Central Health’s core objective is to provide Travis County residents who are low-income or uninsured with access to quality health care coverage and services. The healthcare district is also obligated to the taxpayers of Travis County—who fund the majority of Central Health’s budget—to operate in a fiscally responsible and transparent manner. All of these goals would be severely hindered without access to data; that helps us understand where low-income populations are concentrated; that teaches us where we need to help people enroll in health care coverage; that guides our decisions on adding new services; and that shines light on health inequities within our communities.

One of the leading tools Central Health uses to collect and report data is its Demographic Report. Central Health released its first Demographic Report in the fall of 2015 and a second report in 2017. Each report provided information regarding the areas of Travis County with the highest number of families in poverty, as well as demographic analysis related to age, gender and race/ethnicity.

The 2020 Central Health Demographic Report represents a paradigm shift in how Central Health collects and uses information related to poverty, burdens of disease and accessing care. As a result of improved data sources and staff resources, the 2020 Demographic Report contains elements not captured in previous reports. For example, patient-level geographic data is now being reported at the census tract level, providing more detailed and granular analysis than the previous ZIP code-based data Central Health relied on. The new data points collected in 2020 will serve as baselines to guide system improvements implemented by Central Health. The impact of these efforts will be measured and reported in future demographic reports.

In addition to Central Health patient data, the Demographic Report uses Claritas’ Pop-Facts Premier database for 2020. This database incorporates the Census Bureau’s American Community Survey (ACS) and other proprietary market data sources to provide current year estimates. The Claritas data also allows Central Health to analyze 20 years of historical poverty trends, and provides information that is more current than the ACS’s most recent 2018 estimates.

Elements within the Demographic Report include:

• MAP, MAP BASIC, and Sliding Fee Scale (SFS) enrollment in Travis County by census tract;
• Families in poverty in Travis County by census tract;
• Twelve defined focus areas for FY2020 based on the highest number of families in poverty;
• Race, ethnicity, enrollment and utilization analysis by focus area;
• Social factors including transportation and insurance access;
• Prevalence of disease burden and total disease diagnosis by focus area;
• Five-year projections for changes in poverty in Travis and surrounding counties.

The Demographic Report’s first function is to call out where the greatest concentrations of people and families living below the poverty level reside in Travis County. By identifying these dispersions of poverty, and grouping them into 12 geographic locations, Central Health is able to compare the relative need among various communities and understand how prioritizing specific neighborhoods can and may affect health outcomes in others. This approach will ensure the ability to track changes over time, prioritize areas of high need, and right-size the services provided.

The report’s next utility is to identify where and how many residents with low income are lacking options to access health care services. The Demographic Report provides a more precise focus on identifying the areas of greatest need among communities, and offering targeted assistance to those who lack access to health care and bear the highest burden of disease. The results will assist the Central Health Board of Managers in evaluating the efficacy of programs and guiding future policy directions.

Finally, the 2020 Demographic Report will also support a systems planning strategy under consideration by the Central Health board. This new method takes a comprehensive and proactive approach to planning across the entire continuum of care and uses relevant data to explore persistent issues and prioritize solutions to chronic problems. As services are planned, Central Health will balance modality, disease burden, geography of clinics and providers’ payer mix. This data-driven approach seeks to achieve health equity by addressing avoidable inequalities in how and where health care is delivered. For example, because of the data developed for this report, Central Health now understands the prevalence rates of eight chronic conditions within Travis County’s lowest income communities. This data creates baselines to measure the success of future interventions.

High-level findings from the Demographic Report include:

• Concentrations of poverty remain highest in Austin along the I-35 corridor;
• Due to significant population increases, new census tract boundaries coming in 2022 will split up census tracts in Pflugerville, Hornsby Bend and Del Valle, likely resulting in dramatic changes in the number of families in poverty per census tract;
• Many of the areas with the highest rates of enrollees accessing care do not have a physical clinic in their community, which means that proximity to clinics may not impact access as much as previously thought;
• Relative to levels of poverty, enrollment is low in East Austin, Montopolis and Leander/Jonestown—particularly when compared to areas with similar levels of poverty yet significantly higher enrollment;
• The highest concentrations of residents enrolled in Central Health coverage programs but not accessing services are in the Rundberg, St. John’s and Montopolis neighborhoods;
• While poverty numbers remain highest along the I-35 corridor, they are also increasing regionally, particularly in areas adjacent to Travis County;
• Low income communities in Austin and Northwest Travis County report low rates of household vehicle access, with more than one 1 out of every 10 households lacking access to a vehicle;
• Areas with high poverty rates also report low rates of employer-based insurance;
• Enrollment in health coverage drives up the diagnosis of chronic conditions within a respective area;
• The burden of disease is significantly high in East Central Austin and Leander/Jonestown across nearly every chronic condition.

Finally, much more data than could be included in this report was collected during the production process. It is expected that as this report is distributed and utilized, new questions will need to be answered using the databases this report was built on. Central Health staff looks forward to working with the people it serves to actionize this information and build healthier and more equitable Travis County communities.