Unlock Financial Success with CalAIM: Budget Estimator Tool for CBOs

The CalAIM Budget Estimator Tool helps CBOs navigate the financial complexities of contracting under CalAIM. It offers an Excel-based template with built-in assumptions, cost input fields, revenue customization, and a summary tab. The tool supports informed decision-making, negotiation power, and sustainability, empowering organizations to enhance care and expand services.

Introduction

Navigating the financial complexities of contracting under the California Advancing and Innovating Medi-Cal (CalAIM) initiative can be challenging for community-based organizations (CBOs). With new Medi-Cal benefits such as Enhanced Care Management and Community Supports, understanding potential revenue and expenses is crucial. This is where the CalAIM Budget Estimator Tool comes in, offering a robust template to help CBOs project financial viability and ensure their mission’s sustainability.

Understanding the CalAIM Budget Estimator Tool

CalAIM Budget Estimator Tool: The CalAIM Budget Estimator Tool is an Excel-based template designed to help organizations estimate costs and potential revenue from providing Medi-Cal Enhanced Care Management and selected Community Support Services. These services include housing-related services and medically tailored meals.

Key Features

Built-in Assumptions: The tool incorporates assumptions about payment structures for these services, as outlined in the California Department of Health Care Services CALAIM Enhanced Care Management Policy Guide and Community Supports Policy Guide.
Cost Input: Users can enter organization-specific expenses such as staffing costs and other direct and indirect costs.
Revenue Customization: It includes generic rate ranges and areas for customizing expected revenue sources to calculate the program margin (ratio of revenue to expenses).
Summary Tab: A summary tab displays the projected margin by program year, helping users understand if their assumptions lead to a fiscally viable program.

The Importance of Financial Viability for CBOs

For CBOs, financial viability is paramount. The adage “No margin, no mission” rings true as these organizations aim to enhance services for individuals with complex health and social needs. The CalAIM Budget Estimator Tool enables organizations to model various scenarios for their programs, supporting meaningful feasibility discussions with financial officers and other decision-makers.

How the CalAIM Budget Estimator Tool Supports CBOs

The CalAIM Budget Estimator Tool is designed to facilitate informed discussions about future programming and the financial feasibility of providing new Medi-Cal services. Here’s how it supports CBOs:

Modeling Various Scenarios: The tool allows organizations to create multiple financial scenarios, enabling a comprehensive understanding of different potential outcomes.
Justifying Rate Requests: By organizing and highlighting critical financial information, the tool helps CBOs justify rate requests to MCOs during contract negotiations.
Enhancing Financial Confidence: With detailed projections, CBOs can confidently navigate the financial aspects of contracting with MCOs.

Step-by-Step Guide to Using the CalAIM Budget Estimator Tool

Step 1: Download the Tool

Click the link below to download the budget estimator tool in Excel format:
Download the Budget Estimator Tool in Excel Format

Step 2: Enter Costs

Input your organization-specific expenses, including staffing costs and other direct and indirect costs.

Step 3: Customize Revenue Sources

Use the tool to enter expected revenue sources. Customize the rates to reflect realistic projections for your organization.

Step 4: Review Summary Tab

Examine the summary tab to view the projected margin by program year. This will help you understand the financial viability of your program.

Benefits of Using the CalAIM Budget Estimator Tool

Informed Decision-Making: The tool provides comprehensive data to support strategic financial decisions. Enhanced Negotiation Power: With detailed financial projections, CBOs can negotiate better rates with MCOs. Sustainability: Ensuring financial viability helps CBOs sustain their mission and expand services under CalAIM.

Frequently Asked Questions

What is the CalAIM Budget Estimator Tool? The CalAIM Budget Estimator Tool is an Excel-based template designed to help organizations estimate costs and potential revenue from providing Medi-Cal Enhanced Care Management and selected Community Support Services.

How does the tool support CBOs in contracting with MCOs? The tool enables CBOs to model various financial scenarios, justify rate requests during negotiations, and make informed decisions about program viability.

What are the key features of the CalAIM Budget Estimator Tool? Key features include built-in assumptions, cost input fields, revenue customization, and a summary tab displaying projected margins.

Can the tool be customized for specific organizational needs? Yes, users can customize expense inputs and revenue projections to reflect their specific organizational needs.

How do I get started with the CalAIM Budget Estimator Tool? Download the tool, enter your organization-specific costs, customize revenue sources, and review the summary tab to understand financial projections.

Why is financial viability important for CBOs? Financial viability ensures that CBOs can sustain their mission and expand services, ultimately enhancing care for individuals with complex health and social needs.

Conclusion

The CalAIM Budget Estimator Tool is an invaluable resource for CBOs looking to contract with managed care organizations under CalAIM. By providing detailed financial projections, the tool empowers organizations to make informed decisions, justify rate requests, and ensure the sustainability of their mission. Download the tool today and take the first step towards financial success and enhanced service offerings.

Utilizing California State Data to Enhance Care for Foster Youth

The Continuum of Care for children in out-of-home settings can be enhanced by leveraging existing data sources. California’s CDSS, DDS, DHCS, and CDE provide crucial data on community care facilities, placement, mental health services, education, and more. These insights will guide targeted strategies for improving support and care for all children.

In the journey to enhance the Continuum of Care for children in out-of-home settings, it’s crucial to leverage existing data sources to understand the current capacity. This approach will inform the identification of potential needs or gaps in systems, services, or placements. The State Technical Assistance (TA) Team has pinpointed a variety of state data sources that will be instrumental in this process. Here’s an overview of these sources:

California Department of Social Services (CDSS)

CDSS provides a wealth of administrative data crucial for assessing the landscape of community care facilities and foster care placements:

Licensed Community Care Facilities: This data includes the number and capacity of licensed facilities.
Current Placement Data: Information on children currently placed in these facilities.
Supportive Services Data: Data from the Child Welfare Services/Case Management System.
Child Adolescent Needs and Services (CANS) Data: Assessment data reflecting the needs and services for children.
Mental Health Services Referral Data: Data on child welfare screening and subsequent referral for mental health services.
Probation Youth Data: Information on probation youth previously served in child welfare.
California Child and Family Services Review (CFSR) Data: Case review data.
Structured Decision Making (SDM) Data: Tools and data used for decision-making processes.
CalWORKs Data: Information on services and supports provided through CalWORKs.

Department of Developmental Services (DDS)

DDS offers data on facilities and services for individuals with developmental disabilities:

DDS Operated Facilities Data: Data on facilities directly operated by DDS.
Regional Center Vendored Residential Care Data: Information on residential care settings operated by regional centers.
Supportive Services Claims Data: Claims data for services provided or contracted by regional centers.

