Community Health Needs Assessment Volusia County, Florida 2015 Prepared for Florida Hospital Memorial Medical Center By FQHCmd Consulting Group April 21, 2015
ABOUT FQHCMD CONSULTING FQHCmd Consulting was founded in 2008 and is headquartered in Cape Coral, Florida. The firm serves as a resource that helps healthcare organizations conduct community health needs assessments, develop implementation strategies and address priorities. The firm works closely with Hospitals, Federally Qualified Health Centers, and local government authorities with planning, program assessments, health care strategies and organization and structure development. With a particular focus on the most needy of the community, FQHCmd offers an array of programs that include Needs Assessments, Efficiency and Productivity Audits, Organizational Restructurings, Training and Development, Grant Writing and Compliance Auditing as well as long term Strategic Development and aligning goals with organizations with needs of the community. FQHCmd is a recognized leader in the everchanging health care environment relative to Federally Qualified Health Centers and helps many organizations reach their goals in respect to providing health care to the community s most needy. FQHCmd s fundamental concern is regarding the health of vulnerable people and the organizations that serve them. More information on the firm and its qualifications and partner profiles can be found at www.fqhcmd.com. 1
TABLE OF CONTENTS About FQHCmd Consulting..... 1 Table of Contents.2 Introduction....4 A Diverse and Fragmented County..5 1. Volusia County Service Area...6 2. East Volusia Service Area and Zip Codes....8 3. West Volusia Service Area and Zip Codes....9 4. Southern Volusia Service Area and Zip Codes.....10 Executive Summary Volusia County...... 11 Volusia County by the Numbers.11 Eastern Volusia County Service Area by the Numbers 12 West Volusia Service Area by the Numbers 13 Southern Volusia County Service Area by the Numbers 14 Overall Summary 15 List of Priority Community Needs..19 Community Health Needs Assessment (CHNA) Report... A-1 Methodology. A-2 Analytic Methods... A-2 Information Gaps... A-2 Definition of Community and Service Area s Assessed...A-3 Service Area 1 East Volusia County Service Area.A-5 Service Area 2 West Volusia Service Area....A-7 Service Area 3 Southern Volusia Service Area...A-9 Demographics.A-12 Race A-12 Employment in Volusia County.. A-15 Age Distribution in Volusia County and Service Areas A-17 Key Insights Demographics A-20 Economic Indicators..A-21 Poverty A-21 Poverty, Persons 0 17..A-22 The Medically Underserved. A-24 Medically Underserved Areas of Volusia County....A-25 Income Levels... A-26 Unemployment. A-28 Insurance Coverage.....A-30 Safety Net Funding.A-31 Utilization Rates of Safety Net Clinics..A-34 2
Health Care Reform..A-38 LIP Funding..A-41 Key Insights Economic Indicators.A-44 Health Status and Access Indicators A-46 Health Status Indicators (Core Health Indicators).A-48 Diabetes..A-48 Cardiovascular Disease.A-49 Cancer A-50 Prenatal and Perinatal Health..A-51 Child Health..A-52 Behavior Health.A-53 Additional Health Indicators.A-54 Health Status Indicators Summary..A-55 Health Status Indicator Summary Key Insights A-58 Access to Healthcare.A-59 Population to 1 FTE Primary Care Provider.A-60 Percent of Population below 200% of Poverty.A-61 Percent of Population Uninsured..A-62 Travel time to the nearest Primary Care Provider accepting new Medicaid and Uninsured Patients...A-63 Federally Qualified Health Centers/Look Alikes..A-64 FQHC s and FQHC Look Alikes in Volusia County A-64 Other FQHC s and FQHC Look Alikes close to Volusia County A-65 Hospitals in the Service Area.A-67 Other Safety Net Providers and Resources.A-69 Map of Volusia County, Florida..A-70 3
INTRODUCTION This Community Health Needs Assessment (CHNA) was requested by the Florida Hospital Memorial Medical Center because the hospital wants to better understand community health needs and to possibly develop an effective implementation strategy to address priority needs. The CHNA is focused on Volusia County as a whole, as well as broken down into 3 sub service area, corresponding geographically to the three Florida Hospitals that reside in Volusia County, including Florida Hospital Memorial Medical Center in Daytona Beach, FL; Florida Hospital Deland in Deland, FL and Florida Hospital Fish Memorial located in Orange City, FL. Though Federal regulations require that tax-exempt hospitals provide and report community benefits to demonstrate that they merit exemption from taxation and as specified in the IRS instructions for form 990, community benefits are programs or activities that provide treatment and/or promote health and healing as a response to identified community needs, it was outside of these parameters that this CHNA was developed. Though it is recognized that this CHNA could possibly be used to help meet that requirement, the objective seems to be one and the same. The Community benefit activities or programs seek to achieve objectives, including: improving access to health services enhancing public health, advancing increased general knowledge, and relief of a government burden to improve health 1 This CHNA seeks to identify priority health status and access issues for Volusia County, Florida and populations by focusing on the following questions: Who in the community is most vulnerable in terms of health status or access to care? What are the unique health status and/or access needs for these populations? Where do these people live in the county? 1 Instructions for IRS Form 990, Schedule H, 2014. 4
