chapter nine, southern tier dsrip region needs...

Chapter Nine

Southern Tier DSRIP Region Needs Assessment

New York State Office of Mental Health

Executive Summary This community needs assessment of the New York State Southern Tier DSRIP region summarizes specific health care service data to identify mental health and substance use disorder treatment needs in the region. The data included are intended to enable planners and others to identify service gaps and disparities and plan for improved service delivery.

Population Socioeconomic Characteristics The Southern Tier region includes Broome, Chenango, Delaware, Tioga and Tompkins counties. The region has a population of approximately 450,000 and two of its five counties are designated rural. The socioeconomic characteristics of the region’s population are more indicative of need than those in other DSRIP regions. Its median household income of $47,795 is well below the NYS median household income of $58,857. Region-wide, 17% of the population lives below the poverty level (the second highest percentage in any DSRIP region), and 12% receive food stamps/SNAP benefits. In the Southern Tier region, 11% of adults are without a high school diploma and 27% have a bachelor’s degree or higher.

Thirty-three percent of the region’s population is on some type of public health insurance, 23% are Medicaid beneficiaries, and 8% have no health insurance coverage. Special populations in the region include 13% who are disabled and 9% who are Veterans. The percentages of individuals with disabilities in Chenango and Delaware counties (16% each) are the highest percentage in any NYS county. Six percent of the region’s population is foreign born and 9% speak a primary language other than English.

Health Care Resource Constraints Maldistributions and shortages of health care providers in the Southern Tier region are recognized by federal Health Resources and Services Administration (HRSA) health professional shortage area (HPSA) designations. Three counties have a whole county primary care shortage designation, and two counties have a census tract, population or facility designated as a primary care Medically Underserved Area/Population (MUA/P). The Medicaid eligible populations in all counties have been designated primary care MUPs and the low income population in one county has been designated a primary care MUP. Four counties have a whole county MH professional shortage designation and their Medicaid eligible populations are designated MH professional MUPs. The Southern Tier region has 32 MH professionals per 10,000 population. There are no psychiatrists in Chenango and Delaware counties.

The region’s total psychiatric bed capacity is 44 per 100,000 adults and 35 per 100,000 children. The total average daily census (ADC) per 100,000 adults is 44, and the total ADC per 100,000 children is 35.

The region’s acute care hospitals have no chemical dependence detox inpatient beds. There is one substance use disorder (SUD) crisis program in the region located in Broome County. The region’s two inpatient rehabilitation program are located in Broome and Delaware counties, and its four residential programs are located in Broome and Tompkins counties. These programs have a total capacity of four per 10,000 and an average daily enrollment (ADE) of three per 10,000, which is the second lowest ADE rate in any DSRIP region. The Southern Tier region has one opioid treatment program located in Broome County, with a region-wide capacity and average daily enrollment of three per 10,000 each, which are the second lowest rates in any DSRIP region.

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Health Status Challenges Among all DSRIP regions, the Southern Tier region has the highest: 1) Percentage of adults with current asthma. 2) Average death rate due to accidents.

Compared to all DSRIP regions, the region has the second highest: 1) Percentage of adults with diabetes or angina, heart attack or stroke 2) Average death rate due to chronic lower respiratory disease.

Delaware County’s AIDS case rate is the second highest in any NYS county outside of New York City.

Unmet Service Needs Measures of behavioral health medication management suggest unmet need in the region. Sixty-five percent of adults with schizophrenia adhere to anti-psychotic medications (35% do not). Region-wide, 54% of individuals with major depression remain on anti-depressant medication during the entire acute treatment phase and 38% remain on these medications during continuation phase treatment (62% do not).

Fifty-two percent of children prescribed ADHD medication have one follow-up visit with a practitioner within 30 days after starting the medication. Fifty-seven percent of children with a new prescription for ADHD medication remain on the medication for seven months and/or have at least two follow-up visits in the nine month period after the initiation phase.

Region-wide 43% of individuals have follow-up care within 7 days after hospitalization for a mental illness (57% do not) and 58% follow-up within 30 days. Engagement in alcohol and other drug dependence (AOD) treatment also suggests unmet need, with only 18% of individuals engaging in AOD treatment within 30 days after initiation (82% do not, the highest percentage in any DSRIP region).

In the Southern Tier region, rates of potentially avoidable emergency room visits and hospital admissions suggest a need for further outpatient resources. The region has the highest rate of potentially avoidable emergency room visits in all DSRIP regions, and high rates of potentially avoidable hospital admissions for diabetes chronic conditions.

Stakeholder Input The Southern Tier region counties’ surveys of consumer and provider stakeholders to assess local needs indicate that access to transportation to health care is the issue that needs attention in the mental illness and chemical dependency populations.


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I. Description of Communities to Be Served

1. Geographic Service Area The Southern Tier DSRIP region is in south central New York State, west of the Catskill Mountains and along the northern border of Pennsylvania. It includes five counties: Broome, Chenango, Delaware, Tioga and Tompkins.

Approximately 450,000 people live in the region (Table 1). Estimated county populations range from a low of 47,930 in Delaware County to a high of 200,183 in Broome. Two of the region’s counties have been designated rural by the U.S. Office of Management and Budget (OMB).1 Population density per square mile ranges from a low of 33.2 in Delaware County to a high of 283.6 in Broome.

Table 1. Southern Tier Region: Population Size, Density and Urban/Rural County Designations

County US Census ACS 2010-2014 Est.

Population

Population Density per Square Mile

OMB Urban/Rural

Designation1

Broome 200,183 283.6 Urban Chenango 50,651 56.7 Rural Delaware 47,930 33.2 Rural Tioga 51,151 98.6 Urban Tompkins 101,305 213.4 Urban

Totals 451,221 111.8 Data is from the U.S. Department of Health and Human Services, Health Resources Services Administration Data Warehouse. Retrieved April 14, 2016 from http://datawarehouse.hrsa.gov/ tools/analyzers/geo/Rural.aspx

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2. Population Characteristics

A. Gender, Race, Ethnicity and Age In the Southern Tier region, slightly more than half (51%) of the population are female (Table 2) and percentages of females are similar across counties.

Table 2. Southern Tier Region: Gender, Race/Ethnicity and Age


Population

American Community Survey Data 2010-2014 Gender Race/Ethnicity Age

Male Female White African

American Asian Other*

Hispanic or Latino Ethnicity

19 and Under

65 and Over

Broome 200,183 49% 51% 88% 5% 4% 4% 3% 24% 15% Chenango 50,651 50% 50% 97% 1% 0% 2% 2% 25% 16% Delaware 47,930 50% 50% 95% 2% 1% 2% 3% 23% 19% Tioga 51,151 49% 50% 97% 1% 1% 2% 1% 26% 15% Tompkins 101,305 50% 51% 83% 4% 9% 4% 4% 26% 10%

Totals 451,221 49% 51% 90% 3% 4% 3% 3% 25% 15% *Other includes American Indian and Alaska Native, Native Hawaiian and other Pacific Islander, some other race, and two or more races

The population in the region is primarily White, with percentages varying from a low of 83% in Tompkins County to a high of 97% each in Chenango and Tioga. Urban Tompkins County is more racially and ethnically diverse than the region’s other counties: 9% of its population are Asian and 4% each are African America, some other race, or of Hispanic or Latino ethnicity. Region-wide, 4% are Asian and 3% each are African American, some other race, and/or of Hispanic or Latino ethnicity.

A quarter of the Southern Tier population are age 19 and under and 15% are age 65 and over (the second highest percentage in any DSRIP region). The percentage of the population age 19 and under ranges from a low of 23% in Delaware County to a high of 26% each in Tioga and Tompkins. The percentage of the population age 65 and over ranges from a low of 10% in Tompkins County (the lowest percentage in any NYS county) to a high of 19% in Delaware (the second highest percentage in any NYS county).

B. Income, Education, Unemployment and Poverty The median household income in the Southern Tier region is $47,795 (Table 3), which is well below the New York State median household income of $58,687.2 Median household incomes range from a low of $43,636 in Delaware County to a high of $54,824 in Tioga.



Table 3. Southern Tier Region: Income, Education, Unemployment and Poverty


Population

American Community Survey Data 2010-2014

Median Household

Income

Educational Attainment1 Unemployment and Indicators of Poverty

Less than High School

Bachelor's Degree or Higher Unemployed2 Below Poverty

Level On Cash Public

Assistance On Food Stamps/

SNAP Benefits

Broome 200,183 45,652 11% 26% 6% 18% 4% 13% Chenango 50,651 44,220 15% 17% 6% 16% 2% 14% Delaware 47,930 43,636 13% 19% 6% 14% 2% 10% Tioga 51,151 54,824 10% 23% 6% 9% 3% 11% Tompkins 101,305 50,642 7% 50% 4% 21% 2% 9%

Totals 451,221 47,795 11% 27% 5% 17% 3% 12% 1 Educational attainment are calculated based on population 25 years and older. 2 Unemployment data is the average for 2015 and is from the NYS Department of Labor.

Eleven percent of the Southern Tier region’s population age 25 and older do not have a high school diploma and 27% have a bachelor’s degree or higher. Educational attainment varies by county. Adults without a high school diploma range from a low of 7% in Tompkins County (the lowest percentage in any NYS county) to a high of 15% in Chenango. Adults with a bachelor’s degree or more range from a low of 17% in Chenango County to a high of 50% in Tompkins, which is the second highest percentage in any NYS county.

The Southern Tier region has a 5% unemployment rate and 17% of the region’s population live below the poverty level, which is the second highest percentage in any DSRIP region. Tompkins County has the largest percentage (21%) of persons living below the poverty level (the third highest percentage in any NYS county), and Tioga County has the lowest (9%).

Three percent of the region’s population are on cash public assistance and 12% receive food stamps/SNAP benefits. Food stamps/SNAP beneficiaries range from a low of 9% in Tompkins County to a high of 14% in Chenango.

C. Health Insurance Status In the Southern Tier region, 33% of the population are on some type of public health insurance3 and 8% have no health insurance coverage (Table 4). Percentages of the population on public health insurance range from a low of 24% in Tompkins County to a high of 40% in Chenango. Those with no health insurance range from a low of 6% in Tompkins County (the lowest percentage in any NYS county) to a high of 10% each in Chenango and Delaware.



Table 4. Southern Tier Region: Health Insurance Status


Population

American Community Survey Data 2010-2014

Public Health

Insurance1

Coverage

No Health Insurance Coverage

Unemployed w/Public Health

Insurance

Unemployed w/No Health Insurance

Broome 200,183 36% 9% 36% 29% Chenango 50,651 40% 10% 36% 40% Delaware 47,930 38% 10% 26% 26% Tioga 51,151 32% 9% 31% 28% Tompkins 101,305 24% 6% 24% 24%

Totals 451,221 33% 8% 32% 29% 1 Public coverage includes Medicare, Medicaid and other federal medical assistance programs; VA Health Care; the Children’s Health Insurance Program (CHIP); and individual state health plans.

Among the region’s unemployed, 32% are on public health insurance and 29% have no health insurance. While the rates of the unemployed on public health insurance are comparable to those of the general population, the rates of the unemployed with no health insurance are more than three times as high as those in the general population (29% compared to 8%).

Medicaid Population Nearly one quarter (23%) of the estimated population in the Southern Tier region are Medicaid beneficiaries (Table 5). By county, Medicaid beneficiaries range from a low of 15% of the population in Tompkins County to a high of 28% of the population in Chenango.

Table 5. Southern Tier Region: Medicaid Beneficiaries as Percentage of Total Population

County US Census

ACS 2010-2014 Est. Population

Total # Medicaid Beneficiaries

% Est. Population Receiving Medicaid

Broome 200,183 51,407 26% Chenango 50,651 13,939 28% Delaware 47,930 10,436 22% Tioga 51,151 11,101 22% Tompkins 101,305 15,235 15%

Totals 451,221 102,118 23% Data is from the NYS Department of Health’s Medicaid Beneficiaries Inpatient Admissions and Emergency Room Visits data base; 2012 data. Retrieved May 12, 2016 from https://health.data.ny.gov/ Health/Medicaid-Beneficiaries-Inpatient-Admissions-and-Em/m2wt-pje4#About



In the Southern Tier region, 66% of Medicaid beneficiaries are adults and 34% are children (Table 6). By county, adult Medicaid beneficiaries range from a low of 62% in Tioga County to a high of 68% in Delaware.

Medicaid beneficiaries include individuals that receive Medicaid only and dual-eligible individuals that receive both Medicare and Medicaid benefits by virtue of their age or disability and low incomes.4 In the region, 82% of Medicaid beneficiaries receive Medicaid only and 18% are dual-eligible. Medicaid only beneficiaries range from a low of 80% each in Chenango and Delaware counties to a high of 84% in Tompkins.

Table 6. Southern Tier Region: Medicaid Beneficiaries by Population and Eligibility Type

County All Medicaid Beneficiaries

Medicaid Population Eligibility Type

Adults Children Medicaid Only Dual Medicaid and Medicare

# # % # % # % # % Broome 51,407 33,853 66% 17,554 34% 42,610 83% 8,797 17% Chenango 13,939 9,309 67% 4,630 33% 11,130 80% 2,809 20% Delaware 10,436 7,074 68% 3,362 32% 8,333 80% 2,103 20% Tioga 11,101 6,934 62% 4,167 38% 9,192 83% 1,909 17% Tompkins 15,235 10,010 66% 5,225 34% 12,793 84% 2,442 16%

Totals 102,118 67,180 66% 34,938 34% 84,058 82% 18,060 18% Data is from the NYS Department of Health’s Medicaid Beneficiaries Inpatient Admissions and Emergency Room Visits data base; 2012 data. Retrieved May 12, 2016 from https://health.data.ny.gov/ Health/Medicaid-Beneficiaries-Inpatient-Admissions-and-Em/m2wt-pje4#About

D. Special Populations, Foreign Born and Primary Language In the Southern Tier region, 13% of the population are disabled and 9% are Veterans (Table 7). Individuals with disabilities range from a low of 10% in Tompkins County to a high of 16% each in Chenango and Delaware (the highest percentage in any NYS county). The percentage of Veterans ranges from a low of 6% in Tompkins County to a high of 12% in Tioga.

There are 536 children 19 years and younger in foster care and 835 individuals in jail in the Southern Tier region. Region-wide, 6% of the population are foreign born, with the percentage ranging from a low of 2% each in Chenango and Tioga counties to a high of 13% in Tompkins.



Table 7. Southern Tier Region: Special Populations and Foreign Born


Population

American Community Survey Data 2010-2014 Special Populations

Foreign Born Disabled Veterans

In Foster

Care1 In Jail2

Broome 200,183 14% 10% 256 486 6% Chenango 50,651 16% 11% 34 103 2% Delaware 47,930 16% 11% 83 86 4% Tioga 51,151 13% 12% 24 79 2% Tompkins 101,305 10% 6% 139 81 13%

Totals 451,221 13% 9% 536 835 6% 1 Foster care data includes individuals 19 and under during the 2014 calendar year and is from the NYS Office of Children and Families. 2Jail data is for 2014 calendar year and is from the NYS Division of Criminal Justice Services.

Table 8 describes the primary languages spoken at home and those who speak English less than ”very well” in the population aged five years and older. In the Southern Tier region, 91% of this population speak English as their primary language, 2% speak Spanish, 4% speak other Indo-European languages, 3% speak an Asian/Pacific Islander language, and 3% speak English less than “very well” (the second lowest percentage in any DSRIP region).

Table 8. Southern Tier Region: Primary Language Spoken at Home

County

US Census ACS 2010-2014 Est. Population 5

Years and Older

American Community Survey Data 2010-2014 Language Spoken at Home

Speak English less than "very

well" English Spanish

Other Indo-European

Asian and Pacific

Islander Other

Broome 189,557 91% 2% 4% 2% 0% 3% Chenango 47,750 96% 1% 2% 0% 0% 1% Delaware 45,408 94% 2% 3% 1% 0% 1% Tioga 48,161 97% 1% 2% 0% 0% 1% Tompkins 97,358 85% 3% 5% 7% 1% 4%

Totals 428,233 91% 2% 4% 3% 0% 3%

Percentages of the population aged five and over that speak English as their primary language vary from a low of 85% in Tompkins County to a high of 97% in Tioga (the highest percentage in any NYS county). Those who speak English less than “very well” range from a low of 1% each in Chenango, Delaware and Tioga counties to a high of 4% in Tompkins.