Department of Health Care Services (DHCS)

DHCS data is essential for understanding the utilization of health and mental health services:

Penetration and Engagement Rates for Specialty Mental Health Services (SMHS): Data on the utilization of mental health services.
Penetration and Engagement Rates for DMC/DMC-ODS Services: Data on the utilization of substance use disorder services.
SMHS Claims Data: Claims data related to specialty mental health services.
Child Adolescent Needs and Services (CANS) Data: Needs assessment data for children and adolescents.
Pediatric Symptoms Checklist (PSC-35) Data: Data on pediatric symptoms.
California Children’s Services Program Data: Information on services provided under this program.
Psychiatric Health Facilities Claims Data: Claims data for psychiatric health facilities and acute psychiatric inpatient services.
Crisis Services Claims Data: Information on the utilization of crisis services.
Planned Services Claims Data: Data on follow-up services after a crisis.
SUD Services Claims Data: Claims and/or CalOMS data for substance use disorder services.
Medi-Cal Services Data: Data on Medi-Cal services provided through managed care plans or fee-for-service providers.
Pharmacy Data: Information on prescription medications.
Unapproved Claims Data: Data on claims that were not approved.
MCP Referral Rates to County MHPs: Data on referral rates by managed care plans to county mental health plans.
MCP Referral Rates to DMC/DMC-ODS Programs: Data on referrals to substance use disorder programs.
MHSA Programs and Services Data: Information on programs and services funded by MHSA.
LEA Medi-Cal Billing Option Program (BOP) Data: Data on services billed through this program.
School-Based Medi-Cal Administrative Activities (SMAA) Data: Information on administrative activities billed through Medi-Cal.

California Department of Education (CDE)

CDE provides crucial data on the educational outcomes and attendance of foster youth:

High School Completion and College Data: Graduation and dropout rates, other high school completion types, and college-going rates.
Attendance and Enrollment Data: Chronic absence rates, foster match rates by county, and enrollment data for foster youth.
Academic Achievement Data: CAASPP scores in English Language Arts and Mathematics.
School Climate Data: Suspension and expulsion rates and counts, and suspension by most serious offense.
Foster Youth Data Liaison: Data matching efforts and collaboration with CDSS.
AB 114-Educationally Related Mental Health Services (ERMHS) Data: Information on mental health services provided under AB 114.

Conclusion

By utilizing these comprehensive data sources, we can better understand the current capacity and identify areas that need improvement or additional support within the Continuum of Care for children in out-of-home settings. These insights will guide the development of targeted strategies to ensure that all children receive the care and support they need to thrive.

Stay tuned for more updates and detailed analyses as we progress through the phases of this critical initiative.

Source	Data Category	Details
CDSS	Licensed Community Care Facilities	Administrative data on the number and capacity of licensed facilities.
CDSS	Current Placement Data	Data on children in foster care placed in licensed community care facilities.
CDSS	Supportive Services Data	Data from the Child Welfare Services/Case Management System.
CDSS	Child Adolescent Needs and Services (CANS) Data	Assessment data reflecting the needs and services for children.
CDSS	Mental Health Services Referral Data	Data on child welfare screening and subsequent referral for mental health services.
CDSS	Probation Youth Data	Information on probation youth previously served in child welfare.
CDSS	California Child and Family Services Review (CFSR) Data	Case review data.
CDSS	Structured Decision Making (SDM) Data	Tools and data used for decision-making processes.
CDSS	CalWORKs Data	Information on services and supports provided through CalWORKs.
DDS	DDS Operated Facilities Data	Data on facilities directly operated by DDS.
DDS	Regional Center Vendored Residential Care Data	Information on residential care settings operated by regional centers.
DDS	Supportive Services Claims Data	Claims data for services provided or contracted by regional centers.
DHCS	SMHS Penetration and Engagement Rates	Data on the utilization of specialty mental health services.
DHCS	DMC/DMC-ODS Penetration and Engagement Rates	Data on the utilization of substance use disorder services.
DHCS	SMHS Claims Data	Claims data related to specialty mental health services.
DHCS	Child Adolescent Needs and Services (CANS) Data	Needs assessment data for children and adolescents.
DHCS	Pediatric Symptoms Checklist (PSC-35) Data	Data on pediatric symptoms.
DHCS	California Children’s Services Program Data	Information on services provided under this program.
DHCS	Psychiatric Health Facilities Claims Data	Claims data for psychiatric health facilities and acute psychiatric inpatient services.
DHCS	Crisis Services Claims Data	Information on the utilization of crisis services.
DHCS	Planned Services Claims Data	Data on follow-up services after a crisis.
DHCS	SUD Services Claims Data	Claims and/or CalOMS data for substance use disorder services.
DHCS	Medi-Cal Services Data	Data on Medi-Cal services provided through managed care plans or fee-for-service providers.
DHCS	Pharmacy Data	Information on prescription medications.
DHCS	Unapproved Claims Data	Data on claims that were not approved.
DHCS	MCP Referral Rates to County MHPs	Data on referral rates by managed care plans to county mental health plans.
DHCS	MCP Referral Rates to DMC/DMC-ODS Programs	Data on referrals to substance use disorder programs.
DHCS	MHSA Programs and Services Data	Information on programs and services funded by MHSA.
DHCS	LEA Medi-Cal Billing Option Program (BOP) Data	Data on services billed through this program.
DHCS	School-Based Medi-Cal Administrative Activities (SMAA) Data	Information on administrative activities billed through Medi-Cal.
CDE	High School Completion and College Data	Graduation and dropout rates, other high school completion types, and college-going rates.
CDE	Attendance and Enrollment Data	Chronic absence rates, foster match rates by county, and enrollment data for foster youth.
CDE	Academic Achievement Data	CAASPP scores in English Language Arts and Mathematics.
CDE	School Climate Data	Suspension and expulsion rates and counts, and suspension by most serious offense.
CDE	Foster Youth Data Liaison	Data matching efforts and collaboration with CDSS.
CDE	AB 114-Educationally Related Mental Health Services (ERMHS) Data	Information on mental health services provided under AB 114.

Child and Family Health Policy Insights: CCF Blog Analysis

The Center for Children and Families (CCF) at Georgetown University’s McCourt School of Public Policy offers extensive insights into health policy issues affecting children and families. The CCF blog, “Say Ahhh!,” covers topics such as Medicaid, CHIP, health equity, maternal and early childhood health, and more.

One recent article discusses the positive momentum in Medicaid coverage for doula services. This coverage aims to address maternal and infant health crises by providing support during pregnancy, labor, and postpartum periods, particularly for low-income families. The article notes that as of now, 43 states and D.C. have taken steps to include doula care in Medicaid coverage (Center For Children and Families).

