chapter two, capital dsrip region needs...

Chapter Two

Capital DSRIP Region Needs Assessment

New York State Office of Mental Health

Executive Summary This community needs assessment of the New York State Capital 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 Capital region includes Albany, Columbia, Greene, Rensselaer, Saratoga and Schenectady counties. The region has a population of nearly one million and four of its six counties are designated urban. The socioeconomic characteristics of the region’s population may be less indicative of need than those in other DSRIP regions. Its median household income of $57,554 is third highest among all DSRIP regions. Region-wide, 12% of the population lives below the poverty level, 2% are on cash public assistance (the lowest percentage in any DSRIP region), and 9% receive food stamps/SNAP benefits (the second lowest percentage in any DSRIP region). In the Capital region, 12% of adults are without a high school diploma and 32% have a bachelor’s degree or higher.

Nearly a third of the region’s population is on some type of public health insurance, 19% are Medicaid beneficiaries (the second lowest percentage in any DSRIP region), and 7% have no health insurance coverage (the lowest percentage in any DSRIP region). In Saratoga County, 6% of the population is without health insurance, which is the lowest percentage in any NYS county. Special populations in the region include 12% who are disabled and 10% who are Veterans. Greene County’s population includes 15% disabled, which is the second highest percentage in any NYS county. Nine percent of the region’s population is foreign born and 7% speak a primary language other than English.

Health Care Resources Maldistributions and shortages of health care providers in the Capital region are recognized by federal Health Resources and Services Administration (HRSA) health professional shortage area (HPSA) designations. Greene County has HPSA whole county primary health care and mental health (MH) professional shortage designations. Greene and Schenectady counties have both primary health care and MH professional Medically Underserved Area/Population (MUA/P) designations. The Medicaid eligible populations in Greene and Schenectady counties are designated primary health care MUPs. The Capital region has 37 MH professionals per 10,000 population, which is second highest rate in any upstate DSRIP region. There are, however, few psychiatrists in Columbia, Greene and Rensselaer counties.

The region’s total psychiatric bed capacity is 46 per 100,000 adults and 40 per 100,000 children. Greene County has no psychiatric bed capacity, and psychiatric beds for children are located only in Albany, Saratoga, and Schenectady counties. The total average daily census (ADC) per 100,000 adults is 40 and the total ADC per 100,000 children is 32.

There are three crisis and three rehabilitation substance use disorder (SUD) inpatient programs located in Albany, Rensselaer and Schenectady counties. All counties have SUD residential programs. These programs have a total capacity of nine per 10,000 and an average daily enrollment (ADE) of eight per 10,000, which are the highest rates in any DSRIP region. The region’s three opioid treatment programs are located in Albany County. Columbia County has no physicians certified in addiction medicine.

Capital DSRIP Region Needs Assessment – December 2016

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Health Status Challenges Among all DSRIP regions, the Capital region has the highest average percentage of adults with asthma. Compared to all DSRIP regions, the Capital region has the second highest: 1) Average AIDS case rate. The HIV case rate in Albany County is the second highest in any NYS

county outside of New York City. 2) Average percentage of adults with angina, heart attack or stroke. 3) Average percentage of adults that reported binge drinking. 4) Average percentage of adults that reported poor mental health for 14 or more days in the last

month.

Greene County’s death rate due to malignant neoplasms is the highest in any NYS county.

Behavioral Health Care Utilization Challenges Compared to all DSRIP regions, the Capital region has the largest percentages of Medicaid beneficiaries with:

1) Inpatient admissions for alcohol use disorder. 2) ER visits for PTSD. 3) ER visits for cocaine use disorder.

Unmet Service Needs Measures of behavioral health medication management suggest unmet need in the region. More than half (58%) of adults with schizophrenia adhere to anti-psychotic medications (42% do not). Region-wide, 52% of individuals with major depression remain on anti-depressant medication during the entire acute treatment phase and 36% remain on these medications during continuation phase treatment (64% do not).

More than half (53%) of children prescribed ADHD medication have one follow-up visit with a practitioner within 30 days after starting the medication. Fifty-eight 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 54% of individuals have follow-up care within 7 days after hospitalization for a mental illness and 71% follow-up within 30 days. These are the highest follow-up rates in any DSRIP region. Engagement in alcohol and other drug dependence (AOD) treatment also suggests unmet need, with only 24% of individuals engaging in AOD treatment within 30 days after initiation (76% do not). With regard to physical health, high rates of potentially avoidable hospital admissions for diabetes and cardiac chronic conditions in the Capital region also suggest a need for additional outpatient resources.

Stakeholder Input The Capital region counties’ surveys of consumer and provider stakeholders to assess local needs indicate that access to supported housing and community-based services are issues that need attention for the population with mental health concerns, and workforce recruitment and retention is an issue that needs attention for the population with chemical dependency concerns.

Equinox, a clinic in the Capital region, surveyed 17 consumers and six providers regarding community behavioral health needs in its geographic service area. The needs most frequently reported by both consumers and providers include: transportation to health care services; reduced wait times for an appointment; assistance with paying for services; ambulatory detox; inpatient mental health; housing; and convenient provider hours (evenings and weekends).


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I. Description of Communities to Be Served

1. Geographic Service Area The Capital DSRIP region is in the mid-eastern most part of New York State. It includes six counties: Albany, Columbia, Greene, Rensselaer, Saratoga, and Schenectady.

Nearly 950,000 people live in the region (Table 1). Estimated county populations range from a low of 49,212 in Greene County to a high of 304,423 in Albany County. 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 76 in Greene County to a high of 753 in Schenectady.

Table 1. Capital 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

Albany 304,423 582.3 Urban Columbia 62,990 99.2 Rural Greene 49,212 76.0 Rural Rensselaer 159,082 243.8 Urban Saratoga 218,984 270.4 Urban Schenectady 154,008 753.0 Urban

Totals 948,699 273.3 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

Capital DSRIP Region Needs Assessment – December 2016 61


2. Population Characteristics

A. Gender, Race, Ethnicity and Age In the Capital region, slightly more than half (51%) of the population are female (Table 2). County percentages of females range from a low of 48% in Greene County to a high of 52% each in Albany and Schenectady counties.

Table 2. Capital 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

Albany 304,423 48% 52% 78% 12% 5% 4% 5% 24% 13% Columbia 62,990 50% 49% 91% 4% 2% 3% 4% 23% 17% Greene 49,212 52% 48% 90% 6% 1% 3% 5% 22% 17% Rensselaer 159,082 49% 51% 88% 6% 2% 4% 4% 25% 13% Saratoga 218,984 49% 51% 94% 2% 2% 2% 2% 25% 13% Schenectady 154,008 48% 52% 80% 10% 4% 6% 6% 26% 14%

Totals 948,699 49% 51% 85% 7% 3% 4% 4% 25% 14% *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 78% in Albany County to a high of 94% in Saratoga. The two most densely populated urban counties are more racially diverse than the other counties. Twelve percent of the population in Albany County and 10% in Schenectady County are African American, compared to 2% in Saratoga County. Three percent of the region’s population is Asian and 4% identify as some other race. Four percent of the population identifies as of Hispanic or Latino ethnicity.

A quarter of the region’s population are age 19 and under and 14% are age 65 and over. The smallest percentages of persons age 19 and under and the largest percentages of persons age 65 and over are in rural Columbia and Greene counties.

B. Income, Education, Unemployment and Poverty The median household income in the Capital region is $57,554 (Table 3), which is slightly lower than the New York State median household income of $58,687.2 In the region, median household incomes range from a low of $48,065 in Greene County to a high of $68,081 in Saratoga County. Compared to other DSRIP regions, the Capital region has the third highest median household income.



Table 3. Capital 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

Albany 304,423 58,500 13% 39% 4% 14% 2% 9% Columbia 62,990 56,827 12% 28% 4% 10% 3% 8% Greene 49,212 48,065 14% 19% 6% 14% 2% 9% Rensselaer 159,082 57,791 10% 28% 5% 13% 3% 11% Saratoga 218,984 68,081 7% 36% 4% 7% 2% 6% Schenectady 154,008 56,061 9% 29% 5% 13% 3% 10%

Totals 948,699 57,554 11% 32% 5% 12% 2% 9% 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.

More than 10% of the Capital region’s population age 25 and older do not have a high school diploma, and nearly one third 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 Saratoga County to a high of 14% in Greene County. Adults with a bachelor’s degree or more range from a low of 19% in Greene County to a high of 39% in Albany.

The Capital region has a 5% unemployment rate and 12% of the region’s population live below the poverty level. Percentages of the population living below the poverty level range from a low of 7% in Saratoga County (the lowest percentage in any NYS county) to a high of 14% each in Albany and Greene counties. Two percent of the region’s population is on cash public assistance (the lowest percentage in any DSRIP region), and 9% receive food stamps/SNAP benefits (the third lowest percentage in any DSRIP region). Food stamps/SNAP beneficiaries range from a low of 6% in Saratoga County to a high of 11% in Rensselaer County.

C. Health Insurance Status In the Capital region, 29% of the population is on some type of public health insurance,3

and 7% of the population has no health insurance coverage (Table 4), which is the lowest percentage in any DSRIP region. Percentages of the population on public health insurance range from a low of 25% in Saratoga County to a high of 35% in Greene County. Those with no health insurance range from a low of 6% in Saratoga County (the lowest percentage in any NYS county) to a high of 9% each in Columbia and Greene counties.



Table 4. Capital 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

Albany 304,423 28% 7% 30% 30% Columbia 62,990 34% 9% 33% 29% Greene 49,212 35% 9% 28% 38% Rensselaer 159,082 30% 7% 37% 30% Saratoga 218,984 25% 6% 20% 29% Schenectady 154,008 30% 8% 29% 36%

Totals 948,699 29% 7% 29% 31% 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, 29% are on public health insurance and nearly a third have no health insurance. While the rates of the unemployed on public health insurance are the same as those of the general population (29% each), the rates of the unemployed with no health insurance are more than four times as high as those in the general population (31% compared to 7%).

Medicaid Population Nearly one fifth (19%) of the estimated population in the Capital region are Medicaid beneficiaries (Table 5), which is the second lowest percentage among all DSRIP regions. By county, Medicaid beneficiaries range from a low of 14% of the population in Saratoga County to a high of 25% in Schenectady.

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

County US Census

ACS 2010-2014 Est. Population

Total # Medicaid Beneficiaries

% Est. Population Receiving Medicaid

Albany 304,423 57,567 19% Columbia 62,990 12,499 20% Greene 49,212 10,938 22% Rensselaer 159,082 33,153 21% Saratoga 218,984 30,722 14% Schenectady 154,008 39,147 25%

Totals 948,699 184,026 19% 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 region, 65% of Medicaid beneficiaries are adults and 35% are children (Table 6). By county, adult Medicaid beneficiaries range from a low of 63% each in Rensselaer and Schenectady counties to a high of 68% each in Greene and Saratoga counties.

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 Capital region, 82% of Medicaid beneficiaries receive Medicaid only and 18% are dual-eligible. Medicaid only beneficiaries range from a low of 79% in Columbia County to a high of 84% in Schenectady County.

