Primary Care Office (PCO) - Maryland Health Benefit Exchange

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Primary Care Office (PCO) - Maryland Health Benefit Exchange
Primary Care Office (PCO) Data Overview
MDOT
May 20, 2015 NA-ECP Meeting
Prevention and Health Promotion Administration
Elizabeth Vaidya
PCO Director
Office of Primary Care Access
MISSION
Maryland Primary Care Office (PCO)
A federally funded program which is housed
within the Maryland government to improve
access to health care services for all Maryland
residents.
Prevention and Health Promotion Administration
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PCO – Principal Functions
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Shortage Designations
Workforce Development
Community Engagement
Data Collection
Technical Assistance: Data, Maps, etc.
Prevention and Health Promotion Administration
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Shortage Designations
• Geographic
• Special
Populations
• Contiguous
Area Access
• Geographic
• Special
Populations
• Facility
Type
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Primary Care (3500:1 or 3000:1)
Dental Health (5000:1 or 4000:1)
Mental Health (30,000:1 psych)
or, (9,000:1 psych and CMHP),
or (6,000:1 CMHP and 20,000:1
Psych)
Medically Underserved
Areas/Medically
Underserved Populations
(MUA/MUP)
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Primary Care (3500:1 or
3000:1)
Correctional Institutions/Youth
Detentions, Public/Non-Profit
Private Facilities, and
State/County Mental Hospitals
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Primary Care
Dental Health
Mental Health
Health Professional Shortage
Areas (HPSA)
Prevention and Health Promotion Administration
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Benefits of Designation
• Component for Eligibility for certain HRSA Grants like:
• Federally Qualified Health Center or Look-Alike applications
• Rural Health Center applications
• CMS Bonuses for Providers
• Area Health Education Centers
• National Health Service Corps’ loan repayment and scholarship
programs
• Maryland state loan repayment program
• J-1 Visa Waiver & National Interest Waiver Programs
Prevention and Health Promotion Administration
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Shortage Designation: Types of Providers
Primary Care
Providers
General Practice
General Internal
Medicine
Family Practice
Pediatrics
Obstetrics and
Gynecology
Nurses
Physician
Assistants
Mental Health Providers
Psychiatrist
Dentists (DDS or DMD)
General Dentistry
Clinical Psychologist
Clinical Social Worker
Pediatric Dentistry
Psychiatric Nurse
Specialist
Marriage/Family
Therapist
Licensed Clinical
Professional Counselor
Prevention and Health Promotion Administration
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Primary Care & Mental Health Provider Data
Overview
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Data Needed:
– Provider Name
– Provider Type
– Number of hours rendering
service
– Site location(s)
– Accept Medicaid, Medicare,
Federal Sliding Fee Scale (SFS)
– Medicaid Claims
– Waiting time for an appt for
established and first time
patients
– Accepts new patients
– Provider’s % of Patients with
Medicaid and SFS
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Maryland Board of Physicians
Provides:
– Everything except waiting time
for patients and % of Medicaid
and SFS patients
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Maryland Medicaid Provides:
– Primary Care and Mental
Health Medicaid Claims
– Number of residents eligible
for Maryland Medicaid per
county.
Prevention and Health Promotion Administration
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Primary & Mental Health Data Provider
Concerns
• Not able to do low income population or
insufficient capacity designations
• Only physician data is provided, need data for:
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Clinical Psychologists
Clinical Social Workers
Nurses
Marriage and Family Therapists
Physician Assistants
Prevention and Health Promotion Administration
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Dental Provider Data Overview
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Data Needed:
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Provider’s Name
Provider Type
Dental Medicaid Claims
Accepts new patients
Waiting time for an appt for
established and first time
patients
Number of hours rendering
services
Site location(s)
Number of Auxiliaries
Dentist’s Age
Accept Medicaid, Medicare,
Federal Sliding Fee Scale (SFS)
Provider’s % of Patients with
Medicaid and SFS
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Maryland Board of Dental
Examiners Provides:
– Name of Dentist
– Provider Type
– Address which can be either
home or site location
– License Status
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Maryland Medicaid Provides:
– Dental Medicaid Claims
Prevention and Health Promotion Administration
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Dental Data Provider Concerns
• Not able to do geographic, low income population
or insufficient capacity designations
• Rely on community with limited resources to do
surveying
• Inaccurate site locations causes provider to patient
ratios to be incorrect
Prevention and Health Promotion Administration
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Data Sources
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Maryland Board of Physicians data
Maryland Board of Physicians data
Maryland Vital Statistics
Medicaid Claims, Hilltop Institute
Maryland Medicaid ehealth Statistics
Claritas data
Annual Report, Homeless Services in
Maryland
Maryland Board of Dental Examiners
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Maryland Transit Administration
Washington Metro Transit
Maryland Alcohol and Drug Abuse
Administration Adolescent Outlook
and Outcomes
Community Surveys
Medicaid Sanctioned Providers
Oral Health Program, Water Fluoride
Levels
GIS Jurisdictional Areas
Census Bureau
Tourists/Seasonal Residents from
Community
Prevention and Health Promotion Administration
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Contact Information
Elizabeth Vaidya, PCO Director (410) 767-5695
[email protected]
Primary Care Office
OPCA-PHPA-DHMH
201 West Preston Street
Baltimore, MD 21201
PCO Website:
http://hsia.dhmh.maryland.gov/opca/SitePages/pco-home.aspx
Prevention and Health Promotion Administration
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