Another post highlights the new rule allowing Deferred Action for Childhood Arrivals (DACA) grantees to access Marketplace coverage starting in November 2024. This change will enable DACA recipients to purchase qualified health plans with financial assistance, which is expected to cover an additional 100,000 uninsured individuals. However, the rule does not extend to Medicaid and CHIP, which remains a significant gap in coverage (Center For Children and Families).

The Center for Children and Families (CCF) at Georgetown University’s McCourt School of Public Policy is a rich resource for information on health policy issues impacting children and families, especially those with low and moderate incomes. Their blog, “Say Ahhh!,” features a range of topics, from Medicaid and CHIP to maternal and early childhood health.

Key Topics and Articles:

Medicaid and Doula Services:
- Doula services are gaining momentum as states incorporate these services into Medicaid to improve maternal and infant health outcomes. Doulas provide non-clinical support during the perinatal period, which can reduce adverse birth outcomes and improve perinatal mental health. States like Washington have increased reimbursement rates for doulas to $3,500 per birth, the highest in the country, highlighting the importance of sufficient reimbursement to encourage more doulas to become Medicaid providers (Center For Children and Families).
Marketplace Coverage for DACA Grantees:
- A recent rule allows DACA grantees to access Marketplace coverage starting in November 2024. This rule enables them to purchase qualified health plans with financial help, potentially covering an additional 100,000 uninsured individuals. However, this rule does not extend to Medicaid and CHIP, maintaining a gap in coverage for DACA recipients (Center For Children and Families).
State Medicaid Enrollment and Coverage:
- Articles discuss the impact of the unwinding of continuous Medicaid coverage, with significant declines in child Medicaid enrollment. This situation underscores the need for states to take action to prevent children from losing coverage (Center For Children and Families).
Behavioral Health Integration:
- CMS has introduced new state opportunities to address behavioral, physical, and health-related social needs through the “Innovation in Behavioral Health” model. This initiative aims to integrate care for individuals covered by Medicaid and Medicare, addressing comprehensive health needs (Center For Children and Families).
Child and Family Health Policy:
- The blog frequently covers changes and challenges in health policy, such as the impact of federal and state regulations on health coverage, and innovative strategies to improve access to care for vulnerable populations (Center For Children and Families) (Center For Children and Families).

Additional Key Topics and Articles:

Medicaid and CHIP Eligibility and Enrollment:
- The blog discusses the variability in state performance regarding Medicaid and CHIP eligibility and enrollment, particularly during the unwinding of continuous enrollment protections put in place during the pandemic. This includes detailed analyses of state policies and their impacts on children and families (Center For Children and Families) (Center For Children and Families).
Behavioral Health Initiatives:
- The CMS has introduced new opportunities for states to advance behavioral health care integration. This initiative aims to test new approaches for addressing behavioral, physical, and health-related social needs of individuals covered by Medicaid and Medicare. These models seek to improve overall health outcomes by integrating various aspects of care (Center For Children and Families).
Impact of Policy Changes on Health Coverage:
- Articles often examine how changes in federal and state policies affect health coverage for children and families. For example, discussions on the implications of the federal poverty level adjustments and how these changes impact eligibility for various health programs (Center For Children and Families).
Innovations in Maternal and Child Health:
- The blog covers innovations and state-level initiatives to improve maternal and early childhood health. This includes state efforts to expand Medicaid coverage for doula services and the outcomes associated with these initiatives, such as reduced adverse birth outcomes and improved maternal mental health (Center For Children and Families).
Health Equity and Access:
- CCF emphasizes the importance of health equity, particularly in how policies and programs are designed to ensure all children and families have access to affordable and high-quality health care. This includes addressing disparities in health outcomes among different racial and socioeconomic groups (Center For Children and Families).
State-Specific Health Policy Developments:
- The blog provides updates on state-specific health policy developments, such as new legislation, budget allocations, and innovative programs aimed at improving health coverage and care for children and families. For instance, discussions on how states like Washington are increasing doula reimbursement rates to promote better maternal health (Center For Children and Families).

Subscribe for Updates:

To stay updated with the latest posts and insights from the Center for Children and Families, you can subscribe to their updates here (Center For Children and Families).

These topics highlight the comprehensive efforts and detailed research conducted by CCF to improve health policies and outcomes for children and families in the U.S. For more in-depth articles and the latest updates, visiting the CCF blog directly is recommended.

Introducing the Care MAP Tool: A Comprehensive Guide

Introducing the Care MAP Tool, designed to support healthcare providers in managing complex care needs. This user-friendly, Excel-based tool offers a structured framework for effective care coordination, resource allocation, and patient management. With modules for an overview and practical scenarios, plus a comprehensive resource library and FAQ section, the Care MAP Tool enhances care strategies and improves patient outcomes. Download it today and elevate your care management practices.

Effective care management is crucial in today’s complex healthcare landscape. To support healthcare professionals and organizations, we are excited to introduce the Care MAP Tool, a valuable resource designed to aid in complex care management. This blog will provide an overview of the Care MAP Tool, walk you through an example scenario, and offer access to a resource library and frequently asked questions (FAQ) section.

Module 1: Care MAP Overview

The Care MAP (Management and Planning) Tool is designed to support healthcare providers in managing and planning care for patients with complex health needs. This tool provides a structured framework to help clinics navigate the intricacies of care coordination, resource allocation, and patient management. Here’s what you can expect from the Care MAP Tool:

Framework for Complex Care Management: The tool offers a comprehensive structure to address the multifaceted needs of patients requiring intensive care management.
User-Friendly Interface: The Excel-based tool is intuitive and easy to navigate, ensuring that healthcare providers can quickly integrate it into their workflows.
Scalable and Adaptable: Whether you’re a small clinic or a large healthcare organization, the Care MAP Tool can be scaled and adapted to fit your unique needs.

Module 2: Example Scenario

To illustrate the practical application of the Care MAP Tool, let’s walk through an example scenario:

Scenario: Managing a Patient with Multiple Chronic Conditions

Patient Overview:
- Name: Jane Doe
- Age: 65
- Conditions: Diabetes, Hypertension, Chronic Obstructive Pulmonary Disease (COPD)
Initial Assessment:
- Medical History Review: Gather comprehensive information about Jane’s medical history, including past treatments, hospitalizations, and medications.
- Social Determinants of Health: Assess factors such as living conditions, access to transportation, and social support.
Care Coordination:
- Interdisciplinary Team: Form a care team that includes primary care physicians, specialists, nurses, social workers, and community health workers.
- Care Plan Development: Create a personalized care plan that addresses Jane’s medical and social needs, with clear goals and timelines.
Monitoring and Evaluation:
- Regular Check-ins: Schedule regular appointments and follow-ups to monitor Jane’s progress.
- Adjustments: Modify the care plan as needed based on Jane’s response to treatment and changes in her condition.

