chapter seven, mohawk valley dsrip region needs assessment

Chapter Seven

Mohawk Valley DSRIP Region Needs Assessment

New York State Office of Mental Health

Executive Summary This community needs assessment of the New York State Mohawk Valley 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 Mohawk Valley region includes Fulton, Herkimer, Montgomery, Otsego and Schoharie counties. The region has a population of nearly 265,000 and three of its five counties are designated rural. The socioeconomic characteristics of the region’s population are more indicative of need than those in other DSRIP regions. Its median household income of $46,085 is second lowest among all DSRIP regions. Region-wide, 16% of the population lives below the poverty level (the third highest percentage in any DSRIP region), and 14% receive food stamps/SNAP benefits (the second highest percentage in any DSRIP region). In the Mohawk Valley region, 12% of adults are without a high school diploma and 32% have a bachelor’s degree or higher. In Fulton County, 15% of the adult population have a bachelor’s degree or higher (the second lowest percentage in any NYS county).

Thirty-eight percent of the region’s population is on some type of public health insurance, 25% are Medicaid beneficiaries, and 10% have no health insurance coverage. The percentages of the region’s population on public health insurance and with no health insurance coverage are the second highest percentages in any DSRIP region. Special populations in the region include 15% who are disabled (the highest percentage in any DSRIP region) and 11% who are Veterans (the second highest percentage in any DSRIP region). Three percent of the region’s population is foreign born and 6% speak a primary language other than English.

Health Care Resource Constraints Maldistributions and shortages of health care providers in the Mohawk Valley region are recognized by federal Health Resources and Services Administration (HRSA) health professional shortage area (HPSA) designations. Four counties have a whole county primary care shortage designation, and three counties have a census tract, population or facility designated as a primary care Medically Underserved Area/Population (MUA/P). The Medicaid eligible populations in two counties and the low income population in one county are designated primary care MUPs. All counties in the region have a whole county MH professional shortage designation, and three counties have a census tract, population or facility designated as a MH professional Medically Underserved Area/Population (MUA/P). The Medicaid eligible populations in two counties are designated MH professional MUPs. The Mohawk Valley region has 15 MH professionals per 10,000 population, which is the lowest rate in any DSRIP region. There are no psychiatrists in Herkimer County, and only one each in Fulton and Schoharie.

The region’s total psychiatric bed capacity is 20 per 100,000 adults and 0 per 100,000 children. It is the only DSRIP region that has no psychiatric beds for children. The total average daily census (ADC) per 100,000 adults is 23 (the lowest rate in any DSRIP region), and the total ADC per 100,000 children is 29 (the second lowest rate in any DSRIP region).

There are no substance use disorder (SUD) crisis programs in the region. The region’s one SUD inpatient rehabilitation program is located in Montgomery County, and its three SUD residential programs are located in Fulton, Herkimer, and Montgomery counties. These programs have a total capacity and an average daily enrollment (ADE) of two per 10,000 each, which are the lowest rates in any DSRIP region.

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The Mohawk Valley region has one opioid treatment program located in Montgomery County, and two physicians certified in addiction medicine, who are located in Otsego County.

Health Status Challenges Among all DSRIP regions, the Mohawk Valley region has the highest: 1) Average death rate due to chronic lower respiratory disease. 2) Average death rate due to suicide. Schoharie County’s death rate due to suicide is second highest

in any NYS county. 3) Average percentage of adults that reported they are current smokers. 4) Average percentage of current smokers among adults that report poor mental health.

Compared to all DSRIP regions, the region has the second highest: 1) Premature death rate from cardiovascular disease. 2) Average death rate due to diabetes. Montgomery County’s death rate due to diabetes is the

second highest in any NYS county. 3) Average death rate due to cirrhosis of the liver. 4) Average rates of hospitalizations for stroke and diabetes. 5) Average percentage of adults reporting food insecurity.

Behavioral Health Care Utilization Challenges Compared to all DSRIP regions, the Mohawk Valley region has the highest percentages of Medicaid beneficiaries with: 1) Inpatient hospital admissions for chronic stress and anxiety diagnoses. 2) ER visits for chronic stress and anxiety diagnoses. 3) ER visits for drug abuse: cannabis/NOS/NEC.

Unmet Service Needs Measures of behavioral health medication management suggest unmet need in the region. Sixty-five percent of adults with schizophrenia adhere to anti-psychotic medications (35% do not). Region-wide, 51% of individuals with major depression remain on anti-depressant medication during the entire acute treatment phase and 38% remain on these medications during continuation phase treatment (62% do not). Fifty-two percent of children prescribed ADHD medication have one follow-up visit with a practitioner within 30 days after starting the medication. Sixty 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.

Among all DSRIP regions, the Mohawk Valley region’s percentage of follow-up within seven days (53%) after a mental illness hospitalization is second highest and percentage of follow-up within 30 days (71%) is highest. Schoharie County’s percentages of follow-up after a mental illness hospitalization within seven days (78%) and 30 days (90%) are the highest in any NYS county. Engagement in alcohol and other drug dependence (AOD) treatment also suggests unmet need, with only 21% of individuals engaging in AOD treatment within 30 days after initiation (79% do not). With regard to physical health, high rates of potentially avoidable hospital admissions for cardiac chronic conditions in the Mohawk Valley region also suggest a need for further outpatient resources.

Stakeholder Input The Mohawk Valley region counties’ surveys of consumer and provider stakeholders to assess local needs indicate that access to transportation and workforce recruitment and retention are issues that need attention for the population with mental health concerns, and access to transportation to health care and coordination and integration with other systems are issues that need attention in the population with chemical dependency concerns.


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I. Description of Communities to Be Served

1. Geographic Service Area The Mohawk Valley DSRIP region is in central New York State and is located between the Adirondack and Catskill Mountains. It includes five counties: Fulton, Herkimer, Montgomery, Otsego and Schoharie.

Overall, nearly 265,000 people live in the region (Table 1). Estimated county populations range from a low of 32,653 in Schoharie County to a high of 62,338 in Otsego. Three of the region’s counties have been designated rural by the U.S. Office of Management and Budget (OMB).1

Table 1. Mohawk Valley 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

Fulton 55,373 111.8 Rural Herkimer 64,371 45.6 Urban Montgomery 49,983 124.0 Rural Otsego 62,338 62.2 Rural Schoharie 32,653 52.5 Urban

Totals 264,718 67.3 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

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Population density per square mile ranges from a low of 45.6 in Herkimer County to a high of 124 in Montgomery. The Mohawk Valley region has the third lowest population density of any DSRIP region and is the second most rural.

2. Population Characteristics

A. Gender, Race, Ethnicity and Age In the Mohawk Valley region, slightly more than half (51%) of the population are female (Table 2), and percentages of females range from a low of 50% each in Fulton and Schoharie counties to a high of 52% in Otsego.

Table 2. Mohawk Valley 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

Fulton 55,373 50% 50% 96% 2% 1% 2% 2% 24% 15% Herkimer 64,371 49% 51% 97% 1% 0% 2% 2% 25% 16% Montgomery 49,983 49% 51% 91% 2% 1% 7% 11% 26% 15% Otsego 62,338 48% 52% 95% 2% 1% 2% 3% 24% 16% Schoharie 32,653 50% 50% 96% 1% 1% 2% 3% 24% 16%

Totals 264,718 49% 51% 95% 2% 1% 3% 4% 25% 16% *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 91% in Montgomery County to a high of 97% in Herkimer. Rural Montgomery County is more racially diverse than the region’s urban counties. Seven percent of the county’s population is some other race and 11% identifies as having Hispanic or Latino ethnicity. Region-wide, 2% of the population is African American, 1% is Asian, 3% identify as some other race, and 4% is of Hispanic or Latino ethnicity.

A quarter of the Mohawk Valley population are age 19 and under and 16% are age 65 and over, which is the highest percentage in any DSRIP region. The percentages of these age groups are similar across the region’s counties.

B. Income, Education, Unemployment and Poverty The median household income in the Mohawk Valley region is $46,085 (Table 3), which is second lowest in any DSRIP region, and well below the New York State median household income of $58,687.2 Median household incomes range from a low of $43,402 in Montgomery County to a high of $51,735 in Schoharie.



Table 3. Mohawk Valley 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

Fulton 55,373 44,772 15% 15% 7% 16% 3% 15% Herkimer 64,371 43,996 13% 20% 6% 16% 3% 16% Montgomery 49,983 43,402 17% 17% 7% 19% 3% 16% Otsego 62,338 46,522 12% 27% 5% 16% 2% 9% Schoharie 32,653 51,735 12% 20% 6% 13% 2% 11%

Totals 264,718 46,085 14% 20% 6% 16% 2% 14% 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.

Fourteen percent of the Mohawk Valley region’s population age 25 and older do not have a high school diploma (the second highest percentage in any DSRIP region) and 20% have a bachelor’s degree or higher (the second lowest percentage in any DSRIP region). Educational attainment varies by county. Adults without a high school diploma range from a low of 12% each in Otsego and Schoharie counties to a high of 17% in Montgomery. Adults with a bachelor’s degree or more range from a low of 15% in Fulton County (the second lowest percentage in any NYS county) to a high of 27% in Otsego County.

The region has a 6% unemployment rate and 16% of its population live below the poverty level, which is third highest percentage in any DSRIP region. Rural Montgomery County has the largest percentage (19%) of persons living below the poverty level, while urban Schoharie County has the smallest (13%).

Two percent of the Mohawk Valley region’s population are on cash public assistance and 14% receive food stamps/SNAP benefits (the second highest percentage in any DSRIP region). Food stamps/SNAP beneficiaries range from a low of 9% in Otsego County to a high of 16% each in Herkimer and Montgomery counties.

C. Health Insurance Status In the Mohawk Valley region, 38% of the population are on some type of public health insurance3 and 10% have no health insurance coverage (Table 4). These are the second highest percentages in any DSRIP region. Percentages of the population on public health insurance range from a low of 34% in Otsego County to a high of 41% each in Fulton and Montgomery counties. Those with no health insurance range from a low of 8% each in Otsego and Schoharie counties to a high of 11% in Montgomery.



Table 4. Mohawk Valley 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

Fulton 55,373 41% 10% 38% 39% Herkimer 64,371 40% 10% 38% 30% Montgomery 49,983 41% 11% 41% 30% Otsego 62,338 34% 8% 31% 30% Schoharie 32,653 36% 8% 35% 26%

Totals 264,718 38% 10% 37% 32% 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, 37% are on public health insurance and nearly a third have no health insurance. While the rates of the unemployed on public health insurance are largely comparable to those of the general population, the rates of the unemployed with no health insurance are more than three times as high as those in the general population (32% compared to 10%).

Medicaid Population One quarter of the estimated population in the Mohawk Valley region are Medicaid beneficiaries (Table 5). By county, Medicaid beneficiaries range from a low of 20% each of the populations in Otsego and Schoharie counties to a high of 32% of the population in Fulton County.

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

County US Census

ACS 2010-2014 Est. Population

Total # Medicaid Beneficiaries

% Est. Population Receiving Medicaid

Fulton 55,373 17,888 32% Herkimer 64,371 14,901 23% Montgomery 49,983 15,572 31% Otsego 62,338 12,307 20% Schoharie 32,653 6,554 20%

Totals 264,718 67,222 25% 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 Mohawk Valley region, 67% of Medicaid beneficiaries are adults and 33% are children (Table 6). By county, adult Medicaid beneficiaries range from a low of 65% in Montgomery County to a high of 69% in Otsego County.