1 Urban areas (metro areas) are geographic entities defined by the U.S. Office of Management and Budget (OMB) for use by Federal statistical agencies in collecting, tabulating, and publishing Federal statistics. An urban area includes one or more counties containing a core urban area of 50,000 or more people, together with any adjacent counties that have a high degree of social and economic integration (as measured by commuting to work) with the urban core. The OMB defines rural as all counties outside metropolitan areas based on 2010 census data. There are currently 24 counties designated rural in New York State. Retrieved April 14, 2016 from http://datawarehouse.hrsa.gov/tools/analyzers/geo/Rural.aspx 2 Retrieved April 14, 2016 from http://www.census.gov/quickfacts/table/RHI225214/36 3 Public coverage includes the federal programs Medicare, Medicaid and other medical assistance programs, VA Health Care; the Children’s Health Insurance Program (CHIP); and individual state health plans. Retrieved April 14, 2016 from https://www.census.gov/hhes/www/hlthins/methodology/definitions/acs.html4 In this analysis dual status was based upon the last month of enrollment/eligibility during the year. If the Medicaid beneficiary was indicated as being eligible for Part A, B, C or D Medicare services they are classified as dual eligible. The dual-eligible Medicare and Medicaid population is diverse and includes individuals with multiple chronic conditions, physical disabilities, and cognitive impairments such as dementia, developmental disabilities, and mental illness. It also includes some individuals who are relatively healthy. Retrieved May 12, 2016 from http://www.medpac.gov/documents/data-book/january-2015-medpac-and-macpac-data-book-beneficiaries-dually-eligible-for-medicare-and-medicaid.pdf


http://www.medpac.gov/documents/data-book/january

https://www.census.gov/hhes/www/hlthins/methodology/definitions/acs.html

http://www.census.gov/quickfacts/table/RHI225214/36

http://datawarehouse.hrsa.gov/tools/analyzers/geo/Rural.aspx


II. Physical and Behavioral Health Care Resources

This section describes physical and behavioral health care resources in the Southern Tier DSRIP region. Its findings should be considered with those in Section V of this report, which describes unmet service need by DSRIP region.

Physical Health Care Resources

1. Inpatient Physical Health Care Facilities The Southern Tier region has six acute care hospitals and 26 nursing homes that provide inpatient health care (Table 1).

Table 1. Southern Tier Region: Inpatient Physical Health Care by Certified Beds

County

Acute Care Hospitals Nursing Homes

# Hospitals

# Certified Beds # Nursing

Homes

# Certified Beds Total # All Bed Types

Chemical Dependence

Rehab

Chemical Dependence

Detox Psychiatric Total Beds

BH Intervention Beds

Broome 3 742 20 0 56 12 1,192 0 Chenango 1 58 0 0 0 5 404 0 Delaware 1 4 0 0 0 2 202 0 Tioga 0 0 0 0 0 2 277 0 Tompkins 1 212 0 0 26 5 455 0

Totals 6 1,016 20 0 82 26 2,530 0 Acute care hospital data is from the NYS Open Data Health Facility General Information dataset. Retrieved April 12, 2016 from https://health.data.ny.gov/Health/Health-Facility-General-Information/vn5v-hh5r . Nursing home data is from the NYS Open Data Nursing Home Profile dataset. Retrieved April 12, 2016 from https://health.data.ny.gov/Health/Nursing-Home-Profile/dypu-nabu

In the region, all counties, except Tioga, have at least one acute care hospital. The region has a total of 1,016 beds where physical health care is the primary type of care provided. Among these beds are 82 psychiatric beds and 20 chemical dependence rehab beds. The region has no chemical dependence detox beds. The region’s 26 nursing homes have a total of 2,530 beds, but no behavioral health intervention beds.1

All counties have nursing homes.

2. Outpatient Physical Health Care Facilities In the Southern Tier region, home health care is provided in all counties, except Chenango (Table 2). Broome, Delaware and Tompkins counties have long-term home health care facilities (n=4). The region has one ambulatory surgical center in Tompkins County.



Table 2. Southern Tier Region: Outpatient Physical Health Care

County

Home Health Care Ambulatory

Surgical Centers

Primary Health Care

Certified Home Health

Long-term Home Health

School-based Health Centers

Diagnostic and Treatment Centers

Federally Qualified

Health Centers

# Facilities

Broome 2 2 0 4 8 0 Chenango 0 0 0 3 0 0 Delaware 1 1 0 5 0 0 Tioga 1 0 0 1 0 0 Tompkins 1 1 1 0 12 2

Totals 5 4 1 13 20 2 Ambulatory surgical center data is from the NYS HCRA Provider List dataset. Retrieved April 12, 2016 from https://www.health.ny.gov/regulations/hcra/provider/provamb.htm. Federally qualified HC data is from the HRSA Data Warehouse. Retrieved April 21, 2016 from http://datawarehouse.hrsa.gov/tools/hdwreports/Filters.aspx?id=60#. All other data is from the NYS Open Data Health Facility General Information dataset. Retrieved April 12, 2016 from https://health.data.ny.gov/Health/ Health-Facility-General-Information/vn5v-hh5r .

There are three types of institutional providers that provide primary care: school-based health centers, diagnostic and treatment centers,2 and federally qualified health centers.3 All counties, except Tompkins, have at least one school-based health center (n=13). Broome and Tompkins counties have diagnostic and treatment centers (n=20), and there are two federally qualified health centers in Tompkins County.

3. Physical Health Care Practitioners Physical health care providers include primary care providers, medical specialists, dentists, and physical rehabilitation specialists. Health practitioners in primary care and medical specialties include physicians, physician assistants, and nurse practitioners.

Primary Care Providers In the Southern Tier region, family medicine providers include 343 physicians and a total of 253 nurse practitioners and physician assistants (Table 3). The number of family medicine providers of all types is lowest in Chenango County (n=60) and highest in Broome (n=328).

Internal medicine providers include 295 physicians and a total of 85 nurse practitioners and physician assistants. The number of internal medicine physicians is highest in Broome County (n=203) and lowest in Tioga (n=6). Internal medicine nurse practitioners and physician assistants are found in the greatest numbers in Broome County (n=59) and the fewest are in Delaware and Tioga (n=5 each).



Table 3. Southern Tier Region: Primary Care Providers

County US Census


Family Medicine

Internal Medicine

Pediatrics Total

Total per 10,000

population MD/DO NP/PA MD/DO NP/PA MD/DO NP/PA

Broome 200,183 194 134 203 59 63 22 675 34 Chenango 50,651 28 32 28 7 9 11 115 23 Delaware 47,930 34 32 21 5 5 1 98 20 Tioga 51,151 35 26 6 5 0 2 74 14 Tompkins 101,305 52 29 37 9 16 8 151 15

Totals 451,221 343 253 295 85 93 44 1,113 25 MD=medical doctor; DO=doctor of osterpathy; NP=nurse practitioner; PA=physician assistant. Data is from the DSRIP Managed Care Provider Network Database. Retrieved April 21, 2016 from https://www.health.ny.gov/health_care/ medicaid/redesign/providernetwork/

Pediatric health care providers are the smallest group of primary care providers in the region. Throughout the Southern Tier region there are 93 physicians providing pediatric care and 44 pediatric nurse practitioners and physician assistants. The number of pediatric health providers is highest in Broome County (n=85) and lowest in Tioga (n=2).

The maldistribution of primary care providers in the Southern Tier region is made clearer by looking at the number of providers per 10,000 population in the region. The region has 25 primary care providers per 10,000 population, which is the second lowest rate in any DSRIP region. By county, Broome County has 34 primary care providers per 10,000 population, and Tioga has 14.

These maldistributions are recognized by designations of county health professional shortage areas (HPSAs) made by the federal Health Resources and Services Administration (HRSA).4 In addition to county wide shortage area designations, HRSA also makes county census tract, special population, and health care facility shortage designations. Table 3a describes all of the HRSA primary care professional shortage designations for the counties in the Southern Tier region.

Table 3a. Southern Tier Region: HRSA Federal Primary Care Professional Shortage Designations

County Whole County Census tract,

populations or facilities

Medicaid Eligible population

Low Income Population

Broome Yes Yes Chenango Yes Yes Delaware Yes Yes Yes Tioga Yes Yes Tompkins Yes Yes

HRSA federal shortage designations retrieved March 17, 2016 from http://datawarehouse.hrsa.gov/tools/analyzers/hpsafind.aspx



In the region, Chenango, Tioga and Tompkins counties have a whole county primary care shortage designation. Broome and Delaware counties each has a census tract, population or facility designated as a primary care Medically Underserved Area/Population (MUA/P). The Medicaid eligible populations in all counties are designated primary care MUPs. In Delaware County, the low income population is designated a primary care MUP.

Physical Health Medical Specialists The Southern Tier region has a total of 315 physical medical health specialists or 7 providers per 10,000 population, which is the lowest ratio in any DSRIP region (Table 4).

Table 4. Southern Tier Region: Physical Medical Specialists


Population

Allergy and Immunology

Cardiology and Other Cardiology

Specialties

Endocrinology and Other Endocrinology Related Specialties

Obstetrics and Gynecology

General Surgery Total

Total per 10,000

population MD/DO NP/PA MD/DO NP/PA MD/DO NP/PA MD/DO NP/PA MD/DO NP/PA

Broome 200,183 8 5 48 9 4 10 39 22 53 16 214 11 Chenango 50,651 0 0 1 0 1 0 10 2 5 0 19 4 Delaware 47,930 0 0 9 0 0 0 3 1 7 1 21 4 Tioga 51,151 0 0 0 0 0 0 2 0 4 1 7 1 Tompkins 101,305 8 4 10 1 0 1 9 5 13 3 54 5

Total 451,221 16 9 68 10 5 11 63 30 82 21 315 7 MD=medical doctor; DO=doctor of osterpathy; NP=nurse practitioner; PA=physician assistant. Data is from the DSRIP Managed Care Provider Network Database. Retrieved April 21, 2016 from https://www.health.ny.gov/health_care/medicaid/redesign/providernetwork/

Allergy and immunology providers (n=25) and endocrinology providers (n=16) are in shortest supply. Providers in general surgery (n=103) are most prevalent, followed by obstetrics and gynecology (n=93), and cardiology (n=78). The number of medical specialists is highest in Broome County (n=214) and lowest in Tioga (n=7). Tioga County’s one physical health medical specialist per 10,000 population is the lowest rate in any NYS county.

Dentists In the Southern Tier region, there is a total of 112 dentists serving the population of approximately 450,000 residents (Table 5). The number of dentists ranges from a low of four in Chenango County to a high of 76 in Broome. Region-wide there are two dentists per 10,000 population, which is the lowest rate in any DSRIP region.

Table 5. Southern Tier Region: Dentists

County US Census


Number of Dentists Per 10,000 Population

General Dentist

Specialist Dentist

Total

Broome 200,183 65 11 76 4 Chenango 50,651 4 0 4 1 Delaware 47,930 11 0 11 2 Tioga 51,151 5 3 8 2 Tompkins 101,305 12 1 13 1

Totals 451,221 97 15 112 2 Data is from the DSRIP Managed Care Provider Network Database. Retrieved April 21, 2016 from https://www.health.ny.gov/health_care/medicaid/redesign/providernetwork/



Physical Rehabilitation Specialists The Southern Tier region has a total of 335 physical rehabilitation specialists serving its population of approximately 450,000 residents (Table 6).

Table 6. Southern Tier Region: Physical Rehabilitation Specialists


Population

Occupational Therapy

Physical Therapy

Speech Therapy

Total Total per

10,000 population

Broome 200,183 9 161 7 177 9 Chenango 50,651 1 9 1 11 2 Delaware 47,930 12 81 3 96 20 Tioga 51,151 0 8 0 8 2 Tompkins 101,305 3 39 1 43 4

Totals 451,221 25 298 12 335 7 Data is from the DSRIP Managed Care Provider Network Database. Retrieved April https://www.health.ny.gov/health_care/medicaid/redesign/providernetwork/

21, 2016 from

In the region, speech therapists (n=12) and occupational therapists (n=25) are in shortest supply, and physical therapists are most prevalent (n=298). The number of physical rehabilitation specialists ranges from a low of eight in Tioga County to a high of 177 in Broome. Region-wide there are seven physical rehabilitation specialists per 10,000 population, the third lowest rate in any DSRIP region.

Behavioral Health Care Resources

4. Inpatient Behavioral Health Care Facilities and Programs The data presented in this section is by county of provider location, with the exception of psychiatric inpatient average daily census, which is by patient county of residence. Individuals may access services in a county other than the county in which they reside.

Mental Health Inpatient Facilities The Southern Tier region has a total of 152 adult psychiatric beds and 40 psychiatric beds for children (Table 7).5 The adult psychiatric beds are located in Broome (n=132) and Tompkins (n=20) counties. The children’s psychiatric beds are located in Broome (n=16), Chenango (n=18), and Tompkins (n=6) counties. Total psychiatric bed capacity in the region is 44 per 100,000 adults and 35 per 100,000 children.



Table 7. Southern Tier Region: Total Psychiatric Inpatient Bed Capacity by Provider County and Average Daily Census by Patient County of Residence

County

- Adults - - Children -Total

Inpatient

Beds1

Total Bed Capacity per

100,000

Total Inpatient

ADC2,3

Total ADC

per 100,0004

Total Inpatient

Beds1

Total Bed Capacity per

100,000

Total Inpatient

ADC

Total ADC

per 100,0004

Broome 132 89 88 59 16 33 19 38 Chenango 0 0 11 30 18 142 7 51 Delaware 0 0 8 22 0 0 2 21 Tioga 0 0 8 22 0 0 2 18 Tompkins 20 27 33 44 6 23 10 37

Totals 152 45 148 44 40 36 40 35 Notes: 1. Includes General Hospital, Private Psychiatric Hospital and State Psychiatric Centers’ budgeted capacity for the county of the providers. Children’s capacity includes residential treatment facility (RTF) beds for the county of the providers. 2. Average Daily Census (ADC) covers General, Private Psychiatric, State Psychiatric hospital and RTF (children only). 3. ADC is shown for patient county of residence. 4. The ADC per 100,000 population of adults or children as indicated. Data Sources: Capacity -- General Hospital and Private Psychiatric Hospital current capacity: NYSOMH CONCERTS database, 10/2015. Current capacity includes all beds licensed for operation as of that date. State Psychiatric Center budgeted capacity: NYSOMH MHARS EHR, 10/2015. RTF capacity: NYSOMH CAIRS database, 10/2015. US Census 2014 Est. Populations. Average Daily Census -- General Hospital (Art. 28): SPARCS, CY 2014. Private Psychiatric Hospital (Art. 31): Medicaid, CY 2014. Institutional Cost Report (ICR), CY 2014: county distribution using the 2013 Patient Characteristics Survey (PCS). State Psychiatric Centers: MHARS, CY 2014. RTF: CAIRS, CY 2014. US Census 2014 estimates.

In the Southern Tier region, the total inpatient average daily census (ADC) for adult beds is 148. Broome County has the highest total ADC for adults (n=88) and Delaware and Schoharie have the lowest (n=8 each). In comparison, Broome County has the highest total ADC for children (n=19, which is greater than the total number of beds in the county) and Delaware and Tioga have the lowest (n=2 each).

In the region, the total ADC per 100,000 adults is 44, and the total ADC per 100,000 children is 35. For adults, the total ADC per 100,000 adults is highest for residents of Broome County (n=59) and lowest for residents of Delaware and Tioga (n=22 each). The total ADC per 100,000 children is highest for residents of Chenango County (n=51) and lowest for residents of Tioga (n=18).