Resource Library

The Resource Library is a curated collection of materials to further support your use of the Care MAP Tool. Here, you’ll find:

Guides and Manuals: Detailed instructions on how to use the Care MAP Tool effectively.
Case Studies: Real-world examples of the tool in action, showcasing its impact on patient outcomes.
Training Videos: Step-by-step video tutorials to help you and your team get up to speed quickly.

FAQ

To ensure you have all the information you need, we’ve compiled a list of frequently asked questions:

Q1: Who can use the Care MAP Tool?
A1: The tool is designed for healthcare providers, including clinicians, care coordinators, and administrative staff.

Q2: Is there a cost associated with the Care MAP Tool?
A2: No, the Care MAP Tool is available for free download.

Q3: How do I get support if I encounter issues with the tool?
A3: Support is available through our online helpdesk. You can also refer to the Resource Library for troubleshooting guides.

Care MAP Tool Download

By using the Care MAP Tool, you acknowledge that you have read and agree to the disclaimer below. If you share the tool, ensure that all individuals given access to it have reviewed and agreed to the disclaimer language before using it for any purpose.

Disclaimer: The Care MAP Tool is intended as a general framework to support considerations around complex care management in a clinic setting. It is not meant for final staffing, clinical, administrative, operational, and/or financial decision-making. Information obtained from this tool is not and should not be taken as legal or financial advice and is not a substitute for consulting a qualified professional. Community Initiatives does not accept responsibility for any loss that may arise from reliance on this tool.

Source Link:

Care MAP Tool

Download Materials:

Care-MAP-Tool-Example-Scenario-3 Download

Care-MAP-Tool-Blank-1 Download

Feel free to reach out with any questions or feedback about the Care MAP Tool. Happy planning!

Dashboards: Breastfeeding Intention and Duration Indicators

The Breastfeeding Intention and Duration Indicators are key measures used to track breastfeeding practices and intentions among new mothers. These indicators include plans to breastfeed exclusively or in combination with formula, actual breastfeeding activities, and breastfeeding duration up to three months. They exclude mothers whose infants were not living with them at the survey time, ensuring data accuracy. These indicators help shape effective breastfeeding support programs, inform policy decisions.

Introduction

Breastfeeding is a critical component of infant health, providing essential nutrients and antibodies that help protect against infections and diseases. To monitor and improve breastfeeding practices, it’s essential to have accurate indicators that reflect breastfeeding intentions and behaviors. This blog post delves into key breastfeeding indicators, defining terms and outlining the criteria for inclusion and exclusion in related data surveys.

Breastfeeding Intention and Duration Indicators

1. Intended to Breastfeed

This indicator captures the mother’s or parent’s plan before delivery regarding breastfeeding. Specifically, it includes those who planned to either exclusively breastfeed or combine breastfeeding with formula feeding. It’s important to note that mothers or parents whose infants did not reside with them at the time of the survey are excluded from the denominator. This exclusion ensures that the data reflects the intentions of those who were in a position to breastfeed their child.

2. Intended to Breastfeed Exclusively

This indicator focuses on the mother’s or parent’s plan to exclusively breastfeed before delivery, without the use of formula or other supplements. Similar to the previous indicator, mothers or parents whose infants did not reside with them at the time of the survey are excluded from the denominator. This approach helps in accurately assessing the intention to exclusively breastfeed among those who had the opportunity to do so.

3. Ever Breastfed

The “ever breastfed” indicator refers to any instance of breastfeeding or feeding of breast milk by the mother or parent since the birth of the child. This broad indicator captures any initial breastfeeding activity and excludes mothers or parents whose infants did not reside with them at the time of the survey. By doing so, it ensures that the data accurately represents those who had the chance to initiate breastfeeding.

4. Any Breastfeeding at 3 Months

This indicator measures the extent to which infants are fed breast milk for at least three months after delivery. It includes both exclusive breastfeeding and breastfeeding combined with formula, other liquids, or food. The infant’s age is calculated from the date of birth on the birth certificate. Mothers or parents whose infants did not reside with them or whose infants were not yet three months old at the time the survey was completed are excluded from the denominator. This exclusion helps maintain the relevance and accuracy of the data by focusing on those who reached the three-month milestone.

Importance of Accurate Indicators

Accurate breastfeeding indicators are crucial for several reasons:

Policy and Program Development: Reliable data helps policymakers and healthcare providers develop targeted programs to support breastfeeding mothers and improve breastfeeding rates.
Resource Allocation: Understanding breastfeeding intentions and behaviors allows for better allocation of resources, ensuring that support systems are in place where they are most needed.
Public Health Insights: These indicators provide valuable insights into public health trends, enabling better planning and intervention strategies to promote infant health and well-being.

Conclusion

Breastfeeding indicators play a vital role in understanding and improving breastfeeding practices. By clearly defining terms and carefully excluding certain groups from the denominator, these indicators provide accurate and meaningful data. This data, in turn, supports efforts to promote breastfeeding, contributing to better health outcomes for both mothers and infants. As we continue to monitor and analyze breastfeeding trends, we can work towards creating a more supportive environment for breastfeeding families.

Access: Breastfeeding Intention and Duration

Breastfeeding Intention and Duration Indicators

Intended to Breastfeed: This indicator measures the mother’s or parent’s plan before delivery to either exclusively breastfeed or to combine breastfeeding with formula. Excluded from this measure are mothers/parents whose infants did not reside with them at the time of the survey.

Intended to Breastfeed Exclusively: This captures the mother’s or parent’s pre-delivery plan to solely breastfeed without any formula or supplements. Mothers/parents whose infants were not living with them at the time of the survey are excluded.

Ever Breastfed: This indicator reflects any instance of breastfeeding or feeding of breast milk by the mother/parent since the birth of the infant. It excludes mothers/parents whose infants did not reside with them at the time of the survey.

Any Breastfeeding at 3 Months: This measure looks at whether the mother/parent fed their infant breast milk for at least three months after delivery, with or without supplementing with formula, other liquids, or food. Infants not yet three months old or not residing with their mother/parent at the time of the survey are excluded.

Importance of These Indicators
These breastfeeding indicators are crucial for developing support programs, informing policy decisions, and enhancing public health initiatives. They provide accurate insights into breastfeeding behaviors and intentions, helping to promote better health outcomes for both mothers and infants.

35 States with Any Willing Provider laws

As a provider, if your request to join a payer network in the following markets has been denied, you might have some recourse for appeals.

Any Willing Provider and Freedom of Choice laws restrict the ability of managed care
entities, including pharmacy benefit managers, to selectively contract with providers. The
managed care entities argue this limits their ability to generate cost savings, while proponents of
the laws suggest that such selective contracts limit competition, leading to an increase in
aggregate costs.

