Client(s): Erie Community Foundation
Services: Health Care & Public Health Planning, Applied Research & Evaluation
Technical Expertise: Chronic Disease Management, Community Health Coalitions, Health Care Reform, Primary Care, Safety Net
The Patient Protection and Affordable Care Act (PPACA) is having and will continue to have a dramatic impact on the health care delivery system in the United States--particularly the country's primary care system.
When PPACA is fully implemented in 2015, the core provision will dramatically reduce the number of uninsured in the United States, which will increase demand for services and challenge the systems ability to meet this new demand--particularly in the area of primary care medical services. PPACA and the service delivery and payment reform policies that it is promoting put a much greater emphasis on primary care, disease prevention, and health promotion. As a result, communities throughout the country are urgently trying to better understand the impacts and implications of PPACA on its primary care system. To what extent will PPACA increase demand for primary care services? Will there be shortages in primary care capacity? If so, what segments of the population will be most affected by these shortages and what types of providers are most needed?
JSI was hired by the Erie Community Foundation in Erie, Pennsylvania, to conduct a primary care capacity and demand assessment on behalf of a broadly represented community coalition made up of business leaders, health, and social service providers, health plans, and other community leaders.
The purpose of the assessment was to provide the coalition with clear, actionable information on what the increased demand for primary care services might be in the future and the extent that there might be a primary care capacity shortage. To this end, JSI collected census data and other health related-data to quantify and characterize the Erie County population by age, race/ethnicity, gender, income, ratio of poverty, insurance status, immigration status, and other variables. The project team used this information to understand primary care demand and to isolate the impacts on specific segments of the county’s population.
In addition, JSI is inventoryied the county’s primary care providers by collecting data from the National Plan and Provider Enumeration System (NPPES) database and the Pennsylvania Primary Care Office as well as directly from the leading health care providers in the County. This data was used to understand primary care capacity and was joined with the demand data mentioned above to ascertain whether there is currently a primary care capacity gap.
The team used GIS mapping and interviewed stakeholders on the strength and capacity of the training workforce and how the county is responding to PPACA more broadly.
The primary care gap analysis identified that the current provider to population ratio for the county is 87.2 FTE primary care providers per 10,000 people which includes capacity supplied by MDs, NPs, and PAs. This ratio is consistent with recent rates calculated by the commonwealth (75 FTE per 100,000) and according to the Health Resources Services Administration thresholds, does not constitute a shortage of primary care services for the county.While there is adequate supply, only 20 FTE of primary care providers are fully dedicated to serve low-income, Medicaid-insured or uninsured populations regardless of their ability to pay.