Spatial Clustering of COVID-19 Mortality Rates across Counties and by Noncore, Micropolitan, and Metropolitan County Characteristics, December 2020–January 2021

This policy brief examines spatial clusters of COVID-19 mortality rates across counties in the United States between December 2020 and January 2021. Between December 2020 and January 2021, COVID-19 deaths were at their peak, hospital capacity was stretched, and COVID-19 vaccines were not widely available, making this a critical time period to examine.

Key Findings:

• Spatial clusters of high COVID-19 mortality rates occurred in Iowa, South Dakota, Kansas, Pennsylvania, Texas, and Arizona.
• A higher percentage of clusters of high COVID-19 mortality rates were in noncore and micropolitan counties compared to metropolitan counties.
• High COVID-19 mortality cluster counties tended to have higher average percentages of Hispanic populations, particularly in micropolitan counties.
• Noncore counties that were high COVID-19 mortality clusters had the highest average nursing home bed density and the highest average proportion of Medicare beneficiaries with multiple chronic conditions.

Read the full brief here.

Differences in the Merit-based Incentive Payment System (MIPS) Performance of Clinicians in Metropolitan and Nonmetropolitan Counties in 2018

Mina Shrestha, PhD; Lili Xu, MS; Hari Sharma, PhD; Fred Ullrich, BA; A. Clinton MacKinney, MD; Keith Mueller, PhD

The Merit-based Incentive Payment System (MIPS) is a pay-for-performance system for clinicians under the Medicare Quality Payment Program designed to reward clinicians providing higher quality of care and lower costs. This study compared clinicians’ MIPS performance in 2018 based on their practice location, size, and minority population proportion.

Key Findings:

• The overall performance in the MIPS program was comparable for metropolitan and nonmetropolitan clinicians. However, a smaller proportion of nonmetropolitan clinicians were likely to receive exceptional performance payments.
• Most of the clinicians receiving reduced payments were in solo practice in both metropolitan and nonmetropolitan areas.
• Clinicians serving a high proportion of minorities were less likely to get exceptional performance payments but were also less likely to have their payments reduced under MIPS.

Nonmetropolitan clinicians had a lower total risk-adjusted Medicare Spending Per Beneficiary than metropolitan clinicians indicating that nonmetropolitan clinicians have lower Medicare spending for similar beneficiaries.

Pennsylvania ranks 22nd overall in child well-being, according to the 2023 KIDS COUNT® Data Book, a 50-state report of recent household data developed by the Annie E. Casey Foundation analyzing how children and families are faring. When looking specifically at economic well-being, the state ranks 22nd, while it ranks 20th in health.

The health domain looks at the percentage of children who lack health insurance, child and teen death rates, the percentage of low birth-weight babies and obesity among 10–17-year-olds. The Data Book reports that Pennsylvania’s rate of uninsured children is 4% and approximately 126,000 children cannot access affordable, quality health care coverage through Medicaid and the Children’s Health Insurance Program. In addition, Pennsylvania is ranked 23rd for the percentage of low birth-weight babies.

Pennsylvania families who rely on Medicaid for coverage for themselves and their children may have recently noticed a significant change: the Medicaid redetermination process that began April 1st through which DHS determines whether enrollees still qualify. This change comes about with the end of the public health emergency. During this unwinding process, it is imperative that children no longer eligible be connected to CHIP to avoid gaps in coverage and to ensure that children who remain eligible for Medicaid keep their coverage without experiencing inappropriate terminations or disruptions that often affect children more than the adult population.

The Data Book also reports that too many parents cannot secure child care compatible with work schedules and commutes. The Data Book reports that in 2020—21, 12% of children birth to age 5 in Pennsylvania lived in families in which someone quit, changed, or refused a job because of problems with child care. And women are five to eight times more likely than men to experience negative employment consequences related to caregiving.