These laws generally require health insurance companies to allow any qualified healthcare provider who is willing to meet the terms and conditions of the insurer’s contract to participate in their networks.

States listed below have some form of Any Willing Provider laws:

Alabama:

Section 27-1-19: The agreement providing coverage to an insured may not exclude assignment of benefits to any provider at the same benefit paid to a contract provider.

Section 27-45-3: Plan Beneficiaries may choose the licensed pharmacist or pharmacy of their choice. Health insurance policies and employee benefit plans may not deny licensed pharmacies or pharmacists the right to participate.

Arkansas:

Sections 23-201, 23-202, 23-203, 23-204, 23-205, 23-206, 23-207, 23-208, 23-209 : Benefit differentials are prohibited. Insurers must give qualified health care providers the opportunity to participate if providers are willing to accept the plan’s terms and conditions.

Colorado:

Section 10-16-122: Any PBM/intermediary whose contract with a carrier includes an open network must allow all area pharmacy providers to participate if they agree to the terms and conditions of the contract. PBms/Intermediaries may contract with exclusive pharmacy networks if a 60-day notice is given before the termination or the effective date of such contract by publication in a newspaper of general circulation.

Connecticut:

Section 38a-471: A prescription program administrator shall allow a pharmacy to enroll in a program absent cause for excluding it.

Delaware:

Sections 18-7301, 18-7302, 18-7303: Beneficiaries may choose any pharmacy that has agreed to participate according to the terms. Benefit differentials are prohibited.

Florida:

Section 110.12315: The state employees’ prescription drug program requires the Department of Management services to allow prescriptions to be filled by any licensed pharmacy pursuant to contractual claims processing provisions.

Section 440.13(3) (j): The worker’s compensation statute allows for a sick or injured employee to have free, full and absolute choice in the selection of the pharmacy.

Georgia:

Section 26-2-144(a)(9): That at least 30 days prior to the date a program becomes effective, the program contract therefor shall be offered to all pharmacies located within those counties wherein reside enrollees in that program, which pharmacies shall have at least 30 days from the time they receive the offer to accept that offer and become participating pharmacies.

Section 33-30-25: Insurers may impose “reasonable limits” on the number/classes of preferred providers that meet the insurers’ standards. Insurers must give all licensed and qualified providers within a defined service are the opportunity to become a preferred provider.

Section 33-30-4.3: Beneficiaries who do not use mail-order shall not be penalized if the provider used by the insured has agreed to the same terms and conditions applicable to mail-order and has agreed to accept payment or reimbursement at no more than the same amount that would be paid for the same mail-order services.

Hawai’i:

Section 451 R-1: It shall be a violation of this section for a prescription drug benefit plan, health benefits plan under chapter 87A, or pharmacy benefit manager to refuse to accept an otherwise qualified retail community pharmacy as part of a pharmacy benefit manager’s retail pharmacy network.

Idaho:

Sections 41-2872 & 41-3927: Any insurance company or health maintenance organization issuing benefits must be willing to contract with qualified providers who meet the terms of the organization. Organizations issuing benefits must be willing to contract with qualified providers who meet the terms of the organization

Illinois:

Section 215-5/370h: Insurers/administrators must be willing to enter into agreements with any non- institutional providers who meet the established terms and conditions. The terms and conditions may not discriminate unreasonably against or among non-institutional providers.

Section 215-134/72(a) : A plan may not refuse to contract with a pharmacy provider that meets the terms and conditions established by the plan.

Indiana:

Section 27-8-11-3 : Pharmacists who agree to comply with established terms and conditions

are entitled to enter into contracts with insurers. Terms and conditions established by insurers may not discriminate unreasonably against or among providers.

Iowa:

Section 514C.5: Policies or contracts providing for third-party payment may not require a beneficiary to order prescriptions by mail if the pharmacy chosen by the beneficiary agrees to comply with the same terms and conditions as the mail-order pharmacy.

Kentucky:

Section 304.17A-270: A health insurer shall not discriminate against any provider who is located within the geographic coverage area of the plan and who is willing to meet the terms and conditions for participation established by the plan, including the Kentucky State Medicaid program and Medicaid partnerships.

Section 304.17A-505: …if the provider meets the insurer’s enrollment criteria and is willing to meet the terms and conditions for

participation, the provider has the right to become a provider for the insurer.

Louisiana:

Section: 22:1964: Policies/plans must allow beneficiaries to select the pharmacy/pharmacist of their choice as long as the chosen pharmacy agrees to meet the terms and conditions of the plan.

Pharmacies that agree to meet the established terms and conditions have the right to participate as contract providers. Renamed from Section 22:1214(15).

Section 22:2181: The Louisiana State University Health Sciences Center Health Maintenance Organization shall enter into a contract with any willing provider licensed by the Louisiana State Board of Medical Examiners or the Louisiana State Board of Dental Examiners to provide primary care services delivered in an outpatient setting including medical and surgical services.

Maine:

24-A M.R.S.A. § 4317: insurance carriers offering health plans subject to the Maine Health Plan Improvement Act that provide prescription drug benefits through a network of participating pharmacies may not refuse to contract with a pharmacy that is willing to meet the terms and conditions for participation in the health plan’s pharmacy network. If the network is a tiered network, Maine pharmacies must be offered the opportunity to participate in each tier. A pharmacy benefits manager may not require a pharmacist or pharmacy to participate in one network in order to participate in another network. The pharmacy benefits manager may not exclude an otherwise qualified pharmacist or pharmacy from participation in one network solely because the pharmacist or pharmacy declined to participate in another network managed by the pharmacy benefits manager.

Massachusetts:

Section 176D(3B): Carriers who offer restricted pharmacy networks must follow certain requirements in contracting. Carriers must neither exclude nor favor individual pharmacies and must not impose greater restrictions on non-network pharmacies than those required on in-network pharmacies.

Mississippi:

Section 83-9-6: Beneficiaries may choose any pharmacy that has agreed to participate in the plan according to the insurer’s terms. Pharmacies that accept those terms are entitled to participate.

Benefit differentials are prohibited. Plans that restrict pharmacy participation shall give 60 days notice of offer to participate to all pharmacies in the geographic area.

Missouri:

Section 354.535: Every Health maintenance organization has to apply the same coinsurance, co- payment and deductible factors to all prescriptions filled by a pharmacy provider who participates in the network if the provider meets the contact’s product cost determination. Also HMOs may not set a limit on the quantity of drugs which an enrollee may obtain at any one time with a prescription unless such limit is applied uniformly to all pharmacy providers in the network.