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 Mohawk Valley region 80% of Medicaid beneficiaries receive Medicaid only (the second lowest percentage in any DSRIP region) and 20% are dual-eligible. Medicaid only beneficiaries range from a low of 79% each in Fulton and Otsego counties to a high of 82% in Montgomery County.

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

County All Medicaid Beneficiaries

Medicaid Population Eligibility Type

Adults Children Medicaid Only Dual Medicaid and Medicare

# # % # % # % # % Fulton 17,888 11,964 67% 5,924 33% 14,213 79% 3,675 21% Herkimer 14,901 9,940 67% 4,961 33% 11,893 80% 3,008 20% Montgomery 15,572 10,045 65% 5,527 35% 12,811 82% 2,761 18% Otsego 12,307 8,434 69% 3,873 31% 9,699 79% 2,608 21% Schoharie 6,554 4,452 68% 2,102 32% 5,257 80% 1,297 20%

Totals 67,222 44,835 67% 22,387 33% 53,873 80% 13,349 20% 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 Mohawk Valley region, 15% of the population are disabled and 11% are Veterans (Table 7). Among all DSRIP regions, the Mohawk Valley’s percentage of disabled is highest and its percentage of Veterans is second highest. Percentages of individuals with disabilities range from a low of 13% in Otsego County to a high of 16% each in Fulton, Montgomery and Schoharie counties (the highest percentage in any NYS county). The percentage of Veterans is similar across all counties.

There are 227 children 19 years and younger in foster care and 338 individuals in jail in the Mohawk Valley region. Three percent of the population are foreign born, which is the lowest percentage in any DSRIP region.



Table 7. Mohawk Valley Region: Special Populations and Foreign Born


Population

American Community Survey Data 2010-2014 Special Populations

Foreign Born Disabled Veterans

In Foster

Care1 In Jail2

Fulton 55,373 16% 11% 41 101 2% Herkimer 64,371 14% 11% 74 30 3% Montgomery 49,983 16% 10% 31 132 4% Otsego 62,338 13% 10% 37 75 4% Schoharie 32,653 16% 11% 44 - 2%

Totals 264,718 15% 11% 227 338 3% 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 Mohawk Valley region, 93% of this population speak English as their primary language (the second highest percentage in any DSRIP region), 3% each speak Spanish or other Indo-European languages, and 2% speak English less than “very well” (the lowest percentage in any DSRIP region).

Table 8. Mohawk Valley 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

Fulton 52,320 96% 2% 2% 0% 0% 1% Herkimer 60,876 94% 2% 4% 0% 0% 2% Montgomery 47,038 87% 8% 4% 1% 0% 5% Otsego 59,483 94% 2% 3% 1% 0% 1% Schoharie 31,026 96% 1% 2% 0% 0% 1%

Totals 250,743 93% 3% 3% 0% 0% 2%

Percentages of the population aged five and over that speak English as their primary language vary from a low of 87% in Montgomery County to a high of 96% each in Fulton and Schoharie counties (the second highest percentage in any NYS county). Those who speak English less than “very well” range from a low of 1% each in Fulton, Otsego and Schoharie counties to a high of 5% in Montgomery 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 Mohawk Valley DSRIP region. Its findings should be considered with those in Section V of this report, which describes unmet service need by DSRIP region.

Physical Health Care Resources

1. Inpatient Physical Health Care Facilities The Mohawk Valley region has six acute care hospitals and 15 nursing homes that provide inpatient health care (Table 1).

Table 1. Mohawk Valley 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

Fulton 1 74 0 0 0 3 360 0 Herkimer 0 0 0 0 0 4 523 0 Montgomery 2 130 14 0 20 5 350 0 Otsego 2 240 0 0 20 3 384 0 Schoharie 1 40 0 0 0 0 0 0

Totals 6 484 14 0 40 15 1,617 0 Acute care hospital data is from the NYS Open Data Health Facility General Information dataset. Retrieved April 12, 2016 from https://health.data.ny.gov/Health/Health-Facility-General-Information/vn5v-hh5r . Nursing home data is from the NYS Open Data Nursing Home Profile dataset. Retrieved April 12, 2016 from https://health.data.ny.gov/Health/Nursing-Home-Profile/dypu-nabu

In the region, all counties have at least one acute care hospital, except Herkimer. The region has a total of 484 beds where physical health care is the primary type of care provided. Among these beds are 40 psychiatric beds and 14 chemical dependence rehab beds. There are no chemical dependence detox beds in the region. The region’s 15 nursing homes have a total of 1,617 beds, but no behavioral health intervention beds.1 All counties, except Schoharie, have nursing homes.

2. Outpatient Physical Health Care Facilities In the Mohawk Valley region home health care is provided in all counties, except Herkimer (Table 2). Only Fulton and Otsego counties have long-term home health care facilities. The region has five ambulatory surgical centers located in Fulton, Herkimer and Montgomery counties.



Table 2. Mohawk Valley 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

Fulton 1 1 2 0 0 0 Herkimer 0 0 1 0 0 0 Montgomery 1 0 2 0 15 0 Otsego 1 1 0 12 0 0 Schoharie 1 0 0 0 0 0

Totals 4 2 5 12 15 0 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 In the region, there are no federally qualified health centers. There are 12 school-based health centers located in Otsego County and 15 diagnostic and treatment centers located in Montgomery.

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 Mohawk Valley region, family medicine providers include 156 physicians and a total of 142 nurse practitioners and physician assistants (Table 3). The number of family medicine providers of all types is lowest in Schoharie County (n=21) and highest in Fulton (n=97).

Internal medicine providers include 195 physicians and a total of 90 nurse practitioners and physician assistants. The number of internal medicine physicians is highest in Otsego County (n=85) and lowest in Schoharie (n=5). The largest number of internal medicine nurse practitioners and physician assistants are in Fulton County (n=37) and the fewest are in Schoharie (n=7).



Table 3. Mohawk Valley Region: Primary Care Providers

County US Census


Family Medicine

Internal Medicine

Pediatrics Total

Total per 10,000

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

Fulton 55,373 43 54 38 37 36 5 213 38 Herkimer 64,371 34 17 32 14 8 4 109 17 Montgomery 49,983 32 31 35 10 18 8 134 27 Otsego 62,338 35 45 85 22 32 23 242 39 Schoharie 32,653 12 9 5 7 7 0 40 12

Totals 264,718 156 142 195 90 101 40 724 27 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. In the Mohawk Valley region, there are 101 physicians providing pediatric care and 40 pediatric nurse practitioners and physician assistants. The number of pediatric health providers is highest in Otsego County (n=55) and lowest in Schoharie (n=7).

The maldistribution of primary care providers in the Mohawk Valley region is made clearer by looking at the number of providers per 10,000 population in the region’s counties. Schoharie County has 12 primary care providers per 10,000 population (the lowest ratio in any NYS county) and Otsego County has 39.

These maldistribution 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 Mohawk Valley region.

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

County Whole County Census tract,

populations or facilities

Medicaid Eligible population

Low Income Population

Fulton Yes Herkimer Yes Yes Montgomery Yes Yes Otsego Yes Yes Yes Schoharie Yes Yes

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



All counties in the region, except Otsego, have a whole county primary care shortage designation. Three counties, including Otsego, have a census tract, population or facility designated as a primary care Medically Underserved Area/Population (MUA/P). The Medicaid eligible populations in Herkimer and Otsego counties and the low income population in Otsego County are designated primary care MUPs.

Physical Health Medical Specialists The Mohawk Valley region has a total of 321 physical medical health specialists or 12 providers per 10,000 population, which is the third lowest ratio in any DSRIP region (Table 4).

Table 4. Mohawk Valley 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

Fulton 55,373 2 0 8 1 0 0 16 12 37 7 83 15 Herkimer 64,371 0 0 19 7 0 2 7 4 10 0 49 8 Montgomery 49,983 1 1 8 0 1 0 11 8 26 7 63 13 Otsego 62,338 1 0 25 12 3 2 17 10 27 16 113 18 Schoharie 32,653 0 0 1 0 1 0 3 6 2 0 13 4

Total 264,718 4 1 61 20 5 4 54 40 102 30 321 12 MD=medical doctor; DO=doctor of osterpathy; NP=nurse practitioner; PA=physician assistant. Data is from the DSRIP Managed Care Provider Network Database. Retrieved April 21, 2016 from https://www.health.ny.gov/health_care/medicaid/redesign/providernetwork/

Allergy and immunology (n=5) and endocrinology (n=9) providers are in shortest supply, while those in general surgery (n=132) are most prevalent, followed by obstetrics and gynecology (n=94), and cardiology (n=81). The number of medical specialists is highest in Otsego County (n=113) and lowest in Schoharie (n=13). Schoharie County has the third lowest number (n=4) of physical health medical specialists per 10,000 population in any NYS county.

Dentists In the Mohawk Valley region, there is a total of 91 dentists serving the population of nearly than 265,000 residents (Table 5). The number of dentists ranges from a low of five in Schoharie County to a high of 31 in Otsego. Region-wide there are three dentists per 10,000 population, the second lowest rate in any DSRIP region.

Table 5. Mohawk Valley Region: Dentists

County US Census


Number of Dentists Per 10,000 Population

General Dentist

Specialist Dentist

Total

Fulton 55,373 15 3 18 3 Herkimer 64,371 19 0 19 3 Montgomery 49,983 14 4 18 4 Otsego 62,338 29 2 31 5 Schoharie 32,653 5 0 5 2

Totals 264,718 82 9 91 3 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 Mohawk Valley region, there is a total of 145 physical rehabilitation specialists serving the population of nearly 265,000 residents (Table 6).

Table 6. Mohawk Valley Region: Physical Rehabilitation Specialists


Population

Occupational Therapy

Physical Therapy

Speech Therapy

Total Total per

10,000 population

Fulton 55,373 1 12 0 13 2 Herkimer 64,371 3 51 1 55 9 Montgomery 49,983 3 54 1 58 12 Otsego 62,338 1 15 0 16 3 Schoharie 32,653 0 3 0 3 1

Totals 264,718 8 135 2 145 5 Data is from the DSRIP Managed Care Provider Network Database. Retrieved April https://www.health.ny.gov/health_care/medicaid/redesign/providernetwork/

21, 2016 from

In the region, speech therapists (n=2) and occupational therapists (n=8) are in shortest supply, while physical therapists are most prevalent (n=135). The number of physical rehabilitation specialists ranges from a low of three in Schoharie County to a high of 58 in Montgomery. Region-wide there are five physical rehabilitation specialists per 10,000 population, which is the second lowest rate in any DSRIP region.

Behavioral Health Care Resources

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

Mental Health Inpatient Facilities The Mohawk Valley region has a total of 40 adult psychiatric beds (Table 7).5 It is the only DSRIP region that has no psychiatric beds for children. The adult psychiatric beds are located in Montgomery and Otsego counties (n=20 each).

Total psychiatric bed capacity in the region is 20 per 100,000 adults and zero per 100,000 children, which are the lowest psychiatric bed capacity rates in any DSRIP region.



Table 7. Mohawk Valley 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


Totals 40 20 45 23 0 0 19 29 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 Mohawk Valley region, the total inpatient average daily census (ADC) for adult beds is 45, which is larger than the total number of beds (n=40). Herkimer and Otsego counties have the highest total ADC for adults (n=12 each) and Schoharie has the lowest (n=4). In comparison, Fulton County has the highest total ADC for children (n=7) and Schoharie has the lowest (n=1, the second lowest ADC for children in any NYS county).