Even if parents can find an opening for child care near their home, they often can’t pay for it. Pennsylvania’s average annual cost of center-based child care for a toddler was $11,346, or 10% of the median income for a married couple and 35% of a single mother’s income in the state.

The U.S. Census Bureau has released the 2022 Detailed National, State, and County Population Estimates, the final set of detailed population estimates for this vintage. The data as of July 1, 2022, provides estimates at the national, state, and county levels for population by age, sex, race, and Hispanic origin.

Highlights from this release include:

• The population cohorts aged 75 to 79 and 70 to 74 were the fastest-growing, with those aged 75 to 79 far exceeding other growing cohorts.
• For every 10 non-Hispanic White individuals lost in Pennsylvania from 2020 to 2022, the state roughly gained 8 persons of color.
• The most substantial growth occurred in the Hispanic or Latino, multiracial*, and Asian* populations.

*Refers to non-Hispanic individuals.

To read more, visit: https://pasdc.hbg.psu.edu/Data/Research-Briefs.

CMS has released new estimates on diabetes prevalence and an accompanying infographic to describe the latest data and known disparities among Medicare enrollees with diabetes.

Diabetes is a condition of particular concern to many minority and underserved communities. The number of people in the U.S. with diabetes increased from almost 29 million in 2012 to more than 37 million in 2019. The new CMS diabetes prevalence infographic highlights existing health disparities as well as prevention resources to address the epidemic. The infographic also spotlights how the increased prevalence of non-gestational diabetes among minority populations has led to additional health complications. Finally, the infographic includes information on the increased impact that diabetes has on Medicare enrollees and the disparities that are observed among various subpopulations in the Medicare community.

In addition to the infographic, CMS has released the Medicare Current Beneficiary Survey (MCBS) Public Use File on diabetes prevalence and self-management among Medicare beneficiaries living in the community in 2020. This file presents estimates on diabetes prevalence, diabetes-related health issues, and diabetes knowledge and self-management by a variety of beneficiary characteristics including race/ethnicity, income, and primary language spoken at home.

You can find more information and access the Public Use File and supporting documentation here.

For more information on health equity, visit https://go.cms.gov/omh for the latest updates on resources, data, and more equity work, sign up for our listserv.

In order to spend funding received through the national settlement and other opioid-related settlements, states have developed legislative and legal frameworks that distribute funds and decision-making authorities between the state government, local governments, and/or special abatement funds or trusts. States are in different stages in the process of receiving money, deciding how to spend it, implementing funded programs, and reporting on spending and outcomes. However, 17 states have now approved and published their plans for a first year of spending, which often include priority areas or approved uses for funds. A smaller subset of states have awarded settlement funds to specific abatement programs. Many of these plans were published in the final months of 2022 or first months of 2023 as part of annual reports on settlement spending activity.

This issue brief provides an overview of published statewide opioid settlement spending plans and appropriations made to date and highlights initial priorities and investments outlined in these plans.

Check out our data webpage for recent Pennsylvania KIDS COUNT® Data Center updates!

We have updated information from the 2020 Census release this past week for our population and housing indicators and the most recent information on births from the state Department of Health!

ARC has released the 13th update of The Appalachian Region: A Data Overview from the 2017-2021 American Community Survey, also known as “The Chartbook.” The report, written in partnership with the Population Reference Bureau, features more than 300,000 data points comparing Appalachia’s economy, income, education, and more with the rest of the nation.

The 2023 report shows that Appalachia continued to make progress in educational attainment, labor force participation, income levels, and poverty rates from 2017-2021. Despite positive trends, work remains for the Appalachian Region — particularly its oldest, youngest, and most rural residents — to achieve parity with the nation.

To address Appalachia’s key vulnerabilities, ARC launched the Appalachian Regional Initiative for Stronger Economies (ARISE) for large-scale economic transformation. The funding opportunity has a new application process that will be reviewed in detail during ARC’s pre-application webinar on June 22.