Montana:

Section 33-22-1704: A preferred provider agreement must provide all providers with the opportunity to participate on the basis of a competitive bid.

Nebraska:

Section 44-513.02: Beneficiaries shall not be required to obtain pharmaceutical services from mail- order in order to obtain reimbursement.

Section 44-313(2) :…an insurer may contract with a licensed pharmacist for pharmacist professional

services. Nothing in this section shall prohibit an insurer from contracting with a licensed pharmacist who is not employed or associated with a pharmacy. Nothing in this section shall require a licensed pharmacist to contract with an insurer for pharmacist professional services.

New Hampshire:

Section 420-B:12(V): HMOs seeking bids from pharmacies for agreements to be preferred providers must admit and list all pharmacies that meet the bid.

New Jersey:

Sections 17:48-6j & 26:2J-4.7: An enrollee/subscriber shall be permitted to select a pharmacy/pharmacist provided the pharmacist or pharmacy is registered. Pharmacies/pharmacists shall have the right to participate as preferred providers if the agreement provides for coverage by preferred providers, so long as the pharmacy/pharmacist complies with the terms of the agreement. Benefit differentials shall not be imposed. Enrollees/subscribers shall not be required to use a mail- order pharmacy.

New Mexico:

Section16.19.6.7(f): “Point of care vendor” means an entity contracted with a prescriber to generate or transmit electronic prescriptions authorized by a practitioner directly to a pharmacy or to a “contracted” intermediary or “network vendor”, who will ultimately transmit the prescription order to a patient’s pharmacy of choice. Vendor must provide an unbiased listing of provider pharmacies and not use

pop-ups or other paid advertisements to influence the prescriber’s choice of therapy or to interfere with patient’s freedom of choice of pharmacy. Presentation of drug formulary information, including preferred and non-preferred drugs and co-pay information if available, is allowed.

North Carolina:

Section 58-51-37: Beneficiaries may choose any pharmacy that has agreed to participate according to the insurer’s terms. Pharmacies that accept such terms are entitled to participate and must participate if offered the opportunity. Benefit differentials are prohibited. Plans that limit pharmacy participation shall give 60 days notice of an offer to participate to all pharmacies in the geographic area.

North Dakota:

Section 26.1-36-12.2: Beneficiaries may choose any licensed pharmacy/pharmacist to provide services. Benefit differentials are prohibited. Licensed pharmacists who accept the terms may participate in the plan.

Oklahoma:

Section 36-3634.3 & 36-4511: Pharmacies must be provided the right to bid on a periodic basis on any pharmacy contract to provider pharmacy services. Employers may not require employees to obtain drugs from a mail-order pharmacy as a condition for reimbursement. Employers may not impose benefit differentials if they do not use mail-order.

Title 15 § 15-788(c): No third party prescription program administrator shall deny any pharmacy the opportunity to participate in any third party prescription program offered in this state in a manner which will restrain the right of a consumer to select a pharmacy.

Rhode Island:

Sections 27-18-33, 27-19-26, 27-20-23, 27-41-38: Insurers may not require covered persons to obtain prescriptions from a mail-order pharmacy as a condition of obtaining benefits.

RI Gen. Laws 27-29-1: Unfair competition and practices.

South Carolina:

Section 38-71-147: No individual or group accident and health or health insurance policy or HMO may prohibit a participant/beneficiary from selecting pharmacies/pharmacists that agreed to participate in the plan according to the terms of the insurer, or may deny pharmacies/pharmacists the right to participate as contract providers if they agree to insurer’s terms and conditions.

South Dakota:

Section 58-18-37: Group health insurance policies may not refuse to accept licensed pharmacies/pharmacists as participating providers if they agree to the same terms and conditions offered to other providers of pharmacy services under the policy.

Tennessee:

Section 56-7-117: Group medical benefit contracts covering prescriptions may not require a covered person to obtain prescriptions from mail-order, or to pay an additional fee, or be subjected to a penalty for declining to use a designated mail-order pharmacy.

Section 56-7-2359: Licensed pharmacies may not be denied right to participate on the same terms and conditions offered other participants; benefit differentials are prohibited.

Texas:

Section 21.52B 2(a) (2): A pharmacy/pharmacist may not be denied the right to participate as a contract provider under the plan if the pharmacy/pharmacist agrees to provide pharmaceutical services that meet all terms and requirements and to include the same administrative, financial, and professional conditions that apply to pharmacies/pharmacists that have been designated as providers under plan.

Utah:

Section 31A-22-617: Insurers must allow providers to apply for and be designated as preferred providers if they agree to meet established terms and conditions. “Reasonable limitations” may be placed on the number of designated preferred providers.

Virginia:

Section 38.2-3407: Insurers shall establish terms and conditions in order to receive payment as a preferred provider. The terms and conditions shall not discriminate unreasonably against or among such health care providers and cannot exclude any provider willing to meet the terms and conditions.

Section 38.2-3407.7: Insurers shall not prohibit any person receiving pharmacy benefits from selecting, without limitation, the pharmacy of his choice.

Section 38.2-4209: Providers who are willing to accept established terms and conditions may qualify for payment under preferred provider contracts.

Section 38.2-4209.1: Corporations must allow beneficiaries to select the pharmacy of their choice if pharmacies that are non-preferred providers have previously notified the corporation of their agreement to accept reimbursement at rates applicable to preferred providers.

Section 38.2-4312.1: No Health maintenance organization shall prohibit any person receiving pharmaceutical benefits from selecting, without limitation, the pharmacy of his choice. No monetary penalty which would affect or influence any person’s choice of pharmacy shall be imposed.

Wisconsin:

Section 628.36 (2m): An annual 30-day open enrollment period during which any pharmacist may elect to participate is required.

Wyoming:

Section 26-22-503: Any provider willing to meet the established requirements has the right to enter into contracts relating to health care services.

Section 26-34-134: Providers willing to meet an HMO’s established terms shall not be denied the right to contract. An HMO may not discriminate against a provider on the basis of the provider’s academic degree.

Please note that laws can change over time, so it’s always a good idea to verify the current status of AWP laws in specific states if you need the most up-to-date information.

State Policies on Provider Market Power

The Source is a comprehensive platform that monitors and documents various state-level activities related to healthcare prices and competition. It provides valuable resources in the form of legislation and litigation databases, which are searchable and easily accessible.

The Database of State Laws Impacting Healthcare Cost and Quality focuses on legislative measures that have an impact on the cost and quality of healthcare. This database allows stakeholders at the state level to gain insights into their legal and regulatory environment. By understanding the laws in place, these stakeholders can make informed decisions and take necessary actions to enhance access, quality, and efficiency in healthcare while also striving to reduce costs.

