Rhode Island - The Robert Graham Center

Report
Rhode Island:
A Brief State of the
State
D Roxanne Richards
May 24, 2012
Today’s Objectives

Rhode Island Characteristics



Workforce characteristics



Current Primary Care Workforce
Training milieu
Primary Care Infrastructure



Demographics
Economy
Mapping Need
Key Disparities
Trends


In the News
Recent Legislative Actions and Agency Programs
Rhode Island Characteristics
State of Rhode Island and
Providence Plantations
Rhode Island in United States (zoom) (extra close) (US48).svg from Wikimedia Commons1
Metropolitan vs.
Non-metropolitan Areas
“The Health of Rhode Island Non-Metropolitan Communities”, Office of Primary Care and Rural Health, November 2011.
Ethnicity Composition
Census 2010 Quick Facts: Rhode Island
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
Mapping Poverty:
Population at or below 100% FPL
UDS Mapper, http://www.udsmapper.org, accessed May 23, 2012
Insurance Rates and
Healthcare 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
Insurance Rates and
Healthcare Expenditures
Kaiser Family Foundation, StateHealthFacts.org
Insurance Rates:
Compared to Neighboring States
Fact Finder 2, US Census Bureau
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
Health Reform:
Where is RI at in the process?

HIE established


PCIP in place


State is active purchaser
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
Workforce Characteristics
Current PC Provider Supply:
Total Active Physicians per Population
AAMC Physician Workforce State Profiles
Current PC Provider Supply:
Active PC Physicians per Population
AAMC Physician Workforce State Profiles
Current Nurse Practitioner Supply
“Total Nurse Practitioners, 2011”, Kaiser Family Foundation
Current Physician Assistant Supply
“Total Physician Assistants, 2011”, Kaiser Family Foundation,
Distribution of All RI Physicians:
RI AHEC Primary Care Mapping Project (2008)
RI AHEC Primary Care Mapping Project (2008)
Distribution of PC Physicians:
RI AHEC Primary Care Mapping Project (2008)
RI AHEC Primary Care Mapping Project (2008)
Physician Density by Municipality:
RI AHEC Primary Care Mapping Project (2008)
RI AHEC Primary Care Mapping Project (2008)
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
Physician Retention: UME
AAMC Physician Workforce State Profiles
Physician Training:
GME in New England Region
ACGME data from AMA-MF
Physician Retention: GME
AAMC Physician Workforce State Profiles
Migration of Physicians into RI:
Most Common GME States,
All Physicians
ACGME data from AMA-MF
Migration of Physicians into RI:
Most Common GME States,
PC Physicians
ACGME data from AMA-MF
Primary Care Infrastructure
Mapping Need in RI:
HPSA’s
UDS Mapper, udsmapper.org
Mapping Need in RI:
MUA’s/MUP’s
UDS Mapper, udsmapper.org
Mapping Need in RI:
Section 330 Grantee Access Points
UDS Mapper, udsmapper.org
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.
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
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
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
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
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
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
Trends in Rhode Island
In The News…
“RI Foundation Grant Supports
“UnitedHealthcare donates
Inspiring Mentorships”
$250K to physicians loan
forgiveness program”
April 2011, http://www.giving.brown.edu37
October 11, 2011, http://www.pbn.com
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
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
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
Summary
 Workforce




Higher numbers of specialists and PC physicians
Lower rates of NP’s and PA’s
Few training programs
Lower rates of retention
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
In The News
 Healthcare Reform
 Medicaid Budget
 Support for Primary Care via loan forgiveness,
mentorship programs, etc
Questions, Discussion…
References
(correlate with RI_full_outline.docx)
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Census 2010 Quick Facts: Rhode Island,
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“Focus on Health Reform: How Competitive Are State Insurance Markets? “ Kaiser Family
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Connecticut, Physician Assistants: State Laws and Regulations, 12th Edition, January
2011. CONN. GEN. STAT. §20-12d, CONN. GEN. STAT. §20-12a(7)(A), and CONN. GEN.
STAT. §20-12a(7)(B), as accessed from
http://www.aapa.org/uploadedFiles/content/The_PA_Profession/Federal_and_Stat
e_Affairs/Resource_Items/Connecticut%202011.pdf (accessed May 22, 2012)
Massachusetts, Physician Assistants: State Laws and Regulations, 12th Edition,
January 2011. MASS. GEN. LAWS ch. 112, §9E, MASS. GEN. LAWS ch. 94C, §7(g), and
263 MASS. CODE REGS. 5.07, as accessed from
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Maine, Physician Assistants: State Laws and Regulations, 12th Edition, January 2011.
02-373-2 ME. CODE R. §6 and 02-373-2 ME. CODE R. §6(A)(2), as accessed from
http://www.aapa.org/uploadedFiles/content/The_PA_Profession/Federal_and_Stat
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New Hampshire, Physician Assistants: State Laws and Regulations, 12th Edition,
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Vermont, Physician Assistants: State Laws and Regulations, 12th Edition, January
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“The Health of Rhode Island Non-Metropolitan Communities”, Office of Primary
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Tuition and Student Fees Reports, AAMC,
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23,2012
RI AHEC Primary Care Mapping Project http://med.brown.edu/ahec/mapping_project/,
accessed May 23, 2012
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