In the region, the total ADC per 100,000 adults is 23 (the lowest rate in any DSRIP region), while the total ADC per 100,000 children is 29 (the second lowest rate in any DSRIP region). For adults, the total ADC per 100,000 adults is highest for residents of Otsego County (n=26) and lowest for residents of Schoharie (n=15). The total ADC per 100,000 children is highest for residents of Fulton County (n=52) and lowest for residents of Schoharie (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 There are no SUD crisis programs in the Mohawk Valley region (Table 8). The region’s one inpatient rehabilitation program is located in Montgomery County, and its three residential programs are located in Fulton, Herkimer, and Montgomery counties.



Table 8. Mohawk Valley 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

Fulton 55,373 – – – – 1 20 20 4 Herkimer 64,371 – – – – 1 15 15 2 Montgomery 49,983 – – 1 14 1 12 26 5 Otsego 62,338 – – – – – – – – Schoharie 32,653 – – – – – – – –

Totals 264,718 0 0 1 14 3 47 61 2Notes and Data Sources: *Includes State Addiction Treatment Centers. Data is from the NYS Office of Alcoholism and Substance Abuse Services (OASAS) Provider Directory System. Includes programs that were operational as of April 2, 2016. More information about OASAS inpatient programs is available at http://www.oasas.ny.gov/hps/state/CD_descriptions.cfm

The region’s inpatient rehabilitation capacity is 14 and its residential capacity is 47. The regional capacity per 10,000 for all SUD inpatient programs is two, which is the lowest capacity in any DSRIP region.

Table 9 describes the average daily enrollment (ADE) in these programs. The ADE in the region is 12 for inpatient rehabilitation and 39 for residential. The regional ADE per 10,000 for these programs is two, which is the lowest ADE in any DSRIP region.

Table 9. Mohawk Valley 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

Fulton 55,373 – – – – 1 17 17 3 Herkimer 64,371 – – – – 1 12 12 2 Montgomery 49,983 – – 1 12 1 10 22 4 Otsego 62,338 – – – – – – – – Schoharie 32,653 – – – – – – – –

Totals 264,718 0 0 1 12 3 39 50 2 *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 Mohawk Valley region’s capacity and service use in these programs are presented in Table 10.

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

County

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

Clinics: Total Number of Adults Locally Operated Clinics

Recipients in State-operated

Clinics4

Clinic Treatment per 100,000

Adults5Capacity1

(Slots)

Slots per 100,000

Adults5

Medicaid

Recipients2

Non-Medicaid

Recipients

(Estimated #)3

Fulton 93 226 641 376 ─ 2,470 Herkimer ─ - 265 144 892 2,736 Montgomery 150 412 1,789 240 ─ 5,573 Otsego ─ - 1,436 560 ─ 4,299 Schoharie ─ - 411 152 ─ 2,311

Totals 243 124 4,542 1,472 892 3,525 Notes and Data Sources: Clinics are not licensed for specific slot capacities, therefore size is measured by estimated total number of persons served annually. 1. Includes the total capacity for Partial Hospitalization (PH), Intensive Psychiatric Rehabilitative Treatment (IPRT), Continuing Day Treatment (CDT), Personalized Recovery-Oriented Services (PROS) and Assertive Community Treatment (ACT) (Data Source: New York State Office of Mental Health (NYSOMH) CONCERTS database, 10/2015). 2. Includes adults and children enrolled in Medicaid and served annually in non-State clinic programs (Data Source: Medicaid, CY 2014). 3. Includes annual estimate of adults not receiving Medicaid and served in non-State clinics during the NYSOMH 2013 Patient Characteristics Survey (PCS). 4. Includes adults served annually in State-run clinics (Data Source: NYSOMH MHARS database, CY 2014). 5. US Census ACS 2010-2014 Est. Population.

Outpatient programs (other than clinic) are located in Fulton (n=93 slots) and Montgomery (n=150 slots) counties. There are a total of 243 non-clinic outpatient program slots in the region or 124 slots per 100,000 adults. Clinics may be locally- or state-operated. All counties in the region have locally-operated clinics and there are state-operated clinics in Herkimer County.

The locally-operated clinics served a total of 4,542 adult Medicaid recipients and 1,472 adult non-Medicaid recipients. In the region, 3,525 adults received clinic treatment per 100,000 adults. Montgomery County’s rate of 5,573 adults per 100,000 adults is the highest rate in any NYS county. Schoharie County’s service rate of 2,311 adults per 100,000 adults is the lowest in the region. The state-operated clinics in Herkimer County served a total of 892 adults.



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

Table 11. Mohawk Valley 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

Fulton 16 118 258 136 ─ 2,914 Herkimer ─ ─ 76 4 ─ 497 Montgomery ─ ─ 569 228 ─ 6,175 Otsego ─ ─ 719 136 ─ 5,641 Schoharie ─ ─ 161 52 ─ 2,680

Totals 16 24 1,783 556 ─ 3,563 Notes and Data Sources: Clinics are not licensed for specific slot capacities, therefore size is measured by estimated total number of children served annually. 1. Includes the total capacity for Partial Hospitalizations (PH), Day Treatment (DT) and Children's Assertive Community Treatment (ACT) (Data Source: New York State Office of Mental Health (NYSOMH) CONCERTS database, 10/2015). 2. Includes children enrolled in Medicaid and served annually in locally-operated (non-State) clinic programs (Data Source: Medicaid, CY 2014). 3. Includes annual estimate of children not receiving Medicaid and served in locally-operated (non-State) clinics during the week of the NYSOMH 2013 Patient Characteristics Survey (PCS). 4. Includes children served annually in State-run clinics (Data Source: NYSOMH MHARS database, CY 2014). 5. US Census ACS 2010-2014 Est. Population.

In the region, child outpatient programs (other than clinic) are located in Fulton County. These programs have a total of 16 slots or 24 slots per 100,000 children region-wide, which is the second lowest capacity in any DSRIP region. There are locally-operated clinics in all counties, and no state-operated clinics. The locally-operated clinics served a total of 1,783 Medicaid child recipients and 556 non-Medicaid child recipients.

In the Mohawk Valley region, 3,563 children received clinic treatment per 100,000 children, which is the highest rate in any DSRIP region. Montgomery County’s rate of 6,175 children per 100,000 children is the highest in any NYS county. Herkimer County’s service rate of 497 children per 100,000 children is the lowest in the region.



Mental Health Emergency and Community Support Programs

Adults Table 12 describes the Mohawk Valley region’s service use in adult mental health emergency and community support programs. A total of 37 adults were served in emergency programs located in Montgomery and Otsego counties. In the region 19 adults received emergency services per 100,000 adults.

Table 12. Mohawk Valley 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

Fulton ─ ─ 171 398 Herkimer ─ ─ 83 165 Montgomery 16 41 248 641 Otsego 21 42 88 178 Schoharie ─ ─ 73 289

Totals 37 19 663 338 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 region, which collectively served 663 adults. In the region, 338 adults per 100,000 adults received services from community support programs, which is the highest rate in any DSRIP region. In the counties, service rates per 100,000 adults ranged from a low of 165 in Herkimer County to a high of 641 in Montgomery, which is the second highest rate in any NYS county.

Children The Mohawk Valley region’s service use in child mental health emergency and community support programs is presented in Table 13. Forty children received emergency services from programs in Herkimer, Montgomery and Otsego counties. In the region, 61 children received emergency services per 100,000 children, which is the highest rate in any DSRIP region. Montgomery County’s rate of 244 children per 100,000 is the highest rate in any NYS county.

Community support programs for children (e.g., vocational, home-based family treatment, and residential treatment facility transition) are located in all counties in the region and served 184 children. These programs served 280 children per 100,000 children, which is the highest rate in any DSRIP region. In the counties, service rates per 100,000 children ranged from a low of 82 in Herkimer County to a high of 1,046 in Montgomery.



Table 13. Mohawk Valley 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

Fulton ─ ─ 21 189 Herkimer 7 52 11 82 Montgomery 27 244 116 1,046 Otsego 6 52 13 112 Schoharie ─ ─ 23 366

Totals 40 61 184 280 Data Sources: Includes children receiving emergency services and support services (e.g., vocational, home-based family treatment, residential treatment facility transition) as reported by the New York State Office of Mental Health 2013 Patient Characteristics Survey (PCS). US Census ACS 2010-2014 Est. Population. Service use is reported because there are no licensed capacities for nearly all of these programs.

Behavioral Health Housing Programs

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

Table 14. Mohawk Valley 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

Fulton 5 32 19 ─ 30 209 Herkimer 8 21 8 ─ 30 141 Montgomery 7 34 24 ─ 37 280 Otsego ─ 8 8 ─ 34 108 Schoharie ─ 12 14 ─ 31 234

Totals 20 107 73 ─ 162 185 Data Sources: Licensed and unlicensed beds: New York State Office of Mental Health CONCERTS database; data as of 10/2015. US Census ACS 2010-2014 Est. Population.


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


In the region, licensed family care beds (n=20) are located in Fulton, Herkimer and Montgomery counties. Licensed congregate treatment beds (n=107) and apartment treatment beds (n=73) are available in all counties. Unlicensed supported housing beds (n=162) are available in all counties. There are no unlicensed housing support programs in the region. The housing capacity per 100,000 adults in the region is 185. In the counties, housing capacity per 100,000 adults ranged from a low of 108 in Otsego County to a high of 280 in Montgomery.

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). Child housing services in the Mohawk Valley region are described in Table 15.

The region has no teaching family home beds. Licensed child and youth community residence beds (n=18) are located in Montgomery and Otsego counties. The Mohawk Valley region has a capacity of 27 child and youth community residence beds per 100,000 children, which is the highest rate in any DSRIP region.

Table 15. Mohawk Valley 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

Fulton ─ ─ ─ 6 44 Herkimer ─ ─ ─ 6 37 Montgomery ─ 9 70 6 46 Otsego ─ 9 59 12 79 Schoharie ─ ─ ─ 6 75

Totals ─ 18 27 36 55 Data Sources: New York State Office of Mental Health databases. Licensed housing capacity: CONCERTS, 10/2015. Home & Community-based Services (HCBS): CAIRS, CY 2014. US Census ACS 2010-2014 Est. Population.

All counties in the region have HCBS slots (n=36), ranging from a high of 12 in Otsego County to a low of six in each of the other counties. The region’s HCBS slots served 55 children per 100,000 children. In the counties HCBS slots per 100,000 children ranged from a low of 37 in Herkimer County to a high of 79 in Otsego.

Substance Use Disorder Outpatient Programs New York State has a variety of substance use disorder (SUD) outpatient programs including clinic and rehabilitation. In the Mohawk Valley region, all counties have SUD outpatient programs. The average daily enrollment (ADE) in these programs (n=655) is described in Table 16. In the region, Montgomery County has the highest ADE (n=202), and Herkimer County has the lowest (n=94).



Table 16. Mohawk Valley 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

Fulton 55,373 147 27 Herkimer 64,371 94 15 Montgomery 49,983 202 40 Otsego 62,338 116 19 Schoharie 32,653 95 29

Totals 264,718 655 25 Notes and Data Sources: Outpatient programs (OP) include Medically Supervised Outpatient, Outpatient Rehabilitation, Specialized OP – Traumatic Brain Injury, Outpatient Chemical Dependency for Youth, Specialized OP – Mobile, and Specialized Services OP Rehabilitation. Data is from the NYS Office of Alcoholism and Substance Abuse Services (OASAS) Provider Directory System. Includes programs that were operational as of April 2, 2016.