Substance Use Disorder Inpatient Programs In New York State, substance use disorder (SUD) inpatient programs include crisis, inpatient rehabilitation, and residential programs.6 In the Southern Tier region (Table 8), there is one SUD crisis program located in Broome County. The region’s two inpatient rehabilitation program are located in Broome and Delaware counties, and its four residential programs are located in Broome (n=3) and Tompkins counties.



Table 8. Southern Tier Region: Substance Use Disorders Inpatient Program Capacity

County

US Census ACS 2010-2014 Est.

Population

Inpatient Programs Total

Capacity per 10,000

Crisis Inpatient

Rehabilitation* Residential Total

Capacity

# Programs Capacity # Programs Capacity # Programs Capacity

Broome 200,183 1 20 1 20 3 81 121 6 Chenango 50,651 – – – – – – – – Delaware 47,930 – – 1 10 – – 10 2 Tioga 51,151 – – – – – – – – Tompkins 101,305 – – – – 1 60 60 6

Totals 451,221 1 20 2 30 4 141 191 4 Notes and Data Sources: *Includes State Addiction Treatment Centers. Data is from the NYS Office of Alcoholism and Substance Abuse Services (OASAS) Provider Directory System. Includes programs that were operational as of April 2, 2016. More information about OASAS inpatient programs is available at http://www.oasas.ny.gov/hps/state/CD_descriptions.cfm

The region’s inpatient rehabilitation capacity is 30 and its residential capacity is 141. The regional capacity per 10,000 for all SUD inpatient programs is four.

Table 9 describes the average daily enrollment (ADE) in these programs. The ADE in the region is 17 for crisis programs, 15 for inpatient rehabilitation, and 118 for residential. The regional ADE per 10,000 for these programs is three, which is the second lowest ADE in any DSRIP region.

Table 9. Southern Tier Region: Substance Use Disorders Inpatient Program Average Daily Enrollment

County


Population

Inpatient Programs

Crisis Inpatient

Rehabilitation* Residential

Total Avg. Daily

Total Avg. Daily

Enrollment

# Programs Avg. Daily Enrollment



Enrollment per 10,000

Broome 200,183 1 17 1 11 3 63 91 5 Chenango 50,651 – – – – – – – – Delaware 47,930 – – 1 4 – – 4 1 Tioga 51,151 – – – – – – – – Tompkins 101,305 – – – – 1 54 54 5

Totals 451,221 1 17 2 15 4 118 149 3 *Includes State Addiction Treatment Centers. Data is from the NYS Office of Alcoholism and Substance Abuse Services (OASAS) Provider Directory System. Includes programs that were operational as of April 2, 2016.



5. Outpatient Behavioral Health Care Services The data presented here is by county of provider location. Individuals may access services in a county other than the county in which they reside.

Mental Health Outpatient and Clinic Programs

Adults Adult mental health outpatient programs include: assertive community treatment (ACT), clinic, continuing day treatment (CDT), intensive psychiatric rehabilitative treatment (IPRT), partial hospitalization (PH), and personalized recovery-oriented services (PROS). The Southern Tier region’s capacity and service use in these programs are presented in Table 10.

Table 10. Southern Tier Region: Adult Mental Health Outpatient Capacity and Service Use by Provider County

County

Outpatient Programs (PH, IPRT, CDT, PROS, ACT)

Clinics: Total Number of Adults Locally Operated Clinics

Recipients in State-operated

Clinics4

Clinic Treatment per 100,000

Adults5Capacity1

(Slots)

Slots per 100,000

Adults5

Medicaid

Recipients2

Non-Medicaid

Recipients

(Estimated #)3

Broome 68 46 2,097 372 811 2,203 Chenango ─ ─ 638 300 ─ 2,517 Delaware ─ ─ 572 176 ─ 2,069 Tioga ─ ─ 322 212 ─ 1,423 Tompkins 70 94 1,116 1,320 ─ 3,270

Totals 138 41 4,745 2,380 811 2,374 Notes and Data Sources: Clinics are not licensed for specific slot capacities, therefore size is measured by estimated total number of persons served annually. 1. Includes the total capacity for Partial Hospitalization (PH), Intensive Psychiatric Rehabilitative Treatment (IPRT), Continuing Day Treatment (CDT), Personalized Recovery-Oriented Services (PROS) and Assertive Community Treatment (ACT) (Data Source: New York State Office of Mental Health (NYSOMH) CONCERTS database, 10/2015). 2. Includes adults and children enrolled in Medicaid and served annually in non-State clinic programs (Data Source: Medicaid, CY 2014). 3. Includes annual estimate of adults not receiving Medicaid and served in non-State clinics during the NYSOMH 2013 Patient Characteristics Survey (PCS). 4. Includes adults served annually in State-run clinics (Data Source: NYSOMH MHARS database, CY 2014). 5. US Census ACS 2010-2014 Est. Population.

Outpatient programs (other than clinic) are located in Broome (n=68 slots) and Tompkins (n=70 slots) counties. There are a total of 138 non-clinic outpatient program slots in the region or 41 slots per 100,000 adults, which is the second lowest rate in any DSRIP region.

Clinics may be locally- or state-operated. All counties in the region have locally-operated clinics and there are state-operated clinics in Broome. The locally-operated clinics served a total of 4,745 adult Medicaid recipients and 2,380 adult non-Medicaid recipients. State-operated clinics served 811 adults. In the region, 2,374 adults received clinic treatment per 100,000 adults. County rates per 100,000 adults range from a low of 1,423 in Tioga County to a high of 3,270 adults in Tompkins.



Children Mental health outpatient programs that serve children include: assertive community treatment (ACT), clinic, day treatment (DT), and partial hospitalization (PH). The Southern Tier region’s capacity and service use in these programs are presented in Table 11.

Table 11. Southern Tier Region: Child Mental Health Outpatient Capacity and Service Use by Provider County

County

Outpatient Programs (PH, DT, ACT)

Clinics: Total Number of Children Locally Operated Clinics

Recipients in State-operated

Clinics4

Clinic Treatment per 100,000

Children5Capacity1

(Slots)

Slots per 100,000

Children5

Medicaid

Recipients2

Non-Medicaid

Recipients

(Estimated #)3

Broome 34 70 708 160 498 2,799 Chenango ─ ─ 247 56 ─ 2,383 Delaware ─ ─ 113 52 ─ 1,479 Tioga ─ ─ 132 144 ─ 2,107 Tompkins 72 272 317 280 ─ 2,252

Totals 106 94 1,517 692 498 2,411 Notes and Data Sources: Clinics are not licensed for specific slot capacities, therefore size is measured by estimated total number of children served annually. 1. Includes the total capacity for Partial Hospitalizations (PH), Day Treatment (DT) and Children's Assertive Community Treatment (ACT) (Data Source: New York State Office of Mental Health (NYSOMH) CONCERTS database, 10/2015). 2. Includes children enrolled in Medicaid and served annually in locally-operated (non-State) clinic programs (Data Source: Medicaid, CY 2014). 3. Includes annual estimate of children not receiving Medicaid and served in locally-operated (non-State) clinics during the week of the NYSOMH 2013 Patient Characteristics Survey (PCS). 4. Includes children served annually in State-run clinics (Data Source: NYSOMH MHARS database, CY 2014). 5. US Census ACS 2010-2014 Est. Population.

In the region, child outpatient programs (other than clinic) are located in Broome and Tompkins counties. These programs have a total of 106 slots in the region or 94 slots per 100,000 children. There are locally-operated clinics in all counties and state-operated clinics in Broome County. The locally-operated clinics served a total of 1,517 Medicaid child recipients and 692 non-Medicaid child recipients. Broome County’s state-operated clinics served 498 children.

In the region, 2,411 children received clinic treatment per 100,000 children. County rates per 100,000 children range a high of 2,799 in Broome County to a low of 1,479 in Delaware.



Mental Health Emergency and Community Support Programs

Adults Table 12 describes the Southern Tier region’s service use in adult mental health emergency and community support programs. A total of 66 adults were served in emergency programs located in Broome, Delaware and Tompkins counties. In the region, 20 adults received emergency services per 100,000 adults.

Table 12. Southern Tier Region: Adult Mental Health Emergency Programs and Community Support Programs by Provider County

County Emergency Programs Community Support Programs

# Adults Served # Served per

100,000 Adults # Adults Served

# Served per 100,000 Adults

Broome 58 37 444 284 Chenango ─ ─ 89 228 Delaware 7 19 74 196 Tioga ─ ─ 64 164 Tompkins 1 1 210 250

Totals 66 20 881 264 Data Sources: Includes adults receiving emergency services and support services (e.g., vocational, self-help, care coordination) as reported by the New York State Office of Mental Health 2013 Patient Characteristics Survey (PCS). US Census ACS 2010-2014 Est. Population. Service use is reported because there are no licensed capacities for nearly all of these programs.

There are adult community support programs (e.g., vocational, self-help and care coordination) in each county in the Southern Tier region which collectively served 881 adults. In the region, 264 adults per 100,000 adults received services from community support programs. In the counties, service rates per 100,000 adults ranged from a low of 164 in Tioga County to a high of 284 in Broome.

Children The Southern Tier region’s service use in child mental health emergency and community support programs is presented in Table 13. Forty children received emergency services from programs in Broome and Tompkins counties. In the region, 36 children received emergency services per 100,000 children.

Community support programs for children (e.g., vocational, home-based family treatment, and residential treatment facility transition) are located in all counties in the region and together served 156 children. These programs served 139 children per 100,000 children. In the counties, service rates per 100,000 children ranged from a low of 84 in Tioga County to a high of 318 in Chenango.



Table 13. Southern Tier Region: Child Mental Health Emergency Programs and Community Support Programs by Provider County

County Emergency Programs

Community Support Programs

# Children Served

# Served per 100,000 Children

# Children Served

# Served per 100,000 Children

Broome 35 85 73 178 Chenango ─ ─ 33 318 Delaware ─ ─ 8 90 Tioga ─ ─ 9 84 Tompkins 5 24 33 161

Totals 40 36 156 139 Data Sources: Includes children receiving emergency services and support services (e.g., vocational, home-based family treatment, residential treatment facility transition) as reported by the New York State Office of Mental Health 2013 Patient Characteristics Survey (PCS). US Census ACS 2010-2014 Est. Population. Service use is reported because there are no licensed capacities for nearly all of these programs.

Behavioral Health Housing Programs

Adults In New York State, adult behavioral health housing services are provided in licensed beds in family care, congregate treatment and apartment treatment programs, and in unlicensed beds in housing support and supported housing programs. More information about these programs is available on the NYS Office of Mental Health web page at http://bi.omh.ny.gov/adult_housing/index. These adult housing services in the Southern Tier region are described in Table 14.

Table 14. Southern Tier Region: Adult Behavioral Health Community-Based Housing Capacity by Provider County

County

Licensed Beds Unlicensed Beds Housing

Family Care

Congregate Treatment

Apartment Treatment

Housing Support

Programs

Supported Housing

Capacity per 100,000 Adults

Broome 99 62 54 ─ 217 290 Chenango ─ 8 6 ─ 51 174 Delaware ─ 10 10 ─ 30 138 Tioga ─ 10 10 ─ 27 125 Tompkins 6 61 32 ─ 78 238

Totals 105 151 112 ─ 403 231 Data Sources: Licensed and unlicensed beds: New York State Office of Mental Health CONCERTS database; data as of 10/2015. US Census ACS 2010-2014 Est. Population.


http://bi.omh.ny.gov/adult_housing/index


In the region, licensed family care beds (n=105) are located in Broome (n=99) and Tompkins counties and licensed congregate treatment beds (n=151) and apartment treatment beds (n=112) are available in all counties. There are no unlicensed housing support programs in the region, but unlicensed supported housing beds (n=403) are available in all counties. The housing capacity per 100,000 adults in the region is 231. In the counties, housing capacity per 100,000 adults ranged from a low of 125 in Tioga County to a high of 290 in Broome.

Children In New York State, child behavioral health housing services are provided in licensed beds in teaching family homes and child and youth community residences, and in home and community-based services (HCBS). These child housing services in the Southern Tier region are described in Table 15.

The region has no teaching family home beds. Licensed child and youth community residence beds (n=8) are located in Broome County. The Southern Tier region has a capacity of seven child and youth community residence beds per 100,000 children.

Table 15. Southern Tier Region: Child Behavioral Health Community-Based Housing Capacity and Home & Community-Based Services (HCBS) Slots by Provider County

County

Number of Licensed Housing Beds HCBS Slots

Teaching Family Home

Child & Youth Community Residence

Capacity per 100,000

Children

Number of Slots

Slots per 100,000 Children

Broome ─ 8 16 30 61 Chenango ─ ─ ─ 6 47 Delaware ─ ─ ─ 12 108 Tioga ─ ─ ─ 12 92 Tompkins ─ ─ ─ 12 45

Totals ─ 8 7 72 64 Data Sources: New York State Office of Mental Health databases. Licensed housing capacity: CONCERTS, 10/2015. Home & Community-based Services (HCBS): CAIRS, CY 2014. US Census ACS 2010-2014 Est. Population.

All counties in the region have HCBS slots (n=72) ranging from a high of 30 in Broome to a low of six in Chenango County. The region’s HCBS slots served 64 children per 100,000 children. In the counties, HCBS slots per 100,000 children ranged from a low of 45 in Thompkins County to a high of 108 in Delaware.

Substance Use Disorder Outpatient Programs New York State has a variety of substance use disorder (SUD) outpatient programs including clinic and rehabilitation. In the Southern Tier region, all counties have SUD outpatient programs. The average daily enrollment (ADE) in these programs (n=1,144) is described in Table 16. In the region, Broome County has the highest ADE (n=523), and Tioga has the lowest (n=58).



Table 16. Southern Tier Region: Substance Use Disorders Outpatient Program Average Daily Enrollment

County US Census ACS

2010-2014 Est. Population

Outpatient Avg. Daily Enrollment Total Per 10,000

Broome 200,183 523 26 Chenango 50,651 129 25 Delaware 47,930 100 21 Tioga 51,151 58 11 Tompkins 101,305 334 33

Totals 451,221 1,144 25 Notes and Data Sources: Outpatient programs (OP) include Medically Supervised Outpatient, Outpatient Rehabilitation, Specialized OP – Traumatic Brain Injury, Outpatient Chemical Dependency for Youth, Specialized OP – Mobile, and Specialized Services OP Rehabilitation. Data is from the NYS Office of Alcoholism and Substance Abuse Services (OASAS) Provider Directory System. Includes programs that were operational as of April 2, 2016.

Region-wide these SUD programs have an ADE of 25 per 10,000. In the counties, ADE per 10,000 ranged from a low of 11 in Tioga County to a high of 33 in Tompkins.

New York State also has outpatient opioid treatment programs (Table 17). The Southern Tier region has one opioid treatment program located in Broome County, which has a capacity of 150 and an average daily enrollment (ADE) of 113.

Table 17. Southern Tier Region: Substance Use Disorders Outpatient Opioid Treatment Program Capacity and Average Daily Enrollment

County US Census


Number of Programs

Opioid Treatment (Methadone) Capacity Avg. Daily Enrollment

Total Per 10,000 Total Per 10,000

Broome 200,183 1 150 7 113 6 Chenango 50,651 – – – – – Delaware 47,930 – – – – – Tioga 51,151 – – – – – Tompkins 101,305 – – – – –

Totals 451,221 1 150 3 113 3

Data is from the NYS Office of Alcoholism and Substance Abuse Services (OASAS) Provider Directory System. Includes programs that were operational as of April 2, 2016.

Region-wide the program has a capacity and ADE of three per 10,000 each, which are the second lowest rates in any DSRIP region.



6. Care Coordination New York State’s Medicaid health home initiative is designed to expand and improve care management for beneficiaries with intensive, high-cost service needs. The health home model provides the basis for unified systems of care to coordinate and integrate physical and behavioral health care, and social services provided to health home members. The Southern Tier region has four Health Home providers and each county is served by one provider, except for Broome, which is served by two (Table 18).

