Western New York Community Health Needs Assessment

Lake Ontario
Lake Erie
Western New York Community Health Needs Assessment
Delivery System Reform Incentive Payment (DSRIP) Program
VOLUME TWO

Western New York Community Health Needs Assessment
for the
Delivery System Reform Incentive Payment Program
for the Millennium Care Collaborative PPS and Catholic Medical Partners/Catholic Health System PPS
by the University at Buffalo Regional Institute HMS Associates
The P2 Collaborative of WNY and FTI Consulting Center for Healthcare Economics and Policy
November 2014

Western New York Community Health Needs Assessment
Delivery System Reform Incentive Payment (DSRIP) Program. Volume Two

Western New York Community Health Needs Assessment
Table of Contents
Resource Inventory....................................................... 3 a. Safety Net Providers Inventory........................ 12 b. Health Care Providers Inventory..................... 46 c. Community Support Providers Inventory..... 293

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Western New York Community Health Needs Assessment
Resource Inventory

Assessing regional proximity of health care resources
Many factors influence an individual’s access to health care services and community support. One of the most important is the simple geographic proximity of providers to the populations they serve. This analysis, therefore, attempts to show where services are located in relation to the residents who use them, especially those insured by Medicaid.
The major observation to be made for Western New York is simply that health care resources tend to be concentrated in center cities and their suburbs while they are relatively sparse in rural areas. Services are most frequently located and most densely concentrated where the most people are. Rural areas, with fewer people, have proximate access to fewer providers. The key question is whether those resources are proportionate to the need.
The greatest concentration of health care providers for acute care, primary care, and mental and behavioral care are in the region’s two largest cities, Buffalo and Niagara Falls. With the exception of primary care, the greatest concentration of “safety net” providers -- those with a significant share of volume with Medicaid patients -- are also in the metropolitan core.
Rural residents typically find themselves farther from needed services than their urban counterparts. Even residents near small cities in rural counties may be more distant from providers than residents in the metropolitan area. How do we assess whether or not these communities are underserved?
This analysis considers the distance of providers from population combined with the ratio of providers to population. Is the supply of providers big enough? is it close enough? There’s a more extensive explanation of the methodology below. The short answer is that in many cases small cities in the outlying counties as well as rural areas are relatively underserved. Yet this analysis will suggest that these gaps in proximity to services might be addressed with the addition of only a few providers if positioned strategically in the region.
Methodology
The following analysis uses proximity as a proxy for access to find which areas within Western New York have relatively low or high access to certain types of health care providers. A proximity score based on the number of providers per population and their relative distance to the population is calculated for each ZIP code for a key set of provider types. The proximity score for each ZIP code is determined by counting the number of providers per population within specified linear distances of each ZIP code’s center of population, weighting them

based on their distance from the zip code and adding them together (see formula below).
Proximity Score = ∑a+.4b+.2c+.1d
Where: a = # of providers within 2 miles (per 100,000 people); b = # of providers within 2-5 miles (per 100,000 people); c = # of providers within 5-10 miles (per 100,000 people); and d = # of providers within 10-20 miles (per 100,000 people).
For example, this means that one provider within two miles of a ZIP code’s population center is equivalent to twenty providers within twenty miles of that ZIP’s population center. Also, if one ZIP code has a large population and another has a small population, but the number and distances to providers are equal, the ZIP code with the lower population will produce a higher proximity score. After initial scoring, all 198 included ZIP codes are ranked on a 0-100 scale, with lower numbers indicating lower proximities to health care providers.
The analysis is performed for key types of health care providers: (1) hospitals, (2) Safety Net primary care providers, (3) Safety Net Primary Care providers, (4) Safety Net mental health care providers, (5) non-Safety Net mental health care providers, (6) Safety Net behavioral health care providers, (7) non-Safety Net behavioral health care providers, and (8) all specialty care providers.
A different method is used to measure proximity to hospitals. This simply measures the linear distance of each ZIP code’s center of population to the nearest acute care hospital. ZIP codes are sorted by these distances and ranks are assigned to each ZIP code, where greater distances from the ZIP code to the nearest hospital indicate lower proximities.
The analysis does not account for health care providers beyond the eight-county area of Western New York and therefore may underestimate the proximity to health care providers for ZIP codes near the borders of the region, especially along the eastern border.
These findings are discussed in further detail on the following pages and in an appendix to this report. In the pages that immediately follow, we show maps that indicate the relative ranking of ZIP codes for proximity to providers in several key categories. As with other maps and tables in this report, green is good (more proximate supply) and red is bad (less proximate supply).
The appendix to this report includes an exhaustive listing of providers, including community support resources, organized by category and mapped across the region with a narrative discussion of key findings.