The question of how the organization and/or community resources to address priority needs has to be addressed following this CHNA. This assessment considers multiple data sources, including secondary data (regarding demographics and measures of health care access), and primary recognized data sources from community surveys, and a multitude of Federal, State and Local reports. The following topics and data area assessed in this report: Demographics, e.g., numbers and locations of vulnerable people Economic issues, e.g., poverty and unemployment rates as well as other economic indicators Community issues, e.g., homelessness, lack of affordable housing, crime and available social services Health status indicators Health access indicators Health disparities indicators Availability of healthcare facilities and resources. The primary focus was on Federal resources rather than State and Local. The assessment identifies a list of community health needs. How the community and/or Florida Hospital addresses those needs is not included in the subject of this report. 5
A DIVERSE AND FRAGMENTED COUNTY When evaluating the overall healthcare needs of Volusia County, it was impossible and impractical to view the county as one entity. With overall significant differences in economic and social factors, such as household income, race, unemployment and access to health care, Volusia County has to be segregated into distinct regions to properly evaluate and determine the needs and the resources of the county and where those needs are more prevalent. This CHNA considers the overall needs of the entire county, but also broke Volusia County into three distinct regions: 1) East Volusia Service Area that includes Ormond Beach, Daytona Beach, and Port Orange and would be the primary service area of Florida Hospital Memorial Medical Center; 2) West Volusia Service Area that includes Deland, De Leon Springs, Pierson and Lake Helen and is the primary service area of Florida Hospital Deland and 3) Southern Volusia County Service Area that includes Deltona, Orange City and Debary and is the primary service area for Florida Hospital Fish Memorial. The three regions combined capture over 86% of the total population of Volusia County. 6
1. Volusia County 7
2. East Volusia Service Area Zip Code City 32174 Ormond Beach 32176 Ormond Beach 32118 Daytona Beach 32117 Daytona Beach 32114 Daytona Beach 32129 Port Orange 32127 Port Orange 32128 Port Orange 32124 Daytona Beach 32119 Daytona Beach 8
3. West Volusia Service Area Zip Code City 32724 Deland 32130 De Leon Springs 32180 Pierson 32720 Deland 32744 Lake Helen 9
4. Southern Volusia Service Area Zip Code City 32725 Deltona 32738 Deltona 32763 Orange City 32713 Debary 10
EXECUTIVE SUMMARY VOLUSIA COUNTY Volusia County by the Numbers Population (2013): 501,201 Population Change since 2000: 11.6% Median Age of Volusia County: 45.3 Median Household Income: $42,457 Unemployment Rate: 5.3% 90% of the county is considered Medically Underserved Poverty Rate in Volusia County: 16.3% Childhood Poverty Rate: 25.3% # of residents considered Medically Underserved: 180,000 % of residents utilizing safety net clinics: 7.34% Population Uninsured: 18.6% Elderly Population: 21.1% 11
Eastern Volusia County Service Area by the Numbers Population (2008-2012): 225,612 Population Change since 2000: 5.1% Median Age of East Volusia: 46.2 Median Household Income: $39,930 Unemployment Rate: 6.0% Residents considered Medically Underserved: 84,527 Residents utilizing safety Net Clinics: 1.29% Population Uninsured: 24.6% Elderly Population: 23.1% 12
West Volusia Service Area by the Numbers Population (2008-2012): 77,446 Population Change since 2000: 14.6% Median Age of West Volusia: 42.5 Median Household Income: $43,110 Unemployment Rate: 5.4% Residents considered Medically Underserved: 29,571 Residents utilizing safety Net Clinics: 18.42% Population Uninsured: 20.7% Elderly Population: 19.3% 13
Southern Volusia County Service Area by the Numbers Population (2008-2012): 128,964 Population Change since 2000: 47.4% Median Age of Southern Volusia: 40.3 Median Household Income: $46,225 Unemployment Rate: 5.3% Residents considered Medically Underserved: 45,193 Residents utilizing safety Net Clinics: 13.26% Population Uninsured: 20.3% Elderly Population: 15.9% 14