Table 18. Southern Tier Region: Health Homes Serving Medicaid Enrollees by County

County Total # Health Homes

Serving Region # Health Homes Serving County

Broome

4

2 Chenango 1 Delaware 1 Tioga 1 Tompkins 1 Data is from the NYS Department of Health Designated Health Homes Web page. Retrieved May 4, 2016 from https://www.health.ny.gov/health_care/ medicaid/program/medicaid_health_homes/contact_information/list_by_county.htm #clinton

7. Behavioral Health Care Practitioners

Licensed Mental Health Professionals In New York State, the licensed mental health (MH) workforce includes psychiatrists, psychologists, clinical or master level social workers, nurse practitioners–psychiatry, marriage and family therapists, mental health counselors, psychoanalysts, and creative arts therapists.7 The number and distribution of these practitioners in the Southern Tier region is presented in Table 19.

Table 19. Southern Tier Region: Licensed Mental Health Professionals

County


Population

Psychiatrists Psychologists LCSWs LMSWs Mental Health

Counseling

Nurse Practitioner -

Psychiatry *Other Total Per 10,000

Broome 200,183 33 76 257 261 20 18 18 683 34 Chenango 50,651 0 4 43 33 3 1 3 87 17 Delaware 47,930 0 7 35 23 5 3 5 78 16 Tioga 51,151 4 6 59 47 8 4 6 134 26 Tompkins 101,305 21 62 189 151 22 8 24 477 47

Totals 451,221 58 155 583 515 58 34 56 1,459 32 Data for psychiatrists is from the American Board of Psychiatry and Neurology, Inc. and was retrieved from https://application.abpn.com/verifycert/verifycert.asp on July 15, 2014. Data for all other professions is as of June 2, 2014 and was provided by the Office of the Professions at the New York State Education Department. *Other category includes marriage and family therapists, psychoanalysts, and creative arts therapists.



The Southern Tier region has a total of 1,459 licensed MH professionals or 32 per 10,000 population. There are maldistributions of MH professionals across the region’s counties. Tompkins County has the highest rate in the region ─ 47 per 10,000 and Delaware County has the lowest ─ 16 per 10,000. There are no psychiatrists in Chenango and Delaware counties.

MH Professional Shortage Designations The maldistribution of licensed MH professionals in the Southern Tier region is recognized by federally designated health professional shortage areas (HPSAs). HPSAs are designated on the county level by the federal Health Resources and Services Administration (HRSA). HPSAs are designated using several criteria, including population-to-clinician ratios. This ratio is usually 6,000 to 1 for mental health care.

Table 19a. Southern Tier Region: HRSA Federal Mental Health Professional Shortage Designations

County Whole County Census tract,

populations or facilities

Medicaid Eligible population

Broome Yes Yes Chenango Yes Yes Delaware Yes Yes Tioga Tompkins Yes Yes HRSA federal shortage designations retrieved March 17, 2016 from http://datawarehouse.hrsa.gov/tools/analyzers/hpsafind.aspx

All of the counties in the Southern Tier region, except Tioga, have a whole county MH professional shortage designation (Table 19a). The Medicaid eligible populations in all counties, except Tioga, are designated MH professional Medically Underserved Populations (MUPs).

Certified and Credentialed Substance Use Disorder Professionals In New York State, the certified and credentialed substance use disorder (SUD) workforce includes physicians and counselors. The number and distribution of these practitioners in the Southern Tier region is presented in Table 20.

Table 20. Southern Tier Region: Certified and Credentialed Substance Use Disorder Professionals

County US Census


Physicians Counselors

Total Per 10,000 Population Board Certified

Addiction Medicine

Authorized for Buprenorphine

Prescription

Credentialed Alcoholism and Substance Abuse

Certified Rehabilitation

Broome 200,183 2 19 39 11 69 3 Chenango 50,651 0 4 6 0 10 2 Delaware 47,930 0 5 18 2 25 5 Tioga 51,151 0 6 8 0 14 3 Tompkins 101,305 2 11 29 3 43 4

Totals 451,221 4 45 100 16 161 4 Data is from the NYS Office of Alcoholism and Substance Abuse Services (OASAS) Human Resources Office and is as of May 13, 2016.



SUD physicians include those board certified in addiction medicine and those authorized to prescribe buprenorphine to treat opioid addiction. In the Southern Tier region, there are four physicians certified in addiction medicine, the third lowest number in any DSRIP region. All counties in the region have physicians authorized to prescribe buprenorphine.

SUD counselors include those credentialed in alcoholism and substance abuse and those certified in rehabilitation. All counties in the region have alcoholism and substance abuse counselors, and Broome, Delaware and Tompkins counties have rehabilitation counselors. Overall, the Southern Tier region has a total of 161 certified and credentialed SUD professionals or four per 10,000 population, which is the lowest rate in any DSRIP region.

While there are no HPSA shortage designations for SUD professionals, an area will be considered to have unusually high needs for mental health services if: 1) there is a high prevalence of alcoholism in the population, as indicated by prevalence data showing the area's alcoholism rates to be in the worst quartile of the nation, region, or State; or 2) there is a high degree of substance abuse in the area, as indicated by prevalence data showing the area's substance abuse to be in the worst quartile of the nation, region, or State.8

1 NYS Nursing Home Behavioral Intervention Services: This program must include a discrete unit with a planned combination of services with staffing, equipment and physical facilities designed to serve individuals whose severe behavior cannot be managed in a less restrictive setting. The program’s services are directed at attaining or maintaining the individual at the highest practicable level of physical, affective, behavioral and cognitive functioning. Retrieved April 21, 2016 from https://www.health.ny.gov/facilities/nursing/all_services.htm . 2 Diagnostic and Treatment Centers provide a comprehensive range of primary health care services to a population that includes uninsured individuals.3 Federally qualified health centers (FQHCs) include all organizations receiving grants under Section 330 of the Public Health Service Act (PHS). FQHCs qualify for enhanced reimbursement from Medicare and Medicaid, as well as other benefits. FQHCs must serve an underserved area or population, offer a sliding fee scale, and provide comprehensive services. 4 A primary care HPSA is a collection of census tracts that has been designated as having a shortage of primary care health professionals. HRSA uses two methodologies to determine whether there are adequate health care resources for specific geographical areas. Aggregate ZIP codes or census tracts can be designated as a Medically Underserved Area/Population (MUA/P) based on an analysis of four criteria: the ratio of primary care medical care physicians per 1,000 population, infant mortality rate, percentage of the population with incomes below the poverty level, and percentage of the population age 65 or over. A medically underserved population faces economic barriers (e.g. low-income or Medicaid-eligible populations), or cultural and/or linguistic access barriers to primary medical care services, and population specific information is assessed according to the above criteria to achieve MUP designation. 5 In this report adults are individuals aged 20 and older and children are individuals aged 19 and younger. 6 More information about OASAS inpatient programs is available at http://www.oasas.ny.gov/hps /state/CD_descriptions.cfm 7 Licensed Mental Health Workforce Data Sources and Limitations: Data for psychiatrists is from the American Board of Psychiatry and Neurology, Inc. and was retrieved from https://application.abpn.com/verifycert/verifycert.asp on July 15, 2014. Data for all other professions is as of June 2, 2014 and was provided by the Office of the Professions at the New York State Education Department. Licensees must be registered in order to practice and use a professional title in NYS; being registered, however, does not necessarily mean the licensee is actively engaged in practice. In addition, NYS licensing data show only “nurse practitioners-psychiatry” as a BH-psychiatric


https://application.abpn.com/verifycert/verifycert.asp

http://www.oasas.ny.gov/hps

https://www.health.ny.gov/facilities/nursing/all_services.htm


nurse specialty. All other nursing specialties that contribute to the licensed BH workforce are combined in the general category of “nurse” in the NYS licensing data and are not counted in the licensed BH workforce described here. This limitation also extends to other data sources such as professional nursing organizations, which also combine a l l nursing specialties in a general category of “nurse” in their data collection processes.8 HRSA Guidelines for Mental Health HPSA Designation. Retrieved May 24, 2016 from http://bhpr.hrsa.gov/shortage/hpsas/designationcriteria/mentalhealthhpsaguidelines.html


http://bhpr.hrsa.gov/shortage/hpsas/designationcriteria/mentalhealthhpsaguidelines.html


III. Health Status

This section describes the health status of individuals in the Southern Tier DSRIP region. Its findings should be considered with those in Section V of this report, which describes unmet service need by DSRIP region.

1. Disease Prevalence Chronic Health Conditions In the Southern Tier region, 10% of adults are diagnosed with diabetes, 8% with angina, heart attack or stroke, 28% have high blood pressure, 63% are overweight or obese, and 12% have current asthma (Table 1). Among all DSRIP regions, the percentage of adults in the Southern Tier with current asthma is highest and the percentages with diabetes or angina, heart attack or stroke are second highest.

Table 1. Southern Tier Region: Prevalence of Chronic Health Conditions Among Adults

County

Age-adjusted Percentage of Adults

With physician diagnosed diabetes

With physician diagnosed

angina, heart attack or stroke

Ever told they have high

blood pressure

Overweight or obese

(BMI 25 or higher)

With current asthma

Broome 9 7 29 64 12 Chenango 12 9 32 68 14 Delaware 9 8 28 66 12 Tioga 11 7 27 62 9 Tompkins 7 6 24 55 15 Region Average 10 8 28 63 12

*Suppressed due to small sample size. Data Source is the NYS Department of Health Community Health Indicator Reports (CHIRS): Latest Data. Retrieved May 2, 2016 from https://health.data.ny.gov/Health/Community-Health-Indicator-Reports-CHIRS-Latest-Da/54ci-sdfi

In the region, Chenango County has the highest percentages of adults with diabetes (12%), angina, heart attack or stroke (9%), high blood pressure (32%) and that are overweight or obese (68%). Tompkins County has the lowest percentages of adults with these conditions: diabetes (7%), angina, heart attack or stroke (6%), high blood pressure (24%) and overweight or obese (55%). Tompkins County has the highest percentage of adults with current asthma (15%), and Tioga has the lowest (9%).

HIV, AIDS and Cancer The average case rates of HIV and AIDS in the Southern Tier region are 4 per 100,000 each. AIDS case rates per 100,000 range from one in Tioga County to seven in Delaware, which is second highest rate in any NYS county outside of New York City (Table 2). The region’s cancer incidence rate is 512 per 100,000. The highest cancer incidence rate is in Chenango County (n=543) and the lowest is in Delaware (n=471).



Table 2. Southern Tier Region: Rates of HIV, AIDS, and Cancer

County

Age-adjusted case rate per 100,000

Age-adjusted all cancers incidence rate per

100,000 HIV AIDS

Broome 5 4 510 Chenango 4 3 543 Delaware 4 7 471 Tioga 2 1 537 Tompkins 5 2 501

Region Average 4 4 512 Data Source is the NYS Department of Health Community Health Indicator Reports (CHIRS): Latest Data. Retrieved May 2, 2016 from https://health.data.ny.gov/Health/Community-Health-Indicator-Reports-CHIRS-Latest-Da/54ci-sdfi

2. Health Behaviors and Risk Factors In the Southern Tier region, Broome and Chenango counties have the highest percentages of adults that report they have experienced food insecurity in the past 12 months (27% each, Table 3), and Tompkins has the lowest (18%). Chenango County has the highest percentage of adults that report poor mental health for 14 or more days in the last month (16%) and Delaware has the lowest (6%).

Table 3. Southern Tier Region: Adult Self-Reported Health Behaviors and Risk Factors

County Survey

Sample Size

Percentage of Adults Who Self-Reported: Binge

drinking during past

month

Food insecurity in

past 12 months

Housing insecurity in

past 12 months

Poor health Current smoker

Did not receive medical care

because of cost in past 12 mos

Poor mental health for 14 or more days in last month

Cigarette smoking among those who report poor mental

health

Broome 4,683 19% 27% 38% 5% 22% 12% 11% 47% Chenango 3,068 11% 27% 43% 6% 19% 9% 16% 29% Delaware 3,074 13% 21% 34% 5% 23% 9% 6% * Tioga 3,202 22% 23% 33% 6% 23% 10% 12% * Tompkins 3,291 20% 18% 21% 5% 14% 9% 7% * Region Total/Avg. 17,318 17% 23% 34% 5% 20% 9% 10% 38% *Suppressed due to small sample size. Data is from the CDC Expanded Behavioral Risk Factor Surveillance System (BRFSS) 2013-14 Survey. Retrieved April 27, 2016 from https://health.data.ny.gov/Health/Expanded-Behavioral-Risk-Factor-Surveillance-Surve/jsy7-eb4n?_sm_au_=iVVnMrPRnsfs8P5M

Tioga County has the highest percentages of adults that report binge drinking during the past month (22%) and current smokers (23%). Chenango County has the lowest percentage reporting binge drinking (11%) and Tompkins has the lowest percentage reporting current smoking (14%). Adults reporting housing insecurity in the past 12 months range from a low of 21% in Tompkins County (the lowest percentage in any NYS County) to a high of 43% in Chenango. Adults reporting they did not receive medical care because of cost in the past 12 months range from a low of 9% each in



Chenango, Delaware and Tompkins counties to a high of 12% in Broome. Reports of cigarette smoking among those with poor mental health range from a low of 29% in Chenango County to a high of 47% in Broome. Percentages of adults reporting poor health are similar across counties.

Compared to all DSRIP regions, the Southern Tier has the lowest percentages of adults reporting not receiving medical care because of cost in the past 12 months (9%), and poor mental health for 14 or more days in the last month (10%).

3. Hospitalization Rates by Disease or Cause In the Southern Tier region, cardiovascular disease is the leading cause for hospitalizations (Table 4). Broome County has the highest hospitalization rate per 10,000 due to stroke (n=23), asthma (n=11), and self-inflicted injury (n=10). Chenango County has the highest rate of hospitalizations for cardiovascular disease (n=135) and diabetes (n=20). Delaware County has the highest rate for drug-related (n=23), and Chenango County has the highest rate for newborn drug-related diagnosis (n=162).

Table 4. Southern Tier Region: Hospitalization Rates by Disease or Cause

County

Age-adjusted hospitalization rate per 10,000 Newborn drug-related diagnosis rate per 10,000

newborn discharges

Total hospitalizations

Cardiovascular disease

Cerebrovascular disease (stroke)

Diabetes (primary

diagnosis) Asthma

Self-inflicted injury

Drug-related

Broome 1,053 128 23 14 11 10 14 142 Chenango 1,116 135 21 20 8 8 17 162 Delaware 986 128 16 10 8 4 23 111 Tioga 595 66 13 8 3 5 12 122 Tompkins 808 101 17 6 5 5 16 69

Region Average 911 111 18 11 7 7 16 121 Data Source is the NYS Department of Health Community Health Indicator Reports (CHIRS): Latest Data. Retrieved May 2, 2016 from https://health.data.ny.gov/Health/Community-Health-Indicator-Reports-CHIRS-Latest-Da/54ci-sdfi

Tioga County has the lowest hospitalization rates for cardiovascular disease (n=66), stroke (n=13), asthma (n=3) and drug-related (n=12). Tioga County’s rates for cardiovascular disease, stroke and asthma are the lowest in any NYS county. Tompkins County has the lowest hospitalization rate for diabetes (n=6, the lowest rate in any NYS county) and the lowest rate of discharges of newborn drug-related diagnosis (n=69). Delaware County has the lowest hospitalization rate for self-inflicted injury (n=4).

Compared to all DSRIP regions, the Southern Tier region has the lowest average rates of hospitalizations per 10,000 for cardiovascular disease (n=111), stroke (n=18), diabetes (n=11) and asthma (n=7).



4. Mortality Rates Premature Mortality In the Southern Tier region, the percentage of premature deaths is 38%, which is the second lowest percentage in any DSRIP region. Premature deaths range from a low of 35% in Broome County to a high of 39% each in Chenango, Delaware and Tioga counties (Table 5).

