2020 Uniform Data System Trends - Health Resources And Services .
2020 Uniform Data System TrendsPublic PresentationAugust 10, 2021Office of Quality ImprovementBureau of Primary Health Care (BPHC)
Opening RemarksAlek Sripipatana, PhD, MPHDirector, Data and Evaluation DivisionOffice of Quality ImprovementBureau of Primary Health Care2
National Health Center Week3
PresentersAugust 10thLorraine Burton, MSHSMManagement AnalystData and EvaluationDivisionLara Chausow, PhDData StatisticianQuality DivisionElissa Golan, MPHPublic Health AnalystData and EvaluationDivisionBen Picillo, MPHHealth StatisticianData and EvaluationDivision4
AGENDAPresentation Overview Story of 2020 UDS Trends Adapting to COVID-19 Questions and Discussion Analyses Applying the Data UDS Data Resources5
Adapting to COVID-19Uniform Data System 20206
The Uniform Data System (UDS)An Overview Standardized health center reporting systemRequired by Section 330 of Public Health Service ActAnnual reports submitted by health centers by 2/15Annual changes announced via Program AssistanceLetter (PAL)UDS Manual provides reporting instructionsUDS is updated every year to: Align with national reportingstandards Keep pace with the currenthealthcare environment Reflect stakeholder feedback Ensure evaluation of bureau andDepartmental priorities7
2020 UDS ReportingWhat’s New or Notable COVID-19 Data on novel coronavirus testing, diagnosis, and treatment Added the COVID-19 Uninsured Program, coronavirus and provider relieffunding, COVID-19 vaccinationsGeneral New clinical quality measures: breast cancer screening, HIV screening,depression remission; and removed the asthma measure Captured data related to human trafficking, intimate partner violence, PrEPManagement Added Health Center Information Technology (HIT) Capabilities Enhanced Social Determinants of Health (SDOH) screening Refined demographic data reporting: added unknown line for sexualorientation and for gender identity8
Executive Summary2020 UDS DataIncreasedAccess to Care 770 service deliverysites for a total of13,5551 in 5 rural residentsare served via thehealth center programImprovedDelivery ofServicesAdvancedQualityof Care 1,267 MAT eligibleproviders for a total of8,36279% of health centersmet or exceeded one ormore nationalbenchmarks 2,144 full-timeequivalents for a total of255,01255% of HCs improved in5 or more ClinicalQuality MeasuresAddressedPublic HealthEmergency99.05% of health centersoffered telehealthservices3,732,745 health centerpatients receiveddiagnostic tests for novelcoronavirusSource: Uniform Data System, 2020.Note: 1,370 health centers were funded in 2019 & 2020.9
COVID-19 and the Delivery of Primary Health CareServices in 2020: Health Center Patient VisitsHealth centers provided 114.2 million patient visits in 2020,a 7% decrease overall from 2019.Not all services were impacted equally: Mental Health visits increased by 15.1% ( 1.8 M visits) Medical visits decreased by 3.8% (-3.1 M visits) Enabling services visits decreased by 9.6% (-608,800 visits) Vision care visits decreased by 27.9% (-305,000 visits) Dental visits decreased by 34.4% (-5.9 M visits)Source: Uniform Data System 2019 & 202010
COVID-19 and Health Center Patient Visits:Shift from In-Person to VirtualIn-person visits decreased by 36.63 million, or 30% from 2019Virtual visits increased by nearly 6,000% – 28.05 million more virtual visits than in 8,530,608478,33320192020In-Person VisitsVirtual VisitsSource: Uniform Data System 2019 & 2020 – Table 511
Total Health Center VisitsAnnual Comparison by Types of Services140.0 MNumber of visits120.0 M In-person clinical visits decreased by 30% but increase in122.8 M114.2 M100.0 M 81.3 M80.0 Mvirtual care offset impact of COVID on access to careHalf of behavioral health visits were provided virtually78.2 M60.0 M40.0 M17.3 M20.0 M0.0 M20192020All201920202019MedicalClinical VisitsDental11.3 M14.1 M15.8 M202020192020Behavioral HealthVirtual VisitsSource: Uniform Data System 2020, Table 5Note: “All” includes other types of visits not displayed on this slide. Behavioral health includes SUD and mental health services (excludingany data reported in UDS Addendum Table)12
