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PRIMARY INSIGHTS

Counties along the coast of Florida tend to have more of their health needs met than those inland.
The most prevalent health conditions in our patient population include diabetes, mental health, and a BMI of 30+
Patients with commercial and Medicaid insurance have consistently lower morbidity risk scores across all counties
Average yearly cost has doubled for the past two years
Lifetime cost decreases slightly with higher education levels and individuals with unknown levels of education have significantly lower lifetime cost.

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WHAT GEOGRAPHICAL GAPS EXIST IN THE COMMUNITY?

Community Health Needs Score provides an overall assessment of the community’s needs and allows us to identify gaps
Areas of darker blue indicate counties with the most unmet health needs.
Counties along the coast tend to have more of their health needs met.
Putnam County has the most unmet health needs

WHAT COUNTIES HAVE THE MOST HEALTH NEEDS?

ANALYZING THE BIGGER PICTURE

The southern tip of Florida is the most populous region.
Alachua County has the highest incidence of ED visits per capita (0.91) and could be an area of future focus
Alachua County has the highest proportion of PCP per 2000 (3.16)
Coastal areas tend to have a higher proportion of PCP
A lower incidence of ED visits per capita is seen in the Northern region (Liberty Co. to Bradford Co.)

PATIENT DEMOGRAPHIC BREAKDOWN

The median age of the patient population is 41 with half of the population falling between 22-60 years old.
25% of the population is 60 and above, and 25% is 22 or below
The median income is $49,113 with half of the population making between $25,106 and $89,794
Commercial insurance is the most prevalent insurance type making up 55% of the population
21.5% of the population is uninsured
77% of the population is white
55% of the population is married

WHAT IS THE INSURANCE TYPE BREAK DOWN?

Commercial is the most common insurance type within this patient set
Commercial and Medicare average patient income is over double that of the other insurance types
Medicare and dual enrolled patients have a higher average age

MORBIDITY RISK

Average morbidity risk score ranges from 0 (Hamilton County and others) to 82.3 (Lafayette County)
Counties with an average of 0 likely are missing adequate data
Patients with commercial and Medicaid insurance have consistently lower morbidity risk scores across all counties

MORBIDITY RISK

WHAT CONDITIONS ARE MOST PREVALENT?

Diabetes is present in 43% of the population
A BMI of 30+ is seen in 47% of the population
Mental health conditions is seen in 47% of the population
Also of note, 92% of the population has received a wellness visit within the last 18 months even though 21.5% are uninsured

IS OVERUTILIZATION EVIDENT?

Average lifetime cost by county ranges from $3,084,217 (Gilchrist County) to $261,555 (Hamilton County)
This large of difference certainly warrants further investigation and potentially points to counties with overutilization or inefficient practices.

UTILIZATION AND OVERUSE RISK

Average cost per year about doubles each year for the last 2 years
Uninsured individuals have significantly higher costs than insured
Lifetime costs appear similar across all races with native and white being the highest
Lifetime cost appear similar across genders
Lifetime cost decreases slightly with higher education levels suggesting health literacy may have an impact on patient cost
Individuals with unknown levels of education have significantly lower lifetime cost. This could use further investigation.
Some counties have only 1 or 2 insurance types present which is interesting to note and an area for further investigation.

CAN OUR POPULATION BE FURTHER SEGMENTED?

An area of focus and form of patient segmentation can be done via insurance type as seen throughout.
A second form of clustering patients can be done by cost and age which can be helpful for identifying high utilizers and outliers
Cluster 6 should be an area of focus consisting of our highest utilizers

RECOMMENDATIONS

A focus should be placed on weight management, mental health, and diabetes prevention. Further explore possible reasons for high prevalence of these conditions and develop programs accordingly.
Further investigate counties with high proportion of ED visits. Explore additional options such as Telehealth and primary care visits, to potentially reduce ED utilization.
Explore why areas in northern Florida may have lower ED visits in comparison to other regions. Perhaps their strategies can be implemented throughout the state.
Evaluate drivers for rising costs in the past two years. Why have yearly costs doubled?
Focus on inland areas community health needs including developing incentives to increase PCPs in the area.
Explore differences in average lifetime cost per county. Counties with lower average costs should be used as an example with their strategies being implements throughout the state.
Review high utilization patients to determine potential areas of overutilization.
Further investigate cost differences across education levels. Implement health education strategies within patient care.