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Hospitals
Acute care hospitals in Western New York are concentrated around population centers. Of the 42 acute care hospitals in the region, more than half (25) are located in the region’s two metropolitan counties, Erie and Niagara. This concentration leads to higher proximity scores for ZIP codes in the cities of Buffalo, Niagara Falls, and also in their adjacent suburbs, which have lower concentrations of Medicaid enrollees.
In the region’s more rural counties, cities like Jamestown, Olean and Batavia also have hospitals and show relatively high proximity scores. However, the dispersed populations just beyond these centers are the most underserved by hospitals in Western New York. This is most apparent in the northern swath of Allegany County and the southern edge of Wyoming County, which includes the highest intensity of the relatively low proximity scores across the region.
In sum, the map confirms the commonly-held assumption that rural populations are more isolated from, and therefore have poorer access to hospitals, than their urban counterparts. Unlike all subsequent assessments, this proximity measure is based solely on distance and does not factor in for the number of people in each ZIP code and thus may overstate low access to hospitals for rural populations.

LAKE ONTARIO

Proximity to Providers
Acute Care Hospitals
WNY Rank 1 - 10 11 - 20 21 - 30 31 - 40 41 - 50 51 - 60 61 - 70 71 - 80 81 - 90 91 - 100

NIAGARA ERIE

LAKE ERIE

ORLEANS GENESEE
WYOMING

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Western New York Community Health Needs Assessment

Safety Net Primary Care Providers
Safety Net primary care providers are also concentrated in the region’s cities, while other places with relatively high population densities, like the suburbs of Buffalo, have a comparatively small number of facilities offering Safety Net Primary care. Although these towns may have one or two Safety Net primary care providers nearby, and also may be within twenty miles of several others in nearby cities, they hold many residents and, therefore, yield lower proximity scores. However, since these towns have many non-Safety Net primary doctors and generally more affluent populations, low proximity to Safety Net doctors in these places may not be as problematic as it is for rural populations on the southern and eastern borders of Erie County and wide stretches of Cattaraugus, Chautauqua, and Niagara counties where there are higher proportions of low-income residents and fewer Safety Net providers.
Many of Western New York’s rural ZIP codes show high measures of proximity to Safety Net primary care providers even though providers are dispersed broadly throughout these communities. This is partly due to the low population in these locations, but also because Safety Net primary care providers here, though few, are strategically scattered in rural centers, like Wellsville, Albion, Warsaw and Arcade, that are commonly within a reasonable distance of most of the surrounding rural populations.

Proximity to Providers
Primary Care (Safety Net)
WNY Rank 1 - 10 11 - 20 21 - 30 31 - 40 41 - 50 51 - 60 61 - 70 71 - 80 81 - 90 91 - 100
LAKE ERIE

LAKE ONTARIO
NIAGARA
ERIE

ORLEANS GENESEE
WYOMING

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Non-Safety Net Primary Care Providers
Even while accounting for their smaller populations in the proximity score, rural ZIP codes still generate the lowest proximity scores for non-Safety Net primary care providers. For instance, all ZIP codes within Orleans County, which has only four non-Safety Net primary care providers within its borders, fall in the bottom twenty percent of the region’s ZIP codes on this measure. Many ZIP codes in other rural counties also produce low proximity scores for non-Safety Net primary care providers, including those within cities like Jamestown, Batavia and Salamanca.
The communities where low access to primary care is most severe lie in western Cattaraugus County, especially zip codes 14719, and 14755 which fall within the bottom ten percent of proximity scores for both Safety Net and non-Safety Net primary care providers. Conversely, many suburban areas that received low proximity scores for Safety Net primary care providers reveal high, or at least fair, proximity scores for non-Safety Net providers. And in Niagara County, Lockport and North Tonawanda ZIP codes that score relatively low on this measure also showed low scores of proximity to Safety Net primary care providers.

LAKE ONTARIO

Proximity to Providers
Primary Care (Non-Safety Net)
WNY Rank 1 - 10 11 - 20 21 - 30 31 - 40 41 - 50 51 - 60 61 - 70 71 - 80 81 - 90 91 - 100

NIAGARA ERIE

LAKE ERIE

ORLEANS GENESEE
WYOMING

CHAUTAUQUA

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ALLEGANY

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