COVID-19 and Health Center Virtual Visits1 in 4 visits were virtual in 2020Top five services offered via telehealth Primary CareMental HealthSubstance Use DisorderChronic ConditionsNutrition and Dietary Counseling99% of health centers offered virtual visits in2020, compared to 43% in 2019Percentage of health centers offering virtual services, byselect service %40.00%20.00%0.00%Source: Uniform Data System, .08%Dental9.09%0.43%Vision13
Behavioral Health Access Summary2019 to 2020Behavioral Healthand Telehealth 51.75% Mental Health visitsSubstance Use Disorder 8.81% in providers offeringtreatment and carewere virtual 33.06% SUD visits were virtual Over 90% of Health Centersoffered Mental Health and/orSUD services via telehealthMental Health 15.11% in visits 6.97% in providersSource: Uniform Data System 2019 & 2020, Tables 5, 6A, 6B, 7* New Measure for 2020 UDS14
COVID-19 and Health Center WorkforceTotal Health centers employed more than255,000 FTEs in 2020 – a 0.85% increasefrom 2019.-0.8%-198 FTEEnabling Services8.8% 188 FTESubstance Use Disorder Growth was not distributed uniformly7.0% 944 FTEMental Healthacross all health center staff: Mental Health and Substance UseDisorder staff increased. Dental and Vision staff decreased.0.8%-8.4%-85 FTE-10.7%-2,116 FTEVisionDentalMedical-15.0%-10.0%2.0% 1,690 FTE-5.0%0.0%5.0%Percent Change in FTEs, 2019-202010.0%15.0%Source: Uniform Data System 2019 & 2020 – Table 515
Cost, Funding, Revenue Summary2019 to 2020Cost Per Patient 10.76% total cost per patient 56.58 medical cost per medical patient 45.30 BPHC grant dollars per patientTotal Funding & Costs 1.09B total BPHC grant dollars 1.91B in total accrued costsRevenue Medicaid remains the largestrevenue source 39.5% of health centerrevenue is from Medicaid Health Center Grants is thesecond largest revenuesource 17.6% of health centerrevenue is from BPHCSource: Uniform Data System 2019 & 2020, Table 9E, 9D16
Testing, Treating, Expanding TelehealthUniform Data System 202017
COVID-19 Diagnostic TestingHealth Center Patients and 53,000,0002,000,0001,000,0000278,722Novel coronavirus (SARSCoV2)diagnostic testNumber ofPatients316,155Novel coronavirus (SARSCoV2)antibody testNumber ofVisitsSource: Uniform Data System 2020, Table 6A18
COVID-19 TreatmentHealth Center Patients and 44,594600,000400,000200,000070,419Novel coronavirus (SARSCoV2)diseaseSource: Uniform Data System 2020, Table 6ANumber ofPatients98,932Acute respiratory illness due to novel coronavirus(SARSCoV2) diseaseNumber ofVisits19
Patients, Visits, and ServicesUniform Data System 202020
COVID-19 and the Delivery of Primary Health CareServices in 2020: Health Center PatientsHealth centers served 28.6 million patients in 2020,a 4% decrease overall from 2019.Ages 65 Ages 18-64Ages 0-17Total 2,931,66310.25% of patients 2.34% since 2019Total 17,786,98562.21% of patients 0.11% since 2019Total 7,872,24927.53% of patients-14.48% since 2019Source: Uniform Data System 2019 & 202021
Patient DemographicsInsurance Status: Percent of PatientsSource: Uniform Data System 2016-2020, Table 4Note: “Dual Eligibles” includes patients that have both Medicare and Medicaid insurance. This percentage includes patients already included in theMedicare and Medicaid calculation. (2020 UDS Manual)22
COVID-19 and the Delivery of Primary Health CareServices in 2020: Special PopulationsSource: Uniform Data System 2019 & 2020 – Table 423
Patient DemographicsHispanic and Non-Hispanic Patient†Percent of Patients with Race “Unreported/Refused to Report”: 15.76%.*Does not count Ethnicity “Unreported/Refused to report”: 0.88 M (2017), 1.06 M (2018), 1.24 M (2019) and 1.40 M (2020).Source: Uniform Data System 2016-2020, Table 3B24