Overall Summary Volusia County, which contains 24 ZIP codes in 16 towns (only 7 have over 20,000 residents), benchmarks only favorably on 12 of 33 Core Health Indicators only meet or exceed 1 of the 6 Healthy People 2020 goals examined. Health status and access problems are present, and this assessment seeks to identify the most pressing issues. A person s health is influenced by complex (and interconnected) social and economic factors, including income, education, race/ethnicity, and local environment. Racial and ethnic minority groups, children, the elderly, and those with special needs are more likely to lack the social and economic resources necessary to maintain optimal health. Such inequalities can create barriers to access (to health services, employment, quality education, healthy food, housing, and other necessities and opportunities) and thus contribute to poor health. Demographics 21.1% of the county residents is 65 years old or older and 82.5% are white. Blacks make up 10.5% of the population and Hispanics account for 11.2%. Overall Volusia County is aging, but in the South Volusia County Service Area, the Median Age has dropped significantly since 2000 (47.2 to 40.3). This is predominately due to the larger, younger Hispanic population that is increasing. Hispanics account for over 30% of the Southern Volusia population compared to 11% overall. Blacks in the Eastern Volusia Service Area account for over 35% of the population compared to 10.5% overall and is over twice the state levels. The Eastern Volusia Service Area also has the lowest percentage of white residents (57.8%) compared to Volusia County (82.5%). Economics Poverty, Childhood Poverty, and Medically Underserved individuals are all a concern in Volusia County. Poverty rates are higher than state and national levels with over 16% of the population living in poverty and childhood poverty of over 25%. Both of these trend higher than state and national levels. Medically underserved (persons earning under 200% of the poverty level) account for over 180,000 residents of Volusia County and is at 36.2%. This is almost 10% above national levels. West Volusia has the highest poverty rate (19.2%) and persons considered Medically Underserved (38.2%), while Southern Volusia has the lowest poverty rate (13.3%) and Medically Underserved (35.1%). Median Household Income also trends below state and national averages. Volusia County s Median Income is at $42,457 which is 7.5% below state levels and 20% below national levels. Eastern Volusia s household income trends the lowest in Volusia County with $39,930 which is 6% lower than the county average. This is more dramatic with the black population that has a median household income of $24,259 which 15
is 55% below the national level, 48% below the state level and 43% below the county level. Unemployment for Volusia County fares better than state and national levels currently at 5.3% compared to 5.7% and 5.5% respectively. But we still see pockets of higher unemployment particularly in the east and the Daytona Beach area, where unemployment is over 6%. Volusia County has more people insured than state levels at 83.4% compared to 79.6%, but again the Eastern Volusia Service Area trends lower with only 75.4% of its residents that have health insurance. Eastern Volusia County has more than 50% of its residents on Medicaid or without insurance, compared to Southern Volusia County (37.6%), West Volusia County (38.9%) and Volusia County in total (35.0%). National levels are currently at 36.6%. Safety Net Funding The primary manner the federal government funds for safety net clinics and health centers is through the Federally Qualified Health Center (FQHC) program. This is done through grants and the health centers are required to offer primary medical care, preventative dental, and behavior health. They also participate in the 340 B discount drug program, providing medication on a discount basis to patients that qualify. Volusia County is home to one FQHC; Northeast Florida Health Services (NEFHS). NEFHS has 3 locations in the West Volusia Service area (one in Pierson and two in Deland), and 1 location in the Southern Volusia Service Area (located in Deltona). There are no facilities in the Eastern part of the county. Current annual grant levels for NEFHS is approximately $879,000 and they currently report having slightly over 10,000 patients in total. NEFHS has not obtained the status of a Patient Centered Medical Home. We took the amount of federal funding and compared it to the total number of underserved patients and see that Volusia County lags far behind the state. Currently, Florida receives $19.08 per underserved resident and Volusia County only receives $4.86 from the Federal government through the FQHC program. The main reason appears to be that NEFHS expanded utilizing Low Income Pool funding from the state and local hospital taxing authority funding (West Volusia Hospital Authority). These two funding sources are being greatly reduced (LIP funding is ending June 30, 2015 and with the ACA, the West Volusia Hospital Authority patient base has basically been cut in half. This, in our opinion, coupled with the low federal funding, will leave NEFHS, and parts of the county vulnerable in the near future.* 16