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

County All Medicaid Beneficiaries

Medicaid Population Eligibility Type

Adults Children Medicaid Only Dual Medicaid and Medicare

# # % # % # % # % Albany 57,567 38,032 66% 19,535 34% 47,395 82% 10,172 18% Columbia 12,499 8,328 67% 4,171 33% 9,890 79% 2,609 21% Greene 10,938 7,447 68% 3,491 32% 8,924 82% 2,014 18% Rensselaer 33,153 20,937 63% 12,216 37% 27,487 83% 5,666 17% Saratoga 30,722 20,804 68% 9,918 32% 24,736 81% 5,986 19% Schenectady 39,147 24,670 63% 14,477 37% 32,895 84% 6,252 16%

Totals 184,026 120,218 65% 63,808 35% 151,327 82% 32,699 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 Capital region, 12% of the population is disabled and 10% are Veterans (Table 7). Percentages of individuals with disabilities range from a low of 11% in Saratoga County to a high of 15% in Greene County (the second highest percentage among all NYS counties). Veterans range from a low of 8% in Albany County to a high of 12% in Greene County.

There are 735 children 19 years and younger in foster care and 1,833 individuals in jail the Capital region. Seven percent of the region’s population are foreign born, and the largest percentages are in Albany and Schenectady counties (9% each).



Table 7. Capital Region: Special Populations and Foreign Born


Population

American Community Survey Data 2010-2014 Special Populations

Foreign Born Disabled Veterans

In Foster

Care1 In Jail2

Albany 304,423 11% 8% 165 832 9% Columbia 62,990 14% 11% 94 93 6% Greene 49,212 15% 12% 66 43 5% Rensselaer 159,082 12% 10% 134 351 5% Saratoga 218,984 11% 10% 66 194 4% Schenectady 154,008 13% 10% 210 320 9%

Totals 948,699 12% 10% 735 1,833 7% 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 Capital region, 91% of this population speak English as their primary language, 4% speak other Indo-European languages, 3% speak Spanish, 2% speak Asian and Pacific Islander languages, 1% speak some other language and 3% speak English less than “very well”.

Table 8. Capital 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

Albany 289,545 88% 3% 5% 3% 1% 4% Columbia 59,926 93% 3% 4% 1% 0% 2% Greene 46,843 93% 3% 3% 1% 0% 2% Rensselaer 150,487 93% 2% 3% 1% 0% 2% Saratoga 207,878 94% 2% 3% 1% 0% 2% Schenectady 145,140 90% 4% 4% 2% 0% 3%

Totals 899,819 91% 3% 4% 2% 1% 3%

Percentages of the population aged five and over that speak English as their primary language vary from a low of 88% in Albany County to a high of 94% in Saratoga. Those who speak English less than “very well” range from a low of 2% in most counties to a high of 4% in Albany County.

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 DSRIP Capital region. Its findings should be considered with those in Sections V and VI of this report, which describe unmet service need by DSRIP region.

Physical Health Care Resources

1. Inpatient Physical Health Care Facilities The Capital region has 13 acute care hospitals and 42 nursing homes that provide inpatient health care (Table 1).

Table 1. Capital 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

Albany 5 1,381 40 18 26 13 1,675 0 Columbia 1 192 0 0 22 5 448 0 Greene 0 − − − − 2 256 0 Rensselaer 3 423 20 25 63 9 884 0 Saratoga 1 171 0 0 16 4 755 0 Schenectady 3 538 0 0 52 9 1,054 0

Totals 13 2,705 60 43 179 42 5,072 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 Capital region, all counties except Greene have at least one acute care hospital. There are five in Albany County, three each in Rensselaer and Schenectady counties, and one each in Columbia and Saratoga counties. The region has 2,705 beds where physical health care is the primary type of care provided. Among these beds are 179 psychiatric beds and 103 chemical dependence beds. The region’s 42 nursing homes have a total of 5,072 beds, but no behavioral health intervention beds.1 All of the counties have nursing homes.

2. Outpatient Physical Health Care Facilities In the Capital region, home health care is provided in all counties, except Greene (Table 2). All counties, except Greene, have certified home health care facilities and Albany, Saratoga and Schenectady counties have long-term home health care facilities. The region has a total of 10 ambulatory surgical centers located in Albany, Saratoga, and Schenectady counties.



Table 2. Capital 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

Albany 2 1 6 5 11 1 Columbia 1 0 0 1 2 1 Greene 0 0 0 0 2 0 Rensselaer 1 0 0 0 1 1 Saratoga 2 1 4 0 5 1 Schenectady 1 1 2 0 4 1

Totals 7 3 12 6 25 5 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 Only Albany and Columbia counties have school-based health centers. Each county has at least one diagnostic and treatment center, and all counties, except Greene, have one federally qualified health center.

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 Capital region, family medicine providers include 641 physicians and a total of 385 nurse practitioners and physician assistants (Table 3). The number of family medicine providers of all types are lowest in Greene County (n=55) and highest in Albany County (n=315).

Internal medicine providers include 851 physicians and a total of 268 nurse practitioners and physician assistants. The number of internal medicine providers of all types is lowest in Greene County (n=22) and highest in Albany County (n=592).



Table 3. Capital Region: Primary Care Providers

County US Census


Family Medicine

Internal Medicine

PediatricsTotal

Total per 10,000

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

Albany 304,423 203 112 457 135 228 38 1,173 39 Columbia 62,990 44 20 35 12 10 4 125 20 Greene 49,212 27 28 16 6 11 1 89 18 Rensselaer 159,082 102 49 126 39 49 10 375 24 Saratoga 218,984 149 109 105 45 86 34 528 24 Schenectady 154,008 116 67 112 31 43 11 380 25

Totals 948,699 641 385 851 268 427 98 2,670 28 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: there are 427 physicians providing pediatric care and 98 pediatric nurse practitioners and physician assistants. The number of pediatric health providers is highest in Albany County (n=266) and lowest in Greene (n=12).

The maldistribution of primary care providers in the Capital region is made clearer by looking at the number of providers per 10,000 population in the region’s counties. Greene County has 18 primary care providers respectively per 10,000 population compared to 39 per 10,000 in Albany County.

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 Capital region.

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

County Whole County

Census tract,

populations or

facilities

Medicaid Eligible

population

Low Income

Population

Albany Columbia Greene Yes Yes Yes Rensselaer Saratoga Schenectady Yes Yes HRSA federal shortage designations retrieved March 17, 2016 from http://datawarehouse.hrsa.gov/tools/analyzers/hpsafind.aspx



Greene County has a whole county primary care shortage designation. Both Greene and Schenectady counties have a census tract, population or facility designated as a primary care Medically Underserved Area/Population (MUA/P), and their Medicaid eligible populations are also designated primary care MUPs.

Physical Health Medical Specialists The Capital region has a total of 1,356 physical medical health specialists or 14 providers per 10,000 population (Table 4).

Table 4. Capital Region: Physical Medical Specialists

County US Census ACS

2010-2014 Est. 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

Albany 304,423 15 6 119 35 25 4 144 46 169 50 613 20 Columbia 62,990 2 0 11 2 2 0 9 2 46 10 84 13 Greene 49,212 0 0 6 0 1 0 2 3 2 0 14 3 Rensselaer 159,082 7 2 37 8 4 0 22 10 41 8 139 9 Saratoga 218,984 13 3 34 14 6 4 66 32 67 20 259 12 Schenectady 154,008 8 5 47 20 3 1 34 26 70 34 248 16

Total 948,699 45 16 254 79 41 9 277 119 395 121 1,356 14 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/

Endocrinology providers (n=50) and allergy and immunology providers (n=61) are in shortest supply, while those in general surgery are most prevalent (n=516), followed by obstetrics and gynecology (n=396), and cardiology (n=333). Albany County has the highest total number of medical specialists (n=613) and highest number per 10,000 (n=20), while Greene County has the lowest total number of medical specialists (n=14) and lowest number per 10,000 (n=3).

Dentists In the Capital region, there is a total of 455 dentists serving the population of 948,699 residents (Table 5). The number of dentists ranges from a low of 14 in Greene County to a high of 172 in Albany County. Region-wide there are five dentists per 10,000 population.

Table 5. Capital Region: Dentists

County US Census


Number of Dentists Per 10,000 Population

General Dentist

Specialist Dentist

Total

Albany 304,423 126 46 172 6 Columbia 62,990 25 8 33 5 Greene 49,212 13 1 14 3 Rensselaer 159,082 59 11 70 4 Saratoga 218,984 65 32 97 4 Schenectady 154,008 52 17 69 4

Totals 948,699 340 115 455 5 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 In the Capital region, there are 1,577 physical rehabilitation specialists serving the population of population of 948,699 residents (Table 6).

Table 6. Capital Region: Physical Rehabilitation Specialists


Population

Occupational Therapy

Physical Therapy

Speech Therapy

Total Total per

10,000 population

Albany 304,423 122 437 63 622 20 Columbia 62,990 6 44 3 53 8 Greene 49,212 1 38 0 39 8 Rensselaer 159,082 18 294 6 318 20 Saratoga 218,984 31 322 18 371 17 Schenectady 154,008 6 164 4 174 11

Totals 948,699 184 1,299 94 1,577 17

Data is from the DSRIP Managed Care Provider Network Database. Retrieved Aprilhttps://www.health.ny.gov/health_care/medicaid/redesign/providernetwork/

21, 2016 from

In the region, speech therapists (n=94) are in shortest supply, while physical therapists are most prevalent (n=1,299), followed by occupational therapists (n=184). The number of physical rehabilitation specialists ranges from a low of 39 in Greene County to a high of 622 in Albany. Region-wide, there are 17 physical rehabilitation specialists per 10,000 population, the highest 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 Capital region has a total of 323 adult psychiatric beds and 93 psychiatric beds for children (Table 7).5 Adult psychiatric beds are located in all counties, except Greene. Psychiatric beds for children are located in Albany, Saratoga, and Schenectady counties.

Albany County has the largest number of adult beds (n=155) and Saratoga County has the largest number of beds for children (n=57). Total psychiatric bed capacity in the region is 46 per 100,000 adults and 40 per 100,000 children.



Table 7. Capital 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

Albany 155 68 136 59 20 27 16 22 Columbia 22 46 16 33 0 0 2 15 Greene 0 0 13 33 0 0 4 35 Rensselaer 63 53 51 43 0 0 17 42 Saratoga 47 29 32 20 57 104 20 36 Schenectady 36 32 39 34 16 40 16 41

Totals 323 46 287 40 93 40 75 32 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 Capital region, the total inpatient average daily census (ADC) for adult beds is 287, while the ADC for child beds is 75. Albany County has the highest total ADC for adults (n=136) and Greene County has the lowest (n=13). In comparison, Saratoga County has the highest total ADC for children (n=20) and Columbia County has the lowest (n=2).

In the region, the total ADC per 100,000 adults is 40 and the total ADC per 100,000 children is 32. The total ADC per 100,000 adults is highest for residents of Albany County (n=59) and lowest for residents of Saratoga (n=20). In comparison, the total ADC per 100,000 children is highest for residents of Rensselaer County (n=42) and lowest for residents of Columbia (n=15).

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 Capital region (Table 8) there are three SUD crisis programs and three inpatient rehabilitation programs, all of which are located in Albany, Rensselaer and Schenectady counties. All counties in the region have SUD residential programs.



Table 8. Capital 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

Albany 304,423 1 18 1 40 12 313 371 12 Columbia 62,990 – – – – 2 13 13 2 Greene 49,212 – – – – 1 12 12 2 Rensselaer 159,082 1 10 1 20 4 90 120 8 Saratoga 218,984 – – – – 2 22 22 1 Schenectady 154,008 1 34 1 171 4 75 280 18

Totals 948,699 3 62 3 231 25 525 818 9Notes 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 crisis capacity is 62, inpatient rehabilitation capacity is 231 and its residential capacity is 525. The regional capacity per 10,000 population for all SUD inpatient programs is nine, which is the highest rate in any DSRIP region.