Among all DSRIP regions, the Southern Tier has the second lowest average premature death rate from stroke (9 per 100,000), and Chenango County’s rate of 6 is the second lowest rate in any NYS county. Premature death rates per 100,000 from cardiovascular disease range from a low of 83 in Tompkins County to a high of 144 in Delaware.

Table 5. Southern TIer Region: Percentage and Rates of Premature Death and Alcohol Related Motor Vehicle Injuries and Deaths

County

Percentage premature deaths (aged less than 75

years)

Rate per 100,000

Premature Death (aged 35-64 years) Alcohol related motor vehicle injuries and

deaths Cardiovascular

disease Cerebrovascular disease (stroke)

Broome 35 131 11 42 Chenango 39 107 6 62 Delaware 39 144 9 60 Tioga 39 90 8 63 Tompkins 36 83 10 41 Average % or Rate 38 111 9 53

Data Source is the NYS Department of Health Community Health Indicator Reports (CHIRS): Latest Data. Retrieved May 2, 2016 from https://health.data.ny.gov/Health/Community-Health-Indicator-Reports-CHIRS-Latest-Da/54ci-sdfi

Rates of alcohol related motor vehicle injuries and deaths per 100,000 range from a low of 41 in Tompkins County to a high of 63 in Tioga.

Top Ten Causes of Death In the Southern Tier region, heart disease is the number one cause of death in Broome, Chenango and Tompkins counties (Table 6). Malignant neoplasms are the leading cause of death in Delaware and Tioga counties. In the region, Broome County has the highest death rates due to diabetes (n=20) and cirrhosis of the liver (n=9). Tompkins County has the lowest death rate for diabetes (n=11), and Tioga has the lowest rate for cirrhosis of the liver (n=3).



Table 6. Southern Tier Region: 2014 Top Ten Causes of Death — Rates* per 100,000 Population by Resident County

County Heart Disease

Malignant Neoplasms

Cerebrovascular Disease (Stroke)

AIDS Pneumonia

Chronic Lower

Respiratory Disease

Accidents Diabetes Mellitus

Homicide or Legal

Intervention

Cirrhosis of Liver

Suicide

Broome 166 154 26 2 13 36 43 20 2 9 13 Chenango 243 165 27 0 12 58 38 16 8 6 6 Delaware 158 163 29 0 13 58 48 17 0 8 16 Tioga 144 153 28 0 7 44 49 16 0 3 17 Tompkins 139 128 31 2 18 36 38 11 1 7 5 Region Average 170 152 28 1 13 47 43 16 2 7 11 Data is from the NYS Department of Health. Retrieved April 26, 2016 from https://www.health.ny.gov/statistics/vital_statistics/2014/table40.htm *Age-Sex adjusted rates are directly standardized using the age-sex distribution for the United States 2000 Census.

Chenango County has the highest death rates for heart disease (n=243, the highest rate in any NYS county), malignant neoplasms (n=165), and chronic lower respiratory disease (n=58). Tompkins County has the lowest death rates for these diseases: heart disease (n=139), malignant neoplasms (n=128), and chronic lower respiratory disease (n=36). In contrast, Tompkins County has the highest death rates for stroke (n=31) and pneumonia (n=18). The lowest death rates for these causes are in Broome (stroke, n=26) and Tioga (pneumonia, n=7) counties. Tioga County has the highest death rate due to accidents (n=49), which is the highest rate in any NYS county.

Among all DSRIP regions, the Southern Tier has the highest average death rate per 100,000 due to accidents (n=43) and the second highest rate due to chronic lower respiratory disease (n=47).

5. Patients in the Public Mental Health System Every other year, the NYS Office of Mental Health (OMH) collects information about patients served over a one week period in NYSOMH funded or licensed outpatient and inpatient facilities. Tables 7 and 8 report the chronic health conditions and behavioral health diagnoses of those served in 2015.

Chronic Health Conditions Overall, smoking (29%), obesity (17%), and high blood pressure (15%) are the leading chronic health conditions for the public mental health population in the Southern Tier region (Table 7).



Table 7. Southern Tier Region: Chronic Health Conditions Among Those Served in the NYS Public Mental Health System

Age Group

Percentage of Patients Served with Chronic Health Conditions

Current Smokers

Diabetes Obesity High Blood Pressure

Hyperlipidemia Had a Heart

Attack Had a Stroke

Under 21 6 1 6 0 0 0 0 21-64 40 13 22 19 14 2 1 65+ 21 23 18 41 21 6 5 Total Average 29 10 17 15 10 1 1 Data is from the NYS Office of Mental Health 2015 Patient Characteristics Survey. Data retrieved April 28, 2016.

For patients ages 21-64, the Southern Tier region has the highest percentage that have had a heart attack (2%), and the second highest percentage of those that have diabetes (13%) in all DSRIP regions.

For patients ages 65 and older, the region has the highest percentage of those that have had a stroke (5%) and the second highest percentage that have had a heart attack (6%) in all DSRIP regions.

Behavioral Health Diagnoses Overall, depressive disorders (24%), schizophrenia spectrum and other psychotic disorders (18%), and bipolar and related disorders (16%) are the leading behavioral health diagnoses for the public mental health population in the region (Table 8).

Table 8. Southern Tier Region: Behavioral Health Diagnoses Among Those Served in the NYS Public Mental Health System

Age Group

Percentage of Patients Served by Diagnostic Category

Anxiety Disorder

Bipolar and related Disorders

Depressive Disorders

Disruptive Impulse Conduct Disorder

Neurodevelop-mental

Disorders

Schizophrenia Spectrum & other

Psychotic Disorders

Trauma Stress or Adjustment

Not a Mental Illness

With a Co-Occuring Disorder

Under 21 11 9 21 9 22 2 24 3 2 21-64 10 19 25 1 1 24 12 2 25 65+ 8 14 30 0 0 34 3 1 11 Total Average 10 16 24 3 7 18 15 2 18 Data is from the NYS Office of Mental Health 2015 Patient Characteristics Survey. Data retrieved April 28, 2016.

Among all DSRIP regions, the Southern Tier has the second highest percentages of patients served with anxiety disorders (10%) and trauma, stress or adjustment disorders (15%).

Among patients under the age of 21, the region has second highest percentage of those with trauma, stress or adjustment disorders (24%) in all DSRIP regions.



For patients ages 21-64, it has the second highest percentages of those with anxiety disorder (10%) and trauma, stress or adjustment disorders (12%) in all DSRIP regions.



IV. Behavioral Health Care Utilization

This section describes behavioral health care utilization in hospitals and emergency rooms by Medicaid beneficiaries in the Southern Tier DSRIP region. Its findings should be considered with those in Sections V and VI of this report, which describe unmet service need by DSRIP region.

1. Medicaid Beneficiaries with Mental Health Diagnoses

Mental Health Diagnosis Inpatient Admissions Table 1 describes the number of Medicaid beneficiaries in the Southern Tier region with inpatient hospital admissions (n=6,302) by mental health diagnosis. By county, admissions ranged from a high of 3,829 in Broome to a low of 343 in Delaware. Region-wide, the largest percentages of Medicaid beneficiaries with a mental health inpatient hospital admission had depressive disorders (47%), followed by other mental health diagnoses (15%), chronic stress and anxiety diagnoses (14%), schizophrenia (13%), bi-polar disorder (9%), and PTSD (2%).

Table 1. Southern Tier Region: Number of Medicaid Beneficiaries with Inpatient Hospital Admissions by Mental Health Diagnosis

County

Bi-Polar Disorder Depressive Disorders

Schizophrenia Chronic Stress and Anxiety Diagnoses

Post Traumatic Stress Disorder

Other Mental Health Diagnoses

Total Medicaid Beneficiaries with

Number/Percentage of Medicaid Beneficiaries MH Inpatient

N % N % N % N % N % N % Admission

Broome 399 10% 1,757 46% 505 13% 513 13% 103 3% 552 14% 3,829 Chenango 36 6% 308 52% 69 12% 98 17% 14 2% 62 11% 587 Delaware 0 0% 181 53% 54 16% 84 24% 0 0% 24 7% 343 Tioga 40 8% 248 50% 48 10% 74 15% 10 2% 73 15% 493 Tompkins 64 6% 468 45% 137 13% 134 13% 28 3% 219 21% 1,050

Totals 539 9% 2,962 47% 813 13% 903 14% 155 2% 930 15% 6,302 Data is from the NYS Department of Health Medicaid Chronic Conditions and Inpatient Admissions data base, 2012 data. Retrieved May 4, 2016 from https://health.data.ny.gov/ Health/Medicaid-Chronic-Conditions-Inpatient-Admissions-a/2yck-xisk#Export

In the region, the percentages of Medicaid beneficiaries hospitalized for mental health diagnoses were highest by diagnosis in the following counties: bipolar disorder in Broome County (10%), depressive disorders (53%), schizophrenia (16%), and chronic stress and anxiety diagnoses (24%, the highest in any NYS county) in Delaware County, PTSD in Broome and Tompkins counties (3% each), and other mental health diagnoses in Tompkins County (21%).

Table 2 describes the number of Medicaid inpatient hospital admissions in the Southern Tier region (n=10,969) by mental health diagnosis. By county, admissions ranged from a high of 6,832 in Broome County to a low of 542 in Delaware.



Table 2. Southern Tier Region:Number of Medicaid Inpatient Hospital Admissions by Mental Health Diagnosis

County Bi-Polar Disorder


Schizophrenia Chronic Stress

and Anxiety Diagnoses


Other Mental Health

Diagnoses

Total Number of

MH

Number of Admissions Admissions

Broome 778 3,036 888 885 189 1,056 6,832 Chenango 60 470 110 159 19 109 927 Delaware 0 296 78 127 0 41 542 Tioga 76 427 82 150 15 112 862 Tompkins 123 771 237 217 48 410 1,806

Totals 1,037 5,000 1,395 1,538 271 1,728 10,969 Data is from the NYS Department of Health Medicaid Chronic Conditions and Inpatient Admissions data base, 2012 data. Retrieved May 4, 2016 from https://health.data.ny.gov/ Health/Medicaid-Chronic-Conditions-Inpatient-Admissions-a/2yck-xisk#Export

Depressive disorders accounted for the largest number of inpatient admissions in all counties and were highest in Broome (n=3,036). Across counties, admissions were highest in Broome County for all diagnoses.

Mental Health Diagnosis Emergency Room Visits Table 3 describes the total number of Medicaid beneficiaries in the Southern Tier region with emergency room visits (n=15,056) by mental health diagnosis. By county, ER visits ranged from a high of 8,513 in Broome to a low of 763 in Tioga.

Table 3. Southern Tier Region: Number of Medicaid Beneficiaries with Emergency Room Visits by Mental Health Diagnosis



Schizophrenia Chronic Stress and Anxiety Diagnoses


Other Mental Health Diagnoses Total Medicaid

Beneficiaries Number/Percentage of Medicaid Beneficiaries

with MH ER Visit# % # % # % # % # % # %

Broome 832 10% 3,389 40% 1,159 14% 1,238 15% 276 3% 1,619 19% 8,513 Chenango 101 5% 865 45% 216 11% 309 16% 56 3% 395 20% 1,942 Delaware 89 5% 724 41% 191 11% 350 20% 75 4% 352 20% 1,781 Tioga 48 6% 351 46% 74 10% 116 15% 23 3% 151 20% 763 Tompkins 117 6% 815 40% 226 11% 320 16% 88 4% 491 24% 2,057

Totals 1,187 8% 6,144 41% 1,866 12% 2,333 15% 518 3% 3,008 20% 15,056 Data is from the NYS Department of Health Medicaid Chronic Conditions and Emergency Room Visits database, 2012 data. Retrieved May 4, 2016 from https://health.data.ny.gov/Health/Medicaid-Chronic-Conditions-Inpatient-Admissions-a/wybq-m39t

Region-wide by diagnosis, the largest percentages of Medicaid beneficiaries with a mental health ER visit were for depressive disorders (41%), followed by other mental health diagnoses (20%), chronic stress and anxiety diagnoses (15%), schizophrenia (12%), bi-polar disorder (8%), and PTSD (3%).

In the region, the percentages of Medicaid beneficiaries with ER visits were highest by diagnosis in the following counties: depressive disorders in Tioga County (46%), bipolar disorder (10%) and schizophrenia (14%) in Broome County, chronic stress and anxiety



diagnoses in Delaware County (20%), and other mental health diagnoses in Tompkins County (24%).

Table 4 describes the total number of Medicaid ER visits in the Southern Tier region (n=49,954) by mental health diagnosis. By county, ER visits ranged from a high of 29,904 in Broome County to a low of 2,075 in Tioga.

Table 4. Southern Tier Region: Number of Medicaid Emergency Room Visits by Mental Health Diagnosis


Depressive Disorders Schizophrenia

Chronic Stress and Anxiety Diagnoses


Other Mental Health Diagnoses

Total Number of ER Visits

Number of ER Visits

Broome 3,105 11,159 3,980 4,470 1,154 6,036 29,904 Chenango 417 2,723 672 1,030 210 1,296 6,348 Delaware 369 2,398 698 1,214 257 1,025 5,961 Tioga 195 885 202 353 71 369 2,075 Tompkins 346 2,186 642 824 258 1,410 5,666

Totals 4,432 19,351 6,194 7,891 1,950 10,136 49,954 Data is from the NYS Department of Health Medicaid Chronic Conditions and Emergency Room Visits database, 2012 data. Retrieved May 4, 2016 from https://health.data.ny.gov/Health/Medicaid-Chronic-Conditions-Inpatient-Admissions-a/wybq-m39t

Depressive disorders accounted for the largest number of ER visits in all counties and were highest in Broome (n=11,159). Across counties, ER visits were highest in Broome County for all diagnoses.

Medicaid Mental Health Beneficiaries Compared to All Medicaid Beneficiaries Table 5 describes Medicaid mental health beneficiaries compared to all Medicaid beneficiaries in the Southern Tier region. In the region, 6% of all Medicaid beneficiaries had a mental health inpatient hospital admission and 15% had a mental health ER visit.

Table 5. Southern Tier Region: Percentage of Medicaid Population with Mental Health Inpatient Hospital Admission or Emergency Room Visit

County All Medicaid

Medicaid Beneficiaries with MH Inpatient Admission

Medicaid Beneficiaries with MH ER Visit


N % N %

Broome 51,407 3,829 7% 8,513 17% Chenango 13,939 587 4% 1,942 14% Delaware 10,436 343 3% 1,781 17% Tioga 11,101 493 4% 763 7% Tompkins 15,235 1,050 7% 2,057 14%

Totals 102,118 6,302 6% 15,056 15%Data is from the NYS Department of Health Medicaid Chronic Conditions and Inpatient Admissions data base, 2012 data. Retrieved May 4, 2016 from https://health.data.ny.gov/ Health/Medicaid-Chronic-Conditions-Inpatient-Admissions-a/2yck-xisk#Export



By county, Broome and Tompkins had the highest percentage of Medicaid beneficiaries with a mental health inpatient admission (7% each), while Delaware had the lowest (3%). Broome and Delaware counties had the highest percentage of Medicaid beneficiaries with a mental health ER visit (17% each) and Tioga had the lowest (7%).

2. Medicaid Beneficiaries with Substance Use Disorders

Substance Use Disorder Inpatient Admissions Table 6 describes the total number of Medicaid beneficiaries in the Southern Tier region with inpatient hospital admissions (n=2,391) by substance use disorder (SUD). By county, admissions ranged from a high of 1,669 in Broome to a low of 90 in Chenango. Region-wide, the largest percentages of Medicaid beneficiaries with a SUD inpatient hospital admission had alcohol use disorder (33%), followed by drug abuse: cannabis/NOS/NEC (23%), opioid use disorder (20%), other SUD diagnoses (14%), and cocaine use disorder (10%).