Patient DemographicsProportion of Patients with Known Reported Race/Ethnicity†American Indian/AlaskanNative, 1.46%More than one race,3.08%Black/African American,21.26%White Hispanic/Latino,27.41%62.24% ofpatients are of aRacial and/orEthnic MinorityNative Hawaiian/OtherPacific Islander, 0.20%Asian, 4.05%White NonHispanic/Latino, 41.72%†Percent of Patients with Race “Unreported/Refused to Report”: 15.76%.*Does not count Ethnicity “Unreported/Refused to report”: 0.88 M (2017), 1.06 M (2018), 1.24 M (2019) and 1.40 M (2020).Source: Uniform Data System 2016-2020, Table 3B25
Patient DemographicsNumber of Patients by Known Sexual OrientationAccurate reporting of sexual orientation is an important part of advancing health equityand delivering culturally competent careSexual Orientation is defined as: Lesbian or gay, straight, bisexual, or something else.Source: Uniform Data System 2016 – 2020, Table 3B26
Patient DemographicsNumber of Patients by Gender IdentityAccurate reporting of gender identity assistshealth care providers in providing medicallyappropriate and culturally competent careSource: Uniform Data System 2016-2020, Table 3B27
Standardized Screening for Social Risk Factors 947 (68.87%) of health centers screened for social risk factors 25% of health centers plans to collect risk factors in the futureNumerator: Number of Health Centers that use specific screenersDenominator: Health Centers that collect data on patients outside of UDSSource: Uniform Data System 2019 & 2020 – Table: Health Information Technologies Capabilities28
Patients Seeking ServicesMedical and DentalSource: Uniform Data System 2016-2020, Table 529
Patients Seeking ServicesBehavioral HealthSource: Uniform Data System 2017, 2018, 2019 & 2020 - Table 530
National Trends in Medication Assisted TreatmentPatients, Providers, VisitsThere are strong upward trends in patients receiving MAT, providers eligible to prescribe MAT, and health centers providing MAT.Providers* eligible toprescribe MAT180,000181,896 Patients receiving ,0008007,0956,0004,0009008,362 392%7,000Providers200,000Health centers providingMAT to PatientsHealth CentersPatients receiving iders eligible to prescribe MAT2016803 123%2018201920202016Health centers providing MAT toPatients2017201820192020*Definition of MAT providers expanded to include physician assistants & certified nurse practitioners in 2017.Source: Uniform Data System 2016-2020, Table ODE31
Infectious Disease ServicesHealth Center Patients6.00 MNumber of Patients5.00 M4.44 M3.80 M4.00 M3.31 M4.04 M3.8 M4.79 M3.99 M3.39 M2.00 M1.00 M1.42 M0.97 M0.70 M0.56 M0.00 M20160.72 M20173.73 MNovel Coronavirus(SARSCoV2)Diagnostic Test3.04 M3.00 M1.81 M4.54 M2.04 M1.07 M2.23 M1.18 M0.93 M1.23 M0.77 M0.28 M0.88 M20182.05 M2019Hepatitis B TestHepatitis C TestHIV TestSeasonal Flu VaccineNovel coronavirus (SARSCoV2)diagnostic testNovel coronavirus (SARSCoV2)antibody testNovel Coronavirus(SARSCoV2)Antibody Test2020Selected ImmunizationsSource: Uniform Data System 2016-2020, Table 6A32
Types of Patient ServicesNumber of Comprehensive Services ProvidedTypes of ComprehensiveServices Provided: Dental Mental Health Vision Medical EnablingSource: Uniform Data System 2016-2020, Table 533
Clinical Quality MeasuresUniform Data System 202034
Healthy People 2020 Goal2020 UDS90% met or exceeded at least 1 goal29% met or exceeded at least 3 goalshttps://www.healthypeople.gov/Numerator: Number of health centers that met or exceeded the HP2020 benchmarks.Denominator: Number of health centers that reported in UDS 2019, 2020.Sources: Uniform Data System 202035
Healthy People 2030 Goal2020 UDS78% met or exceeded at least 1 goal9% met or exceeded at least 3 goalshttps://www.healthypeople.gov/Numerator: Number of health centers that met or exceeded the HP2030 benchmarks.Denominator: Number of health centers that reported in UDS 2019,2020.Sources: Uniform Data System 202036
COVID-19 and Health Center Clinical Quality Measures 55% of health centers reported improvements in 5 clinical quality measures (CQMs). 16% of health centers improved in 8 CQMs.Maternal & Child HealthClinical QualityMeasureEarly Entry Into PrenatalCareLow Birth WeightCancer ScreeningChronic DiseasesUDS2020Clinical QualityMeasureUDS2019UDS202074%74%Ischemic Vascular Disease– Use of Aspirin81%79%8%8%70%72%65%58%68%64%UDS2019Source: Uniform Data System 2019 & 2020 – Table 6B1New CQM for 2020Statin Therapy forCardiovascular DiseaseHypertension Control (lessthan 140/90 mm Hg)Diabetes Control (HbA1c 9%)Clinical QualityMeasureUDS2019UDS2020Breast Cancer Screenings1---45%Cervical Cancer Screenings57%51%Colorectal Screenings46%40%37