Table 9 describes the average daily enrollment (ADE) in these programs. The ADE in the region for crisis programs is 40, inpatient rehabilitation is 200 and residential is 494. The regional ADE per 10,000 for these programs is eight, which is the highest in any DSRIP region.

Table 9. Capital 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

Albany 304,423 1 11 1 32 12 282 325 11 Columbia 62,990 – – – – 2 35 35 5 Greene 49,212 – – – – 1 12 12 2 Rensselaer 159,082 1 4 1 17 4 74 96 6 Saratoga 218,984 – – – – 2 20 20 1 Schenectady 154,008 1 24 1 150 4 72 247 16

Totals 948,699 3 40 3 200 25 494 734 8 *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 Capital region’s capacity and service use in these programs are presented in Table 10.

Outpatient programs (other than clinic) are located in all Capital region counties. Outpatient program capacity is largest in Albany County (n=411 slots) and smallest in Columbia (n=70 slots). There are a total of 854 non-clinic outpatient program slots in the region or 120 slots per 100,000 adults.

Table 10. Capital 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

Local Programs Recipients in

State-operated

Clinics4

Clinic Treatment per 100,000

Adults5Capacity1

(Slots)

Slots per 100,000

Adults5

Medicaid

Recipients2

Non-Medicaid

Recipients

(Estimated #)3

Albany 411 180 1,811 528 553 1,264 Columbia 70 146 806 412 ─ 2,542 Greene 75 198 705 308 ─ 2,680 Rensselaer 90 76 2,722 880 ─ 3,048 Saratoga 100 61 1,091 176 ─ 776 Schenectady 108 96 2,121 240 427 2,465

Totals 854 120 9,256 2,544 980 1,803 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.

Clinics may be locally- or state-operated. All counties in the Capital region have locally-operated clinics. These clinics served a total of 9,256 adult Medicaid recipients and 2,544 adult non-Medicaid recipients. The largest numbers of adult Medicaid recipients (n=2,722) and adult non-Medicaid recipients (n=880) were served in Rensselaer County. In comparison, the smallest number of adult Medicaid recipients (n=705) was served in Greene County and the smallest number of adult non-Medicaid recipients



(n=176) was served in Saratoga County. The Capital region has state-operated clinics in Albany and Schenectady counties which together served 980 adults.

In the region, 1,803 adults received clinic treatment per 100,000 adults. Rensselaer County’s rate of 3,048 adults per 100,000 adults is the highest in region. Saratoga County’s service rate of 776 adults per 100,000 is the lowest in any NYS county.

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

In the region, only Albany County has child outpatient programs other than clinic. These programs have a capacity of 167 slots or 72 slots per 100,000 children region-wide. All counties in the Capital region have locally-operated clinics. These clinics served a total of 3,859 child Medicaid recipients and 748 child non-Medicaid recipients. The largest number of child Medicaid recipients (n=1,174) was served in Schenectady County and the smallest number (n=203) was served in Greene. In comparison, the largest number of child non-Medicaid recipients (n=252) was served in Albany County and the smallest number (n=4) was served in Saratoga.

The Capital region has state-operated clinics in Albany County, which served 285 children.

Table 11. Capital 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

Albany 167 228 960 252 285 2,042 Columbia ─ ─ 245 80 ─ 2,282 Greene ─ ─ 203 124 ─ 3,006 Rensselaer ─ ─ 1,029 152 ─ 2,981 Saratoga ─ ─ 248 4 ─ 459 Schenectady ─ ─ 1,174 136 ─ 3,306

Totals 167 72 3,859 748 285 2,103 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 Capital region, 2,103 children received clinic treatment per 100,000 children. Schenectady County’s rate of 3,306 children per 100,000 children is the highest in the region, and Saratoga County’s service rate of 459 children per 100,000 is the lowest in the region and the third lowest in any NYS county.

Mental Health Emergency and Community Support Programs

Adults Table 12 describes the Capital region’s service use in adult mental health emergency and community support programs. A total of 93 adults were served in emergency programs located in Albany and Rensselaer counties. In the region 13 adults received emergency services per 100,000 adults.

Table 12. Capital 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

Albany 48 19 346 140 Columbia ─ ─ 77 152 Greene ─ ─ 21 53 Rensselaer 45 36 313 247 Saratoga ─ ─ 188 106 Schenectady ─ ─ 260 215

Totals 93 13 1,205 170 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 Capital region which collectively served 1,205 adults. In the region, 170 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 53 in Greene County (the lowest rate in any NYS county) to a high of 247 in Rensselaer.

Children The Capital region’s service use in child mental health emergency and community support programs is presented in Table 13. Forty-two children received emergency services from programs in Albany and Rensselaer counties. In the region 18 children received emergency services per 100,000 children.



Table 13. Capital 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

Albany 31 50 233 377 Columbia ─ ─ 18 159 Greene ─ ─ 22 261 Rensselaer 11 33 68 205 Saratoga ─ ─ 58 123 Schenectady ─ ─ 49 142

Totals 42 18 448 193 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.

Community support programs for children (e.g., vocational, home-based family treatment, and residential treatment facility transition) are located in all counties in the Capital region and together served 448 children. These programs served 193 children per 100,000 children. In the counties, service rates per 100,000 children ranged from a low of 123 in Saratoga County to a high of 377 in Albany.

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 Capital region are described in Table 14. In the region, licensed family care beds (n=21) are located in Columbia and Schenectady counties, congregate treatment beds (n=309) are located in all counties, and apartment treatment beds (n=356) are available in all counties, except Greene. Unlicensed housing support program beds (n=33) are available in Albany and Columbia counties and supported housing beds (n=666) are available in all counties. The housing capacity per 100,000 adults in the region is 195. In the counties, housing capacity per 100,000 adults ranged from a low of 72 in Saratoga County (the lowest rate in any NYS county) to a high of 275 in Columbia.


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


Table 14. Capital 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

Albany ─ 151 155 9 266 254 Columbia 12 14 43 24 39 275 Greene ─ 10 ─ ─ 35 119 Rensselaer ─ 42 72 ─ 125 202 Saratoga ─ 36 34 ─ 48 72 Schenectady 9 56 52 ─ 153 239

Totals 21 309 356 33 666 195 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.

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 Capital region are described in Table 15.

Table 15. Capital 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

Albany ─ 9 12 24 33 Columbia ─ ─ ─ 18 126 Greene ─ ─ ─ 6 55 Rensselaer ─ ─ ─ 21 53 Saratoga ─ ─ ─ 21 38 Schenectady ─ ─ ─ 24 61

Totals ─ 9 4 114 49 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.



The region has no teaching family home beds. Licensed child and youth community residence beds (n=9) are located in Albany County. The Capital region has a capacity of four child and youth community residence beds per 100,000 children, which is the second lowest rate in any DSRIP region.

All counties in the region have HCBS slots (n=114), ranging from a high of 24 each in Albany and Schenectady counties to a low of six in Greene County. The region’s HCBS slots served 49 children per 100,000 children. HCBS slots per 100,000 children ranged from a low of 33 in Albany County to a high of 126 in Columbia.

Substance Use Disorder Outpatient Programs New York State has a variety of substance use disorder (SUD) outpatient programs including clinic and rehabilitation. In the Capital region, all counties have SUD outpatient programs. The average daily enrollment (ADE) in these programs (n=2,689) is described in Table 16.

Table 16. Capital 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

Albany 304,423 1,261 41 Columbia 62,990 133 21 Greene 49,212 121 24 Rensselaer 159,082 361 23 Saratoga 218,984 205 9 Schenectady 154,008 608 40

Totals 948,699 2,689 28 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.

In the region, Albany County has the highest ADE (n=1,261), while Greene has the lowest (n=121). Region-wide these SUD programs have an ADE of 28 per 10,000. In the counties, ADE per 10,000 ranged from a low of 9 in Saratoga County to a high of 41 in Albany County.

New York State also has outpatient opioid treatment programs (Table 17). The Capital region has three opioid treatment programs located in Albany County, which have a combined capacity of 750 and an ADE of 425. Region-wide the program has a capacity of eight per 10,000 and an ADE of four per 10,000.



Table 17. Capital 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

Albany 304,423 3 750 25 425 14 Columbia 62,990 – – – – – Greene 49,212 – – – – – Rensselaer 159,082 – – – – – Saratoga 218,984 – – – – – Schenectady 154,008 – – – – –

Totals 948,699 3 750 8 425 4 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.

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. In the Capital region, there are three Health Home providers. Each county is served by one provider (Table 18).

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

County Total # Health Homes

Serving Region # Health Homes Serving County

Albany

3

1 Columbia 1 Greene 1 Rensselaer 1 Saratoga 1 Schenectady 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 Capital region is presented in Table 19.

Table 19. Capital Region: Licensed Mental Health Professionals

County


Population

Psychiatrists Psychologists LCSWs LMSWs Mental Health

Counseling

Nurse Practitioner -

Psychiatry *Other Total Per 10,000

Albany 304,423 101 226 468 442 127 41 25 1,430 47 Columbia 62,990 4 32 69 65 9 10 7 196 31 Greene 49,212 3 11 48 40 12 1 3 118 24 Rensselaer 159,082 7 34 157 183 56 17 8 462 29 Saratoga 218,984 35 94 269 224 101 22 16 761 35 Schenectady 154,008 32 54 181 220 76 11 13 587 38

Totals 948,699 182 451 1,192 1,174 381 102 72 3,554 37 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 Capital region has a total of 3,554 licensed MH professionals or 37 per 10,000 population. There are maldistributions of MH professionals across the region’s counties. Greene County has the lowest county distribution of MH professionals ─ 24 per 10,000 compared to Albany County which has the highest ─ 47 per 10,000. In addition, there are few psychiatrists in Columbia, Greene and Rensselaer counties.

MH Professional Shortage Designations The maldistribution of licensed MH professionals in the Capital region i s 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. Capital Region: HRSA Federal Mental Health Professional Shortage Designations

County Whole County Census tract,

populations or facilities

Medicaid Eligible population

Albany Columbia Greene Yes Yes Yes Rensselaer Saratoga Schenectady Yes Yes HRSA federal shortage designations retrieved March 17, 2016 from http://datawarehouse.hrsa.gov/tools/analyzers/hpsafind.aspx



In the Capital region, Greene County has a whole county MH professional shortage designation (Table 19a). Greene and Schenectady counties each has a census tract, population or facility designated as a MH Medically Underserved Area/Population (MUA/P), and their Medicaid eligible populations have also been designated MH 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 Capital region is presented in Table 20. All counties in the Capital region have SUD professionals.

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

County US Census


Physicians Counselors

Total Per 10,000 PopulationBoard Certified

Addiction Medicine

Authorized for Buprenorphine

Prescription

Credentialed Alcoholism and Substance Abuse

Certified Rehabilitation

Albany 304,423 7 65 127 26 218 7 Columbia 62,990 0 7 19 2 28 4 Greene 49,212 1 4 12 2 18 4 Rensselaer 159,082 2 11 42 7 60 4 Saratoga 218,984 4 23 68 16 107 5 Schenectady 154,008 1 16 63 8 87 6

Totals 948,699 15 126 331 61 518 5Data 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 Capital region there are 15 physicians certified in addiction medicine, but none in Columbia County. All counties 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 Capital region have both alcoholism and substance abuse counselors and rehabilitation counselors.

