Guest Blog: Regan Hunt, Kentucky Voices for Health – Health Coverage for better Health Outcomes

December 2, 2013
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The Louisville community has over 100,000 uninsured residents. Kentucky Voices for Health is spearheading a statewide project called Get Covered Kentucky. Get Covered Kentucky works in communities to educate people on how and where they can enroll in health coverage. One of the biggest efforts to improve health in our community is going on right now—open enrollment for health coverage under the Affordable Care Act (ACA).

Having health coverage is strongly related to better health outcomes for both children and adults.  Our community’s first step to dramatically improve health outcomes is making sure that people have health coverage.  According to a Mathematica Policy Research brief, the relationship between health coverage and better health outcomes is stronger when health care is affordable, and helps consumers use care appropriately.

Uninsured people with chronic conditions are less likely to get needed care or have regular checkups. Likewise, uninsured people without chronic or pre-existing conditions do not get routine care like insured people. As a result, uninsured people use emergency department visits as their primary care providers. This gives them no continuous coverage and no real health stability, two factors that perpetuate poor health outcomes.

Having health coverage opens doors to over 100,000 Louisville residents. Families will be able to find a local health provider that will help when someone is sick and will help prevent health problems before they happen. In Louisville, we’re working with the local Board of Health, Metro Health and Wellness, Kentuckiana Regional Planning & Development Agency (KIPDA), Family Health Centers, Metro Parks, Metro Community Services and Revitalization, and many other local community-based organizations to spread the word about how and where people can get enrolled in health coverage. We are encouraged by all of these groups working together with one purpose—to get Kentuckians covered.

Kentucky Voices for Health encourages everyone without health coverage to learn about health coverage options. Visit kynect, Kentucky’s Health Care Connection, and let’s get Louisville and Kentucky covered.

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Natural Breaks Algorithm

For each indicator, Greater Louisville Project assigns cities into one of three groups (high-performing, middle-of-the-pack, and low-performing) based on how they compare to other cities. The assignment is based on how cities naturally cluster on that indicator. Sometimes, the differences between cities are very small, and the difference between a city ranked 5th and 6th could simply be a matter of the sampling error that arises from using survey data. Thus, rather than always make a division that declares the top 5 to be the top tier, we use a natural breaks algorithm to look for a cluster of cities that is outperforming the rest, a cluster that is about average, and a cluster that is lagging. This clustering gives us a better indication of where Louisville is thriving and where Louisville has room to learn from cities that are doing better.

Z-Scores

Z-scores (or standardization) is a way to combine data with different units of measurement into a single index. The z-score is a measure of how far away a city (or census tract, etc.) is from the average city. In order to be comparable across different units of measurement, the z-score is the distance from the mean measured in standard deviations (e.g. if Louisville has a z-score of 1 it means Louisville is 1 standard deviation above the mean of its peer cities).

Data from the Robert Wood Johnson Foundation's County Health Rankings use z-scores and all z-scores are relative to the mean of Louisville's peer cities. (On the County Health Rankings site z-scores are relative to all the counties in each state - thus z-scores reported by GLP will be different, because we are using a different reference group). The Greater Louisville Project also uses z-scores in our multidimensional poverty index, which compares each census tract to the mean of all census tracts in Louisville.