Additionally, The Source includes a collection of maps that offer a visual representation of notable legislation and initiatives in health policy and reform across all 50 states. These maps provide a convenient way to explore the different approaches taken by each state and the progress made in addressing healthcare challenges.

If users have specific laws or cases they are interested in, they can utilize the search functionality within the database. This feature enables targeted exploration of laws and cases pertaining to a particular state, making it easier to find relevant information.

Overall, The Source serves as a valuable tool for stakeholders involved in healthcare, providing them with the necessary information to navigate the complex landscape of healthcare legislation and policy across the United States.

Through a review of state laws, CPR found a short list of states – California, Massachusetts, Montana, New Hampshire, North Carolina, Oregon, and Rhode Island – that are particularly active in their policy efforts regarding healthcare provider consolidation and market power.

Click to access State-Policies-on-Provider-Market-Power-1.pdf

State Policies on Provider Market Power Report

The Database of State Laws Impacting Healthcare Cost and Quality (SLIHCQ)

The Source on Healthcare Price & Competition

The Source tracks state activities impacting healthcare price and competition in both legislation (The Database of State Laws Impacting Healthcare Cost and Quality) and litigation in a searchable database to help stakeholders at the state level understand their legal and regulatory environment as they make efforts to improve access, quality, and efficiency, and reduce costs in healthcare.

Browse through the maps below to find out more about notable legislation and initiatives in health policy and reform across 50 states or search the database for specific laws and cases of a particular state.

ARTICLES & REPORT

New Mexico Enacts HB 306 – Threading the Needle on Facility Fees
April 7, 2026 by Anna Chau
On March 6, 2026, New Mexico enacted HB306, the “Fair Pricing for Routine Medical Care Act”, to prohibit charging of healthcare facility fees for certain services, to require the disclosure of facility fees to patients, and to require the reporting of facility fees to the all-payer claims database. The bill prohibits hospitals and clinics from […]
The Source Roundup: April 2026 Edition
April 1, 2026 by Leelah Klauber
Antitrust and Market Competition Playing Favorites — State Protection of Academic Medical Centers from Antitrust Oversight New England Journal of Medicine Jaime S. King, Katherine L. Gudiksen, Anna D. Sinaiko The authors explore a new trend with U.S. academic medical centers (AMCs) merging with nonacademic hospitals and health care systems. These mergers pose risks of […]
Department of Justice Suit Against New York Presbyterian May Be Part of a Larger Antitrust Enforcement Trend
March 31, 2026 by Bruce Allain, Managing Editor
On March 26, 2026, the Department of Justice (DOJ) sued New York-Presbyterian Hospital (NYP), claiming NYP used illegal anticompetitive terms in their contracts with payors. In the related press release, the DOJ stated that “New York-Presbyterian uses its market power to protect its margins, impede competition from rival hospitals, and prevent employers and unions from […]
The Source Staff Co-Author New Research on the State Protection of Academic Medical Centers from Antitrust Oversight
March 25, 2026 by Bruce Allain, Managing Editor
The Source’s founder Jaime S. King, and executive editor Katherine L. Gudiksen, working with Harvard’s Anna D. Sinaiko, have authored a report on state antitrust exemptions for academic medical centers (AMCs) published recently by the New England Journal of Medicine. There is a recent history of AMCs merging with nonacademic systems, with states creating "carve-outs" to exempt AMCs from antitrust oversight. The research […]
California’s Antitrust Reform Recommendation Reaches the Legislature as AB 1776
March 23, 2026 by Kassie Williams
Background In August of last year, The Source shared information about the California Law Revision Committee's (CLRC) antitrust study, spurred by the 2022 Assembly Concurrent Resolution No. 95. At its outset, the study aimed to address the U.S. monopoly problem and the "threat of market concentration" in California. The legislature tasked the CLRC with determining […]
Anticompetitive Provider Contract Terms Come Under Fire
March 16, 2026 by Bruce Allain, Managing Editor
Antitrust scrutiny of anticompetitive healthcare contract terms is on the rise, and the use of anticompetitive contract terms are increasingly in the crosshairs of both regulators and courts. When healthcare systems acquire a dominant market share, one method of capitalizing on this dominance is to impose anticompetitive terms on entities they contract with for financial […]

Minnesota

California

Florida

Unleashing the Power of Healthcare Data: Exploring HRSA’s Data Portal

Discover the power of the HRSA Data Portal in revolutionizing healthcare research and planning. Developed by the Health Resources and Services Administration (HRSA), this web-based platform provides access to a vast array of comprehensive healthcare data. From primary care facilities to health workforce information, the HRSA Data Portal serves as a centralized repository for diverse datasets. Explore its key features, including interactive data visualization tools that enable users to gain insights and identify trends. Customizable reports and dashboards allow for tailored analysis, while the data download capability empowers researchers to perform in-depth analysis and integrate HRSA data into their own workflows. With its potential to inform evidence-based decision-making, the HRSA Data Portal can contribute to improved healthcare delivery, reduced disparities, and targeted interventions. Unlock the potential of data-driven solutions and work towards equitable access to healthcare resources with the HRSA Data Portal. Access it now to drive positive change.

Introduction:

In today’s data-driven world, information has become a valuable asset, particularly in the healthcare industry. Access to accurate and comprehensive healthcare data can drive research, inform policy decisions, and ultimately improve patient outcomes. Fortunately, the Health Resources and Services Administration (HRSA) understands the significance of data transparency and has developed a powerful tool: the HRSA Data Portal. In this blog post, we will delve into the depths of this invaluable resource and explore its potential to revolutionize healthcare research and planning.

What is the HRSA Data Portal?

The HRSA Data Portal is a web-based platform that provides access to a wealth of healthcare data collected by the Health Resources and Services Administration. HRSA is an agency of the U.S. Department of Health and Human Services, tasked with improving access to healthcare services for underserved populations. The Data Portal serves as a centralized repository for various datasets, enabling users to analyze, visualize, and download information relevant to health resources, health workforce, and other critical healthcare domains.

Exploring the Key Features:

Comprehensive Data Collection: The HRSA Data Portal offers an extensive collection of datasets covering diverse aspects of healthcare, including but not limited to primary care facilities, healthcare workforce, medically underserved areas, and health disparities. This wide-ranging data facilitates a holistic understanding of the healthcare landscape and enables researchers, policymakers, and healthcare professionals to identify gaps and target interventions more effectively.
Interactive Data Visualization: The Data Portal incorporates interactive data visualization tools that empower users to explore healthcare data visually. From dynamic charts and graphs to geospatial mapping, these visualization features provide a user-friendly interface for gaining insights and identifying trends, patterns, and disparities across different regions and demographics. This functionality enhances data comprehension and assists in evidence-based decision-making.
Customizable Reports and Dashboards: Users can create custom reports and dashboards using the available datasets within the HRSA Data Portal. This flexibility allows individuals to tailor their analysis and focus on specific areas of interest. Whether one is conducting research on healthcare access in rural communities or examining workforce distribution in underserved regions, the ability to customize reports streamlines the data exploration process and promotes targeted investigations.
Data Download Capability: The Data Portal provides direct access to downloadable datasets in various formats, allowing researchers and analysts to integrate the HRSA data into their own analytical tools and workflows. This feature empowers users to perform in-depth analysis, conduct advanced statistical modeling, or combine HRSA data with other sources to gain a comprehensive understanding of healthcare dynamics.