Overall, the Capital region has a total of 518 certified and credentialed SUD professionals or five per 10,000 population. Columbia, Greene and Rensselaer counties have the lowest county distribution of SUD professionals ─ four per 10,000 compared to the highest in Albany County ─ seven per 10,000.

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 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

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

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

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


III. Health Status

This section describes the health status of individuals in the Capital 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. Disease Prevalence Chronic Health Conditions Compared to all DSRIP regions, the Capital region has the highest average percentage of adults with asthma (12%) and the second highest average percentage of adults with angina, heart attack or stroke (8%). In the region (Table 1), Schenectady County has the highest percentage of adults that are overweight or obese (66%) and Albany County has the highest percentage of adults with asthma (14%).

Table 1. Capital 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

Albany 9 8 31 63 14 Columbia 7 6 25 58 9 Greene 9 7 30 60 10 Rensselaer 9 9 27 61 13 Saratoga 8 9 28 61 11 Schenectady 9 8 31 66 13 Region Average 9 8 29 61 12

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

Albany and Schenectady counties have the highest percentages of adults with high blood pressure (31% each). Columbia County has the lowest percentages of adults with any of these chronic conditions.

HIV, AIDS and Cancer Among all DSRIP regions, the Capital Region has the second highest average AIDS case rate per 100,000 (n=5). The case rates of HIV and AIDS are highest in Albany County and lowest in Saratoga (Table 2). The Albany County AIDS case rate (n=8) is the highest in any NYS county outside of NYC, and its HIV case rate (n=10) is the second highest in any NYS county outside of NYC. The HIV and AIDS case rates in Saratoga County are the lowest in the region (two per 100,000 each).



In the Capital region, the cancer incidence rate per 100,000 is lowest in Schenectady County (n=485) and highest in Rensselaer (n=545).

Table 2. Capital 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

Albany 10 8 520 Columbia 4 4 486 Greene 3 5 509 Rensselaer 5 4 545 Saratoga 2 2 505 Schenectady 7 7 485

Region Average 5 5 508 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 Capital region, Greene County has the highest percentage of adults that report binge drinking (23%), food and housing insecurity (30% and 41% respectively), current smoking (25%), and poor mental health for 14 or more days in the last month (17%) (Table 3). Columbia County has the highest percentage of adults that report poor health (7%), and the lowest percentages of those that report not receiving medical care because of cost in the past 12 months (7%) and poor mental health for 14 or more days in the last month (9%).

Table 3. Capital 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

Albany 7,005 17% 19% 31% 4% 16% 10% 13% 30% Columbia 3,174 17% 20% 31% 7% 21% 7% 9% * Greene 2,909 23% 30% 41% 5% 25% 11% 17% * Rensselaer 4,021 17% 26% 38% 4% 24% 11% 16% 51% Saratoga 6,290 19% 18% 32% 3% 18% 10% 12% 28% Schenectady 3,952 15% 22% 39% 5% 19% 13% 11% 38% Region Total/Avg. 27,351 18% 23% 35% 5% 20% 10% 13% 37%

*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



In the region, Schenectady County has the highest percentage (13%) of adults that reported they did not receive medical care because of cost. In Rensselaer County, 51% of those that report poor mental health are current smokers, which is the highest percentage in the region. Saratoga County has the lowest percentages of adults that report poor health (3%) and food insecurity (18%).

Compared to all other DSRIP regions, the Capital region had the second highest average percentages of those that report binge drinking (18%) and poor mental health for 14 or more days in the last month (13%).

3. Hospitalization Rates by Disease or Cause Cardiovascular disease is the leading cause of hospitalizations in the Capital region (Table 4). In the region, Greene County has the highest hospitalization rate per 10,000 for cardiovascular disease (n=134) and stroke (n=26), and Columbia County has the lowest rates (n=112 and 20 respectively). Rensselaer County has the highest rate of hospitalization for diabetes (n=15) and Saratoga County has the lowest (n=9).

Albany and Rensselaer counties have the highest hospitalization rates per 10,000 for asthma (n=12 each), and Saratoga County has the lowest (n=7). Schenectady County has the highest rate for self-inflicted injury (n=12) and Green has the lowest (n=5). In the region, the rate of drug-related hospitalizations ranges from a high of 30 in Greene County to a low of 14 in Saratoga. The rate of newborn drug-related diagnoses per 10,000 is highest in Schenectady (n=208) and lowest in Saratoga (n=53) counties.

Table 4. Capital 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

Albany 1,048 117 22 14 12 7 18 107 Columbia 1,022 112 20 12 9 6 21 81 Greene 1,106 134 26 10 9 5 30 116 Rensselaer 1,098 131 23 15 12 9 20 110 Saratoga 957 114 21 9 7 8 14 53 Schenectady 1,171 132 25 12 10 12 22 208

Region Average 1,067 123 23 12 10 8 21 112 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

Among all DSRIP regions, the Capital region has the second lowest average rate per 10,000 of hospitalizations for cardiovascular disease (n=123).



Mortality Rates Premature Mortality In the Capital region, Greene County has the highest percentage of premature deaths (45%) and Schenectady County has the lowest (35%) (Table 5). Greene County also has the highest rate per 100,000 of premature death from cardiovascular disease (n=128), and Saratoga has the lowest (n=78). The highest rate per 100,000 of premature death from stroke is in Schenectady County (n=15) and the lowest rate is in Rensselaer (n=8). In the region, the rate of alcohol related motor vehicle injuries and deaths per 100,000 is highest in Greene County (n=61) and lowest in Schenectady (n=40).

Table 5. Capital 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)

Albany 37 104 11 43 Columbia 39 103 13 55 Greene 45 128 9 61 Rensselaer 38 101 8 43 Saratoga 39 78 10 52 Schenectady 35 118 15 40 Average % or Rate 38 105 11 49 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

Top Ten Causes of Death Heart disease is the number one cause of death in all counties in the Capital region, except Greene and Saratoga (Table 6), where malignant neoplasms are the leading cause of death. In the region, Schenectady County has the highest death rate per 100,000 due to hear disease (n=195). Greene County has the highest death rates due to malignant neoplasms (n=195, the highest rate in any NYS county), pneumonia (n=26) and accidents (n=35).

Rensselaer County has the highest death rate due to chronic lower respiratory disease (n=60). Columbia County has the highest death rates due to stroke (n=39) and suicide (n=17). The highest rates of death due to diabetes are in Albany and Rensselaer counties (n=20 each). Albany County also has the highest death rate due to cirrhosis of the liver (n=11).



Table 6. Capital 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

Albany 166 153 24 1 9 30 20 15 4 11 9 Columbia 182 147 39 2 11 30 23 16 0 3 17 Greene 171 195 25 0 26 37 35 14 2 7 14 Rensselaer 188 167 26 2 15 60 25 20 5 10 13 Saratoga 143 149 27 0 14 37 23 14 1 9 7 Schenectady 195 159 31 1 15 38 17 20 4 8 13 Region Average 174 161 29 1 15 39 24 16 3 8 12

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.

4. 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 (33%), obesity (16%) and high blood pressure (15%) are the leading chronic health conditions for the public mental health population in the Capital region (Table 7).

Table 7. Capital 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 7 0 0 0 0 21-64 45 13 20 19 14 1 2 65+ 26 22 19 41 28 4 4 Total Average 33 10 16 15 11 1 1 Data is from the NYS Office of Mental Health 2015 Patient Characteristics Survey. Data retrieved April 28, 2016.

Among all DSRIP regions, the Capital region has the highest percentage of patients that are current smokers (33%).

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



For patients ages 65 and older, the Capital region has the highest percentage of those that are current smokers (26%) and the second lowest percentage of those that have had a heart attack (4%) in all DSRIP regions.

Behavioral Health Diagnoses Overall, depressive and co-occurring disorders (25% each) and schizophrenia spectrum and other psychotic disorders (23%) are the leading behavioral health diagnoses for the public mental health population in the Capital region (Table 8).

Table 8. Captial 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 10 23 21 4 23 2 16 2 4 21-64 6 19 26 0 1 31 8 4 35 65+ 7 11 28 0 0 34 4 3 16 Total Average 7 20 25 1 7 23 10 3 25

Data is from the NYS Office of Mental Health 2015 Patient Characteristics Survey. Data retrieved April 28, 2016.

Among all DSRIP regions, the Capital region has the highest percentages of patients served with bipolar and related disorders (20%) and with a co-occurring disorder (25%). The region has the second lowest percentage of those with anxiety disorder (7%).

Among patients under the age of 21, the region has the highest percentages of those with bipolar and related disorders (23%) and with a co-occurring disorder (4%) in all DSRIP regions.

For patients ages 21-64, it has the lowest percentage of those with anxiety disorder (6%) and the highest percentage of those with a co-occurring disorder (35%) in all DSRIP regions.

For patients ages 65 and older, the Capital region has the highest percentage of those with a co-occurring disorder (16%) 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 Capital 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 Capital region with inpatient hospital admissions (n=18,950) by mental health diagnosis. By county, admissions ranged from a high of 5,656 in Albany to a low of 657 in Greene. Region-wide, the largest percentages of Medicaid beneficiaries with a mental health inpatient hospital admission had depressive disorders (43%), followed by other mental health diagnoses (18%), schizophrenia and chronic stress and anxiety diagnoses (13% each), bi-polar disorder (9%), and PTSD (4%).

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

County Bi-Polar Disorder


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

Albany 534 9% 2,481 44% 747 13% 773 14% 230 4% 891 16% 5,656 Columbia 62 7% 445 51% 94 11% 134 15% 21 2% 118 14% 874 Greene 54 8% 315 48% 65 10% 109 17% 21 3% 93 14% 657 Rensselaer 417 10% 1,686 39% 537 12% 474 11% 269 6% 939 22% 4,322 Saratoga 233 8% 1,271 45% 349 12% 440 16% 93 3% 447 16% 2,833 Schenectady 462 10% 1,920 42% 650 14% 524 11% 205 4% 847 18% 4,608

Totals 1,762 9% 8,118 43% 2,442 13% 2,454 13% 839 4% 3,335 18% 18,950 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 Rensselaer and Schenectady counties (10% each), depressive disorders in Columbia County (51%), schizophrenia in Schenectady County (14%), chronic stress and anxiety diagnoses in Greene County (17%), and PTSD (6%) and other mental health diagnoses (22%) in Rensselaer County.

Table 2 describes the number of Medicaid inpatient hospital admissions in the Capital region (n=36,986) by mental health diagnosis. By county, admissions ranged from a high of 11,362 in Albany County to a low of 1,255 in Greene.



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



Schizophrenia Chronic Stress

and Anxiety Diagnoses


Other Mental Health

Diagnoses

Total Number of

MH

Number of Admissions Admissions

Albany 1,031 5,008 1,367 1,628 498 1,830 11,362 Columbia 129 835 186 248 50 245 1,693 Greene 84 605 117 220 42 187 1,255 Rensselaer 809 3,157 977 916 508 1,852 8,219 Saratoga 453 2,304 663 794 218 935 5,367 Schenectady 944 3,689 1,192 1,032 424 1,809 9,090

Totals 3,450 15,598 4,502 4,838 1,740 6,858 36,986 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 Albany (n=5,008). Across counties, admissions were highest in Albany County for bipolar disorder, depressive disorders, schizophrenia, and chronic stress and anxiety diagnoses. Admissions for PTSD and other mental health diagnoses were highest in Rensselaer County.