Region-wide, these SUD programs have an ADE of 25 per 10,000. In the counties, ADE per 10,000 ranged from a low of 15 in Herkimer County to a high of 40 in Montgomery.

New York State also has outpatient opioid treatment programs (Table 17). The Mohawk Valley region has one opioid treatment program located in Montgomery County, which has a capacity of 100 and an ADE of 96.

Table 17. Mohawk Valley 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

Fulton 55,373 – – – – – Herkimer 64,371 – – – – – Montgomery 49,983 1 100 20 96 19 Otsego 62,338 – – – – – Schoharie 32,653 – – – – –

Totals 264,718 1 100 4 96 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.

Region-wide the program has a capacity and an ADE of four per 10,000 each.



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

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

County Total # Health Homes

Serving Region # Health Homes Serving County

Fulton

3

1 Herkimer 1 Montgomery 1 Otsego 1 Schoharie 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 Mohawk Valley region is presented in Table 19.

Table 19. Mohawk Valley Region: Licensed Mental Health Professionals

County


Population

Psychiatrists Psychologists LCSWs LMSWs Mental Health

Counseling

Nurse Practitioner -

Psychiatry *Other Total Per 10,000

Fulton 55,373 1 8 26 27 4 3 0 69 12 Herkimer 64,371 0 1 36 37 5 1 3 83 13 Montgomery 49,983 6 6 19 21 11 3 1 67 13 Otsego 62,338 6 17 66 28 14 2 6 139 22 Schoharie 32,653 1 2 19 11 7 2 0 42 13

Totals 264,718 14 34 166 124 41 11 10 400 15 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 Mohawk Valley region has a total of 400 licensed MH professionals or 15 per 10,000 population, which is the lowest rate in any DSRIP region. There are maldistributions of MH professionals across the region’s counties. Otsego County has the highest rate in the region ─ 22 per 10,000, while Fulton County has a rate of 12 per



10,000. There are no psychiatrists in Herkimer County and only one psychiatrist each in Fulton and Schoharie counties.

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

Table 19a. Mohawk Valley Region: HRSA Federal Mental Health Professional Shortage Designations

County Whole County Census tract,

populations or facilities

Medicaid Eligible population

Fulton Yes Yes Herkimer Yes Yes Montgomery Yes Yes Otsego Yes Yes Schoharie Yes Yes HRSA federal shortage designations retrieved March 17, 2016 from http://datawarehouse.hrsa.gov/tools/analyzers/hpsafind.aspx

All counties in the Mohawk Valley region have a whole county MH professional shortage designation (Table 19a). Fulton, Herkimer and Schoharie counties have a census tract, population or facility designated as a MH professional Medically Underserved Area/Population (MUA/P). The Medicaid eligible populations in Montgomery and Otsego counties are designated MH professional 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 Mohawk Valley region is presented in Table 20.

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

County US Census


Physicians Counselors

Total Per 10,000 Population Board Certified

Addiction Medicine

Authorized for Buprenorphine

Prescription

Credentialed Alcoholism and Substance Abuse

Certified Rehabilitation

Fulton 55,373 0 5 10 4 19 3 Herkimer 64,371 0 2 10 9 21 3 Montgomery 49,983 0 7 15 0 22 4 Otsego 62,338 2 7 16 0 23 4 Schoharie 32,653 0 2 8 0 10 3

Totals 264,718 2 23 59 13 95 4 Data is from the NYS Office of Alcoholism and Substance Abuse Services (OASAS) Human Resources Office and is as of May 13, 2016.

SUD physicians include those board certified in addiction medicine and those authorized to prescribe buprenorphine to treat opioid addiction. In the Mohawk Valley region there are two physicians certified in addiction medicine, the second lowest



number in any DSRIP region. 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 have alcoholism and substance abuse counselors, and Fulton and Herkimer have rehabilitation counselors. Overall, the Mohawk Valley region has a total of 95 certified and credentialed SUD professionals or four per 10,000 population, which is the lowest rate in any DSRIP region.

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

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


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

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

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


nursing organizations, which also combine a l l nursing specialties in a general category of “nurse” in their data collection processes.8 HRSA Guidelines for Mental Health HPSA Designation. Retrieved May 24, 2016 from http://bhpr.hrsa.gov/shortage/hpsas/designationcriteria/mentalhealthhpsaguidelines.html


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


III. Health Status

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

1. Disease Prevalence Chronic Health Conditions In the Mohawk Valley region, 8% of adults are diagnosed with diabetes or angina, heart attack or stroke, 29% have high blood pressure, 63% are overweight or obese, and 10% have current asthma (Table 1). The percentages of adults with high blood pressure or current asthma are the third highest in any DSRIP region.

Table 1. Mohawk Valley 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

Fulton 8 9 33 62 13 Herkimer 11 7 29 61 11 Montgomery 8 8 28 66 12 Otsego 7 6 26 62 8 Schoharie 8 9 29 66 8 Region Average 8 8 29 63 10

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

In the region, Herkimer County has the highest percentage of adults with diabetes (11%) and Otsego County has the lowest (7%). Fulton and Schoharie counties have the highest percentages with angina, heart attack or stroke (9% each), and Herkimer has the lowest (7%).

Fulton County has the highest percentages of adults with current asthma (13%) and high blood pressure (33%, which is the third highest percentage in any NYS county). Otsego and Schoharie counties have the lowest percentages with current asthma (8% each), and Otsego County has the lowest percentage with high blood pressure (26%).

The percentages of adults in Montgomery and Schoharie counties that are overweight or obese (66% each) are highest in the region, and the percentage is lowest (61%) in Herkimer County.



HIV, AIDS and Cancer Compared to all DSRIP regions, the Mohawk Valley’s average case rates of HIV and AIDS (4 and 3 per 100,000 respectively) are third lowest. The AIDS case rate per 100,000 ranges from one in Schoharie County to four each in Fulton, Herkimer and Montgomery counties (Table 2). The region’s cancer incidence rate is 499 per 100,000. The highest cancer incidence rate is in Fulton County (n=513) and the lowest is in Otsego (n=484).

Table 2. Mohawk Valley 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

Fulton 6 4 513 Herkimer 6 4 493 Montgomery 3 4 507 Otsego 3 2 484 Schoharie 1 1 498

Region Average 4 3 499 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 Mohawk Valley region, Montgomery County has the highest percentages of adults that report they have experienced food (29%) or housing insecurity (39%) in the past 12 months, and that reported poor mental health for 14 or more days in the last month (16%) (Table 3). Schoharie County has the lowest percentages reporting food insecurity (23%) and poor mental health for 14 or more days in the last month (7%). Fulton County has the lowest percentage reporting housing insecurity (35%).

Table 3. Mohawk Valley 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

Fulton 3,511 21% 24% 35% 5% 29% 11% 13% 65% Herkimer 3,378 14% 25% 36% 6% 26% 14% 15% 36% Montgomery 3,076 17% 29% 39% 5% 23% 11% 16% 58% Otsego 3,040 18% 28% 37% 5% 26% 13% 10% * Schoharie 3,164 15% 23% 36% 4% 19% 12% 7% * Region Total/Avg. 16,169 17% 26% 37% 5% 25% 12% 12% 53% *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



Among all DSRIP regions, the Mohawk Valley region has the second highest percentage of adults reporting food insecurity (26%) and the third highest percentage (12%) that reported poor mental health for 14 or more days.

In the region, Fulton County has the highest percentages of adults that report binge drinking during the past month (21%), current smokers (29%), and cigarette smoking among those that report poor mental health (65%, the highest percentage in any NYS county). Current smoking is lowest in Schoharie County (19%), and Herkimer County has the lowest percentages of binge drinking (14%) and cigarette smoking among those that report poor mental health (36%). Compared to all DSRIP regions, the Mohawk Valley region has the highest percentage of current smokers (25%) and current smoking among those that report poor mental health (53%).

Adults reporting poor health range from a low of 4% in Schoharie County to a high of 6% in Herkimer. Adults reporting they did not receive medical care because of cost range from a low of 11% each in Fulton and Montgomery counties to a high of 14% in Herkimer.

3. Hospitalization Rates by Disease or Cause In the Mohawk Valley region, cardiovascular disease is the leading cause for hospitalizations (Table 4). Fulton County has the highest hospitalization rates per 10,000 due to stroke (n=29), diabetes (n=19), asthma (n=16), and self-inflicted injury (n=12). Montgomery County has the highest rate of hospitalizations for cardiovascular disease (n=158) and self-inflicted injury (n=12). Otsego County has the highest rate for drug-related (n=28), and Schoharie County has the highest rate for newborn drug-related diagnosis (n=202).

Table 4. Mohawk Valley 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

Fulton 1,290 154 29 19 16 12 22 128 Herkimer 1,095 152 27 15 8 11 18 110 Montgomery 1,266 158 28 17 11 12 21 106 Otsego 1,058 134 19 12 9 5 28 112 Schoharie 912 112 18 10 6 6 22 202

Region Average 1,124 142 24 15 10 9 22 131 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

Schoharie County has the lowest hospitalization rates for cardiovascular disease (n=112), stroke (n=18), diabetes (n=10), and asthma and self-inflicted injury (n=6 each). Herkimer County has the lowest hospitalization rate for drug-related (n=18) and Montgomery County has the lowest rate (n=106) for newborn drug-related diagnosis.



Compared to all other DSRIP regions, the Mohawk Valley region has the second highest average rates of hospitalizations per 10,000 for diabetes (n=15).

4. Mortality Rates Premature Mortality In the Mohawk Valley region, the percentage of premature deaths is 37% (Table 5). Premature deaths range from a low of 33% in Montgomery County to a high of 44% in Schoharie.

Among all DSRIP regions, the Mohawk Valley region has the lowest average premature death rate for stroke (n=8) and the second highest premature death rate from cardiovascular disease (n=114). Premature death rates per 100,000 from cardiovascular disease range from a low of 93 in Herkimer County to a high of 134 in Montgomery.

Table 5. Mohawk Valley 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)

Fulton 37 119 9 66 Herkimer 36 93 6 40 Montgomery 33 134 10 51 Otsego 37 116 4 53 Schoharie 44 109 12 40 Average % or Rate 37 114 8 50

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

Rates of alcohol related motor vehicle injuries and deaths per 100,000 range from a low of 40 each in Herkimer and Schoharie counties to a high of 66 in Fulton.

Top Ten Causes of Death Heart disease is the number one cause of death in all counties in the Mohawk Valley region, except Schoharie, where the leading cause of death is malignant neoplasms (Table 6). Among all DSRIP regions, the region has the highest average death rates per 100,000 due to chronic lower respiratory disease (n=51) and suicide (n=15), and the second highest average death rates due to diabetes (n=20) and cirrhosis of the liver (n=10).



Table 6. Mohawk Valley 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

Fulton 205 168 34 0 9 64 33 12 0 8 12 Herkimer 190 150 24 0 16 47 30 22 0 12 19 Montgomery 218 136 20 0 15 63 29 33 0 15 6 Otsego 160 142 31 0 12 46 29 22 0 10 16 Schoharie 154 169 31 0 9 35 22 14 0 5 22 Region Average 185 153 28 0 12 51 29 20 0 10 15 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.

In the region, Montgomery County has the highest death rate due to diabetes (n=33), and Schoharie County has the highest death rate due to suicide (n=22), which are the second highest rates in any NYS county.

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

Chronic Health Conditions Overall, smoking (32%), high blood pressure (18%) and obesity (17%) are the leading chronic health conditions for the public mental health population in the Mohawk Valley region (Table 7).