Table 6. Southern Tier Region: Number of Medicaid Beneficiaries with Inpatient Hospital Admissions by Substance Use Disorder

County

Cocaine Use Disorder

Alcohol Use Disorder

Opioid Use Disorder

Drug Abuse: Cannabis/ NOS/NEC

Other SUD Diagnoses

Total Medicaid Beneficiaries with

Number/Percentage of Medicaid Beneficiaries SUD Inpatient

Admission # % # % # % # % # %

Broome 167 10% 547 33% 356 21% 380 23% 219 13% 1,669 Chenango 0 0% 27 30% 24 27% 24 27% 15 17% 90 Delaware 16 12% 54 42% 26 20% 18 14% 16 12% 130 Tioga 0 0% 35 38% 11 12% 38 41% 8 9% 92 Tompkins 54 13% 122 30% 65 16% 91 22% 78 19% 410

Totals 237 10% 785 33% 482 20% 551 23% 336 14% 2,391 Data is from the NYS Department of Health Medicaid Chronic Conditions and Inpatient Admissions data base, 2012 data. Retrieved May 4, 2016 from https://health.data.ny.gov/ Health/Medicaid-Chronic-Conditions-Inpatient-Admissions-a/2yck-xisk#Export

In the region, the percentages of Medicaid beneficiaries hospitalized for SUDs were highest by disorder in the following counties: alcohol use disorder in Delaware County (42%), cocaine use disorder (13%) and other SUD diagnoses (19%) in Tompkins County, opioid use disorder in Chenango County (27%), and drug abuse: cannabis/ NOS/NEC in Tioga County (41%).

Table 7 describes the number of Medicaid inpatient hospital admissions in the Southern Tier region (n=4,429) by substance use disorder. By county, admissions ranged from a high of 3,185 in Broome County to a low of 136 in Chenango.

Alcohol use disorder accounted for the largest number of inpatient admissions in all counties except Tioga, and were highest in Broome (n=547). Across counties, admissions for all disorders were highest in Broome County.



Table 7. Southern Tier Region: Number of Medicaid Inpatient Hospital Admissions by Substance Use Disorder

County

Cocaine Use

Disorder

Alcohol Use

Disorder

Opioid Use

Disorder


Other SUD Diagnoses

Total Number of SUD

Admi iNumber of Admissions

ss ons

Broome 167 547 356 380 219 3,185 Chenango 0 27 24 24 15 136 Delaware 16 54 26 18 16 203 Tioga 0 35 11 38 8 190 Tompkins 54 122 65 91 78 715

Totals 237 785 482 551 336 4,429 Data is from the NYS Department of Health Medicaid Chronic Conditions and Inpatient Admissions data base, 2012 data. Retrieved May 4, 2016 from https://health.data.ny.gov/ Health/Medicaid-Chronic-Conditions-Inpatient-Admissions-a/2yck-xisk#Export

Substance Use Disorder (SUD) Emergency Room Visits Table 8 describes the total number of Medicaid beneficiaries in the Southern Tier region with emergency room (ER) visits (n=4,502) by substance use disorder. By county, ER visits ranged from a high of 2,755 in Broome to a low of 203 in Tioga. Region-wide, the largest percentages of Medicaid beneficiaries with a SUD ER visit were for cocaine use disorder (30%), followed by opioid use disorder and drug abuse: cannabis/NOS/NEC (22% each), other SUD diagnoses (18%), and alcohol use disorder (9%).

Table 8. Southern Tier Region: Number of Medicaid Beneficiaries with Emergency Room Visits by Substance Use Disorder

County

Cocaine Use Disorder

Alcohol Use Disorder

Opioid Use Disorder


Other SUD Diagnoses

Total Medicaid

Beneficiaries with SUD ER

Visit

Number/Percentage of Medicaid Beneficiaries

# % # % # % # % # %

Broome 824 30% 296 11% 624 23% 569 21% 442 16% 2,755 Chenango 116 27% 20 5% 92 22% 112 27% 82 19% 422 Delaware 177 37% 22 5% 81 17% 116 25% 77 16% 473 Tioga 55 27% 11 5% 48 24% 58 29% 31 15% 203 Tompkins 167 26% 50 8% 126 19% 133 20% 173 27% 649

Totals 1,339 30% 399 9% 971 22% 988 22% 805 18% 4,502Data is from the NYS Department of Health Medicaid Chronic Conditions and Emergency Room Visits database, 2012 data. Retrieved May 4, 2016 from https://health.data.ny.gov/Health/Medicaid-Chronic-Conditions-Inpatient-Admissions-a/wybq-m39t

In the region, the percentages of Medicaid beneficiaries with ER visits were highest by disorder in the following counties: cocaine use disorder in Delaware County (37%), alcohol use disorder in Broome County (11%), opioid use disorder (24%) and drug abuse: cannabis/NOS/NEC (29%) in Tioga County, and other SUD diagnoses in Tompkins County (27%).



Table 9 describes the number of Medicaid ER visits in the Southern Tier region (n=17,981) by substance use disorder. By county, ER visits ranged from a high of 11,446 in Broome County to a low of 862 in Tioga. Cocaine use disorder accounted for the largest number of ER visits in Broome, Delaware and Tompkins counties; drug abuse: cannabis/NOS/NEC accounted for the largest number in Chenango; and opioid use disorder accounted for the largest number in Tioga. Across counties, ER visits for all disorders were highest in Broome County.

Table 9. Southern Tier Region: Number of Medicaid Emergency Room Visits by Substance Use Disorder

County

Cocaine Use

Disorder

Alcohol Use

Disorder

Opioid Use

Disorder


Other SUD Diagnoses

Total Number of ER Visits

Number of ER Visits

Broome 3,147 1,280 2,758 2,484 1,777 11,446 Chenango 348 128 425 570 419 1,890 Delaware 618 76 291 333 236 1,554 Tioga 147 22 291 287 115 862 Tompkins 553 186 435 439 616 2,229

Totals 4,813 1,692 4,200 4,113 3,163 17,981 Data is from the NYS Department of Health Medicaid Chronic Conditions and Emergency Room Visits database, 2012 data. Retrieved May 4, 2016 from https://health.data.ny.gov/Health/Medicaid-Chronic-Conditions-Inpatient-Admissions-a/wybq-m39t

Medicaid Substance Use Disorder Beneficiaries Compared to All Medicaid Beneficiaries Table 10 describes Medicaid SUD beneficiaries compared to all Medicaid beneficiaries in the Southern Tier region.

Table 10. Southern Tier Region: Percentage of Medicaid Population with Substance Use Disorder Inpatient Hospital Admission or Emergency Room Visit

County All Medicaid

Medicaid Beneficiaries with SUD Inpatient Admission

Medicaid Beneficiaries with SUD ER Visit


N % N %

Broome 51,407 1,669 3% 2,755 5% Chenango 13,939 90 1% 422 3% Delaware 10,436 130 1% 473 5% Tioga 11,101 92 1% 203 2% Tompkins 15,235 410 3% 649 4%

Totals 102,118 2,391 2% 4,502 4% Data is from the NYS Department of Health Medicaid Chronic Conditions and Inpatient Admissions data base, 2012 data. Retrieved May 4, 2016 from https://health.data.ny.gov/ Health/Medicaid-Chronic-Conditions-Inpatient-Admissions-a/2yck-xisk#Export



In the region, 2% of all Medicaid beneficiaries had a SUD inpatient hospital admission and 4% had a SUD ER visit. By county, Broome and Tompkins counties had the highest percentage of Medicaid beneficiaries with a SUD inpatient admission (3% each), while the remaining counties had the lowest (1% each). Broome and Delaware counties had the highest percentage of Medicaid beneficiaries with a SUD ER visit (5% each) and Tioga had the lowest (2%).

3. Medicaid Beneficiary Hospital Inpatient Admissions and Emergency Room Visits

Medicaid Beneficiaries by Eligibility Type In the Southern Tier region 23% of the estimated population are Medicaid beneficiaries (Table 11). By county, Medicaid beneficiaries range from a high of 28% of the estimated population in Chenango County to a low of 15% of the estimated population in Tompkins.

Medicaid beneficiaries include individuals that receive only Medicaid and individuals that are dually-eligible for Medicare and Medicaid benefits because of their age or disability and low incomes.1 In the Southern Tier region, 82% of Medicaid beneficiaries receive Medicaid only and 18% are dual-eligible. Medicaid only beneficiaries range from a low of 80% in Chenango and Delaware counties to a high of 84% in Tompkins.

Table 11. Southern Tier Region: Medicaid Beneficiaries by Eligibility Type

County


Population

Total Medicaid Beneficiaries

Medicaid Only Dual Medicaid and Medicare

# %

Total Pop # % Total Medicaid

Bene. #

% Total Medicaid

Bene.

Broome 200,183 51,407 26% 42,610 83% 8,797 17% Chenango 50,651 13,939 28% 11,130 80% 2,809 20% Delaware 47,930 10,436 22% 8,333 80% 2,103 20% Tioga 51,151 11,101 22% 9,192 83% 1,909 17% Tompkins 101,305 15,235 15% 12,793 84% 2,442 16%

Totals 451,221 102,118 23% 84,058 82% 18,060 18%

Data is from the NYS Department of Health’s Medicaid Beneficiaries Inpatient Admissions and Emergency Room Visits data base; 2012 data. Retrieved May 11, 2016 from https://health.data.ny.gov/Health/Medicaid-Beneficiaries-Inpatient-Admissions-and-Em/m2wt-pje4#About

Medicaid Beneficiary Hospital Inpatient Admissions Medicaid beneficiary hospital inpatient admissions in the Southern Tier region are described in Table 12.2 In the region, 10% of Medicaid only beneficiaries and 12% of Medicaid/Medicare dual-eligible beneficiaries experienced at least one hospital inpatient admission.

Percentages of Medicaid only beneficiaries with hospital inpatient admissions were consistent across counties. In comparison, hospital inpatient admissions in the dual-eligible Medicaid/Medicare population ranged from a low of 10% in Tompkins County to a high of 13% each in Broome, Delaware, and Tioga.



Table 12. Southern Tier Region: Total Medicaid Inpatient Hospital Admissions by Type of Beneficiary

County

Number of Beneficiaries Number of Beneficiaries

with Inpatient Admissions Total Inpatient

Hospital Admissions

Medicaid Only

Dual Medicaid and Medicare


Medicaid Only


# # # % # % # #

Broome 51,407 42,610 4,123 10% 1,124 13% 5,439 1,430 Chenango 13,939 11,130 1,015 9% 329 12% 1,278 409 Delaware 10,436 8,333 797 10% 274 13% 1,018 340 Tioga 11,101 9,192 879 10% 248 13% 1,141 318 Tompkins 15,235 12,793 1,209 9% 247 10% 1,571 302

Totals 102,118 84,058 8,023 10% 2,222 12% 10,447 2,799 Data is from the NYS Department of Health’s Medicaid Beneficiaries Inpatient Admissions and Emergency Room Visits data base; 2012 data. Retrieved May 11, 2016 from https://health.data.ny.gov/Health/Medicaid-Beneficiaries-Inpatient-Admissions-and-Em/m2wt-pje4#About

Medicaid Beneficiary Emergency Room Visits Emergency room (ER) visits among Medicaid beneficiaries in the Southern Tier region are described in Table 13.3 In the region, 28% of Medicaid only beneficiaries and 16% of Medicaid/Medicare dual-eligible beneficiaries experienced at least one ER visit.

Table 13. Southern Tier Region: Medicaid Emergency Room Visits by Beneficiary Type

County

Number of Beneficiaries Number of Beneficiaries

with ER Visits Total ER Visits



Medicaid Only


# # # % # % # #

Broome 42,610 8,797 12,640 30% 1,791 20% 26,430 4,645 Chenango 11,130 2,809 3,805 34% 504 18% 8,488 1,067 Delaware 8,333 2,103 2,923 35% 410 19% 6,376 895 Tioga 9,192 1,909 1,414 15% 124 6% 2,515 199 Tompkins 12,793 2,442 2,892 23% 108 4% 5,756 228

Totals 84,058 18,060 23,674 28% 2,937 16% 49,565 7,034 Data is from the NYS Department of Health’s Medicaid Beneficiaries Inpatient Admissions and Emergency Room Visits data base; 2012 data. Retrieved May 11, 2016 from https://health.data.ny.gov/Health/Medicaid-Beneficiaries-Inpatient-Admissions-and-Em/m2wt-pje4#About

Percentages of Medicaid only beneficiaries with ER visits ranged from a low of 15% in Tioga County to a high of 35% in Delaware. In comparison, ER visits for the Medicaid/Medicare dual-eligible population ranged from a low of 4% in Tompkins County to a high of 20% in Broome.

In conclusion, in the Southern Tier region the Medicaid only population had a higher percentage of ER visits than the Medicaid/Medicare dual-eligible population, while the Medicaid/Medicare dual-eligible population had a higher percentage of hospital inpatient admissions than the Medicaid only population.



1 In this analysis, dual status was based upon the last month of enrollment/eligibility during the year. If the Medicaid beneficiary was indicated as being eligible for Part A, B, C or D Medicare services they are classified as dual eligible. The dual-eligible Medicare and Medicaid population is diverse and includes individuals with multiple chronic conditions, physical disabilities, and cognitive impairments such as dementia, developmental disabilities, and mental illness. It also includes some individuals who are relatively healthy. Retrieved May 12, 2016 from http://www.medpac.gov/documents/data-book/january-2015-medpac-and-macpac-data-book-beneficiaries-dually-eligible-for-medicare-and-medicaid.pdf 2 In this analysis, inpatient utilization was based on all Medicaid inpatient admissions. To avoid duplication, admissions are counted per Medicaid beneficiary, per hospital, per admission. 3 Emergency room utilization was based on all Medicaid fee-for-service and managed care emergency room visits. To avoid duplication with multiple provider claims on a single ER visit for a Medicaid beneficiary, visits were counted per unique recipient per day.


http://www.medpac.gov/documents/data-book/january


V. Unmet Service Needs

Access to an adequate amount of outpatient care and community resources can reduce hospitalizations and emergency room (ER) visits for both behavioral and physical health problems. For example, high rates of potentially avoidable ER visits and hospital admissions suggest a need for further outpatient resources in the community. This section describes the unmet service needs of individuals in the Southern Tier DSRIP region.

Quality indicators are one of several ways to measure the unmet needs of a community. Unmet service need is reported here using measures of initiation and engagement in behavioral health treatment and measures of potentially avoidable hospitalizations and ER visits. Further information about these measures is included below. Additional information about unmet need in the Southern Tier region from needs assessments of local issues conducted by counties in the region is also included.

1. Behavioral Health Treatment Mental Health Medication Adherence and Management Adherence to Antipsychotic Medications for Individuals with Schizophrenia, and Antidepressant Medication Management are two Healthcare Effectiveness Data and Information Set (HEDIS)/New York State Quality Assurance Reporting Requirement (QARR) measures collected by Performing Provider Systems in the DSRIP program.

Adherence to Antipsychotic Medications for Individuals with Schizophrenia refers to the percentage of members, ages 19 to 64 years, with schizophrenia who were dispensed and remained on an antipsychotic medication for at least 80% of their treatment period.

Antidepressant Medication Management Effective Acute Phase Treatment refers to the percentage of members who remained on antidepressant medication during the entire 12-week acute treatment phase.

Antidepressant Medication Management Effective Continuation Phase Treatment refers to the percentage of members who remained on antidepressant medication for at least six months.

For adults with schizophrenia in the Southern Tier region, 65% adhere to antipsychotic medications (35% do not). Adherence to antipsychotics ranges from a low of 61% in Broome County to a high of 78% in Tioga (Table 1).

In the region, 54% of individuals remained on antidepressant medication during the acute treatment phase and 38% remained on antidepressant medication during the continuation phase (62% did not). These are the second highest antidepressant adherence rates in any DSRIP region. In the region, Delaware County has the highest percentages of adherence to antidepressants for both the acute (64%, the highest in any NYS county) and continuation (42%) phases. The lowest percentages of adherence are in Tompkins (50%, acute phase) and Tioga (34%, continuation phase) counties.