Mental Health Diagnosis Emergency Room Visits Table 3 describes the total number of Medicaid beneficiaries in the Capital region with emergency room visits (n=39,633) by mental health diagnosis. By county, ER visits ranged from a high of 11,780 in Albany to a low of 1,887 in Greene.

Table 3. Capital 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

Beneficiari Number/Percentage of Medicaid Beneficiaries

es with MH ER Visit

# % # % # % # % # % # % Albany 1,172 10% 4,455 38% 1,631 14% 1,613 14% 543 5% 2,366 20% 11,780 Columbia 186 8% 993 42% 264 11% 368 15% 80 3% 498 21% 2,389 Greene 164 9% 721 38% 209 11% 330 17% 89 5% 374 20% 1,887 Rensselaer 846 9% 3,315 35% 1,110 12% 1,110 12% 649 7% 2,396 25% 9,426 Saratoga 521 9% 2,151 38% 668 12% 901 16% 248 4% 1,215 21% 5,704 Schenectady 743 9% 3,189 38% 1,160 14% 1,104 13% 369 4% 1,882 22% 8,447

Totals 3,632 9% 14,824 37% 5,042 13% 5,426 14% 1,978 5% 8,731 22% 39,633 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 (37%), followed by other mental health diagnoses (22%), chronic stress and anxiety diagnoses (14%), schizophrenia (13%), bi-polar disorder (9%), and PTSD (5%).

In the region, the percentages of Medicaid beneficiaries with ER visits were highest by diagnosis in the following counties: depressive disorders in Columbia County (42%), bipolar disorder in Albany County (10%), schizophrenia in Albany and Schenectady counties (14% each), chronic stress and anxiety diagnoses in Greene County (17%), and PTSD (7%) and other mental health diagnoses (25%) in Rensselaer County.

Compared to all other DSRIP regions, the Capital region had the largest percentage of Medicaid beneficiaries with ER visits for PTSD (5%).

Table 4 describes the total number of Medicaid ER visits in the Capital region (n=144,682) by mental health diagnosis. By county, ER visits ranged from a high of 47,355 in Albany County to a low of 5,695 in Greene.

Table 4. Capital 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

Albany 5,175 17,223 6,089 6,808 2,428 9,632 47,355 Columbia 644 3,170 880 1,175 284 1,748 7,901 Greene 476 2,238 596 1,006 271 1,108 5,695 Rensselaer 3,874 11,918 4,239 4,218 2,833 9,242 36,324 Saratoga 1,830 6,367 2,117 2,955 942 4,095 18,306 Schenectady 2,892 10,548 3,687 4,005 1,540 6,429 29,101

Totals 14,891 51,464 17,608 20,167 8,298 32,254 144,682Data 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 Albany (n=17,223). Across counties, ER visits were highest in Albany County for all diagnoses, except PTSD, which was highest in Rensselaer (n=2,833).

Medicaid Mental Health Beneficiaries Compared to All Medicaid Beneficiaries Table 5 describes Medicaid mental health beneficiaries compared to all Medicaid beneficiaries in the Capital region. In the region, 10% of all Medicaid beneficiaries had a mental health inpatient hospital admission and 22% had a mental health ER visit. By county, Rensselaer had the highest percentage of Medicaid beneficiaries with a mental health inpatient admission (13%), while Greene had the lowest (6%). Similarly, Rensselaer County had the highest percentage of Medicaid beneficiaries with a mental health ER visit (28%, the highest in any NYS county) and Greene had the lowest (17%).



Table 5. Capital 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

Beneficiaries Number/Percentage of Medicaid Beneficiaries

N % N %

Albany 57,567 5,656 10% 11,780 20% Columbia 12,499 874 7% 2,389 19% Greene 10,938 657 6% 1,887 17% Rensselaer 33,153 4,322 13% 9,426 28% Saratoga 30,722 2,833 9% 5,704 19% Schenectady 39,147 4,608 12% 8,447 22%

Totals 184,026 18,950 10% 39,633 22% 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

Compared to all other DSRIP regions, the Capital region had the largest percentage of Medicaid beneficiaries with a MH inpatient admission (10%).

2. Medicaid Beneficiaries with Substance Use Disorders

Substance Use Disorder Inpatient Admissions Table 6 describes the total number of Medicaid beneficiaries in the Capital region with inpatient hospital admissions (n=7,192) by substance use disorder (SUD). By county, admissions ranged from a high of 2,630 in Albany to a low of 199 in Greene. Region-wide, the largest percentages of Medicaid beneficiaries with a SUD inpatient hospital admission had alcohol use disorder (35%), followed by drug abuse: cannabis/NOS/NEC (21%), opioid use disorder (19%), cocaine use disorder (13%), and other SUD diagnoses (11%).

Table 6. Capital 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 Admission SUD Inpatient

# % # % # % # % # %

Albany 366 14% 932 35% 528 20% 516 20% 288 11% 2,630 Columbia 26 10% 85 33% 62 24% 57 22% 27 11% 257 Greene 18 9% 56 28% 63 32% 47 24% 15 8% 199 Rensselaer 226 14% 595 37% 240 15% 369 23% 180 11% 1,610 Saratoga 48 6% 317 39% 167 20% 165 20% 122 15% 819 Schenectady 242 14% 565 34% 301 18% 385 23% 184 11% 1,677

Totals 926 13% 2,550 35% 1,361 19% 1,539 21% 816 11% 7,192 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 (39%) and other SUD diagnoses (15%) in Saratoga County, opioid use disorder (32%, the highest in any NYS county) and drug abuse: cannabis/ NOS/NEC (24%) in Greene County, and cocaine use disorder in Albany, Rensselaer and Schenectady counties (14% each). Compared to all other DSRIP regions, the Capital region had the largest percentage of Medicaid beneficiaries hospitalized with alcohol use disorder (35%).

Table 7 describes the number of Medicaid inpatient hospital admissions in the Capital region (n=15,899) by substance use disorder. By county, admissions ranged from a high of 6,141 in Albany County to a low of 421 in Greene.

Table 7. Capital 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

Admissions Number of Admissions

Albany 366 932 528 516 288 6,141 Columbia 26 85 62 57 27 515 Greene 18 56 63 47 15 421 Rensselaer 226 595 240 369 180 3,415 Saratoga 48 317 167 165 122 1,722 Schenectady 242 565 301 385 184 3,685

Totals 926 2,550 1,361 1,539 816 15,899 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

Alcohol use disorder accounted for the largest number of inpatient admissions in all counties except Greene, and were highest in Albany (n=932). Across counties, admissions for all disorders were highest in Albany County.

Substance Use Disorder Emergency Room Visits Table 8 describes the total number of Medicaid beneficiaries in the Capital region with emergency room (ER) visits (n=13,627) by substance use disorder. By county, ER visits ranged from a high of 4,727 in Clinton to a low of 657 in Greene. Region-wide, the largest percentages of Medicaid beneficiaries with a SUD ER visit were for cocaine use disorder (31%), followed by opioid use disorder (22%), drug abuse: cannabis/NOS/NEC (20%), other SUD diagnoses (15%), and alcohol use disorder (13%).

In the region, the percentages of Medicaid beneficiaries with ER visits were highest by disorder in the following counties: cocaine use disorder in Rensselaer County (33%), alcohol use disorder in Albany and Schenectady counties (15% each), opioid use disorder in Columbia County (25%), drug abuse: cannabis/NOS/NEC in Greene County (27%), and other SUD diagnoses in Saratoga County (19%).



Compared to all other DSRIP regions, the Capital region had the smallest percentage of Medicaid beneficiaries with ER visits for other SUD diagnoses (15%) and the largest percentage with cocaine use disorder (31%).

Table 8. Capital 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

# % # % # % # % # %

Albany 1,435 30% 700 15% 971 21% 979 21% 642 14% 4,727 Columbia 195 29% 49 7% 174 25% 181 26% 85 12% 684 Greene 175 27% 51 8% 135 21% 180 27% 116 18% 657 Rensselaer 980 33% 407 14% 718 24% 484 16% 401 13% 2,990 Saratoga 533 30% 155 9% 333 19% 402 23% 331 19% 1,754 Schenectady 840 30% 412 15% 611 22% 482 17% 470 17% 2,815

Totals 4,158 31% 1,774 13% 2,942 22% 2,708 20% 2,045 15% 13,627 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

Table 9 describes the number of Medicaid ER visits in the Capital region (n=59,654) by substance use disorder. By county, ER visits ranged from a high of 22,476 in Albany County to a low of 2,421 in Greene. Cocaine use disorder accounted for the largest number of ER visits in all counties except Greene, and were highest in Albany (n=6,413). Across counties, ER visits for all disorders were highest in Albany County.

Table 9. Capital 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

Albany 6,413 3,101 4,652 4,917 3,393 22,476 Columbia 814 206 789 793 351 2,953 Greene 517 164 530 766 444 2,421 Rensselaer 3,987 1,766 3,182 2,152 1,875 12,962 Saratoga 1,880 554 1,384 1,804 1,342 6,964 Schenectady 3,155 1,718 2,629 2,164 2,212 11,878

Totals 16,766 7,509 13,166 12,596 9,617 59,654 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 Capital region. In the region, 4% of all Medicaid beneficiaries had a SUD inpatient hospital admission and 7% had a SUD ER visit. By county, Albany and Rensselaer counties have the highest percentage of Medicaid beneficiaries with a SUD inpatient admission (5% each), while Columbia and Greene have the lowest (2% each). Rensselaer County had the highest percentage of Medicaid beneficiaries with a SUD ER visit (9%) and Columbia had the lowest (5%).

Table 10. Capital 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

Beneficiaries Number/Percentage of Medicaid Beneficiaries

N % N %

Albany 57,567 2,630 5% 4,727 8% Columbia 12,499 257 2% 684 5% Greene 10,938 199 2% 657 6% Rensselaer 33,153 1,610 5% 2,990 9% Saratoga 30,722 819 3% 1,754 6% Schenectady 39,147 1,677 4% 2,815 7%

Totals 184,026 7,192 4% 13,627 7% 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

Compared to all other DSRIP regions, the Capital region had the largest percentage of Medicaid beneficiaries with a SUD ER visit (7%).

3. Medicaid Beneficiary Hospital Inpatient Admissions and Emergency Room Visits

Medicaid Beneficiaries by Eligibility Type In the Capital region 19% of the estimated population are Medicaid beneficiaries (Table 11). By county, Medicaid beneficiaries range from a high of 25% of the estimated population in Schenectady County to a low of 14% of the estimated population in Saratoga.

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 Capital region, 82% of Medicaid beneficiaries receive Medicaid only and 18% are dual-eligible. Medicaid only beneficiaries range from a low of 79% in Columbia County to a high of 84% in Schenectady.



Table 11. Capital 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.

Albany 304,423 57,567 19% 47,395 82% 10,172 18% Columbia 62,990 12,499 20% 9,890 79% 2,609 21% Greene 49,212 10,938 22% 8,924 82% 2,014 18% Rensselaer 159,082 33,153 21% 27,487 83% 5,666 17% Saratoga 218,984 30,722 14% 24,736 81% 5,986 19% Schenectady 154,008 39,147 25% 32,895 84% 6,252 16%

Totals 948,699 184,026 19% 151,327 82% 32,699 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 Capital region are described in Table 12.2 In the region, 11% of Medicaid only beneficiaries and 16% of Medicaid/ Medicare dual-eligible beneficiaries experienced at least one hospital inpatient admission.

