Integrate Data from State, City, and MCO Partners into MCC’s Geographic Analysis: 1
One of the questions I’m asked most frequently about our mobile clinics is, “how do you choose where to go?” This is a hard question to answer. Our clinics can’t be everywhere at once (though one can hope!). Each mobile clinic can only go to an average of 17 sites each month, which makes the available dates on our calendar our most scarce resource.
The way we choose where to go is, right now, community-based. We ask our patients what they’re hearing from friends, we ask nurses at schools, we ask health partners, and public health officials, and Medicaid Managed Care Organizations. We take it very seriously. If we don’t choose our locations wisely, we risk overlooking the areas of greatest need.
For all nine years that I’ve been at Mobile Care Chicago, in addition to the above, we’ve desperately sought out every scrap of data to help inform our understanding of where mobile clinics can be most helpful: what areas have the highest rate of dental carries? Which neighborhoods lead the County in ED visits for asthma? Which zip codes have the lowest ratios of health infrastructure to population size, which have the fewest providers accepting Medicaid, and which have the highest childhood morbidity/mortality rates due to chronic conditions? Of crucial importance to us: where are low-income people being pushed out of, and which areas are they moving to? Ideally, we would want to see each of these data points (and many others) in three or five year trends, and we would want to bring them into conversation with each other to get a picture of where we are going to be most needed not just in the present, but also in the near future.
Much of Illinois’ potential public health data exists in Medicaid claims because that’s what everyone is required to submit in exchange for money. Claims data is fragmented among many Managed Care Organizations, while public health data is separately kept by the City, County, and/or State. Access to data could inform our decision-making process, and for that reason we unceasingly pursue partnerships that would get us access to aggregate claims data, public health data, or both.
You would think that all of this information would be widely available, and frequently updated. Don’t public health officials have a vested interest in assisting charitable clinics, since each patient MCC takes on saves the State over $15,000 each year? It brings me no pleasure to defy your expectations and report that that data is not only rarely made available, in many cases it partially exists or doesn’t exist at all. There are not centralized “data sharing” repositories in our health departments that are staffed to field aggregate-level data questions from health partners and, with budget cuts in prior years at the City and State levels, in some cases there isn’t a person who even knows who data questions should be directed to. In many cases, if an organization like ours requests data, it has to be pulled together on a one-time basis by public servants who have other responsibilities and, as such, it can take months to receive, and it can’t be replicated or validated with frequency.
Given this long summary, many people (myself included) would be tempted to see this as a textbook case of a Quixotic task and toss it aside in favor of more immediate action. But I appreciate our partners and staff pushing me and all of us at Mobile Care to not only defy that temptation, but to do the opposite and make it a focal point of our Strategic Plan. We cannot lose focus on how crucial this item is, and what it represents: a government-induced access barrier that separates people from the resources that could help them.
We often talk about “access barriers” as something individual people have to overcome: travel, no time off work, inability to afford co-pays and out of pocket costs, etc. To be sure, those are all important. But when we can’t share data, it’s like a football coach telling a quarterback, “here’s the play call, but don’t tell the wide receivers where to run.”
If health providers ask our public health system, “where do you need us most?” and the answer back is we don’t know and we can’t invest to find out, then it’s our fellow residents who suffer. There has to be a better and more compassionate way for us to all consistently align our focus toward the best interest of our neighbors, and until there is one, this item cannot be removed from our priority list.
-Matt Siemer, Executive Director