Table 7. Mohawk Valley 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 8 1 6 1 0 0 0 21-64 44 11 22 23 16 2 2 65+ 15 23 17 46 27 5 5 Total Average 32 9 17 18 12 1 2 Data is from the NYS Office of Mental Health 2015 Patient Characteristics Survey. Data retrieved April 28, 2016.

Among all DSRIP regions, the Mohawk Valley region has the highest percentage of patients served that had a stroke (2%), and the second highest percentage that are current smokers.



Among patients under the age of 21, the region has the second highest percentage that are current smokers (8%) in all DSRIP regions.

For patients aged 21-64, it has the highest percentage that have had a heart attack or stroke (2% each) and the second highest percentages of those that are current smokers (44%) and have high blood pressure (23%) in all DSRIP regions.

For patients aged 65 and older, the Mohawk Valley region has the highest percentage of those that have had a stroke (5%) in all DSRIP regions.

Behavioral Health Diagnoses Overall, depressive disorders (30%) and bipolar and related disorders (18%) are the leading behavioral health diagnoses for the public mental health population in the region (Table 8).

Table 8. Mohawk Valley 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 9 16 15 4 28 2 13 4 2 21-64 10 19 35 1 1 20 11 2 20 65+ 11 12 41 0 0 23 8 5 5 Total Average 10 18 30 2 9 15 11 3 14 Data is from the NYS Office of Mental Health 2015 Patient Characteristics Survey. Data retrieved April 28, 2016.

Among all DSRIP regions, the Mohawk Valley region has the highest percentages of patients served with depressive disorders (30%) and neurodevelopmental disorders (9%). The region has the second highest percentage of those served with anxiety disorder (10%), and the lowest percentage with a co-occurring disorder (14%).

Among patients under the age of 21, the region has the second highest percentages of those with bipolar (16%) and neurodevelopmental disorders (28%), and the lowest percentages of those with disruptive impulse conduct disorder (4%) and with a co-occurring disorder (2%) in all DSRIP regions.

For patients ages 21-64, it has the highest percentage of those with depressive disorders (35%), the second highest percentages of those with anxiety disorder (10%) and bipolar and related disorders (19%), and the lowest percentage of those with a co-occurring disorder (20%) in all DSRIP regions.

For patients ages 65 and older, the Mohawk Valley region has the highest percentages of those with anxiety disorders (11%), depressive disorders (41%),



and trauma, stress or adjustment (8%), and the lowest percentages of those with schizophrenia spectrum and other psychotic disorders (23%) and with a co-occurring disorder (5%) 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 Mohawk Valley 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 Mohawk Valley region with inpatient hospital admissions (n=5,109) by mental health diagnosis. By county, admissions ranged from a high of 1,829 in Fulton to a low of 211 in Schoharie. Region-wide, the largest percentages of Medicaid beneficiaries with a mental health inpatient hospital admission had depressive disorders (47%), followed by other mental health diagnoses (16%), chronic stress and anxiety diagnoses (15%), schizophrenia (13%), bi-polar disorder (8%), and PTSD (2%).

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

County

Bi-Polar Disorder Depressive Disorders

Schizophrenia Chronic Stress and Anxiety Diagnoses

Post Traumatic Stress Disorder

Other Mental Health Diagnoses

Total Medicaid Beneficiaries with

Number/Percentage of Medicaid Beneficiaries MH Inpatient

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

Fulton 187 10% 789 43% 260 14% 242 13% 52 3% 299 16% 1,829 Herkimer 81 7% 578 49% 121 10% 201 17% 14 1% 188 16% 1,183 Montgomery 92 7% 582 46% 184 15% 173 14% 24 2% 198 16% 1,253 Otsego 37 6% 314 50% 68 11% 92 15% 20 3% 102 16% 633 Schoharie 8 4% 128 61% 25 12% 42 20% 0 0% 8 4% 211

Totals 405 8% 2,391 47% 658 13% 750 15% 110 2% 795 16% 5,109 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 Fulton County (10%), chronic stress and anxiety diagnoses (20%) and depressive disorders (61%) in Schoharie County, schizophrenia in Montgomery County (15%), and PTSD in Fulton and Otsego counties (3% each). The percentage of other mental health diagnoses was 16% in all counties, except Schoharie (4%).

Compared to all other DSRIP regions, the Mohawk Valley region had the largest percentage of Medicaid beneficiaries with hospital admissions for chronic stress and anxiety diagnoses (15%).



Table 2 describes the number of Medicaid inpatient hospital admissions in the Mohawk Valley region (n=9.045) by mental health diagnosis. By county, admissions ranged from a high of 3,139 in Fulton County to a low of 391 in Schoharie.

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

County Bi-Polar Disorder


Schizophrenia Chronic Stress

and Anxiety Diagnoses


Other Mental Health

Diagnoses

Total Number of

MH

Number of Admissions Admissions

Fulton 322 1,377 433 425 96 536 3,189 Herkimer 167 1,053 251 364 43 410 2,288 Montgomery 170 932 300 311 51 336 2,100 Otsego 62 527 119 149 32 188 1,077 Schoharie 13 240 43 75 0 20 391

Totals 734 4,129 1,146 1,324 222 1,490 9,045 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 Fulton (n=1,337). Across counties, admissions were highest in Fulton County for all diagnoses.

Mental Health Diagnosis Emergency Room Visits Table 3 describes the total number of Medicaid beneficiaries in the Mohawk Valley region with emergency room visits (n=12,803) by mental health diagnosis. By county, ER visits ranged from a high of 4,247 in Fulton to a low of 1,099 in Schoharie.

Table 3. Mohawk Valley 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

BeneficiariNumber/Percentage of Medicaid Beneficiaries

es with MH ER Visit

# % # % # % # % # % # % Fulton 402 9% 1,616 38% 547 13% 571 13% 125 3% 986 23% 4,247 Herkimer 166 7% 959 40% 278 12% 406 17% 50 2% 535 22% 2,394 Montgomery 210 7% 1,234 42% 390 13% 453 15% 85 3% 600 20% 2,972 Otsego 119 6% 812 39% 237 11% 334 16% 99 5% 490 23% 2,091 Schoharie 82 7% 439 40% 119 11% 228 21% 29 3% 202 18% 1,099

Totals 979 8% 5,060 40% 1,571 12% 1,992 16% 388 3% 2,813 22% 12,803 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 (40%), followed by other mental health diagnoses (22%), chronic stress and anxiety diagnoses (16%), schizophrenia (12%), bi-polar disorder (8%), and PTSD (3%).

In the region, the percentages of Medicaid beneficiaries with ER visits were highest by diagnosis in the following counties: depressive disorders in Montgomery County (42%), bipolar disorder in Fulton County (9%), schizophrenia in Fulton and Montgomery counties (13% each), chronic stress and anxiety diagnoses in Schoharie County (21%), PTSD in Otsego County (5%) and other mental health diagnoses in Fulton and Otsego counties (23% each).

Compared to all other DSRIP regions, the Mohawk Valley region had the largest percentage of Medicaid beneficiaries with ER visits for chronic stress and anxiety diagnoses (16%).

Table 4 describes the total number of Medicaid ER visits in the Mohawk Valley region (n=40,504) by mental health diagnosis. By county, ER visits ranged from a high of 13,171 in Fulton County to a low of 3,373 in Schoharie.

Table 4. Mohawk Valley 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

Fulton 1,457 4,712 1,655 1,972 443 2,932 13,171 Herkimer 558 2,820 891 1,248 227 1,699 7,443 Montgomery 685 3,932 1,213 1,624 269 1,662 9,385 Otsego 507 2,529 781 1,299 382 1,634 7,132 Schoharie 311 1,259 399 648 127 629 3,373

Totals 3,518 15,252 4,939 6,791 1,448 8,556 40,504 Data is from the NYS Department of Health Medicaid Chronic Conditions and Emergency Room Visits database, 2012 data. Retrieved May 4, 2016 from https://health.data.ny.gov/Health/Medicaid-Chronic-Conditions-Inpatient-Admissions-a/wybq-m39t

Depressive disorders accounted for the largest number of ER visits in all counties and were highest in Fulton (n=4,712). Across counties, ER visits were highest in Fulton County for all diagnoses.

Medicaid Mental Health Beneficiaries Compared to All Medicaid Beneficiaries Table 5 describes Medicaid mental health beneficiaries compared to all Medicaid beneficiaries in the Mohawk Valley region. In the region, 8% of all Medicaid beneficiaries had a mental health inpatient hospital admission and 19% had a mental health ER visit. By county, Fulton had the highest percentage of Medicaid beneficiaries with a mental health inpatient admission (10%), while Schoharie had the lowest (3%). Fulton County had the highest percentage of Medicaid beneficiaries with a mental health ER visit (24%) and Herkimer had the lowest (16%).



Table 5. Mohawk Valley 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 %

Fulton 17,888 1,829 10% 4,247 24% Herkimer 14,901 1,183 8% 2,394 16% Montgomery 15,572 1,253 8% 2,972 19% Otsego 12,307 633 5% 2,091 17% Schoharie 6,554 211 3% 1,099 17%

Totals 67,222 5,109 8% 12,803 19% 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

2. Medicaid Beneficiaries with Substance Use Disorders

Substance Use Disorder Inpatient Admissions Table 6 describes the total number of Medicaid beneficiaries in the Mohawk Valley region with inpatient hospital admissions (n=1,356) by substance use disorder (SUD). By county, admissions ranged from a high of 506 in Fulton to a low of 11 in Schoharie. Region-wide, the largest percentages of Medicaid beneficiaries with a SUD inpatient hospital admission had alcohol use disorder (32%), followed by opioid use disorder and drug abuse: cannabis/NOS/NEC (23% each), other SUD diagnoses (14%), and cocaine use disorder (8%).

Table 6. Mohawk Valley 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

SUD Inpatient Number/Percentage of Medicaid Beneficiaries

Admission # % # % # % # % # %

Fulton 32 6% 172 34% 117 23% 111 22% 74 15% 506 Herkimer 33 10% 96 29% 63 19% 94 28% 46 14% 332 Montgomery 46 11% 116 29% 103 26% 82 20% 56 14% 403 Otsego 0 0% 39 38% 24 23% 27 26% 14 13% 104 Schoharie 0 0% 11 100% 0 0% 0 0% 0 0% 11

Totals 111 8% 434 32% 307 23% 314 23% 190 14% 1,356 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 (100%, highest in any NYS county) in Schoharie County, drug abuse: cannabis/ NOS/NEC in Herkimer County



(28%), cocaine use disorder (11%) and opioid use disorder (26%) in Montgomery County, other SUD diagnoses in Fulton County (15%).

Table 7 describes the number of Medicaid inpatient hospital admissions in the Mohawk Valley region (n=2,572) by substance use disorder. By county, admissions ranged from a high of 972 in Fulton County to a low of 17 in Schoharie.

Table 7. Mohawk Valley 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

Fulton 32 172 117 111 74 972 Herkimer 33 96 63 94 46 683 Montgomery 46 116 103 82 56 696 Otsego 0 39 24 27 14 204 Schoharie 0 11 0 0 0 17

Totals 111 434 307 314 190 2,572 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, and were highest in Fulton (n=172). Across counties, admissions for all disorders were highest in Fulton County, except for cocaine use disorder, which was highest in Montgomery.