Table 1. Southern Tier Region: Mental Health Medication Adherence and Management

County Adherence to Antipsychotic

Medications for Individuals with Schizophrenia

Antidepressant Medication Management

Effective Acute Phase Treatment

Effective Continuation Phase Treatment

Broome 61% 53% 38% Chenango * 58% 40% Delaware * 64% 42% Tioga 78% 58% 34% Tompkins 74% 50% 38%

Region Avg. % 65% 54% 38% *Sample size too small to report. Notes and Data Sources: Data is from the NYS Department of Health -Medicaid clinical metrics for Clinical Improvement Projects (Domain 3) of the DSRIP Program database, measurement year 2014 data.

Mental Health Follow-up Care This section presents HEDIS/QARR measures related to mental health follow-up care.

Follow-up after Hospitalization for Mental Illness within 7 Days refers to the percentage of members who were seen on an ambulatory basis or who were in intermediate treatment with a mental health provider within 7 days of hospital discharge.

Follow-up after Hospitalization for Mental Illness within 30 Days refers to the percentage of members who were seen within 30 days of hospital discharge.

Follow-Up Care for Children Prescribed ADHD Medication Initiation Phase refers to the percentage of children with a new prescription for ADHD medication who had one follow-up visit with a practitioner within the 30 days after starting the medication.

Follow-Up Care for Children Prescribed ADHD Medication Continuation & Maintenance Phase refers to the percentage of children with a new prescription for ADHD medication who remained on the medication for 7 months and who, in addition to the visit in the Initiation Phase, had at least 2 follow-up visits in the 9-month period after the initiation phase ended.

After a mental illness hospitalization in the Southern Tier region, 43% have follow-up care within seven days (57% do not) and 58% follow-up within 30 days (Table 2). In the region, Tompkins County has the highest percentages of follow-up care following hospitalization for mental illness within both seven (66%) and 30 days (78%). Broome County has the lowest percentages of follow-up care within seven (31%) and 30 (48%) days.



Table 2. Southern Tier Region: Mental Health Follow-Up Care

County

Follow-up After Hospitalization for Mental Illness

Follow-Up Care for Children Prescribed ADHD Medication

Within 7 Days Within 30 Days Initiation Phase Continuation Phase

Broome 31% 48% 50% 59% Chenango 46% 65% 55% 63% Delaware 59% 77% 63% * Tioga 43% 53% 55% * Tompkins 66% 78% 47% *

Region Avg. % 43% 58% 52% 57% *Sample Size Too Small to Report. Notes and Data Sources: Data is from the NYS Department of Health -Medicaid clinical metrics for Clinical Improvement Projects (Domain 3) of the DSRIP Program database, measurement year 2014 data.

Region-wide the percentage of children prescribed ADHD medication that had follow-up care is 52% during the initiation phase and 57% during the continuation phase. The percentage of children with follow-up care after ADHD medication is lowest in Tompkins County for the initiation phase (47%) and in Broome for the continuation phase (59%). The highest rates of adherence are in Delaware (63%, initiation phase) and Chenango (63%, continuation phase) counties.

Alcohol and Other Drug Dependence Initiation and Engagement in Treatment Performing Provider Systems in the DSRIP program also collect two Alcohol and Other Drug (AOD) Dependence Treatment HEDIS/QARR measures: Initiation and Engagement in treatment.

The Initiation measure is the percentage of members who initiate treatment within 14 days of the diagnosis of AOD dependence.

The Engagement measure is the percentage of members who engage in treatment within 30 days after initiation.

In the Southern Tier region, 43% of individuals initiate treatment within 14 days of an AOD dependence diagnosis (Table 3) and 18% engage in treatment within 30 days after initiation (82% do not). Among all DSRIP regions, the Southern Tier has the lowest rates of both AOD initiation and engagement treatment.



Table 3. Southern Tier Region: Alcohol and Other Drug Dependence Treatment

County Alcohol and Other Drug Dependence Treatment

Initiation Engagement

Broome 37% 15% Chenango 57% 24% Delaware 38% 13% Tioga 52% 23% Tompkins 50% 22%

Region Avg. % 43% 18% Notes and Data Sources: Data is from the NYS Department of Health - Medicaid clinical metrics for Clinical Improvement Projects (Domain 3) of the DSRIP Program database, measurement year 2013 data.

In the region, Broome County has the lowest percentage of AOD initiation treatment (37%) and Delaware has the lowest percentage of engagement treatment (13%, the second lowest in any NYS county). The highest percentages of AOD treatment are in Chenango County: initiation treatment, 57% and engagement treatment, 24%.

2. Potentially Avoidable Hospitalizations The Agency for Healthcare Research and Quality (AHRQ) Prevention Quality Indicators (PQIs) are a set of population-based measures that can be used with hospital inpatient discharge data to identify conditions for which good outpatient care can potentially prevent the need for hospitalization, or for which early intervention can prevent complications. PQIs provide a good starting point for assessing quality of health services in the community.

All PQIs apply only to adult populations (individuals over the age of 18 years). The Observed Rate (per 100,000 people) is the number of PQI discharges

divided by the population, multiplied by 100,000. The Expected Rate (per 100,000 people) is the number of PQI discharges

adjusted by age group, gender and race/ethnicity divided by the population, multiplied by 100,000. Lower ratios of observed to expected rates represent better results.

Diabetes Chronic Conditions In the Southern Tier region’s Medicaid only population, ratios of diabetes short-term complications range from a high of 245/120 in Tioga County to a low of 42/122 in Tompkins (Table 4a). All counties, except Broome, have a lower rate of observed than expected hospitalizations for diabetes long-term complications in this population.



Table 4a. Southern Tier Region: Diabetes Short and Long-Term Complications Inpatient Prevention Quality Indicators by Medicaid Eligibility

County

Diabetes Short-term Complications Diabetes Long-term Complications



Rates per 100,000

Observed Expected Observed Expected Observed Expected Observed Expected


Totals 134 123 69 97 64 109 144 255 Notes and Data Sources: Data is from the NYS Department of Health Quality Prevention Quality Indicators – Adult (AHRQ PQI) for Medicaid Enrollees database, discharge year 2014 data. Retrieved May 6, 2016 from https://health.data.ny.gov/Health/Medicaid-Inpatient-Prevention-Quality-Indicators-P/6kjt-7svn

In the dual Medicaid and Medicare population, Delaware County has the highest observed to expected ratio for diabetes short-term complications (131/87) and Tompkins has the lowest (39/109). For diabetes long-term complications, all counties have lower observed than expected rates in the dual population. Among all DSRIP regions, the Southern Tier has the second lowest observed to expected ratio of diabetes short-term complications (69/97) in the dual population.

Table 4b describes uncontrolled diabetes and lower-extremity amputation rates among patients with diabetes. In the Southern Tier region’s Medicaid only population, Tompkins County has the highest observed to expected ratio (21/18) for uncontrolled diabetes, and Chenango and Delaware counties have no observed cases. In the dual Medicaid and Medicare population, Delaware County has the highest observed to expected ratio for uncontrolled diabetes (44/34), and Tioga has no observed cases.

Table 4b. Southern Tier Region: Diabetes Chronic Conditions Inpatient Prevention Quality

County

Uncontrolled Diabetes Lower-Extremity Amputation

among Patients with Diabetes



Rates per 100,000

Observed Expected Observed Expected Observed Expected Observed Expected


Totals 11 18 27 35 19 12 15 41 Notes and Data Sources: Data is from the NYS Department of Health Quality Prevention Quality Indicators – Adult (AHRQ PQI) for Medicaid Enrollees database, discharge year 2014 data. Retrieved May 6, 2016 from https://health.data.ny.gov/Health/Medicaid-Inpatient-Prevention-Quality-Indicators-P/6kjt-7svn



Tompkins County has the highest observed to expected ratio in the Medicaid only population for lower-extremity amputation among patients with diabetes (32/11), and Delaware has no observed cases. In the dual population, Broome County has the highest ratio for lower-extremity amputation among patients with diabetes (74/42) and all other counties have no observed cases.

Among all DSRIP regions, for lower-extremity amputation among patients with diabetes, the Southern Tier region has the highest observed to expected ratio (19/12) in the Medicaid only population and the lowest ratio (15/41) in the dual population.

Cardiac Chronic Conditions As reported in Table 5a, all counties in the Southern Tier region have lower observed than expected rates of hypertension, heart failure, and angina without procedure in the Medicaid only population.

Table 5a. Southern Tier Region: Cardiac Chronic Conditions Inpatient Prevention Quality Indicators by Medicaid Eligibility

County

Hypertension Heart Failure Angina Without Procedure




Rate per 100,000

Observed Expected Observed Expected Observed Expected Observed Expected Observed Expected Observed Expected

Broome 27 46 53 79 61 121 473 581 7 13 11 24 Chenango 28 38 0 78 85 100 497 629 0 12 33 24 Delaware 34 43 0 78 34 117 305 619 0 14 44 23 Tioga 16 36 244 75 49 96 439 603 0 12 0 22 Tompkins 32 42 39 83 74 107 354 598 0 12 0 25

Total 28 41 67 79 61 108 414 606 1 13 17 23 Notes and Data Sources: Data is from the NYS Department of Health Quality Prevention Quality Indicators – Adult (AHRQ PQI) for Medicaid Enrollees database, discharge year 2014 data. Retrieved May 6, 2016 from https://health.data.ny.gov/Health/Medicaid-Inpatient-Prevention-Quality-Indicators-P/6kjt-7svn

In the dual Medicaid and Medicare population, Tioga County has the highest ratio for hypertension (244/75, the highest ratio in any NYS county) and Delaware County has the highest ratio for angina without procedure (44/23). For both of these indicators, all other counties have a lower observed than expected rate in the dual population. For heart failure, all counties in the region have lower observed than expected rates in the dual population.

Compared to all DSRIP regions, the Southern Tier has the lowest observed to expected ratios for heart failure (61/108) and angina without procedure (1/13) in the Medicaid only population, and the second lowest ratio for heart failure (414/606) in the dual Medicaid and Medicare population.



Asthma Chronic Conditions Asthma chronic conditions are described in Table 5b. In the Southern Tier region, Broome County has the highest observed to expected ratio for asthma in younger adults in the Medicaid only (102/93) and dual Medicaid and Medicare (164/154) populations. All other counties have lower observed than expected rates in both populations.

Table 5b. Southern Tier Region: Asthma Chronic Conditions Inpatient Prevention Quality Indicators by Medicaid Eligibility

County

Asthma in Younger Adults


Rate per 100,000

Observed Expected Observed Expected

Broome 102 93 164 154 Chenango 69 76 0 112 Delaware 0 78 0 120 Tioga 52 77 0 111 Tompkins 0 89 0 150

Total 45 83 33 130 Notes and Data Sources: Data is from the NYS Department of Health Quality Prevention Quality Indicators – Adult (AHRQ PQI) for Medicaid Enrollees database, discharge year 2014 data. Retrieved May 6, 2016 from https://health.data.ny.gov/Health/Medicaid-Inpatient-Prevention-Quality-Indicators-P/6kjt-7svn

Composite PQIs Tables 6 and 7 report observed and expected composite PQIs by county in the Southern Tier region.

The Chronic Composite PQI includes: Diabetes Short-Term and Long-Term Complications Admission Rates, the Asthma in Younger and Older Adults Admission Rates, the Hypertension Admission Rate, the Congestive Heart Failure (CHF) Admission Rate, the Angina without Procedure Admission Rate, the Uncontrolled Diabetes Admission Rate, and the Rate of Lower-Extremity Amputation among Patients with Diabetes.

The Acute Composite includes: the Dehydration Admission Rate, the Bacterial Pneumonia Admission Rate, and the Urinary Tract Infection Admission Rate.

The Overall Composite PQI refers to all PQI measures within the Chronic and Acute Composites.

In the Southern Tier region’s Medicaid only population, Chenango County has the highest observed to expected ratios for the overall composite (1,039/978), Broome County has the highest ratio for the acute composite (314/277), and Tioga County has the highest ratio for the chronic composite (752/691) (Table 6). In this population, the lowest ratios for these indicators are in Tompkins County (overall composite, 487/964, acute composite, 180/266, and chronic composite, 307/697).



Table 6. Southern Tier Region: Prevention Quality Overall, Acute, and Chronic Composite Indicators by Medicaid Eligibility

County

Overall Composite Acute Composite Chronic Composite




Rate per 100,000


Broome 985 1,046 2,471 3,041 314 277 1,031 1,119 672 769 1,441 1,922 Chenango 1,039 978 2,716 3,201 299 276 1,192 1,231 740 702 1,524 1,971 Delaware 845 1,060 2,660 3,156 237 290 1,396 1,218 608 770 1,265 1,938 Tioga 1,014 968 2,587 3,096 262 277 830 1,216 752 691 1,757 1,881 Tompkins 487 964 2,046 3,131 180 266 826 1,137 307 697 1,220 1,993

Totals 874 1,003 2,496 3,125 258 277 1,055 1,184 616 726 1,441 1,941 Notes and Data Source: Data is from the NYS Department of Health Quality Prevention Quality Indicators – Adult (AHRQ PQI) for Medicaid Enrollees database, discharge year 2014 data. Retrieved May 6, 2016 from https://health.data.ny.gov/Health/Medicaid-Inpatient-Prevention-Quality-Indicators-P/6kjt-7svn

In the Southern Tier region’s dual population, all counties have lower observed than expected rates for the overall composite and chronic composite indicators. For the acute composite, Delaware County has the highest observed to expected ratio (1,396/1,218), and all of the other counties have lower observed than expected rates.

Table 7 describes the all diabetes, circulatory and respiratory composite indicators. In the Southern Tier region’s Medicaid only and Medicaid and Medicare dual populations, all counties have lower observed than expected rates for the all circulatory composite indicator. For the all diabetes composite, Tioga County has the highest observed to expected ratio (376/251) in any NYS county for the Medicaid only population. All other counties have lower observed than expected rates for the all diabetes composite in both the Medicaid only and dual populations.

Table 7. Southern Tier Region: Prevention Quality All Diabetes, Circulatory, and Respiratory Composite Indicators by Medicaid Eligibility

County

All Diabetes Composite All Circulatory Composite All Respiratory Composite




Rate per 100,000


Broome 249 279 305 460 95 181 536 684 334 314 610 795 Chenango 242 255 199 417 114 150 530 731 384 302 795 839 Delaware 135 272 262 408 68 173 349 719 406 331 654 827 Tioga 376 251 195 393 65 145 683 700 327 301 878 803 Tompkins 138 255 315 463 106 161 394 706 95 286 512 842

Total 228 262 255 428 90 162 498 708 309 307 690 821 Notes and Data Sources: Data is from the NYS Department of Health Quality Prevention Quality Indicators – Adult (AHRQ PQI) for Medicaid Enrollees database, discharge year 2014 data. Retrieved May 6, 2016 from https://health.data.ny.gov/Health/Medicaid-Inpatient-Prevention-Quality-Indicators-P/6kjt-7svn



For the all respiratory composite, Chenango County has the highest observed to expected ratio (384/302) in the Medicaid only population and Tioga County has the highest ratio (878/803) for the dual population. For the all respiratory composite, Tompkins County has the lowest observed to expected ratios for the Medicaid only (95/286) and dual population (512/842).

Among all DSRIP regions, the Southern Tier region has the lowest all circulatory composite observed to expected ratio in the Medicaid only population (90/162), and the second lowest ratios in the dual population for the all of the composite indicators: all diabetes (255/428), all circulatory (498/708), and all respiratory (690/821).

3. Potentially Avoidable Emergency Room Visits In the Southern Tier region, Chenango County has the highest observed to expected ratios of potentially preventable ER visits (33/17) and Tioga County has the lowest (12/17) (Table 8).

Table 8. Southern Tier Region: All Payers Potentially Preventable Emergency Room Visits

County ER Discharges 2013: Rate per 100,000

Observed Expected

Broome 24 19 Chenango 33 17 Delaware 31 17 Tioga 12 17 Tompkins 30 20

Total 26 18 Notes and Data Sources: Data is from the NYS Department of Health All Payer Potentially Preventable Emergency Visit (PPV) database. Rates by patient county, SPARCS data 2013. Retrieved May 6, 2016 from https://health.data.ny.gov/Health/All-Payer-Potentially-Preventable-Emergency-Visit-/f8ue-xzy3#About

Among all DSRIP regions, the Southern Tier has the highest ratio of observed to expected potentially preventable ER visits (26/18).