Table 12. Capital Region: Medicaid Hospital Inpatient Admissions by Beneficiary Type

County

Number of BeneficiariesNumber of Beneficiaries with

Inpatient Admissions Total Inpatient

Hospital Admissions

Medicaid Only

Dual Medicaid and Medicare


Medicaid Only


# # # % # % # #

Albany 47,395 10,172 5,402 11% 1,655 16% 7,831 2,408 Columbia 9,890 2,609 1,085 11% 447 17% 1,518 637 Greene 8,924 2,014 911 10% 343 17% 1,280 457 Rensselaer 27,487 5,666 3,060 11% 1,019 18% 4,288 1,502 Saratoga 24,736 5,986 2,363 10% 840 14% 3,301 1,098 Schenectady 32,895 6,252 3,571 11% 988 16% 5,012 1,444

Totals 151,327 32,699 16,392 11% 5,292 16% 23,230 7,546 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 hospital inpatient admissions were consistent across counties. In comparison, hospital inpatient admissions in the dual-eligible Medicaid/Medicare population ranged from a low of 14% in Saratoga County to a high of 18% in Rensselaer.



Medicaid Beneficiary Emergency Room Visits Emergency room (ER) visits among Medicaid beneficiaries in the Capital region are described in Table 13.3 In the region, 33% of Medicaid only beneficiaries and 22% of Medicaid/Medicare dual-eligible beneficiaries experienced at least one ER visit. Compared to all other DSRIP regions, the Capital region had the highest percentage of Medicaid/Medicare dual-eligible beneficiaries experienced at least one ER visit.

Percentages of Medicaid only beneficiaries with ER visits ranged from a low of 24% each in Greene and Saratoga counties to a high of 39% in Rensselaer. In comparison, ER visits for the Medicaid/Medicare dual-eligible population ranged from a low of 17% each in Greene and Saratoga counties to a high of 26% each in Albany and Rensselaer (the highest in any NYS county).

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

County

Number of Beneficiaries Number of Beneficiaries

with ER Visits Total ER Visits



Medicaid Only


# # # % # % # #

Albany 47,395 10,172 16,636 35% 2,621 26% 39,390 7,174 Columbia 9,890 2,609 3,245 33% 506 19% 6,976 1,026 Greene 8,924 2,014 2,151 24% 352 17% 4,122 666 Rensselaer 27,487 5,666 10,624 39% 1,465 26% 25,362 4,129 Saratoga 24,736 5,986 5,878 24% 1,003 17% 12,139 2,145 Schenectady 32,895 6,252 11,857 36% 1,377 22% 25,698 2,987

Totals 151,327 32,699 50,391 33% 7,324 22% 113,687 18,127 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

Compared to all other DSRIP regions, the Capital region had the highest percentage of dual Medicaid/Medicare beneficiaries with ER visits (22%).

In conclusion, in the Capital 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.


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


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.



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 Capital 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 Capital DSRIP 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 Capital region, 58% adhere to antipsychotic medications (42% do not). Antipsychotic adherence by county ranges from a low of 46% in Greene County (the lowest percentage in any NYS county) to a high of 73% in Columbia (Table 1).

In the region, 52% of individuals remain on antidepressant medication during the acute phase and 36% remain on antidepressant medication during the continuation phase (64% do not). Adherence to antidepressants is lowest in Rensselaer County for the acute phase (48%) and in Albany County for the continuation phase (32%). In comparison, the highest rates of adherence are found in Greene County for both the acute (59%) and continuation (46%) phases.



Table 1. Capital 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

Albany 57% 50% 32% Columbia 73% 57% 43% Greene 46% 59% 46% Rensselaer 54% 48% 33% Saratoga 70% 56% 42% Schenectady 56% 52% 37%

Region Avg. % 58% 52% 36% 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.

In the Capital region, 54% of individuals follow-up after hospitalization for mental illness within seven days and 71% follow-up within 30 days (Table 2). These are the highest percentages of follow-up care in any DSRIP region. Albany and Saratoga counties have the lowest percentages of follow-up care within seven days (48% each) and Rensselaer has the highest (65%). Follow-up within 30 days is lowest in Albany County (64%) and highest in Rensselaer (81%).



Table 2. Capital 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

Albany 48% 64% 46% 51% Columbia 64% 77% 60% * Greene 59% 74% 60% * Rensselaer 65% 81% 56% 56% Saratoga 48% 68% 52% 56% Schenectady 53% 71% 54% 68%

Region Avg. % 54% 71% 53% 58% *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.

In the region, 53% of children prescribed ADHD medication have follow-up care during the initiation phase and 58% have follow-up care during the continuation phase. Albany County has the lowest percentages of children prescribed ADHD medication with follow-up care for both the initiation (46%) and continuation (51%) phases. ADHD follow-up care is highest for the initiation phase in Columbia and Greene counties (60% each) and in Schenectady for the continuation phase care (68%).

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 Capital region, 50% of individuals initiate treatment within 14 days of the diagnosis of AOD dependence (Table 3) and 24% engage in treatment within 30 days after initiation (76% do not). Greene County has the lowest percentages of AOD initiation (48%) and engagement (19%) treatment. In all other counties the percentage of AOD initiation treatment is 50%. Albany County has the highest percentage of AOD treatment engagement (26%).



Table 3. Capital Region: Alcohol and Other Drug Dependence Treatment

County Alcohol and Other Drug Dependence Treatment

Initiation Engagement

Albany 50% 26% Columbia 50% 21% Greene 48% 19% Rensselaer 50% 23% Saratoga 50% 22% Schenectady 50% 25%

Region Avg. % 50% 24% 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.

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 Medicaid only population, Rensselaer County has the highest observed to expected ratios for diabetes short-term (232/130) and long-term (118/114) complications (Table 4a). Greene County has the lowest observed to expected ratios for diabetes short-term (70/128) and long-term (28/121) complications.

In the dual Medicaid and Medicare population, Columbia County has the highest observed to expected ratios for diabetes short-term complications (176/101), and Saratoga has the lowest (62/98). Saratoga County has the highest observed to expected ratio for diabetes long-term complications in the dual population (277/235), and Greene County has the lowest ratio (44/256).



Table 4a. Capital Region: Diabetes Short and Long-Term Complications Inpatient Prevention

County

Diabetes Short-term Complications Diabetes Long-term Complications



Rates per 100,000

Observed Expected Observed Expected Observed Expected Observed Expected


Totals 135 127 117 113 81 117 185 283 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

Table 4b describes uncontrolled diabetes and lower-extremity amputation rates among patients with diabetes. In the Medicaid only population, Rensselaer County has the highest observed to expected ratio for uncontrolled diabetes (32/20) and Columbia, Greene and Saratoga counties have zero observed rates. For lower-extremity amputations in this population, Rensselaer County has the highest observed to expected ratio (32/11) and Columbia and Greene counties have zero observed rates.

Table 4b. Capital Region: Diabetes Chronic Conditions Inpatient Prevention Quality Indicators

County

Uncontrolled Diabetes Lower-Extremity Amputation

among Patients with Diabetes



Rates per 100,000

Observed Expected Observed Expected Observed Expected Observed Expected


Totals 13 21 11 39 14 12 61 43 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 population, Greene County has the highest observed to expected ratio for uncontrolled diabetes (44/36) and Columbia, Rensselaer and Saratoga have no observed cases. In the dual population, Columbia County has the highest ratio for lower-extremity amputation among patients with diabetes (141/42, the highest in any NYS county), and Albany County has the lowest (27/49).

Among all DSRIP regions, the Capital region has the highest observed to expected ratio of lower-extremity amputation (61/43) and lowest ratio of uncontrolled diabetes (11/39) in the dual Medicaid and Medicare population.

Cardiac Chronic Conditions In the Medicaid only population in the Capital region (Table 5a), Columbia County has the highest observed to expected ratio for hypertension (105/48) and Albany County has the highest ratio for heart failure (176/153). In this population, all counties have lower or equal observed compared to expected rates for angina without procedure. Greene County has the lowest ratios for hypertension (14/45) and heart failure (83/123).

In the region’s dual Medicaid and Medicare population, Albany County the lowest observed to expected ratios for all cardiac chronic conditions. The highest ratios for these conditions are in Greene County (hypertension, 133/79) and Columbia County (heart failure, 184/124, angina without procedure, 70/25). Columbia County’s ratio for heart failure in the dual Medicaid and Medicare population is the highest in any NYS county.

Table 5a. Capital 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

Albany 60 61 36 112 176 153 378 691 3 15 0 28 Columbia 105 48 70 89 739 644 184 124 0 14 70 25 Greene 14 45 133 79 83 123 622 595 14 14 44 23 Rensselaer 22 47 66 89 108 116 548 620 5 13 17 25 Saratoga 27 40 31 76 80 101 431 592 5 13 31 22 Schenectady 50 54 74 97 130 130 795 629 4 14 29 26

Total 46 49 68 90 219 211 493 542 5 14 32 25 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

Among all DSRIP regions, the Capital region has the highest observed to expected rate of angina without procedure (32/25) in the dual population.



Asthma Chronic Conditions Asthma chronic conditions are described in Table 5b. Columbia County has the highest observed to expected ratio for asthma in younger adults in the Medicaid only population (175/89) and Greene County has the lowest (46/85). In the dual population, Albany County has the highest ratio (146/240).

Among all DSRIP regions, the Capital region has lowest observed to expected rate of asthma in younger adults (43/176) in the dual Medicaid and Medicare population.

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

County

Asthma in Younger Adults


Rate per 100,000

Observed Expected Observed Expected

Albany 76 114 146 240 Columbia 175 89 0 157 Greene 46 85 0 130 Rensselaer 157 102 0 191 Saratoga 70 80 0 128 Schenectady 60 107 115 208

Total 97 96 43 176 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 Capital 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 Capital region’s Medicaid only population, Rensselaer County the highest observed to expected ratios for the overall (1,492/1,020), acute (425/267) and chronic composite (1,066/752) indicators and Greene County has the lowest (Table 6).

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

County

Overall Composite Acute Composite Chronic Composite




Rate per 100,000


Albany 1,211 1,134 2,403 3,373 315 278 819 1,131 896 856 1,584 2,243 Columbia 1,195 1,065 3,941 3,218 302 284 1,196 1,193 893 782 2,745 2,025 Greene 723 1,065 2,356 3,118 167 283 533 1,171 556 782 1,822 1,947 Rensselaer 1,492 1,020 3,735 3,166 425 267 1,444 1,144 1,066 752 2,291 2,022 Saratoga 890 965 2,711 3,039 309 272 1,047 1,186 581 693 1,663 1,853 Schenectady 1,072 1,045 3,180 3,177 223 267 1,075 1,095 850 778 2,105 2,083

Totals 1,097 1,049 3,054 3,182 290 275 1,019 1,153 807 774 2,035 2,029Notes 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 dual population, Columbia County has the highest observed to expected ratios for the overall (3,941/3,218) and chronic composite (2,745/2,025) indicators, and Rensselaer County has the highest ratio for the acute composite indicator (1,444/1,144). In this population, the lowest ratios for these indicators are in Albany County (overall composite, 2,403/3,373, chronic composite, 1,584/2,243) and Greene County (acute composite, 533/1,171, lowest in any NYS county).