Substance Use Disorder Emergency Room Visits Table 8 describes the total number of Medicaid beneficiaries in the Mohawk Valley region with emergency room (ER) visits (n=2,898) by substance use disorder. By county, ER visits ranged from a high of 924 in Fulton to a low of 190 in Schoharie. Region-wide, the largest percentages of Medicaid beneficiaries with a SUD ER visit were for cocaine use disorder (28%), followed by drug abuse: cannabis/NOS/NEC (24%), opioid use disorder (22%), other SUD diagnoses (17%), and alcohol use disorder (8%).

In the region, the percentages of Medicaid beneficiaries with ER visits were highest by disorder in the following counties: cocaine use disorder in Otsego and Schoharie counties (32% each), alcohol use disorder in Montgomery County (11%), opioid use disorder in Herkimer County (24%), drug abuse: cannabis/NOS/NEC in Schoharie County (33%, highest in any NYS county), and other SUD diagnoses in Fulton County (19%).



Compared to all other DSRIP regions, the Mohawk Valley region had the largest percentage of Medicaid beneficiaries with ER visits for drug abuse: cannabis/NOS/NEC (24%).

Table 8. Mohawk Valley 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

# % # % # % # % # %

Fulton 263 28% 76 8% 205 22% 209 23% 171 19% 924 Herkimer 186 26% 73 10% 172 24% 154 22% 131 18% 716 Montgomery 184 27% 74 11% 146 21% 179 26% 106 15% 689 Otsego 120 32% 17 4% 71 19% 102 27% 69 18% 379 Schoharie 60 32% 0 0% 40 21% 63 33% 27 14% 190

Totals 813 28% 240 8% 634 22% 707 24% 504 17% 2,898Data 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 Mohawk Valley region (n=11,046) by substance use disorder. By county, ER visits ranged from a high of 3,560 in Fulton County to a low of 579 in Schoharie. Drug abuse: cannabis/NOS/NEC accounted for the largest number of ER visits in Fulton, Montgomery and Otsego counties and were highest in Fulton (n=949).

Table 9. Mohawk Valley 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

Fulton 921 230 850 949 610 3,560 Herkimer 618 297 595 527 538 2,575 Montgomery 573 283 588 681 335 2,460 Otsego 444 97 413 545 373 1,872 Schoharie 171 0 169 165 74 579

Totals 2,727 907 2,615 2,867 1,930 11,046 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

Cocaine use disorder accounted for the largest number of ER visits in Herkimer and Schoharie counties, and were highest in Fulton (n=921). Across counties, ER visits for all disorders were highest in Fulton County, except alcohol use disorder, which were highest in Herkimer.



Medicaid Substance Use Disorder Beneficiaries Compared to All Medicaid Beneficiaries Table 10 describes Medicaid SUD beneficiaries compared to all Medicaid beneficiaries in the Mohawk Valley region. In the region, 2% of all Medicaid beneficiaries had a SUD inpatient hospital admission and 4% had a SUD ER visit. By county, Fulton and Montgomery counties have the highest percentage of Medicaid beneficiaries with a SUD inpatient admission (3% each), while Schoharie had the lowest (0%). Fulton and Herkimer counties have the highest percentage of Medicaid beneficiaries with a SUD ER visit (5% each) and Otsego and Schoharie have the lowest (3% each).

Table 10. Mohawk Valley 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 %

Fulton 17,888 506 3% 924 5% Herkimer 14,901 332 2% 716 5% Montgomery 15,572 403 3% 689 4% Otsego 12,307 104 1% 379 3% Schoharie 6,554 11 0% 190 3%

Totals 67,222 1,356 2% 2,898 4% Data is from the NYS Department of Health Medicaid Chronic Conditions and Inpatient Admissions data base, 2012 data. Retrieved May 4, 2016 from https://health.data.ny.gov/ Health/Medicaid-Chronic-Conditions-Inpatient-Admissions-a/2yck-xisk#Export

3. Medicaid Beneficiary Hospital Inpatient Admissions and Emergency Room Visits

Medicaid Beneficiaries by Eligibility Type In the Mohawk Valley region 25% of the estimated population are Medicaid beneficiaries (Table 11). By county, Medicaid beneficiaries range from a high of 32% of the estimated population in Fulton County to a low of 20% each of the estimated populations in Otsego and Schoharie counties.

Table 11. Mohawk Valley 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.

Fulton 55,373 17,888 32% 14,213 79% 3,675 21% Herkimer 64,371 14,901 23% 11,893 80% 3,008 20% Montgomery 49,983 15,572 31% 12,811 82% 2,761 18% Otsego 62,338 12,307 20% 9,699 79% 2,608 21% Schoharie 32,653 6,554 20% 5,257 80% 1,297 20%

Totals 264,718 67,222 25% 53,873 80% 13,349 20%

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 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 Mohawk Valley region, 80% of Medicaid beneficiaries receive Medicaid only and 20% are dual-eligible. Medicaid only beneficiaries range from a low of 79% in Fulton County to a high of 82% in Montgomery.

Medicaid Beneficiary Hospital Inpatient Admissions Medicaid beneficiary hospital inpatient admissions in the Mohawk Valley region are described in Table 12.2 In the region, 9% of Medicaid only beneficiaries and 15% of Medicaid/Medicare dual-eligible beneficiaries experienced at least one hospital inpatient admission.

Table 12. Mohawk Valley Region: Total Medicaid Inpatient Hospital Admissions by Type of Beneficiary

County

Number of Beneficiaries Number of Beneficiaries

with Inpatient Admissions Total Inpatient

Hospital Admissions

Medicaid Only

Dual Medicaid and Medicare


Medicaid Only


# # # % # % # #

Fulton 14,213 3,675 1,350 9% 589 16% 1,933 788 Herkimer 11,893 3,008 1,220 10% 407 14% 1,647 542 Montgomery 12,811 2,761 989 8% 443 16% 1,327 574 Otsego 9,699 2,608 924 10% 343 13% 1,230 423 Schoharie 5,257 1,297 437 8% 172 13% 572 227

Totals 53,873 13,349 4,920 9% 1,954 15% 6,709 2,554 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 ranged from a high of 10% each in Herkimer and Otsego counties to a low of 8% each in Montgomery and Schoharie counties. In comparison, hospital inpatient admissions in the dual-eligible Medicaid/Medicare population ranged from a low of 13% each in Otsego and Schoharie counties to a high of 16% each in Fulton and Montgomery counties.

Medicaid Beneficiary Emergency Room Visits Emergency room (ER) visits among Medicaid beneficiaries in the Mohawk Valley region are described in Table 13.3 In the region, 33% of Medicaid only beneficiaries and 20% 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 28% in Herkimer County to a high of 36% in Fulton. In comparison, ER visits for the Medicaid/Medicare dual-eligible population ranged from a low of 17% in Herkimer County to a high of 25% in Schoharie.



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

County

Number of Beneficiaries Number of Beneficiaries

with ER Visits Total ER Visits



Medicaid Only


# # # % # % # #

Fulton 14,213 3,675 5,091 36% 738 20% 10,856 1,598 Herkimer 11,893 3,008 3,388 28% 497 17% 6,453 1,040 Montgomery 12,811 2,761 4,266 33% 574 21% 8,816 1,103 Otsego 9,699 2,608 3,108 32% 483 19% 6,285 1,140 Schoharie 5,257 1,297 1,719 33% 322 25% 3,225 730

Totals 53,873 13,349 17,572 33% 2,614 20% 35,635 5,611 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

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

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


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


V. Unmet Service Needs

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

In the Mohawk Valley region the 65% of adults with schizophrenia adhere to their antipsychotic medications (35% do not). Adherence to antipsychotics ranges from a low of 57% in Fulton County to a high of 69% in Montgomery (Table 1).

In the region, 51% of individuals remained on antidepressant medication during the acute treatment phase and 38% remained on antidepressant medication during the continuation phase (62% did not). Among all DSRIP regions, the Mohawk Valley region has the second highest adherence to antidepressants for the continuation phase.

Adherence to antidepressants is lowest in Montgomery County for both the acute (47%) and continuation (31%, the lowest in any NYS county) phases, and highest in Schoharie County for both the acute (56%) and continuation (46%) phases.



Table 1. Mohawk Valley 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

Fulton 57% 53% 39% Herkimer 59% 51% 38% Montgomery 69% 47% 31% Otsego * 51% 39% Schoharie * 56% 46%

Region Avg. % 65% 51% 38% *Sample size too small to report. Notes and Data Sources: Data is from the NYS Department of Health -Medicaid clinical metrics for Clinical Improvement Projects (Domain 3) of the DSRIP Program database, measurement year 2014 data.

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

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

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

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

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

Among all DSRIP regions, the Mohawk Valley region’s percentage of follow-up within seven days after a mental illness hospitalization (53%, Table 2) is second highest and percentage of follow-up within 30 days (71%) is highest. In the region, percentages of follow-up after a mental illness hospitalization are lowest in Otsego County within both seven (36%) and 30 days (49%). Schoharie County’s percentages of follow-up after a mental illness hospitalization within seven (78%) and 30 days (90%) are the highest in any NYS county.



Table 2. Mohawk Valley 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

Fulton 59% 75% 53% 56% Herkimer 44% 58% 47% 44% Montgomery 52% 82% 59% * Otsego 36% 49% 51% * Schoharie 78% 90% 50% *

Region Avg. % 53% 71% 52% 60% *Sample Size Too Small to Report. Notes and Data Sources: Data is from the NYS Department of Health -Medicaid clinical metrics for Clinical Improvement Projects (Domain 3) of the DSRIP Program database, measurement year 2014 data.

Region-wide the percentages of children prescribed ADHD medication that had follow-up care are 52% during the initiation phase and 60% during the continuation phase. In the region, the percentages of children with follow-up care after ADHD medication are lowest in Herkimer County for both the initiation (47%) and continuation (44%) phases. The highest rates of adherence are found in Montgomery (59%, initiation phase) and Fulton (56%, continuation phase) counties.

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

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

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

In the Mohawk Valley region, 52% of individuals initiate treatment within 14 days of AOD dependence diagnosis (Table 3) and 21% engage in treatment within 30 days after initiation (79% do not). The region has the second highest percentage of AOD initiation treatment in any DSRIP region.



Table 3. Mohawk Valley Region: Alcohol and Other Drug Dependence Treatment

County Alcohol and Other Drug Dependence Treatment

Initiation Engagement

Fulton 52% 19% Herkimer 54% 23% Montgomery 51% 19% Otsego 50% 19% Schoharie 52% 27%

Region Avg. % 52% 21% Notes and Data Sources: Data is from the NYS Department of Health - Medicaid clinical metrics for Clinical Improvement Projects (Domain 3) of the DSRIP Program database, measurement year 2013 data.

In the region, Otsego County has the lowest percentage of AOD initiation treatment (50%) and Herkimer County has the highest (54%). Fulton, Montgomery and Otsego counties have the lowest percentage of AOD engagement treatment (19% each) and Schoharie has the highest (27%).

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 Mohawk Valley region’s Medicaid only population, ratios of diabetes short-term complications range from a high of 280/121 in Fulton County (the highest ratio in any NYS county) to a low of 38/121 in Herkimer (Table 4a). In this population, all counties in the region have a lower rate of observed than expected hospitalizations for diabetes long-term complications.

Among all DSRIP regions, the Mohawk Valley’s Medicaid only population has the lowest observed to expected ratio of diabetes long-term complications (54/106).



