Breaking the code: When access to health care is comparable, socio-economic differences determine health outcomes – A community needs assessment in the Hudson Valley region, NY

Social determinants of health have long been established as critical in the evaluation of population health outcomes. Westchester Medical Center is an applicant to the New York State’s Delivery System Reform Incentive Payment Program, a Medicaid waiver that will restructure health care delivery with the goal of reducing avoidable hospitalizations by 25% over 5 years. This study presents the Community Needs Assessment’s results, conducted during the planning phase. 

Methods: We applied geographic information science and spatial analyses to Medicaid claims data to identify population-based health issues. We identified 9 “hot spot” ZIP codes with high needs and potential gaps in care. Consumer surveys across 8 counties (N=4,952) were also collected. 

Results: Despite significant differences in socio-economic characteristics, respondents from the 9 ZIPs (30%, n=1,464) reported no significant differences in their access to care and rates of health services utilization, compared to the rest of the study group. Respondents from these ZIPs, however, reported a higher ER visit rate (32% vs. 24%) and sought more health behavior-related services (alcohol abuse, substance abuse) and less preventive care (cholesterol testing), commensurate with differences in some health outcomes. 

Conclusions: Identifying “hot spots” is an essential first step in the understanding of health issues experienced by unique sub-populations. Survey results suggest that access alone may still be inadequate to address differences in health outcomes. A more holistic, socially supportive undertaking that seeks to understand the impact of neighborhood determinants, in part by working through community-based organizations, may be a better investment of health care resources.