Table 7 describes the all diabetes, circulatory and respiratory composite indicators. In the Capital region’s Medicaid only population, Rensselaer County has the highest observed to expected ratios for the all diabetes (415/276) and all respiratory (522/305) composites, and Columbia County has the highest ratio for the all circulatory composite (289/186). In this population, the lowest ratios for these indicators are found in Greene County (all diabetes, 97/282 and all circulatory, 111/183) and Saratoga County (all respiratory, 250/292).

In the dual population, Columbia County has the highest observed to expected ratios for the all diabetes (457/450), all circulatory (880/757) and all respiratory (1,407/834) composite indicators. Albany County has the lowest ratios for the all diabetes (342/569) and all circulatory (414/831) composite indicators, and Greene County has the lowest ratio for all respiratory (756/834).



Table 7. Capital 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


Albany 261 302 342 569 238 230 414 831 403 331 837 862 Columbia 131 274 457 450 289 186 880 757 473 327 1,407 834 Greene 97 282 267 432 111 183 800 697 348 322 756 834 Rensselaer 415 276 415 485 135 176 631 734 522 305 1,278 820 Saratoga 229 252 385 403 112 154 493 690 250 292 832 774 Schenectady 328 277 383 529 185 198 898 752 345 308 824 820

Total 244 277 375 478 178 188 686 743 390 314 989 824 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

3. Potentially Avoidable Emergency Room Visits In the Capital region, Schenectady County has the highest observed to expected ratio of potentially preventable ER visits (33/24) and Rensselaer County has the lowest (11/20) (Table 8).

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

County ER Discharges 2013: Rate per 100,000

Observed Expected

Albany 22 22 Columbia 24 19 Greene 18 19 Rensselaer 11 20 Saratoga 13 18 Schenectady 33 24

Total 20 20 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



4. Local Assessment of Need by Capital 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 Capital 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.

Table 9. Capital Region: Assessment of Needs by Population and Issue Assessment of Local Need (N=6)

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 33% 67% 0% 0% 33% 67% 0% 0% Access to Crisis Services 33% 67% 0% 0% 67% 33% 0% 0% Access to Treatment Services 33% 67% 0% 0% 33% 50% 17% 0% Access to Supported Housing 50% 50% 0% 0% 83% 17% 0% 0% Access to Transportation 33% 50% 17% 0% 67% 33% 0% 0% Access to Home/Community-based Services 50% 0% 50% 0% 50% 17% 33% 0% Access to Other Support Services 33% 0% 67% 0% 33% 0% 67% 0% Workforce Recruitment and Retention 33% 67% 0% 0% 50% 50% 0% 0% Coordination/Integration with Other Systems 33% 50% 0% 17% 33% 50% 0% 17% Selected Issues Chemical Dependency Population Access to Prevention Services 33% 67% 0% 0% 50% 50% 0% 0% Access to Crisis Services 17% 83% 0% 0% 67% 33% 0% 0% Access to Treatment Services 0% 67% 33% 0% 0% 67% 33% 0% Access to Supported Housing 33% 67% 0% 0% 67% 33% 0% 0% Access to Transportation 33% 50% 17% 0% 33% 67% 0% 0% Access to Home/Community-based Services 33% 17% 50% 0% 50% 0% 50% 0% Access to Other Support Services 33% 0% 67% 0% 17% 17% 67% 0% Workforce Recruitment and Retention 50% 50% 0% 0% 50% 50% 0% 0% Coordination/Integration with Other Systems 33% 50% 0% 17% 33% 50% 0% 17%

Mental Illness Population High Needs In the Capital region mental illness population, the largest rates of high need vary by age group. Among youth (<21) the areas of highest need are access to supported housing and community-based services. For adults (21+) the area of highest need is access to supported housing followed by access to crisis services and transportation.



Chemical Dependency Population High Needs In the Capital region chemical dependency population, the largest rates of high need also vary by age group. Among youth (<21) the area of highest need is workforce recruitment and retention. For adults (21+) the areas of highest need are access to crisis services and supported housing.



VI. Consumer and Provider Input

This section summarizes the Capital region’s consumer and provider input regarding community behavioral health needs. Input for this region was collected by the clinic Equinox, Inc.

Methods To collect data, clinics used focus group templates and/or anonymous surveys created by NYSOMH. These instruments are included in Appendix IV. Collectively, these data collection instruments focus on behavioral health concerns, available programming and services, potential disparities in service access and use, evidence-based practices, trauma-informed services, and recommendations regarding strategies to promote improved community health.

Clinics utilized the instruments to collect consumer, family, caregiver and provider input. Once collected, clinics aggregated and submitted the consumer and provider input to NYSOMH. The consumer survey was made available in English and Spanish.

Participating clinics were asked to gather input from consumers and providers in and outside of the clinic, including:

Clinic consumers ages 15 and older; parents or guardians of consumers younger than 15; and family members or caregivers of consumers. Consumer information was also collected from Veterans and individuals in foster care or homeless shelters who receive services from secondary related agencies that make referrals to behavioral health services.

Provider surveys were administered to and focus groups were conducted with both clinics and secondary related agency providers.

When reporting survey multiple choice item results to NYSOMH, clinics recorded the frequency for each response option. The percentages reported in the tables below are based on those numbers as indicated. For open-ended questions, clinics recorded the most frequently occurring responses or “themes”. All responses to open-ended survey questions are stated as they were submitted to NYSOMH by the clinics, and include response frequencies.

Descriptions of Consumer and Provider Participants Demographics and information about participating consumers and providers is reported in Tables 1 and 2 respectively. Equinox surveyed 17 consumers and 6 providers. All consumer respondents were ages 18 and over, and 6% were age 65 or older. All provider respondents practice at Equinox, and all consumer respondents are patients there.



Table 1. Capital Region: Consumer Input (n=17) – Consumer Demographics

Participant Information % Survey Participants 100% Focus Group Participants 0% Not patients at the Clinic 0% Live in the Clinic county 100%

Age Under age 18 0% Age 18-64 94% 65 or older 6%

Gender Male 24% Female 76%

Race/Ethnicity* White 47% Black/African-American 41% Asian 6% Native-American 0% Other Race 0% Hispanic/Latino Ethnicity 6%

*The race/ethnicity question was asked only in the survey, not in the focus groups. Participants were instructed to select all that apply. Percentage is the number within each group divided by the number who responded to the question.

Table 2. Capital Region Provider Information Participant Information (n=6) % Questionnaire Participants 100% Focus Group Participants 0% Do not practice at the Clinic 0% Practice within the Clinic county 100% Have a Master’s degree or higher 100%

Findings The consumer and provider input is organized into four domains:

1. Service Utilization, Perceived Service Needs, Barriers to Access, and Disparities in Access

2. Scope of Services in Treatment 3. Provider Training Needs 4. Participants Feel Welcome where they Receive Services

1. Service Utilization, Perceived Service Needs, Barriers to Access, and Disparities in Access

A. Service Utilization Table 3 shows the distribution of behavioral health services that respondents reported using (question 6, consumer survey).



Table 3. Capital Region: Consumer Survey Input (n=17) – Behavioral Health Services Used

Service Category %* Mental Health Services a. Outpatient mental health services - (e.g., outpatient clinic) 94% b. Inpatient treatment 29% c. Medication for mental health problems 76% d. Residential treatment Unavailable Substance Use Disorder Services e. Outpatient substance use disorder services (e.g., outpatient clinic) 35% f. Inpatient rehabilitation 18% g. Detoxification 6% h. Residential treatment 12% i. Medication for substance use problems (e.g., methadone or buprenorphine to treat opioid addiction) 6% Other Services j. Case managers or providers who will meet individuals outside of an agency setting (e.g., in the home, church, school, homeless shelter, foster care setting, ER, recreational facility, jail) if necessary 29% k. Providers who will meet with patients via phone or webcam 0% l. Help with finding or maintaining employment 18% m. Help with advancing education or seeking job training 24% n. Help with finding, maintaining, or improving housing 12% o. Education about mental health and substance use issues 12% p. 24-hour crisis phone line 18% q. 24-hour mobile crisis teams 6% r. Peer delivered services (services provided by people who have experienced behavioral health problems and who work to help others with behavioral health problems; e.g., self-help groups, warmlines, and peer specialist services) 18% s. Education and supports (e.g., support groups) for families of individuals in behavioral health treatment 12% *These service categories are not mutually exclusive; one individual could be receiving more than one service.

The most frequently reported services received include outpatient mental health services (94%) and medication for mental health problems (76%). The least frequently reported services include providers who will meet with patients via phone or webcam (0%) and detoxification, medication for substance use problems, and 24-hour mobile crisis teams (6% each). More than one-third (35%) of the consumer respondents reported receiving some form of SUD services.



B. Perceived Service Needs No consumers reported that there were behavioral health services that they wanted but were unable to access within a one hour drive (consumer survey, question 9).

Providers reported the following types of behavioral health services that they thought would be beneficial in their communities, but are currently unavailable (provider survey, question 7).

Need for group services in the clinic (n=2) Need for more care management (n=2) Need for children's services; Need for walk-in appointments (n=1 each)

C. Perceived Barriers Table 4a presents the percentages of consumers and providers that reported barriers to accessing behavioral health treatment (consumer survey, question 7; provider survey, question 4).

Table 4a. Capital Region: Consumer and Provider Input -- Barriers to Accessing Behavioral Health Treatment

Perceived Barrier Consumers

(n=17) Providers

(n=6) %

Problems with transportation 12% 100% Problems paying for services 6% 100% Took too long to get an appointment 0% 83% Provider hours are not convenient 0% 67% Service providers don’t speak my (or the patient’s) preferred language 0% 33% Nearest service provider is too far away 0% 17% No service provider in the area 0% 17% Service providers are not sensitive to other cultures 0% 17% Services were not accessible to people with disabilities 6% 0% Other 3% 0% Local provider does not serve individuals with these particular problems 0% * Services were not available to Veterans or members of the armed forces 0% * Services were not available to children or the elderly 0% * *Provider responses to questions about access for particular demographic groups are reported in Table 4b

The barriers most frequently reported by all providers (100%) and some consumers are problems with transportation and problems paying for services. Providers also reported barriers including: took too long to get an appointment (83%); provider hours are not convenient (67%); and service providers don’t speak patient’s preferred language (33%).



D. Access Disparities Table 4b describes disparities in access to behavioral health services reported by providers (provider survey, question 5). Among provider respondents, 80% reported that services are not available for children in foster care, 60% reported services are not available for children, and 50% reported they are not available for incarcerated individuals.

Table 4b. Capital Region: Provider Input -- Access to Behavioral Health Services by Special Populations

Special Population Total #

Respondents % Answered

"No"

Veterans or members of the armed forces 6 0% Children 5 60% Children in foster care 5 80% Elderly 4 0% Homeless 4 0% Incarcerated 4 50%

2. Scope of Services in Treatment Table 5 describes consumers’ experiences with evidence-based services, care coordination, and integrated care while receiving care from behavioral or physical health providers (consumer survey, question 8).

Table 5. Capital Region: Consumer Survey Input -- Scope of Services within Treatment

Provider Service Total #

Respondents % Answered

"Yes"*

a. Screen for history of traumatic life events or abuse? 11 73% b. Screen for depression, anxiety, substance abuse, or another behavioral health problem? 5 20% c. Screen for physical health problems? 14 71% d. Assess your strengths, abilities, preferences, and goals? 13 85% e. Talk with other providers about your care? 14 64% f. Talk to you about the relationship between thoughts, behaviors, and feelings? 13 92% g. Provide clear information about:

i. How to get treatment for mental health and substance use issue 13 69% ii. How to cope with mental health and substance use issues? 14 86% iii. Crisis management? 12 83%

h. Met all of your health care needs? 15 67% *Percentage is the number that responded "Yes" divided by the total number of respondents.