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

County

Diabetes Short-term Complications Diabetes Long-term Complications



Rates per 100,000

Observed Expected Observed Expected Observed Expected Observed Expected


Totals 115 121 83 96 54 106 160 249 Notes and Data Sources: Data is from the NYS Department of Health Quality Prevention Quality Indicators – Adult (AHRQ PQI) for Medicaid Enrollees database, discharge year 2014 data. Retrieved May 6, 2016 from https://health.data.ny.gov/Health/Medicaid-Inpatient-Prevention-Quality-Indicators-P/6kjt-7svn

For the dual Medicaid and Medicare population, Otsego County has the highest observed to expected ratio for diabetes short-term complications (184/95), and Schoharie County has the highest ratio for diabetes long-term complications (360/242, the highest in any NYS county).

Table 4b describes uncontrolled diabetes and lower-extremity amputation rates among patients with diabetes. In the region’s Medicaid only population, Montgomery has the highest observed to expected ratio of uncontrolled diabetes (24/18) and Herkimer and Schoharie counties have observed rates of zero. In the dual Medicaid and Medicare population, Fulton County has the highest observed to expected ratio for uncontrolled diabetes (51/35), and all other counties have observed rates of zero.

Table 4b. Mohawk Valley Region: Diabetes Chronic Conditions Inpatient Prevention Quality

County

Uncontrolled Diabetes Lower-Extremity Amputation

among Patients with Diabetes



Rates per 100,000

Observed Expected Observed Expected Observed Expected Observed Expected


Totals 12 21 10 32 12 12 37 40 Notes and Data Sources: Data is from the NYS Department of Health Quality Prevention Quality Indicators – Adult (AHRQ PQI) for Medicaid Enrollees database, discharge year 2014 data. Retrieved May 6, 2016 from https://health.data.ny.gov/Health/Medicaid-Inpatient-Prevention-Quality-Indicators-P/6kjt-7svn



For lower-extremity amputation among patients with diabetes, Otsego County has the highest ratios in both the Medicaid only (60/13, the highest ratio in any NYS county) and dual (110/39) populations. In the Medicaid only population all other counties have no observed cases of lower-extremity amputation among patients with diabetes, and in the dual population Fulton, Herkimer and Montgomery counties have no observed cases.

Compared to all DSRIP regions, the Mohawk Valley region has the second lowest observed to expected ratio for uncontrolled diabetes in the dual Medicaid and Medicare population (10/32).

Cardiac Chronic Conditions Table 5a describes cardiac chronic conditions indicator rates. In the Medicaid only population, Herkimer has the highest observed to expected ratio (50/38) for hypertension, and Otsego and Schoharie counties have zero observed rates. In the dual Medicaid and Medicare population, Fulton County has the highest ratio for hypertension (76/73), and all other counties have a lower observed than expected rate.

Table 5a. Mohawk Valley 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

Fulton 11 39 76 73 0 96 481 577 0 12 0 23 Herkimer 50 38 31 77 113 95 786 636 0 12 31 22 Montgomery 48 41 35 90 84 100 766 633 24 12 0 24 Otsego 0 39 74 75 105 105 884 599 0 13 37 22 Schoharie 0 38 72 75 185 102 505 596 0 13 0 23

Total 22 39 58 78 97 100 684 608 5 12 14 23 Notes and Data Sources: Data is from the NYS Department of Health Quality Prevention Quality Indicators – Adult (AHRQ PQI) for Medicaid Enrollees database, discharge year 2014 data. Retrieved May 6, 2016 from https://health.data.ny.gov/Health/Medicaid-Inpatient-Prevention-Quality-Indicators-P/6kjt-7svn

Schoharie County has the highest observed to expected ratio for heart failure (185/102) in the Medicaid only population, and Otsego County has the highest ratio in the dual population (884/599, the second highest ratio in any NYS county). Compared to all DSRIP regions, the Mohawk Valley has the highest observed to expected ratio for heart failure in the dual Medicaid and Medicare population (684/608).

Asthma Chronic Conditions Asthma chronic conditions are described in Table 5b. In the Mohawk Valley region, Fulton County has the highest observed to expected ratio for asthma in younger adults in the Medicaid only population (120/82) and Schoharie has a zero observed rate. In the dual Medicaid and Medicare population, all counties have a zero observed rate of asthma discharges.



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

County

Asthma in Younger Adults


Rate per 100,000

Observed Expected Observed Expected

Fulton 120 82 0 125 Herkimer 40 79 0 116 Montgomery 19 96 0 169 Otsego 73 79 0 113 Schoharie 0 76 0 119

Total 50 82 0 128 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 Mohawk Valley 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 Mohawk Valley region’s Medicaid only population, Fulton County has the highest observed to expected ratios for the overall composite (1,001/949) and acute composite (334/267) indicators (Table 6). For the chronic composite indicator, all counties have lower observed than expected rates in this population. The lowest ratios for these indicators are in Schoharie County (acute composite, 212/282) and Herkimer (overall composite, 663/944, chronic composite, 375/677).



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

County

Overall Composite Acute Composite Chronic Composite




Rate per 100,000


Fulton 1,001 949 3,543 3,042 334 267 1,620 1,159 667 682 1,924 1,883 Herkimer 663 944 4,211 3,180 288 267 2,106 1,254 375 677 2,106 1,926 Montgomery 854 985 3,586 3,225 277 272 1,706 1,206 578 714 1,880 2,020 Otsego 764 996 3,535 3,074 270 276 1,252 1,184 494 719 2,283 1,891 Schoharie 767 1,002 3,100 3,108 212 282 1,009 1,186 556 720 2,091 1,922

Totals 810 975 3,595 3,126 276 273 1,539 1,198 534 702 2,057 1,928 Notes and Data Source: Data is from the NYS Department of Health Quality Prevention Quality Indicators – Adult (AHRQ PQI) for M edicaid 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, Herkimer County has the highest observed to expected ratios for the overall composite (4,211/3,180) and the acute composite (2,106/1,254) indicators. Otsego County has the highest ratio for the chronic composite (2,283/1,891). The lowest ratios for these indicators are in Schoharie County (overall composite, 3,100/3,108, acute composite, 1,009/1,186) and Montgomery County (chronic composite, 1,880/2,020). Among all DSRIP regions, the Mohawk Valley region has the highest observed to expected ratio for the overall composite (3,595/3,126) indicator in the dual population.

Table 7 describes the all diabetes, circulatory and respiratory composite indicators.

Table 7. Mohawk Valley 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


Fulton 323 252 177 422 11 147 557 673 334 287 1,190 803 Herkimer 88 250 189 392 163 145 849 736 125 287 1,069 813 Montgomery 205 259 139 467 156 153 801 747 217 307 940 822 Otsego 195 261 368 411 105 157 994 697 225 307 920 798 Schoharie 159 258 577 407 185 153 577 694 212 314 937 836

Total 194 256 290 420 124 151 755 709 222 300 1,011 815 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 Mohawk Valley region’s Medicaid only population, Fulton County has the highest all diabetes composite ratio (323/252) and all respiratory composite (334/287). Schoharie County has the highest ratio for the all circulatory composite (185/153). The lowest ratios for these indicators are in Fulton County (all circulatory composite, 11/147, lowest in any NYS county) and Herkimer County (all diabetes composite, 88/250, all respiratory composite, 125/287). Among all DSRIP regions, the Mohawk Valley region has the lowest all respiratory composite observed to expected ratio in the Medicaid only population (222/300).

In the region’s dual population, Schoharie County has the highest observed to expected ratio for the all diabetes composite (577/407), Otsego County has the highest ratio for the all circulatory composite (994/697), and Fulton County has the highest ratio for the all respiratory composite (1,190/803). The lowest ratios for these indicators are in Montgomery County (all diabetes composite, 139/467) and Schoharie County (all circulatory composite, 577/694, all respiratory composite, 937/836).

3. Potentially Avoidable Emergency Room Visits In the Mohawk Valley region, Montgomery County has the highest observed to expected ratios of potentially preventable ER visits (34/19), and Fulton has the lowest (10/18) (Table 8).

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

County ER Discharges 2013: Rate per 100,000

Observed Expected

Fulton 10 18 Herkimer 22 17 Montgomery 34 19 Otsego 22 18 Schoharie 24 18

Total 23 18 Notes and Data Sources: Data is from the NYS Department of Health All Payer Potentially Preventable Emergency Visit (PPV) database. Rates by patient county, SPARCS data 2013. Retrieved May 6, 2016 from https://health.data.ny.gov/Health/All-Payer-Potentially-Preventable-Emergency-Visit-/f8ue-xzy3#About

4. Local Assessment of Need by Mohawk Valley 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 Mohawk Valley 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. Mohawk Valley Region: Assessment of Needs by Population and Issue Assessment of Local Need (N=4* Counties)

Youth (<21) Adults (21+)

High Need Moderate

Need Low Need Missing High Need Moderate

Need Low Need Missing

Selected Issues Mental Illness Population

Access to Prevention Services 50% 25% 25% 0% 25% 50% 25% 0% Access to Crisis Services 25% 25% 50% 0% 25% 25% 50% 0% Access to Treatment Services 50% 50% 0% 0% 25% 75% 0% 0% Access to Supported Housing 25% 50% 25% 0% 25% 75% 0% 0% Access to Transportation 50% 50% 0% 0% 75% 25% 0% 0% Access to Home/Community-based Services 50% 25% 25% 0% 50% 0% 50% 0% Access to Other Support Services 25% 25% 50% 0% 50% 0% 50% 0% Workforce Recruitment and Retention 75% 25% 0% 0% 75% 25% 0% 0% Coordination/Integration with Other Systems 50% 25% 25% 0% 50% 25% 25% 0% Selected Issues Chemical Dependency Population

Access to Prevention Services 0% 75% 25% 0% 0% 75% 25% 0% Access to Crisis Services 25% 25% 50% 0% 50% 25% 25% 0% Access to Treatment Services 50% 25% 25% 0% 50% 50% 0% 0% Access to Supported Housing 25% 25% 50% 0% 50% 25% 25% 0% Access to Transportation 50% 50% 0% 0% 75% 25% 0% 0% Access to Home/Community-based Services 25% 50% 25% 0% 50% 0% 50% 0% Access to Other Support Services 25% 25% 50% 0% 50% 0% 50% 0% Workforce Recruitment and Retention 25% 75% 0% 0% 25% 75% 0% 0% Coordination/Integration with Other Systems 75% 0% 25% 0% 50% 25% 25% 0% *Montgomery County did not participate in the LGU needs assessment survey

The Mohawk Valley region counties’ surveys of consumer and provider stakeholders to assess local needs indicate that access to transportation to health care and workforce recruitment and retention are issues that need attention for the population with mental health concerns, and access to transportation and coordination and integration with other systems are issues that need attention in the population with chemical dependency concerns.



Appendix A. Highlights of Mohawk Valley 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 Mohawk Valley region.

I. Population Characteristics Summary Highlights Mohawk Valley Region: Population Characteristics Characteristic Region Region/County Comparison Median household $46,085 Compared to all other DSRIP regions, the Mohawk income Valley region has the 2nd lowest median household

income, which is well below the state median of $58,687.

Education 14% of adults in region are without a high school diploma

The percentage of region’s adult population that do not have a high school diploma is the 2nd highest in any DSRIP region. 20% have a bachelor’s degree or higher, which is the 2nd lowest percentage in any DSRIP region.

15% of Fulton County’s adult population have a bachelor’s degree or higher, which is the 2nd lowest percentage in any NYS county.

Poverty 16% of region’s population lives below poverty level

The percentage living below poverty level is the 3rd

highest percentage in any DSRIP region. 14% of the region’s population receive food

stamps/SNAP benefits, which is the 2nd highest percentage in any DSRIP region.