Building CapacityUniform Data System 202038
Health Center StaffingFull-Time Equivalents by Major Service CategorySource: Uniform Data System 2016-2020, Table 5*Excludes facility and non-clinical support staff39
Training and Workforce Development2020 UDS60,00078.91% of health centers reported providinghealth education or training52,408Individuals ,5345,49010,0000MedicalDental9,4777,5341,943590MH and SUDPre-GradPost-Grad96 686Vision2,546 820 3,366Other ProfessionalsTotalSource: Uniform Data System 2020 – Table Workforce40
Utilization of EHR for Beyond Direct Patient CarePercentage of Health Centers100.00%90.00%98.70%A large percentage of healthcenters are using EHR tobenefit patients in ways otherthan direct patient care.HIT/EHR Use (% of .25%3.05%Quality Improvement Population healthmanagementSource: Uniform Data System 2020 – HITProgram evaluation2019ResearchOther0.58%0.22%Not used for beyonddirect patient care202041
COVID-19 and Health Center RevenuesWhile Medicaid remained the largest source of revenue forhealth centers, supplemental COVID-related funding(including Health Center Program Grants and PRF funding)contributed to an overall increase in health center revenue.2019 Total: 31,432,695,1182020 Total: 34,501,399,304Source: Uniform Data System 2019 & 2020 – Tables 9D & 9ENote: ”Other Federal Grants” category includes Provider Relief Fund (PRF) awards.42
Cost of Care Trends 1,400 1,156.82 1,200 1,000 889.85 941.97 800 600 990.17 1,044.40 577.88 601.51 623.22 647.11 171.01 174.12 170.17 167.672016201720182019 703.69 400 200 0Medical Cost per Medical PatientTotal Cost/Patient 212.972020BPHC Grant Cost/PatientPercentages indicate the percentage change between 2016 to 2020.Source: Uniform Data System 2016-2020, Table 3A, 8A, 9D, and 9E43
Thinking About the FutureUniform Data System 202044
Next StepsUDS Data Now Available Public Data Release 2020 UDS data now available via https://data.hrsa.gov/tools/data-reporting UDS Data in HRSA Electronic Handbooks (for those with access) UDS Rollup ReportHealth Center Trend ReportUDS Summary ReportNational Summary Comparison45
Next StepsApplying the Data Quality Improvement Awards (QIAs) are transitioning to Community Health Quality Recognition (CHQR) AwardsRecognize Health Center Program awardees and Look-Alikesthat have made notable quality improvement achievements AccessQualityHealth equityHealth information technology New: COVID-19 badges Testing Vaccinations Data collection46
Next StepsFollow-Up Analyses COVID-19 Vaccination-related challenges faced byhealth centers (e.g., vaccine hesitancyand financial reimbursement) Influence of COVID-19 HRSA grants onoperations and COVID-related services Factors influencing vaccine wastage Influence of HRSA Health Center COVID19 Vaccination Program participation onvaccination outcomes SDOH and health inequality47
Next StepsHealth Care Program Partners UDS data can help inform: Training and technical assistance aimedat helping health centers and theircommunities recover Work with health center staff andexternal partners to better understandwhere and how health centers excelledand struggled Identify lessons learned to prepare forthe next major service disruption Other ideas?48
Next StepsQuestions49
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COVID-19 and the Delivery of Primary Health Care Services in 2020: Health Center Patient Visits. Health centers provided . 114.2 million patient visits . in 2020, a . 7% decrease overall . from 2019. Not all services were impacted equally: Mental Health visits increased by . 15.1% ( 1.8 M visits) Medical visits decreased by . 3.8% (-3.1 M .
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