Total FQHC patients (patients of NEFHS and other FQHCs outside of Volusia County but that reside in Volusia County) is 13,295 or about 7.3% of the underserved population. This leaves over 180,000 patients without a medical home. Behavior Factors High rates of smoking during pregnancy and other infant health risk factors are present in Volusia County. The rate of cigarette use during pregnancy is almost twice the state s rate (5.2% v. 2.7%). Also, late entry into prenatal care is a factor in Volusia County with over 28% not entering prenatal care during the first trimester. Volusia County does not reach the Healthy People 2020 levels relative to Low Birth Rate (8.3 v. Healthy People 7.8) and Entry into Prenatal Care (Healthy People 2020 goal is 22%). Also Volusia County ranks worse than state levels in Adult Obesity, Adults with no physical activity in the past 30 days, Women with no Pap Test in the past 3 years, Women with no Mammogram in the past 2 years, Adults who smoke cigarettes, Suicide Rates, and Drug overdoses. Many of these factors contribute to the Age- Adjusted Death rate being significantly higher than state level (778.8 per 100,000 residents compared to 670.0 per 100,000 for the state). Mortality We see Volusia County having higher than state levels in the following Mortality from Diseases of the Heart (192.1 v. 189.6); Cerebrovascular Disease Mortality (44.8 v. 38.7); Colorectal Cancer Mortality (16.8 v. 16.1); and Drug Poisoning Mortality (18.0 v. 14.0). Care Access and Delivery. Cost and an undersupply of certain healthcare providers in the community are resulting in barriers to accessing primary, mental health, and dental care. Community residents also need additional support in improving health literacy and knowledge of available community services. The community has a variety of resources working to address access barriers but they are limited, especially in the Eastern Volusia Service Area. There is one Federally Qualified Health Center (FQHC) with four locations, but three are concentrated in the West Volusia Service Area and the other is in the Southern Volusia Service Area. There is a hospital taxing authority in West Volusia but the patients that qualify has gone down significantly over the past 3 years and there are some mental health and homeless facilities throughout the county, but still limited in all areas. Access to transportation is an issue. From some parts of the county, it takes upwards of 45 minutes to an hour to drive to the nearest safety net clinic. Also over 19% of adults said they could not see a doctor in the past year due to cost. These patients more than likely end up in the local hospitals emergency room. 17
Access to dental is also an issue in Volusia County with 34.4% of adults reporting not going to a dentist in the past year. The table that follows describes the health needs identified throughout the assessment as priorities in Volusia County. These needs are presented in alphabetical order, by category. The prioritized list identifies the 17 most problematic community health needs found by this assessment. *Please note that NEFHS is a client of FQHCmd Consulting, but only information that was obtained through public sources were used. The conclusions are our own. 18
List of Priority Community Needs Access to Care Access to affordable and accessible medical care, especially in the Eastern Service Area, but both the West and Southern Areas are vulnerable. Need for increased Care Coordination. The one FQHC in Volusia County is not moving towards a PCMH model. Health Literacy and Knowledge of available resources. Long Drive times to closest Safety Net provider Limited Federal Funding plus state and local funding decreasing or ceasing. With a large elderly population (22.8%), and no transportation to safety net clinics, many of the elderly underserved will end up in the Emergency Room. Dental Health Access to affordable and accessible dental care in all areas is an issue. The one FQHC offers dental in Deland through 1 dentist and 1 hygienist. This is vulnerable as Low Income Program (LIP) funding is ending June 15. Maternal and Child Smoking during Pregnancy (5.2% current level) Access to Prenatal Care (over 28% late) Immunizations (over 29% of children not receiving recommended immunizations) Morbidity and Mortality High Obesity Rate High Mortality from Diseases form the Heart High Cerebrovascular Disease Mortality High Colorectal Cancer Mortality Behavior Health High Suicide Rate High Drug Overdose Rate Social and Economic Factors Basic Needs Insecurity: Financial Hardships, low wages, high unemployment This is particularly acute within the Black populations in the Eastern Volusia Service Area. 19
FQHCmd Consulting Group 1607 NE 36 Street Cape Coral, FL 33909 Phone: 800.546.7106 Fax: 239.790.3712 www.fqhcmd.com 20