Public Health Insurance/ 38% of region’s population is on 2nd highest percentages on public health insurance Medicaid/ Beneficiaries/ public health insurance, 25% and with no health insurance in any DSRIP region. No Health Insurance are Medicaid beneficiaries, and

10% has no health insurance. Special Populations 15% of the region’s population

are disabled and 11% are Veterans.

Among all DSRIP regions, the region’s percentage of disabled is highest and its percentage of Veterans is 2nd highest.

Percentages of individuals with disabilities in Fulton, Montgomery and Schoharie counties (16% each) is the highest percentage in any NYS county.

Foreign Born 3% of the population is foreign born.

Lowest percentage of foreign born in any DSRIP region.

Primary Language other than English

6% of the region’s population age 5 and older speak a primary language other than English.

93% of this population speak English as their primary language (2nd highest percentage in any DSRIP region) and 2% speak English less than “very well” (lowest percentage in any DSRIP region).



Appendix A. Highlights of Mohawk Valley Region Needs Assessment Findings II. Health Care Resources Summary Highlights

Mohawk Valley Region: Health Care Professional Supply and Shortages Domain Region/County Region/County Comparison Supply of Primary Health Care Providers

1. The region has 724 primary care providers or 27 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 321 physical medical health specialists or 12 providers per 10,000 population.

1. This is the 3rd lowest rate in and DSRIP region.

2. Schoharie County has the 3rd lowest number (n=4) of physical health medical specialists per 10,000 population in any NYS county.

Supply of Licensed Mental Health (MH) Professionals

1. The region has 400 licensed MH professionals or 15 per 10,000 population.

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

There are no psychiatrists in Herkimer County and only one each in Fulton and Schoharie counties.

Substance Use Disorder (SUD) Professionals

1. The region has a total of 95 cert i f ied and credentialed SUD professionals or four per 10,000 population.

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

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

Primary Health Care: All counties in the region, except Otsego, have a whole county primary care shortage designation. Three counties, including Otsego, have a census tract, population or facility designated as a primary care Medically Underserved Area/Population (MUA/P). The Medicaid eligible populations in Herkimer and Otsego counties have been designated primary care MUPs, and in Otsego County, the low-income population has been designated a primary care MUP. Mental Health Professionals: All counties in the region have a whole county MH professional shortage designation. Fulton, Herkimer and Schoharie counties have a census tract, population or facility designated as a MH professional Medically Underserved Area/Population (MUA/P). The Medicaid eligible populations in Montgomery and Otsego counties have been designated MH professional MUPs.

A. Mohawk Valley 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.

1. All counties, except Schoharie, have nursing homes.

Mental Health Inpatient Facilities

1. Total psychiatric bed capacity in the region is 20 per 100,000 adults and zero per 100,000 children.

1. These are the lowest psychiatric bed capacity rates in any DSRIP region.

2. The region has no psychiatric bed capacity for children.

Substance Use Disorder (SUD) Inpatient Programs

1. There are no SUD crisis programs in the region.

2. The region’s one SUD inpatient rehabilitation program is in Montgomery County, and its three SUD residential programs are in Fulton, Herkimer, and Montgomery counties.

1. The total capacity per 10,000 for all SUD inpatient programs is 2, which is the lowest rate in any DSRIP region.

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

Mental Health Outpatient and Clinic Programs

1. Adult outpatient programs (other than clinic) are in Fulton and Montgomery counties. There is a total of 243 non-

1. Montgomery County’s adult clinic service rate of 5,573 adults per 100,000 adults is the highest in any county in



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

clinic outpatient program slots in the region or 124 slots per 100,000 adults.

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

3. In the region, only Fulton County has child outpatient programs other than clinic. These programs have a capacity of 16 slots or 24 slots per 100,000 children region-wide.

4. There are locally-operated clinics serving children in all counties and no state-operated clinics.

NYS.

2. In the region, 3,525 adults received clinic treatment per 100,000 adults. Montgomery County’s rate of 5,573 adults per 100,000 adults is the highest rate in any NYS county.

3. This is the 2nd lowest outpatient capacity (other than clinic) for children in any DSRIP region.

4. In the region, 3,563 children received clinic treatment per 100,000 children, which is the highest rate in any DSRIP region. Montgomery County’s rate of 6,175 children per 100,000 children is the highest in any NYS county.

MH Community Support Programs

1. In the region, 338 adults per 100,000 received services from community support programs.

2. Community support programs in the region served 280 children per 100,000.

1. This is the highest adult service rate in any DSRIP region. In Montgomery County, 641 adults per 100,000 received these services, which is the 2nd highest rate in any NYS county.

2. This is the highest child service rate in any DSRIP region.

SUD Outpatient Programs

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

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

2. The region’s ADE of 4 per 10,000 in its opioid treatment programs is among the lowest in any DSRIP region.

III. Health Status Mohawk Valley Region: Health Status Challenges Domain Region/County Comparisons Disease Prevalence Among all DSRIP regions, the percentages of adults with high blood pressure or Chronic Health current asthma are the third highest in any DSRIP region. Conditions Compared to other DSRIP regions, the Mohawk Valley’s average case rates of HIV and

AIDS are third lowest. Health Behaviors and Risk Factors

Among all DSRIP regions, the Mohawk Valley region has the 2nd highest percentage of adults reporting food insecurity (26%) and the third highest percentage (12%) that reported poor mental health for 14 or more days.

Hospitalization Rates by Disease or Cause

Compared to all other DSRIP regions, the Mohawk Valley region has the 2nd highest average rates of hospitalizations per 10,000 for diabetes.

Mortality Among all DSRIP regions, the Mohawk Valley region has the lowest average premature death rate for stroke and the 2nd highest premature death rate from cardiovascular disease.

Among all DSRIP regions, the region has the highest average death rates per 100,000 due to chronic lower respiratory disease and suicide, and the 2nd highest average death rates per 100,000 due to diabetes and cirrhosis of the liver.

The death rates in Montgomery County due to diabetes and in Schoharie County due to suicide are the 2nd highest rates in any NYS county.



Appendix A. Highlights of Mohawk Valley Region Needs Assessment Findings Mohawk Valley Region: Health Status Challenges Domain Region/County Comparisons Patients in the Public Mental Health System

Chronic Health Conditions: Among all DSRIP regions, the Mohawk Valley region has the highest percentage of patients served that had a stroke, and the 2nd highest percentage that are current smokers. Behavioral Health Diagnoses: Among all DSRIP regions, the Mohawk Valley region has the highest percentages of patients served with depressive disorders and neurodevelopmental disorders. The region has the 2nd highest percentage of those served with anxiety disorder, and the lowest percentage with a co-occurring disorder.

IV. Behavioral Health Care Utilization A. Mohawk Valley Region: Medicaid Beneficiary Health Care Utilization by Behavioral Health Diagnosis Domain Utilization by Diagnosis Region

Medicaid Inpatient Admissions

Mental Health Diagnosis Region-wide, the largest percentages of Medicaid beneficiaries with a mental health inpatient hospital admission had depressive disorders (47%), followed by other mental health diagnoses (16%), chronic stress and anxiety diagnoses (15%), schizophrenia (13%), bi-polar disorder (8%), and PTSD (2%).

Compared to all other DSRIP regions, the Mohawk Valley region had the largest percentage of Medicaid beneficiaries with hospital admissions for chronic stress and anxiety diagnoses (15%).

Substance Use Disorder Region-wide, the largest percentages of Medicaid beneficiaries with a SUD inpatient hospital admission had alcohol use disorder (32%), followed by opioid use disorder and drug abuse: cannabis/NOS/NEC (23% each), other SUD diagnoses (14%), and cocaine use disorder (8%).

Medicaid Emergency Room Visits

Mental Health Diagnosis Region-wide by diagnosis, the largest percentages of Medicaid beneficiaries with a mental health ER visit were for depressive disorders (40%), followed by other mental health diagnoses (22%), chronic stress and anxiety diagnoses (16%), schizophrenia (12%), bi-polar disorder (8%), and PTSD (3%).

Compared to all other DSRIP regions, the Mohawk Valley region had the largest percentage of Medicaid beneficiaries with ER visits for chronic stress and anxiety diagnoses (16%).

Substance Use Disorder Region-wide, the largest percentages of Medicaid beneficiaries with a SUD ER visit were for cocaine use disorder (28%), followed by drug abuse: cannabis/NOS/NEC (24%), opioid use disorder (22%), other SUD diagnoses (17%), and alcohol use disorder (8%).

Compared to all other DSRIP regions, the Mohawk Valley region had the largest percentage of Medicaid beneficiaries with ER visits for drug abuse: cannabis/NOS/NEC (24%).

B. Mohawk Valley Region: Medicaid Mental Health and Substance Use Disorder Beneficiaries Compared to All Medicaid Beneficiaries Domain Utilization MH Medicaid In the region, 8% of all Medicaid

beneficiaries had a mental health



Appendix A. Highlights of Mohawk Valley Region Needs Assessment Findings inpatient hospital admission and 19% had a mental health ER visit.

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

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

In the region 9% of Medicaid only beneficiaries and 15% 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 20% of Medicaid/Medicare dual-eligible beneficiaries experienced at least one ER visit.

V. Unmet Service Needs Mohawk Valley Region: Summary Highlights of Unmet Service Needs in Behavioral Health Treatment Domain Measure Region/County Comparison

Mental Health Medication Adherence and Management

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

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

2. Antidepressant medication management effective acute phase treatment.

1. Region-wide 51% of individuals remain on their medication during the entire acute treatment phase.

3. Antidepressant medication 2. Region-wide 38% of individuals remain on their management effective medication during continuation phase treatment (62% do continuation phase treatment. not).

Among all DSRIP regions, the Mohawk Valley region has the 2nd highest adherence to antidepressants for the continuation phase.

Mental Health Follow-up Care

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

1. Among all DSRIP regions, the Mohawk Valley region’s percentage of follow-up within seven days (53%) after a mental illness hospitalization is 2nd highest and percentage of follow-up within 30 days (71%) is highest.

Schoharie County’s percentages of follow-up after a mental illness hospitalization within seven days (78%) and 30 days (90%) are the highest in any NYS county.

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

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

3. Follow-up care for children 3. Region-wide 60% 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

1. AOD Initiation 1. Region-wide 52% of individuals initiate AOD treatment within 14 days of diagnosis.

Among all DSRIP regions, the region has the second



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

highest rate of initiation AOD treatment. 2. AOD Engagement 2. Region-wide 21% of individuals engage in AOD

treatment within 30 days after initiation (79% 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 1. Among all DSRIP regions, the Mohawk Valley’s Medicaid only population has the lowest observed to expected ratio of diabetes long-term complications (54/106).

Compared to all DSRIP regions, the Mohawk Valley region has the 2nd lowest observed to expected ratio for uncontrolled diabetes in the dual Medicaid and Medicare population (10/32).

2. Cardiac Chronic Conditions Among all DSRIP regions, the region has the highest observed to expected ratio for heart failure in the dual Medicaid and Medicare population (684/608).

3. Asthma Chronic Conditions In the dual Medicaid and Medicare population, all counties in the region have no observed asthma discharges.

VI. Stakeholder Feedback The Mohawk Valley region counties’ surveys of consumer and provider stakeholders to assess local needs indicate that access to transportation and workforce recruitment and retention are issues that need attention for the population with mental health concerns, and access to transportation to health care and coordination and integration with other systems are issues that need attention in the population with chemical dependency concerns.


chapter seven, mohawk valley dsrip region needs assessment

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