FAIR Health Delivers Keynote at Texas State of Reform Conference
FAIR Health President Robin Gelburd delivered the morning keynote address at the 2019 Texas State of Reform Health Policy Conference, held in Austin, Texas, on February 5. Addressing attendees from over 160 organizations, Ms. Gelburd brought to light the distinctive aspects of the Texas healthcare sector, the rise of alternative venues of care and the varying approach to treatment for opioid abuse and dependence in Texas and in other states. This keynote address followed on the recent keynotes delivered by Ms. Gelburd at the Alaska State of Reform and Washington State of Reform conferences held in October 2018 and January 2019, respectively.
A detailed assessment of the Texas healthcare environment is possible, Ms. Gelburd noted, because of the geographical specificity of FAIR Health cost and utilization data. FAIR Health tracks 493 distinct geozips nationwide. (A geozip is a geographical region that tends to track with the first three digits of a zip code.) FAIR Health has data for 30 geozips in Texas, as compared to the eight regions that Medicare uses for the state.
Changing Venues of Care
Discussing the rise of alternative venues of care, Ms. Gelburd observed that utilization of retail clinics has grown dramatically in Texas and continues to rise, with an 11,057 percent increase from 2009 to 2017 compared with a 625 percent increase nationally.
Urgent care utilization also rose more in Texas than in the rest of the country, with a 1,300 percent rise from 2009 to 2017 in the state compared to a 533 percent increase nationally. Growth lagged in Texas after 2015, however, possibly due to the presence of freestanding emergency rooms (ERs), which may be competing with urgent care centers.
The top diagnosis in 2017 in both urgent care facilities and ERs was acute respiratory infection. The top diagnosis in ERs nationally was cardiac events, which did not figure in the top five ER diagnoses in Texas. The absence of cardiac events on the Texas list of top five diagnoses may again be attributed to the presence of freestanding ERs in Texas, which do not typically treat cardiac incidents. Paradoxically, the leading cause of death in Texas is heart disease, with a higher rate than in the United States overall.
On the subject of behavioral health, Ms. Gelburd pointed out that the top diagnosis of this kind in Texas in 2017 was major depressive disorder, which accounted for 18 percent of behavioral health claim lines. This was closely followed by mental and behavioral disorders due to psychoactive substance abuse, with 17 percent of claim lines. In contrast, the top behavioral health diagnosis nationally was mental and behavioral disorders due to psychoactive substance abuse (28 percent), followed by major depressive disorder (19 percent).
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