The Potential Impact:

The HRSA Data Portal has the potential to revolutionize healthcare research, planning, and policy development. By fostering transparency and access to valuable information, the platform can facilitate evidence-based decision-making, leading to more effective resource allocation, improved healthcare delivery, and reduced health disparities. Researchers can leverage the data to identify gaps in healthcare access, evaluate the impact of interventions, and propose targeted solutions. Policymakers can utilize the insights gained from the data to shape healthcare policies that address the needs of underserved populations, ultimately enhancing the overall health of communities.

Conclusion:

The HRSA Data Portal stands as a testament to the power of data in transforming the healthcare landscape. Its robust collection of datasets, interactive visualization capabilities, customizable reports, and data download functionality provide a comprehensive toolkit for healthcare researchers, policymakers, and professionals. By leveraging this platform, stakeholders can gain valuable insights, make informed decisions, and work towards a future where healthcare resources are equitably distributed and accessible to all. The HRSA Data Portal serves as a beacon of hope, empowering us to unlock the potential of data-driven solutions in improving healthcare outcomes for communities across the nation.

Area Health Resources Files

BHW Clinician Dashboards

BHW Program Applicant and Award Data

Grants

Health Center Service Delivery and Look–Alike Sites

Health Professions Training Programs

Maternal and Child Health Bureau

National Health Service Corps (NHSC), Nurse Corps, and Substance Use Disorder Treatment and Recovery (STAR) and other Programs

National Practitioner Data Bank

Nursing Workforce Survey Data

Organ Donation and Transplantation

Ryan White HIV/AIDS Program

Shortage Areas

Uniform Data System

Workforce Projections

HRSA Data Portal Access

California Primary Care Clinic Annual Utilization Data

California Primary Care Clinic Annual Utilization Data. Access the complete data set of annual utilization data reported by primary care clinics contains basic clinic identification information.

Introduction

In today’s data-driven world, the ability to collect, analyze, and leverage information is crucial for making informed decisions. This holds true in the healthcare industry as well, where data plays a pivotal role in understanding patient needs, improving healthcare delivery, and optimizing resource allocation. One valuable source of information is the annual utilization data reported by primary care clinics. In this blog post, we will explore the wealth of insights that can be derived from this comprehensive dataset, including clinic identification information, financial data, and utilization trends.

Clinic Identification and Staffing Data

The complete data set of annual utilization data reported by primary care clinics contains basic clinic identification information. This includes details about the community services provided, enabling policymakers and researchers to assess the availability of healthcare resources in specific areas. Additionally, the dataset includes clinic staffing data, which sheds light on the number and types of healthcare professionals working in these clinics. This information is vital for understanding the distribution of primary care providers and identifying potential gaps in staffing.

Patient and Staff Language Data

Understanding the language preferences of both patients and staff is essential for effective communication and ensuring culturally competent care. The utilization dataset includes valuable information on the languages spoken by patients and staff members. By analyzing this data, healthcare organizations can identify linguistic needs within their patient population and make informed decisions about language assistance services and staff training programs.

Financial Information

The utilization dataset also incorporates financial information, providing insights into the financial health of primary care clinics. This includes gross revenue, itemized write-offs by program, and an income statement. By examining these financial metrics, healthcare administrators and policymakers can assess the financial viability of clinics, identify areas of potential improvement, and allocate resources more effectively. Moreover, selected capital project items are included in the dataset, enabling stakeholders to evaluate investments in infrastructure and technology.

Encounters, Diagnoses, and Procedures

A significant component of the utilization dataset is information on encounters, diagnoses, and procedures. This is captured through principal diagnosis and procedure codes, such as CPT codes. By analyzing this data, researchers and healthcare professionals can gain insights into the types of services provided, prevalent health conditions, and procedures performed within primary care clinics. These findings can guide clinical decision-making, resource allocation, and health promotion efforts.

Utilization Trends and Insights

One of the most valuable aspects of the primary care clinic utilization dataset is the ability to derive trends and insights. The dataset provides information on the number of clinics by type, allowing stakeholders to assess the distribution of primary care facilities across different regions or communities. It also includes data on the number of patients by race, ethnicity, gender, and age, enabling the identification of health disparities and the development of targeted interventions.

Furthermore, the dataset provides information on encounters by payer source, shedding light on the financial landscape of primary care clinics. This data can help policymakers evaluate the effectiveness of healthcare financing models and their impact on access to primary care services. Additionally, revenues by payer source, including the average revenue per encounter, offer valuable insights into the financial dynamics of primary care clinics and can inform reimbursement strategies.

Conclusion

The complete data set of annual utilization data reported by primary care clinics is a treasure trove of information that holds immense potential for improving healthcare delivery. From clinic identification and staffing data to financial information and utilization trends, this dataset empowers healthcare administrators, policymakers, and researchers to make data-informed decisions, enhance resource allocation, and promote equitable and patient-centered care. By harnessing the power of this comprehensive dataset, we can strive towards a future where primary care is optimized, accessible, and tailored to meet the diverse needs of communities.

California Primary Care Clinic Annual Utilization Data

The complete data set of annual utilization data reported by primary care clinics contains basic clinic identification information including community services, clinic staffing data, and patient and staff language data; financial information including gross revenue, itemized write-offs by program, an income statement, and selected capital project items; and information on encounters by service, principal diagnosis, and procedure codes (CPT codes). These products provide trend utilization information for primary care clinics in the form of tables and pivot tables. The primary care clinic trends resource includes information on the number of clinics by type, the number of patients (by race, ethnicity, gender and age), the number of encounters by payer source; and revenues by payer source including the average revenue per encounter.

Access Dataset

Maryland Physicians Care (MPC) Provider Relations Representatives Maryland Physicians Care

MPC providers have designated Provider Relations Representatives based on the practice/group location. This specialist will be your primary contact with MPC and will keep you updated on any policy changes. To find your Provider Relations Representative, select a territory for the list below.

Phone: 1-800-953-8854 (follow prompts to PR dept.)
Fax: 866-333-8024

Download the Territory List

MPC Provider Relations Representatives