4. Local Assessment of Need by Southern Tier Region Counties New York State Mental Hygiene Law requires the Office of Mental Health (OMH) and the Office of Alcoholism and Substance Abuse Services (OASAS) to guide and facilitate the process of local planning. As part of the planning process, New York State counties and New York City (local governmental units [LGUs]) conduct a needs assessment of local issues impacting populations with mental illness and chemical dependency. These issues include prevention, treatment, and recovery support service needs, including other individualized person-centered supports and services. The issues of workforce retention and recruitment and coordination/integration with other systems are also included.



Table 9 summarizes the results of the LGUs’ needs assessments for the Southern Tier region. The data were collected from LGUs from March 1, 2015 through June 1, 2015. For each need issue listed, the LGUs indicated the extent to which it is an area of need at the local level for each population by identifying high, moderate or low need.

In the mental illness and chemical dependency populations, the issue with the largest percentage of high need for both youth and adults is access to transportation to health care.

Table 9. Southern Tier Region: Assessment of Needs by Population and Issue Assessment of Local Need (N=5 Counties)

Youth (<21) Adults (21+)

High Need Moderate

Need Low Need Missing High Need Moderate

Need Low Need Missing

Selected Issues Mental Illness Population

Access to Prevention Services 40% 0% 60% 0% 40% 0% 60% 0% Access to Crisis Services 20% 0% 80% 0% 0% 20% 80% 0% Access to Treatment Services 20% 20% 60% 0% 20% 40% 40% 0% Access to Supported Housing 20% 0% 80% 0% 20% 40% 40% 0% Access to Transportation 60% 20% 20% 0% 60% 20% 20% 0% Access to Home/Community-based Services 0% 40% 60% 0% 0% 40% 60% 0% Access to Other Support Services 0% 40% 60% 0% 0% 20% 80% 0% Workforce Recruitment and Retention 20% 20% 60% 0% 40% 20% 40% 0% Coordination/Integration with Other Systems 40% 40% 20% 0% 40% 40% 20% 0% Selected Issues Chemical Dependency Population

Access to Prevention Services 40% 40% 20% 0% 40% 20% 40% 0% Access to Crisis Services 20% 0% 80% 0% 60% 0% 40% 0% Access to Treatment Services 40% 40% 20% 0% 40% 40% 20% 0% Access to Supported Housing 20% 0% 80% 0% 40% 20% 40% 0% Access to Transportation 60% 20% 20% 0% 60% 20% 20% 0% Access to Home/Community-based Services 0% 40% 60% 0% 20% 20% 60% 0% Access to Other Support Services 20% 20% 60% 0% 20% 0% 80% 0% Workforce Recruitment and Retention 20% 20% 60% 0% 40% 20% 40% 0% Coordination/Integration with Other Systems 20% 60% 20% 0% 40% 40% 20% 0%



Appendix A. Highlights of Southern Tier Region Needs Assessment Findings

Appendix A summarizes needs assessment findings that may impact providers meeting the health care service needs of the target consumer population in the Southern Tier region.

I. Population Characteristics Summary Highlights Southern Tier Region: Population Characteristics Characteristic Region Region/County Comparison Median household income

$47,795 The region’s median household income is well below the state median of $58,687.

Education 11% of adults in region are without a high school diploma

50% of the adults in Tompkins County have a bachelor’s degree or more, which is the 2nd highest percentage in any NYS county.

Poverty 17% of region’s population lives below poverty level

Percentage of the region’s population living below the poverty level is the 2nd highest in any DSRIP region.

21% of the population in Tompkins County lives below the poverty level, which is the 3rd highest percentage in any NYS county.

Public Health Insurance/ Medicaid/ Beneficiaries/ No Health Insurance

33% of region’s population is on public health insurance, 23% are Medicaid beneficiaries and 8% have no health insurance.

In Tompkins County 6% of the population have no health insurance, which is the lowest percentage in any NYS county.

Special Populations 13% of the region’s population are disabled and 9% are Veterans.

Percentages of individuals with disabilities in Chenango and Delaware counties (16% each) are the highest in any NYS county.

Foreign Born 6% of the population is foreign born.

Primary Language other than English

9% of the region’s population age 5 and older speak a primary language other than English.

91% of this population speak English as their primary language and 3% speak English less than “very well” (2nd lowest percentage in any DSRIP region).

II. Health Care Resources Summary Highlights

A. Southern Tier Region: Health Care Professional Supply and Shortages Domain Region/County Region/County Comparison Supply of Primary Health Care Providers

1. The region has 1,113 primary care providers or 25 per 10,000 population.

1. This is the 2nd lowest rate in any DSRIP region. There is a maldistribution of these providers (see HPSAs below)

Supply of Physical Health Care Specialists

1. The region has 315 physical medical health specialists or 7 providers per 10,000 population.

1. This is the lowest rate in any DSRIP region.

Supply of Licensed Mental Health (MH) Professionals

1. The region has 1,459 licensed MH professionals or 32 per 10,000 population.

1. There is a maldistribution of these providers (see HPSAs below).

There are no psychiatrists in Chenango and Delaware counties.

Substance Use Disorder (SUD) Professionals

1. The region has a total of 161 cert i f ied and credentialed SUD professionals or four per 10,000 population.

1. This is the lowest rate in any DSRIP region.



Appendix A. Highlights of Southern Tier Region Needs Assessment Findings A. Southern Tier Region: Health Care Professional Supply and Shortages Domain Region/County Region/County Comparison

Region’s HPSA County Designations Federal Health Professional Shortage Areas (HPSAs)

Primary Health Care: Chenango, Tioga and Tompkins counties have a whole county primary care shortage designation. Broome and Delaware counties each has a census tract, population or facility designated as a primary care Medically Underserved Area/Population (MUA/P). The Medicaid eligible populations in all counties are designated primary care MUPs. In Delaware County, the low income population is designated a primary care MUP. Mental Health Professionals: All of the counties, except Tioga, have a whole county MH professional shortage designation. The Medicaid eligible populations in all counties, except Tioga, are designated MH professional MUPs.

B. Southern Tier Region: Facility- and Program-based Health Care Supply, Service Rates and Constraints Facility/Program Region Region/County Comparisons Physical Health AcuteCare Hospitals

1. The region’s nursing homes have no behavioral health intervention beds.

2. The region has no chemical dependence detox beds.

Mental Health Inpatient Facilities

1. Total psychiatric bed capacity in the region is 44 per 100,000 adults and 35 per 100,000 children.

1. Adult psychiatric beds are located in Broome and Tompkins counties.

2. Psychiatric beds for children are located in Broome, Chenango, and Tompkins counties.

Substance Use Disorder (SUD) Inpatient Programs

1. In the region there is one SUD crisis located in Broome County.

2. The region’s two inpatient rehabilitation program are located in Broome and Delaware counties, and its four residential programs are located in Broome (n=3) and Tompkins counties.

3. The region has one opioid treatment program located in Broome County, which has a capacity of 150 and an ADE of 113.

1. The total capacity per 10,000 for all SUD inpatient programs is 4.

2. The total average ADE per 10,000 for these programs is 3, which is the 2nd

lowest in any DSRIP region.

Mental Health Outpatient and Clinic Programs

1. Adult outpatient programs (other than clinic) are located in Broome and Tompkins counties. There are a total of 138 non-clinic outpatient program slots in the region or 41 slots per 100,000 adults.

2. In addition to locally-operated clinics in all counties, the region has state-operated clinics in Broome County serving adults.

3. In the region only Broome and Tompkins counties have child outpatient programs other than clinic. These programs have a capacity of 106 slots or 94 slots per 100,000 children region wide.

1. This is the 2nd lowest rate in any DSRIP region.

MH Community Support Programs

1. In the region, 264 adults per 100,000 received services from community support programs.



Appendix A. Highlights of Southern Tier Region Needs Assessment Findings B. Southern Tier Region: Facility- and Program-based Health Care Supply, Service Rates and Constraints Facility/Program Region Region/County Comparisons

2. Community support programs in the region served 139 children per 100,000.

SUD OutpatientPrograms

1. In the region all counties have SUD outpatient programs. The average daily enrollment (ADE) is 25 per 10,000.

2. The region has one opioid treatment program located in Broome County.

2. Region-wide the opioid treatment program has a capacity and ADE of three per 10,000 each, which are the 2nd lowest rates in any DSRIP region.

III. Health Status Southern Tier Region: Health Status Challenges Domain Region/County Comparisons Disease Prevalence Among all DSRIP regions, the percentage of adults in the Southern Tier with current Chronic Health asthma is highest and the percentages with diabetes or angina, heart attack or stroke Conditions are 2nd highest.

Delaware County’s AIDS case rate is the 2nd highest rate in all NYS counties outside of New York City.

Health Behaviors and Risk Factors

Compared to all DSRIP regions, the Southern Tier has the lowest percentages of adults reporting not receiving medical care because of cost in the past 12 months and poor mental health for 14 or more days in the last month.

Hospitalization Rates by Compared to all other DSRIP regions, the Southern Tier region has the lowest average Disease or Cause rates of hospitalizations per 10,000 for cardiovascular disease, stroke, diabetes and

asthma. Tioga County’s hospitalization rates for cardiovascular disease, stroke and asthma are

the lowest in any NYS county. Tompkins County’s hospitalization rate for diabetes is the lowest in any NYS county.

Mortality In the Southern Tier region, the percentage of premature deaths is the 2nd lowest in any DSRIP region.

Among all DSRIP regions, the Southern Tier has the 2nd lowest average premature death rate from stroke, and Chenango County’s rate is the 2nd lowest in any NYS county.

Among all DSRIP regions, the Southern Tier has the highest average death rate due to accidents, and the 2nd highest due to chronic lower respiratory disease.

Patients in the Public Mental Health System

Behavioral Health Diagnoses: Among all DSRIP regions, the Southern Tier has the 2nd

highest percentages of patients served with anxiety disorders and trauma, stress or adjustment disorders.

IV. Behavioral Health Care Utilization A. Southern Tier Region: Medicaid Beneficiary Health Care Utilization by Behavioral Health Diagnosis Domain Utilization by Diagnosis Region

Medicaid Inpatient Admissions

Mental Health Diagnosis Region-wide, the largest percentages of Medicaid beneficiaries with a mental health inpatient hospital admission had depressive disorders (47%), followed by other mental health diagnoses (15%), chronic stress and anxiety diagnoses (14%), schizophrenia (13%), bi-polar disorder (9%), and PTSD (2%). Substance Use Disorder



Appendix A. Highlights of Southern Tier Region Needs Assessment Findings A. Southern Tier Region: Medicaid Beneficiary Health Care Utilization by Behavioral Health Diagnosis Domain Utilization by Diagnosis Region

Region-wide, the largest percentages of Medicaid beneficiaries with a SUD inpatient hospital admission had alcohol use disorder (33%), followed by drug abuse: cannabis/NOS/NEC (23%), opioid use disorder (20%), other SUD diagnoses (14%), and cocaine use disorder (10%).

Medicaid Emergency Room Visits

Mental Health Diagnosis Region-wide by diagnosis, the largest percentages of Medicaid beneficiaries with a mental health ER visit were for depressive disorders (41%), followed by other mental health diagnoses (20%), chronic stress and anxiety diagnoses (15%), schizophrenia (12%), bi-polar disorder (8%), and PTSD (3%). Substance Use Disorder Region-wide, the largest percentages of Medicaid beneficiaries with a SUD ER visit were for cocaine use disorder (30%), followed by opioid use disorder and drug abuse: cannabis/NOS/NEC (22% each), other SUD diagnoses (18%), and alcohol use disorder (9%).

.

B. Southern Tier Region: Medicaid Mental Health and Substance Use Disorder Beneficiaries Compared to All Medicaid Beneficiaries Domain Utilization MH Medicaid In the region, 6% of all Medicaid

beneficiaries had a mental health inpatient hospital admission and 15% had a mental health ER visit.

SUD Medicaid In the region, 2% of all Medicaid beneficiaries had a SUD inpatient hospital admission and 4% had a SUD ER visit.

C. Southern Tier Region: Medicaid Beneficiary Health Care Utilization by Eligibility Type Domain Utilization by Eligibility Medicaid Inpatient Admissions

In the region 10% of Medicaid only beneficiaries and 12% of Medicaid/Medicare dual-eligible beneficiaries experienced at least one hospital inpatient admission.

Medicaid Emergency Room Visits

In the region 28% of Medicaid only beneficiaries and 16% of Medicaid/Medicare dual-eligible beneficiaries experienced at least one ER visit.



Appendix A. Highlights of Southern Tier Region Needs Assessment Findings V. Unmet Service Needs

Southern Tier Region: Summary Highlights of Unmet Service Needs in Behavioral Health Treatment Domain Measure Region/County Comparison

Mental Health Medication Adherence and Management

1. Adherence to antipsychotic medications for individuals with schizophrenia for at least 80% of their treatment period.

1. Region-wide 65% of adults with schizophrenia are adhering to their medications (35% are not).

2. Antidepressant medication management effective acute phase treatment.

2. Region-wide 54% of individuals do not remain on their medication during the entire acute treatment phase.

3. Antidepressant medication 3. Region-wide 38% of individuals remain on their management effective medication during continuation phase treatment (62% do continuation phase treatment. not).

These are the second highest antidepressant adherence rates in any DSRIP region.

Mental Health Follow-up Care

1. Follow-up care after hospitalization for mental illness within 7 or 30 days of hospital discharge.

1. Region-wide 43% of individuals have follow-up care within 7 days (57% do not) and 58% follow-up within 30 days of discharge.

2. Follow-up care for children prescribed ADHD medication initiation phase.

2. Region-wide 52% of children prescribed ADHD medication have one follow-up visit with a practitioner within 30 days after starting the medication.

3. Follow-up care for children 3. Region-wide 57% of children with a new prescription for prescribed ADHD medication ADHD medication remain on the medication for 7 months continuation and and/or have at least 2 follow-up visits in the 9-month maintenance phase. period after the initiation phase.

Alcohol and other Drug Dependence (AOD) Initiation and Engagement Treatment

1. AOD Initiation 1. Region-wide 43% of individuals initiate AOD treatment within 14 days of diagnosis.

Among all DSRIP regions, the region has the lowest rate of AOD initiation treatment.

2. AOD Engagement 2. Region-wide 18% of individuals engage in AOD treatment within 30 days after initiation (82% do not).

Among all DSRIP regions, the region has the lowest rate of AOD engagement treatment.

Potentially Avoidable Hospitalizations (Conditions for which good outpatient care can potentially prevent the need for hospitalization or for which early intervention can prevent complications)

1. Diabetes Chronic Conditions Among all DSRIP regions, the region has the 2nd lowest observed to expected ratio of diabetes short-term complications (69/97) in the dual Medicaid/Medicare population.

Among all DSRIP regions, for lower-extremity amputation among patients with diabetes, the Southern Tier region has the highest observed to expected ratio (19/12) in the Medicaid only population and the lowest ratio (15/41) in the dual population.

2. Cardiac Chronic Conditions Compared to all DSRIP regions, the region has the lowest observed to expected ratio for heart failure (61/108) and angina without procedure (1/13) in the Medicaid only population, and the 2nd lowest ratio for heart failure (414/606) in the dual Medicaid and Medicare population.

Potentially Avoidable ER Visits

Among all DSRIP regions, the region has the highest ratio of observed to expected potentially preventable ER visits (26/18).



Appendix A. Highlights of Southern Tier Region Needs Assessment Findings VI. Stakeholder Feedback

The Southern Tier region counties’ surveys of consumer and provider stakeholders to assess local needs indicate that access to transportation to health care is the primary issue that needs attention in the mental illness and chemical dependency populations.


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