The least frequently provided services are screening for depression, anxiety, substance abuse, or another behavioral health problem (20%) and talking with other providers about your care (64%). For all other services listed, at least two-thirds of consumer respondents reported receiving them.

3. Provider Training Needs Providers reported the following training needs (provider survey, question 6).

All six providers responded Training in trauma-informed practices is especially important in treating the

clients (n=5)

4. Participants Feel Welcome where they Receive Services No consumers reported not feeling welcome in the places where they receive behavioral health services (consumer survey, question 10). Things that consumers reported that make them feel welcome are listed below.

Five respondents answered this question Staff (either front desk or clinical) that are welcoming, patient or kind (n=4) "meeting people with the same issues as I" (n=1)

Summary Equinox surveyed 17 consumers and six providers. For both consumers and providers, the frequently reported needs included:

Transportation to health care services Reduced wait times for an appointment Assistance with paying for services Ambulatory detox Inpatient mental health Housing Convenient provider hours (evenings and weekends)



Appendix A. Highlights of Capital 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 Capital region.

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

$57,554 Compared to all DSRIP regions, the Capital region has the 3rd highest median household income, which is only slightly lower than the state median of $58,687.

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

Poverty 12% of region’s population lives below poverty level

2% of the region’s population is on cash public assistance (the lowest percentage in any DSRIP region) and 9% receives food stamps/SNAP benefits (the 3rd lowest percentage in any DSRIP region).

Public Health Insurance/ Medicaid/ Beneficiaries/ No Health Insurance

29% of region’s population are on public health insurance, 19% are Medicaid beneficiaries and 7% have no health insurance.

Lowest percentage with no health insurance among all DSRIP regions

2nd lowest percentage of Medicaid beneficiaries in any DSRIP region.

6% of the population in Saratoga County has no health insurance coverage, which is the lowest percentage in any NYS county.

Special Populations 12% of the region’s population are disabled and 10% are Veterans.

15% of Greene County’s population are disabled: 2nd highest percentage among all NYS counties.

Foreign Born 9% of the population are foreign born.

Primary Language other than English

7% 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”.

II. Health Care Resources Summary Highlights

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

1. The region has 2,670 primary care providers or 28 per 10,000 population.

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

Supply of Physical Health Care Specialists

1. The region has 1,356 physical medical health specialists or 14 providers per 10,000 population.

Supply of Licensed Mental Health (MH) Professionals

1. The region has 3,554 licensed MH professionals or 37 per 10,000 population.

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

There are few psychiatrists in Columbia, Greene and Rensselaer counties.

Substance Use Disorder (SUD) Professionals

1. The region has a total of 518 cert i f ied and credentialed SUD professionals or five per 10,000 population.

1. Columbia County has no physician certified in addiction medicine.



Appendix A. Highlights of Capital Region Needs Assessment Findings A. Capital 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: Greene County has a whole county shortage designation. Both Greene and Schenectady counties have Medically Underserved Area/Population (MUA/P) designations, and their Medicaid eligible populations have also been designated MUPs. Mental Health Professionals: Greene County has a whole county shortage designation. Both Greene and Schenectady counties have Medically Underserved Area/Population (MUA/P) designations, and their Medicaid eligible populations have also been designated MUPs.

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

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

Mental Health Inpatient Facilities

1. Total psychiatric bed capacity in the region is 46 per 100,000 adults and 40 per 100,000 children.

1. Greene County has no psychiatric bed capacity.

2. Psychiatric beds for children are in only Albany, Saratoga, and Schenectady counties.

Substance Use Disorder (SUD) InpatientPrograms

1. In the region, there are 3 SUD crisis programs and 3 inpatient rehabilitation programs that are in Albany, Rensselaer and Schenectady counties. All the counties in the region have SUD residential programs.

1. The total capacity per 10,000 for all SUD inpatient programs is 9, which is the highest rate in any DSRIP region.

2. The total average ADE per 10,000 for these programs is 8, which is the highest in any DSRIP region.

Mental Health Outpatient and Clinic Programs

1. Adult outpatient programs (other than clinic) are in all counties. There is a total of 854 non-clinic outpatient program slots in the region or 120 slots per 100,000 adults.

2. In addition to locally-operated clinics in all counties, the region has state-operated clinics in Albany and Schenectady counties serving adults.

3. In the region, only Albany County has child outpatient programs other than clinic. These programs have a capacity of 167 slots or 72 slots per 100,000 children region wide.

1. Saratoga County’s adult clinic service rate of 776 adults per 100,000 adults is the lowest of any county in NYS.

2. Saratoga County’s clinic service rate of 459 children per 100,000 children is the 3rd lowest rate in any NYS county.

MH Community Support Programs

1. In the region, 170 adults per 100,000 received services from community support programs.

2. Community support programs in the region served 193 children per 100,000.

SUD OutpatientPrograms

1. In the region, all counties have SUD outpatient programs. The average daily enrollment (ADE) is 28 per 10,000.

2. The region has 3 opioid treatment program all located in Albany County.

2. The region’s ADE of 4 per 10,000 in its opioid treatment programs is the 3rd

lowest among all DSRIP regions.



Appendix A. Highlights of Capital Region Needs Assessment Findings

III. Health Status Capital Region: Health Status Challenges Domain Region/County Comparisons Disease Prevalence Among all DSRIP regions, the region has the highest average percentage of adults with Chronic Health asthma and the second highest average percentage of adults with angina, heart attack Conditions or stroke.

Among all DSRIP regions, the Capital Region has the second highest average AIDS case rate per 100,000.

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

Health Behaviors and Risk Factors

Compared to all DSRIP regions, the region had the second highest average percentages of those who reported binge drinking and who have had poor mental health for 14 or more days in the last month.

Hospitalization Rates by Disease or Cause

Among all DSRIP regions, the Capital region has the second lowest average rate per 10,000 of hospitalizations for cardiovascular disease, but the disease is the leading cause of hospitalizations in the region.

Mortality Greene County’s death rate per 100,000 due to malignant neoplasms is the highest in any NYS county.

Patients in the Public Chronic Health Conditions: Among all DSRIP regions, the region has the highest percentage Mental Health System of patients who are current smokers.

Behavioral Health Diagnoses: Among all DSRIP regions, the region has the highest percentages of patients served with bipolar and related disorders and those with a co-occurring disorder.

IV. Behavioral Health Care Utilization A. Capital 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 percentage of Medicaid beneficiaries with a mental health inpatient hospital admission had depressive disorders (43%), followed by other mental health diagnoses (18%), schizophrenia and chronic stress and anxiety diagnoses (13% each), bi-polar disorder (9%), and PTSD (4%). Substance Use Disorder Region-wide, the largest percentage of Medicaid beneficiaries with a SUD inpatient hospital admission had alcohol use disorder (35%), followed by drug abuse: cannabis/NOS/NEC (21%), opioid use disorder (19%), cocaine use disorder (13%), and other SUD diagnoses (11%).

Compared to all other DSRIP regions, the Capital region had the largest percentage of Medicaid beneficiaries hospitalized with alcohol use disorder (35%).

Medicaid Emergency Room Visits

Mental Health Diagnosis Region-wide by diagnosis, the largest percentage of Medicaid beneficiaries with a mental health ER visit were for depressive disorders (37%), followed by other mental health diagnoses (22%), chronic stress and anxiety diagnoses (14%), schizophrenia (13%), bi-polar disorder (9%), and PTSD (5%).

Compared to all other DSRIP regions, the Capital region had the largest percentage of Medicaid beneficiaries with ER visits for PTSD (5%).



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

Substance Use Disorder Region-wide, the largest percentage of Medicaid beneficiaries with a SUD ER visit were for cocaine use disorder (31%), followed by opioid use disorder (22%), drug abuse: cannabis/ NOS/NEC (20%), other SUD diagnoses (15%), and alcohol use disorder (13%).

Compared to all other DSRIP regions, the Capital region had the largest percentage of ER visits for cocaine use disorder (31%).

B. Capital Region: Medicaid Mental Health and Substance Use Disorder Beneficiaries Compared to All Medicaid Beneficiaries Domain Utilization MH Medicaid In the region, 10% of all Medicaid

beneficiaries had a mental health inpatient hospital admission and 22% had a mental health ER visit.

SUD Medicaid In the region, 4% of all Medicaid beneficiaries had a SUD inpatient hospital admission and 7% had a SUD ER visit.

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

In the region 11% of Medicaid only beneficiaries and 16% of Medicaid/Medicare dual-eligible beneficiaries experienced at least one hospital inpatient admission.

Medicaid Emergency Room Visits

In the region 33% of Medicaid only beneficiaries and 22% of Medicaid/Medicare dual-eligible beneficiaries experienced at least one ER visit.

Compared to all other DSRIP regions, the Capital region had the highest percentage of dual Medicaid/Medicare beneficiaries with ER visits.

V. Unmet Service Needs Capital 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 58% of adults with schizophrenia are adhering to their medications (42% are not).

2. Antidepressant medication management effective acute phase treatment.

2. Region-wide 52% of individuals do not remain on their medication during the entire acute treatment phase.

3. Antidepressant medication management effective continuation phase treatment.

3. Region-wide 36% of individuals remain on their medication during continuation phase treatment (64% do not).

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 54% of individuals have follow-up care within 7 days and 71% follow-up within 30 days of discharge.

These are the highest percentages of follow-up care in any DSRIP region.



Appendix A. Highlights of Capital Region Needs Assessment Findings Capital Region: Summary Highlights of Unmet Service Needs in Behavioral Health Treatment Domain Measure Region/County Comparison

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

2. Region-wide 53% 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 58% 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 EngagementTreatment

1. AOD Initiation 1. Region-wide 50% of individuals initiate AOD treatment within 14 days of diagnosis.

2. AOD Engagement 2. Region-wide 24% of individuals engage in AOD treatment within 30 days after initiation (76% do not).

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 In the dual Medicaid/Medicare population, Columbia County’s ratio for lower-extremity amputation among patients with diabetes (141/42) is the highest ratio in any NYS county.

Among all DSRIP regions, the region has the highest observed to expected ratio of lower-extremity amputation (61/43) in the dual Medicaid/Medicare population.

2. Cardiac Chronic Conditions 2. Among all DSRIP regions, the region has the highest observed to expected rate of angina without procedure (32/25) in the dual Medicaid/Medicare population.

3. Asthma Chronic Conditions 3. Among all NYS DSRIP regions, the region has the lowest observed to expected ratio for asthma in younger adults in the Medicaid only population (43/176) in the dual Medicaid and Medicare population.

VI. Stakeholder Feedback The Capital region counties’ surveys of consumer and provider stakeholders to assess local needs indicate that access to supported housing and community-based services are issues that need attention for the population with mental health concerns, and workforce recruitment and retention is an issue that needs attention for the population with chemical dependency concerns.

Equinox, a clinic in the Capital region, surveyed 17 consumers and six providers regarding community behavioral health needs in its geographic service area. The needs most frequently reported by both consumers and providers include: transportation to health care services; reduced wait times for an appointment; assistance with paying for services; ambulatory detox; inpatient mental health; housing; and convenient provider hours (evenings and weekends).


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