admissions and emergency room visits by 25% over five years for the Medicaid and uninsured populations in New York State. To inform the health system transformation that is required under the DSRIP program, emerging Performing Provider Systems (PPS’s) must submit a comprehensive Community Needs Assessment (CNA) with their Project Plan applications. New York Hospital Queens (NYHQ) PPS’s CNA, conducted in September and October 2014 included primary and secondary data analysis and had the following aims: ● To describe health care and community resources; ● To describe the communities served by the PPSs; ● To identify the main health and health service challenges facing the community; and ● To summarize the assets, resources, and needs for proposed DSRIP projects. This report describes the primary data methodology and analysis and has been developed as an attachment to the full CNA, and to provide more in-depth information